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Vowles Z, Bash-Taqi R, Kamara A, Kuteh M, Silverio SA, Turay I, Peckham S. The effect of becoming a Fistula Advocate on the recovery of women with Obstetric Fistula in Sierra Leone: A qualitative study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0000765. [PMID: 37043491 PMCID: PMC10096491 DOI: 10.1371/journal.pgph.0000765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 03/09/2023] [Indexed: 04/13/2023]
Abstract
Engaging women affected by Obstetric Fistula as advocates has been proposed as an effective strategy to raise awareness of the condition. Limited literature exists on the experience of those who become advocates. A model of community education, in Sierra Leone, trained women affected by Obstetric Fistula to become volunteer Fistula Advocates. This study explored Advocates' perception of their role and its influence on their recovery and reintegration. This was a qualitative study, undertaken in Sierra Leone, collecting data from 7 Fistula Advocates and 3 Key Informants (with roles in either clinical or outreach care for women with Obstetric Fistula or training and supervision of Advocates), using semi-structured interviews. Data was subject to a thematic analysis and related to a conceptual framework for mental health recovery. Intrinsic factors motivating Advocates to undertake this role were influenced by psycho-social support received and the possibility for financial independence. Advocates used personal stories in their work to define a new identity, change perceptions and reduce stigma. Benefits associated with the interactions and relationships created through providing and receiving peer support were voiced. Surgical treatment was described as an important factor influencing recovery. The Advocates said economic empowerment helped recovery and reintegration, and the voluntary nature of the Advocate role limited the impact of this. Overall Advocates perceived their role positively, reporting psychological, social, and economic benefits. The complexities of recovery from Obstetric Fistula were highlighted and connections drawn between the treatment of physical symptoms, the socio-cultural context and mental health recovery. They described the role positively influencing existing relationships and initiating supportive, empowering social interactions between women affected by Obstetric Fistula and with Non-Governmental Organisation staff and community members. The study offers insights into the potential for community-based approaches to facilitate access to treatment for sensitive and stigmatising health problems and support recovery.
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Affiliation(s)
- Zoë Vowles
- Department of Women & Children’s Health, School of Life Course & Population Sciences, King’s College London, London, United Kingdom
- St Thomas’ Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, The London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | - Mabel Kuteh
- Health Poverty Action, Freetown, Sierra Leone
| | - Sergio A. Silverio
- Department of Women & Children’s Health, School of Life Course & Population Sciences, King’s College London, London, United Kingdom
| | | | - Stephen Peckham
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, The London School of Hygiene and Tropical Medicine, London, United Kingdom
- The Centre for Health Service Studies, University of Kent, Canterbury, United Kingdom
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Degge HM, Laurenson M, Dumbili EW, Hayter M. Insights from birthing experiences of fistula survivors in North-central Nigeria: Interplay of structural violence. Nurs Inq 2020; 27:e12377. [PMID: 32862483 DOI: 10.1111/nin.12377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/08/2020] [Accepted: 07/26/2020] [Indexed: 11/28/2022]
Abstract
Obstetric Fistula is an abnormal opening between the vagina and rectum resulting from prolonged and obstructed labour. Studies indicate that delays in accessing maternal care and home birth contribute to the development of fistula. Survivors are usually women of low socioeconomic status residing in rural locations. This study explores the birthing experiences of 15 fistula survivors through a narrative inquiry approach at a repair centre in North-central Nigeria. Using structural violence as a lens, it describes the role of social, political and health systems in the inequitable access to care for women. For women opting for home births, preference for home delivery was mainly due to lack of finances, poor health systems and cultural practices. Rural location inhibited access as women seeking facility delivery faced transfer delays to referral centres when complications developed. Inequitable maternal health services in rural locations in Nigeria are inherently linked to access to health care, and these contribute to the increased incidence of fistulae. Structural intervention is a health policy priority to address poor health systems and achieve universal health coverage to address maternal health issues in Nigeria.
