A descriptive longitudinal study protocol: recurrence and pregnancy post-repair of obstetric fistula in Guinea

The gendered socioeconomic impact of the COVID-19 pandemic on women with fistula repair in Uganda

Public health mitigation strategies for SARS-COV-2 are effective in limiting the spread of COVID-19; however, these restrictions can create gendered socioeconomic impacts and further isolate marginalized communities from essential resources. Our qualitative study aimed to understand the gendered effects of the COVID-19 lockdown on a population of women in Uganda with a history of prior obstetric fistula repair, a group experiencing greater vulnerability and less support due to intersecting stigmatized identities. We conducted in-depth interviews among 30 women with prior genital fistula and corrective fistula repair surgery at 3 hospitals in Southern Uganda. We found that COVID-19 lockdown measures caused both financial and health-related impacts in this community such as inaccessibility of healthcare and loss of income. Understanding these experiences should inform strategies to ensure equitable, future pandemic responses.

Fistula recurrence, pregnancy, and childbirth following successful closure of female genital fistula in Guinea: a longitudinal study

Background

Female genital fistula is a devastating maternal complication of delivery in developing countries. We sought to analyse the incidence and proportion of fistula recurrence, residual urinary incontinence, and pregnancy after successful fistula closure in Guinea, and describe the delivery-associated maternal and child health outcomes.

Methods

We did a longitudinal study in women discharged with a closed fistula from three repair hospitals supported by EngenderHealth in Guinea. We recruited women retrospectively (via medical record review) and prospectively at hospital discharge. We used Kaplan-Meier methods to analyse the cumulative incidence, incidence proportion, and incidence ratio of fistula recurrence, associated outcomes, and pregnancy after successful fistula closure. The primary outcome was recurrence of fistula following discharge from repair hospital in all eligible women who consented to inclusion and could provide follow-up data.

Findings

481 women eligible for analysis were identified retrospectively (from Jan 1, 2012, to Dec 31, 2014; 348 women) or prospectively (Jan 1 to June 20, 2015; 133 women), and followed up until June 30, 2016. Median follow-up was 28·0 months (IQR 14·6–36·6). 73 recurrent fistulas occurred, corresponding to a cumulative incidence of 71 per 1000 person-years (95% CI 56·5–89·3) and an incidence proportion of 18·4% (14·8–22·8). In 447 women who were continent at hospital discharge, we recorded 24 cases of post-repair residual urinary incontinence, equivalent to a cumulative incidence of 23·1 per 1000 person-years (14·0–36·2), and corresponding to 10·3% (5·2–19·6). In 305 women at risk of pregnancy, the cumulative incidence of pregnancy was 106·0 per 1000 person-years, corresponding to 28·4% (22·8–35·0) of these women. Of 50 women who had delivered by the time of follow-up, only nine delivered by elective caesarean section. There were 12 stillbirths, seven delivery-related fistula recurrences, and one maternal death.

Interpretation

Recurrence of female genital fistula and adverse pregnancy-related maternal and child health outcomes were frequent in women after fistula repair in Guinea. Interventions are needed to safeguard the health of women after fistula repair.

Funding

Belgian Development Cooperation (DGD), Institute of Tropical Medicine of Antwerp (ITM), and Maferinyah Training and Research Center in Rural Health (Guinea).