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Affiliation(s)
| | - Mary Laurenson
- Faculty of Health Sciences, University of Hull, Hull, UK
| | - Emeka W Dumbili
- Department of Sociology and Anthropology, Faculty of Social Sciences, Nnamdi Azikiwe University, Awka, Nigeria
| | - Mark Hayter
- Faculty of Health Sciences, University of Hull, Hull, UK
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Arthur M, Earle A, Raub A, Vincent I, Atabay E, Latz I, Kranz G, Nandi A, Heymann J. Child Marriage Laws around the World: Minimum Marriage Age, Legal Exceptions, and Gender Disparities. JOURNAL OF WOMEN, POLITICS & POLICY 2017; 39:51-74. [PMID: 30828270 PMCID: PMC6382347 DOI: 10.1080/1554477x.2017.1375786] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The marriage of children below 18 is widely recognized in international human rights agreements as a discriminatory global practice that hinders the development and well-being of hundreds of millions of girls. Using a new global policy database, we analyze national legislation regarding minimum marriage age, exceptions permitting marriage at earlier ages, and gender disparities in laws. While our longitudinal data indicate improvements in frequencies of countries with legal provisions that prohibit marriage below the age of 18, important gaps remain in eliminating legal exceptions and gender discrimination.
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Affiliation(s)
- Megan Arthur
- WORLD Policy Analysis Center, Fielding School of Public Health, University of California, Los Angeles, USA
| | - Alison Earle
- WORLD Policy Analysis Center, Fielding School of Public Health, University of California, Los Angeles, USA
| | - Amy Raub
- WORLD Policy Analysis Center, Fielding School of Public Health, University of California, Los Angeles, USA
| | - Ilona Vincent
- Institute for Health and Social Policy, McGill University, Montreal, Canada
| | - Efe Atabay
- Institute for Health and Social Policy, McGill University, Montreal, Canada
| | - Isabel Latz
- WORLD Policy Analysis Center, Fielding School of Public Health, University of California, Los Angeles, USA
| | - Gabriella Kranz
- Institute for Health and Social Policy, McGill University, Montreal, Canada
| | - Arijit Nandi
- Institute for Health and Social Policy and Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
| | - Jody Heymann
- WORLD Policy Analysis Center, Fielding School of Public Health, University of California, Los Angeles, USA
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Browning A, Mbise F, Foden P. The effect of early pregnancy on the formation of obstetric fistula. Int J Gynaecol Obstet 2017; 138:288-292. [DOI: 10.1002/ijgo.12228] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 04/08/2017] [Accepted: 06/01/2017] [Indexed: 11/07/2022]
Affiliation(s)
| | | | - Phil Foden
- Department of Medical Statistics; University Hospital South Manchester; Manchester UK
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Lewis Wall L, Belay S, Haregot T, Dukes J, Berhan E, Abreha M. A case-control study of the risk factors for obstetric fistula in Tigray, Ethiopia. Int Urogynecol J 2017; 28:1817-1824. [PMID: 28550462 DOI: 10.1007/s00192-017-3368-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 05/06/2017] [Indexed: 12/01/2022]
Abstract
INTRODUCTION AND HYPOTHESIS We tested the null hypothesis that there were no differences between patients with obstetric fistula and parous controls without fistula. METHODS A unmatched case-control study was carried out comparing 75 women with a history of obstetric fistula with 150 parous controls with no history of fistula. Height and weight were measured for each participant, along with basic socio-demographic and obstetric information. Descriptive statistics were calculated and differences between the groups were analyzed using Student's t test, Mann-Whitney U test where appropriate, and Chi-squared or Fisher's exact test, along with backward stepwise logistic regression analyses to detect predictors of obstetric fistula. Associations with a p value <0.05 were considered significant. RESULTS Patients with fistulas married earlier and delivered their first pregnancies earlier than controls. They had significantly less education, a higher prevalence of divorce/separation, and lived in more impoverished circumstances than controls. Fistula patients had worse reproductive histories, with greater numbers of stillbirths/abortions and higher rates of assisted vaginal delivery and cesarean section. The final logistic regression model found four significant risk factors for developing an obstetric fistula: age at marriage (OR 1.23), history of assisted vaginal delivery (OR 3.44), lack of adequate antenatal care (OR 4.43), and a labor lasting longer than 1 day (OR 14.84). CONCLUSIONS Our data indicate that obstetric fistula results from the lack of access to effective obstetrical services when labor is prolonged. Rural poverty and lack of adequate transportation infrastructure are probably important co-factors in inhibiting access to needed care.
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Affiliation(s)
- L Lewis Wall
- Department of Obstetrics and Gynecology, Ayder Referral Hospital, College of Health Sciences, Mekelle University, Mekelle, Ethiopia. .,Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, MO, USA. .,Department of Anthropology, Washington University, Campus Box 1114, One Brookings Drive, St Louis, MO, 63130-8159, USA.
| | - Shewaye Belay
- Department of Microbiology, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | | | - Jonathan Dukes
- Performance Solution, Data Engineering and Analytics, Mercy Health, Chesterfield, MO, USA
| | - Eyoel Berhan
- St Paul's Millennium Medical School, Addis Ababa, Ethiopia
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Phillips BS, Ononokpono DN, Udofia NW. Complicating causality: patient and professional perspectives on obstetric fistula in Nigeria. CULTURE, HEALTH & SEXUALITY 2016; 18:996-1009. [PMID: 26958903 DOI: 10.1080/13691058.2016.1148198] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Obstetric fistula, a preventable maternal morbidity characterised by chronic bladder and/or bowel incontinence, is widespread in Nigeria. This qualitative, multi-site study examined the competing narratives on obstetric fistula causality in Nigeria. Research methods were participant observation and in-depth interviews with 86 fistula patients and 43 healthcare professionals. The study found that both patient and professional narratives identified limited access to medical facilities as a major factor leading to obstetric fistula. Patients and professionals beliefs regarding the access problem, however, differed significantly. The majority of fistula patients reported either delivering or attempting to deliver in medical facilities and most patients attributed fistula to a lack of trained medical staff and mismanagement at medical facilities. Conversely, a majority of health professionals believed that women developed obstetric fistula because they chose to deliver at home due to women's traditional beliefs about womanhood and childbirth. Both groups described financial constraints and inadequate transport to medical facilities during complicated labour as related to obstetric fistula onset. Programmatic insights derived from these findings should inform fistula prevention interventions both with healthcare professionals and with Nigerian women.
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Affiliation(s)
- Beth S Phillips
- a Department of Public Health , University of Calabar , Calabar , Nigeria
- b Department of Medicine , University of California-San Francisco , San Francisco , CA , USA
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Kasamba N, Kaye DK, Mbalinda SN. Community awareness about risk factors, presentation and prevention and obstetric fistula in Nabitovu village, Iganga district, Uganda. BMC Pregnancy Childbirth 2013; 13:229. [PMID: 24321441 PMCID: PMC4028862 DOI: 10.1186/1471-2393-13-229] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 12/05/2013] [Indexed: 11/29/2022] Open
Abstract
Background Obstetric fistula is a worldwide problem that is devastating for women in developing countries. The cardinal cause of obstetric fistula is prolonged obstructed labour and delay in seeking emergency obstetric care. Awareness about obstetric fistula is still low in developing countries. The objective was to assess the awareness about risk factors of obstetric fistulae in rural communities of Nabitovu village, Iganga district, Eastern Uganda. Methods A qualitative study using focus group discussion for males and females aged 18-49 years, to explore and gain deeper understanding of their awareness of existence, causes, clinical presentation and preventive measures for obstetric fistula. Data was analyzed by thematic analysis. Results The majority of the women and a few men were aware about obstetric fistula, though many had misconceptions regarding its causes, clinical presentation and prevention. Some wrongly attributed fistula to misuse of family planning, having sex during the menstruation period, curses by relatives, sexually transmitted infections, rape and gender-based violence. However, others attributed the fistula to delays to access medical care, induced abortions, conception at an early age, utilization of traditional birth attendants at delivery, and some complications that could occur during surgical operations for difficult deliveries. Conclusion Most of the community members interviewed were aware of the risk factors of obstetric fistula. Some respondents, predominantly men, had misconceptions/myths about risk factors of obstetric fistula as being caused by having sex during menstrual periods, poor usage of family planning, being a curse.
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Affiliation(s)
| | - Dan K Kaye
- Department of Obstetrics and Gynecology, School of Medicine, College of Health Sciences, Makerere University, P,O, Box 7072, Kampala, Uganda.
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Roka ZG, Akech M, Wanzala P, Omolo J, Gitta S, Waiswa P. Factors associated with obstetric fistulae occurrence among patients attending selected hospitals in Kenya, 2010: a case control study. BMC Pregnancy Childbirth 2013; 13:56. [PMID: 23448615 PMCID: PMC3599423 DOI: 10.1186/1471-2393-13-56] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Accepted: 02/26/2013] [Indexed: 11/28/2022] Open
Abstract
Background In Kenya, about 3000 fistula cases are estimated to occur every year with an incidence of 1/1000 women. This study sought to identify risk factors associated with developing obstetrics fistula in order to guide implementation of appropriate interventions. Methods An unmatched case control study was conducted in three major hospitals in Kenya between October and December 2010. Cases were patients who had fistula following delivery within the previous five years. Controls were systematically selected from women who attended obstetrics and gynecology clinics at these hospitals, and did not have present or past history of fistula. Odds ratio was used as measure of association with their corresponding 95% confidence interval. Factors with p value of <0.1 were included into forward additive logistic regression model to generate adjusted odds ratios. Results Seventy cases and 140 controls were included in the study. Independent risk factors associated with obstetrics fistula included duration of labour of >24 hours (OR = 4.7, 95% CI = 2.4 -9.2), seeking delivery services after 6 hours of labour onset (OR = 6.9, 95% CI = 2.2-21.3), taking more than 2 hours to reach a health facility (OR = 5.7, 95% CI = 2.9 -11.5), having none or primary education (OR = 9.6, 95% CI = 3.3 –27.9) and being referred to another facility for emergency obstetrics services (OR = 8.6, 95% CI = 2.7 –27). Conclusions Risk factors for developing obstetrics fistula were delays in care seeking including delay in making decision to seek delivery servers after six hours of labour onset, taking more than two hours to reach a health facility, labour duration of more than 24 hours and having no formal or primary education. Efforts geared at strengthening all levels of the health system to reduce delays in access to emergency obstetric care are needed.
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Affiliation(s)
- Zeinab Gura Roka
- Kenya Field epidemiology and laboratory program Ministry of Public Health and Sanitation Kenya, P.O. BOX 21691-00100, Nairobi, Kenya.
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Gharoro EP, Agholor KN. Aspects of psychosocial problems of patients with vesico-vaginal fistula. J OBSTET GYNAECOL 2009; 29:644-7. [PMID: 19757273 DOI: 10.1080/01443610903100609] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Our objective was to evaluate psychosocial problems among patients presenting with vesico-vaginal fistula (VVF), and their close relatives. All patients presenting with VVF and their spouses or attendant close relatives were administered a structured questionnaire followed by an in-depth interview. A total of 20 patients and 10 attendant relatives were interviewed. The average age of patients was 24.7 years, range 16-38 years. A total of 11 patients (55%) had their first marriage between the ages of 15-20 years, with one nulliparous, unmarried patient, who acquired VVF following infertility treatment with herbs. Of the interviewed respondents, 19 affirmed that prolonged labour was the cause of VVF, while four patients developed VVF sequel to unsupervised vaginal birth after a previous caesarean section. Reported medical problems were dermatitis (20%), foul smell of urine (15%), recurrent UTI (10%), infertility (5%), amenorrhoea (5%), in that order. Socially, 45% felt ostracised and 50% were economically impoverished by job loss. The divorce rate was 25%, with one case of remarriage and childbirth with an unrepaired VVF. Some 56.6% respondents suggested hospital delivery was a preventive measure, while 33.3% felt avoidance of premarital sex and early marriage would prevent VVF. VVF is still a major social and reproductive health problem and most patients and relatives understand the place of difficult childbirth in VVF formation. The need to empower patients to timely access standard maternity and emergency obstetric care is recommended.
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Affiliation(s)
- E P Gharoro
- Department of Obstetrics and Gynaecology, University of Benin Teaching Hospital, Benin City, Nigeria.
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Tebeu PM, de Bernis L, Doh AS, Rochat CH, Delvaux T. Risk factors for obstetric fistula in the Far North Province of Cameroon. Int J Gynaecol Obstet 2009; 107:12-5. [PMID: 19589525 DOI: 10.1016/j.ijgo.2009.05.019] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2009] [Revised: 04/25/2009] [Accepted: 05/19/2009] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To describe the circumstances of occurrence and identify potential risk factors for obstetric fistula in northern Cameroon. METHODS A case series study of 42 obstetric fistula patients seeking services at the Provincial Hospital of Maroua, Cameroon, between May 2005 and August 2007. Structured interviews were conducted prior to surgical intervention. RESULTS Among obstetric fistula patients, 60% had lived with obstetric fistula for more than 5 years at the time of surgery. Eighty-one percent of patients had received no formal education and 86% were teenagers at their first delivery. Regarding the pregnancy and delivery preceding the occurrence of the fistula, 50% of women reported that they had received no prenatal care and 76% were in labor for more than 12 hours. The majority (83%) of women delivered a stillborn baby. CONCLUSIONS Obstetric fistula patients in the Far North Province of Cameroon had a low level of education, were married at a young age, and had poor access to quality maternal healthcare services.
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Affiliation(s)
- Pierre Marie Tebeu
- Department of Obstetrics and Gynecology, Provincial Hospital, Maroua, Cameroon.
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Obi SN, Ozumba BC, Onyebuchi AK. Decreasing incidence and changing aetiological factors of vesico-vaginal fistula in south-east Nigeria. J OBSTET GYNAECOL 2009; 28:629-31. [DOI: 10.1080/01443610802397686] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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12
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Obstetric fistula in low-income countries. Int J Gynaecol Obstet 2008; 104:85-9. [DOI: 10.1016/j.ijgo.2008.09.011] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2008] [Revised: 09/09/2008] [Accepted: 09/10/2008] [Indexed: 11/22/2022]
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Gerten KA, Venkatesh S, Norman AM, Shu'aibu J, Richter HE. Pilot study utilizing a patient educational brochure at a vesicovaginal fistula hospital in Nigeria, Africa. Int Urogynecol J 2008; 20:33-7. [PMID: 18810301 DOI: 10.1007/s00192-008-0720-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2008] [Accepted: 08/19/2008] [Indexed: 11/28/2022]
Abstract
This paper presents a pilot study exploring the utility and feasibility of use of a vesicovaginal fistula (VVF) patient educational brochure. Women awaiting or recently having undergone VVF surgery examined a six-paneled educational brochure detailing the causes, treatment options, and prevention methods of VVF. Participants answered demographic questions and gave detailed responses to a questionnaire that addressed the brochure material. A convenience sample of 50 patients, with a mean age of 26.1 years, participated. Universally, these women felt that the information they learned from the brochure was useful. Suggestions by participants regarding prevention of VVF included laboring in a hospital (80%), educating other women (30%), and discouraging early marriage (8%). Primary barriers to prevention and treatment included financial restraints (84%) and transportation difficulties (30%). The utilization of a simple, low-cost educational brochure has the ability to educate women on the causes, treatment, and prevention of VVF.
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Affiliation(s)
- Kimberly A Gerten
- Division of Women's Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA.
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Johnson K. Incontinence in Malawi: Analysis of a proxy measure of vaginal fistula in a national survey. Int J Gynaecol Obstet 2007; 99 Suppl 1:S122-9. [PMID: 17870077 DOI: 10.1016/j.ijgo.2007.06.033] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To document the first effort to collect national lifetime prevalence data on vaginal fistulas and discern the usefulness of the measure. METHODS The 11,698 women successfully interviewed in the 2005 Malawi Demographic and Health Survey were asked whether they had ever experienced leakage of urine or stool from their vagina. Multivariate techniques were then used to determine factors associated with fistula symptoms. RESULTS The relationships between fistula symptoms and wealth and fistula symptoms and education were negative and monotonic. Rural women were 40% more likely than urban women to report fistula symptoms. Women who had experienced a stillbirth were 66% more likely to report the symptoms, and those who had experienced sexual violence were 71% more likely to report the symptoms. A crude fistula rate of 15.6 per 1000 live births was found for Malawi. CONCLUSIONS Survey methods may be used to capture the prevalence of vaginal fistula cases in a given country, but further work is needed to improve the sensitivity and specificity of the questions asked.
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Affiliation(s)
- K Johnson
- Macro International, Calverton, Maryland 20705, USA.
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Ojengbede OA, Morhason-Bello IO, Shittu O. One-stage repair for combined fistulas: Myth or reality? Int J Gynaecol Obstet 2007; 99 Suppl 1:S90-3. [PMID: 17761182 DOI: 10.1016/j.ijgo.2007.06.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The repair of combined vesico-vaginal fistulas (VVFs) and recto-vaginal fistulas (RVFs) is challenging to both surgeon and patient. The multistage approach involves at least 3 surgical sessions, all associated with morbidity and sometimes with a colostomy procedure as well. The outcomes of the 1-stage approach were examined. METHODS Twenty patients aged between 16 and 38 years were recruited for a multicenter study conducted from March 2005 to August 2006. Prolonged obstructed labor was the cause of all fistulas. The VVFs were mainly midvaginal (60%), juxtaurethral (25%), and juxtacervical (15%). The RVFs measured between 1 and 3 cm, they were low in 70% of cases, and 1 was associated with fourth-degree perineal tear. Bowel preparation was performed in all patients prior to surgery. No patient underwent temporary colostomy. RESULTS Both VVFs and VVFs were successfully closed in all patients, as evidenced by the continence dye test. CONCLUSION The combined repair relieves economic constraints and emotional challenges, and it accelerates restoration to health and social reintegration for women affected with both VVFs and RVFs.
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Affiliation(s)
- O A Ojengbede
- Department of Obstetrics and Gynecology, University College Hospital, Ibadan, Nigeria.
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Ahmed S, Holtz SA. Social and economic consequences of obstetric fistula: Life changed forever? Int J Gynaecol Obstet 2007; 99 Suppl 1:S10-5. [PMID: 17727854 DOI: 10.1016/j.ijgo.2007.06.011] [Citation(s) in RCA: 121] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To summarize the social, economic, emotional, and psychological consequences incurred by women with obstetric fistula; present the results of a meta-analysis for 2 major consequences, divorce/separation and perinatal loss; and report on improvements in health and self-esteem and on the possibility of social reintegration following successful fistula repair. METHODS We conducted a review of the literature published between 1985 and 2005 on fistula in developing countries. We then performed a meta-analysis for 2 of the major consequences of having a fistula, divorce/separation and perinatal child loss. RESULTS Studies suggest that surgical treatment usually closes the fistula and improves the physical and mental health of affected women. CONCLUSION With additional social support and counseling, women may be able to successfully reintegrate socially following fistula repair.
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Affiliation(s)
- S Ahmed
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205, USA.
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Holme A, Breen M, MacArthur C. Obstetric fistulae: a study of women managed at the Monze Mission Hospital, Zambia. BJOG 2007; 114:1010-7. [PMID: 17506793 DOI: 10.1111/j.1471-0528.2007.01353.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The objective of this study was to describe and compare characteristics of women with obstetric fistula. DESIGN Retrospective cross-sectional study. SETTING Zambia's primary fistula repair centre, Monze Mission Hospital. SAMPLE All women, August 2003 to December 2005. METHOD Review of case notes to obtain data on socio-demographic and obstetric characteristics, causative pregnancy, clinical details, and treatment. Comparison of characteristics with national data was undertaken. RESULTS Of 259 women, 239 had socio-demographic and obstetric records and 254 had surgical records. Educational status and height of women were significantly below the national averages, while antenatal care uptake (97.5%) and proportion from the Northern Province were significantly above. Most women (77.9%) weighed < or = 50 kg. Median age at marriage was 18 and at development of fistula was 22 years. 15.1% of women were divorced, 49.0% were primiparous, and 27.6% were parity four +. 67.5% of women had spent 2 days or longer in labour. Delays in receiving emergency obstetric care (EmOC) were experienced at home (67.5%) and at clinics (49.4%), usually due to transport difficulties. 89.1% delivered in a health facility, 50.2% of deliveries were by caesarean section, and 78.1% of babies were stillborn. 72.9% of repairs were successful, 17.3% resulted in residual stress incontinence, and 9.8% failed. Failure was significantly associated with previous repair. CONCLUSION More obstetric fistulae occur in areas where early marriage and pregnancy before pelvic maturity is attained is common and where obstetric care is inaccessible. In this study, age at marriage and fistula development was older than usually found, which may indicate that poor access to EmOC contributes more to this problem within Zambia.
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Affiliation(s)
- A Holme
- Department of Public Health and Epidemiology, The Medical School, University of Birmingham, Edgbaston, Birmingham, UK.
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Norman AM, Breen M, Richter HE. Prevention of obstetric urogenital fistulae: some thoughts on a daunting task. Int Urogynecol J 2006; 18:485-91. [PMID: 17160530 DOI: 10.1007/s00192-006-0248-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2006] [Accepted: 10/02/2006] [Indexed: 11/25/2022]
Abstract
Significant obstetric-related pelvic floor injury is still all too common in many areas of the world. Vesicovaginal fistula formation typically results from obstructed labor in the setting of limited medical resources for the patient. Many people have dedicated their time and even their lives to repairing these types of pelvic floor injuries, which certainly can impact in a positive way on the quality of life of these suffering women. However, it is time to consistently combine surgical repair initiatives with education, training, and prevention strategies, as well as outcomes research in order to improve on these efforts. It is only through committed initiatives with all of these elements that we may be able to ultimately decrease the prevalence of these types of pelvic floor sequelae.
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Affiliation(s)
- Andy M Norman
- Division of Women's Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA.
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Affiliation(s)
- C M Evans
- Glan Clwyd Hospital, Bodelwydden, North Wales, UK
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Abstract
The present review is based essentially on the literature relating to vesico-vaginal fistulae (VVF) published during the past 2 years. It highlights the major publications regarding aetiology, epidemiology, assessment and management, and indicates my opinions as to the significance of the various contributions. In particular, the route of repair, the value of interposition grafting and the place of diversionary procedures remain topical. Medico-legal aspects of the condition as it arises in the developed world and their impact on management strategies are also covered.
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Affiliation(s)
- P Hilton
- Royal Victoria Infirmary, University of Newcastle upon Tyne, Newcastle upon Tyne, UK.
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