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Barageine JK, Nalubwama H, Obore S, Mirembe E, Mubiru D, Jean A, Akori S, Opio S, Keyser L, McKinney J, Korn AP, Ali S, Byamugisha J, El Ayadi AM. Development and Pilot Test of a Multi-Component Intervention to Support Women's Recovery from Female Genital Fistula. Int Urogynecol J 2024:10.1007/s00192-024-05814-3. [PMID: 38913128 DOI: 10.1007/s00192-024-05814-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 04/21/2024] [Indexed: 06/25/2024]
Abstract
INTRODUCTION AND HYPOTHESIS We evaluated a pilot multi-component reintegration intervention to improve women's physical and psychosocial quality of life after genital fistula surgery. METHODS Twelve women undergoing fistula repair at Mulago Specialized Women and Neonatal Hospital (Kampala, Uganda) anticipated in a 2-week multi-component intervention including health education, psychosocial therapy, physiotherapy, and economic investment. We assessed feasibility through recruitment, retention, and adherence, acceptability through intervention satisfaction, and preliminary effectiveness through reintegration, mental health, physical health, and economic status. We collected quantitative data at enrollment, 6 weeks, 3 months, and 6 months. We conducted in-depth interviews with six participants. Quantitative data are presented descriptively, and qualitative data analyzed thematically. RESULTS Participants had a median age of 34.5 years (25.5-38.0), 50% were married/partnered, 42% were separated, 50$ had completed less than primary education, and 67% were unemployed. Mean number of sessions received was 12 for health education (range 5-15), 8 for counseling (range 8-9), and 6 for physiotherapy (range 4-8). Feasibility was demonstrated by study acceptance among all those eligible (100%); comfort with study measures, data collection frequency and approach; and procedural fidelity. Acceptability was high; all participants reported being very satisfied with the intervention and each of the components. Participant narratives echoed quantitative findings and contributed nuanced perspectives to understanding approach and content. CONCLUSIONS Our results suggest that the intervention and associated research were both feasible and acceptable, and suggested certain modifications to the intervention protocol to reduce participant burden. Further research to determine the effectiveness of the intervention above and beyond surgery alone with regard to the health and well-being of women with fistulas is warranted.
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Affiliation(s)
- Justus K Barageine
- Department of Obstetrics and Gynaecology, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Obstetrics and Gynaecology, Kampala International University, Kampala, Uganda
- Department of Urogynaecology, Mulago Specialized Women and Neonatal Hospital, Kampala, Uganda
| | - Hadija Nalubwama
- Department of Obstetrics and Gynaecology, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Susan Obore
- Department of Urogynaecology, Mulago Specialized Women and Neonatal Hospital, Kampala, Uganda
| | - Esther Mirembe
- Department of Urogynaecology, Mulago Specialized Women and Neonatal Hospital, Kampala, Uganda
| | - Dianah Mubiru
- Department of Urogynaecology, Mulago Specialized Women and Neonatal Hospital, Kampala, Uganda
| | - Angella Jean
- Department of Social Work, Mulago Specialized Women and Neonatal Hospital, Kampala, Uganda
| | - Susan Akori
- Department of Physiotherapy, Mulago Specialized Women and Neonatal Hospital, Kampala, Uganda
| | - Samuel Opio
- Department of Physiotherapy, Kawempe National Referral Hospital, Kampala, Uganda
| | - Laura Keyser
- Mama, LLC, Canton, MA, USA
- Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, CA, USA
| | | | - Abner P Korn
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Shafeesha Ali
- School of Public Health, University of California Berkeley, Berkeley, CA, USA
| | - Josaphat Byamugisha
- Department of Obstetrics and Gynaecology, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Alison M El Ayadi
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA.
- Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16th Street, Third Floor, San Francisco, CA, 94158, USA.
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El Ayadi AM, Nalubwama H, Miller S, Mitchell A, Korn AP, Chen CCG, Byamugisha J, Painter C, Obore S, Barageine JK. Women's sexual activity and experiences following female genital fistula surgery. J Sex Med 2023; 20:633-644. [PMID: 36892111 PMCID: PMC10149378 DOI: 10.1093/jsxmed/qdad010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 12/23/2022] [Accepted: 01/09/2023] [Indexed: 03/10/2023]
Abstract
BACKGROUND Surgical repair has a transformative impact on the lives of women affected by female genital fistula; however, various physical, social, and economic challenges may persist postrepair and prevent complete reengagement in relationships and communities. Nuanced investigation of these experiences is needed to inform programming that aligns with women's reintegration needs. AIM We investigated the sexual activity resumption, experiences, and concerns of women in Uganda during the year following genital fistula repair surgery. METHODS Women were recruited from Mulago Hospital between December 2014 and June 2015. We collected data at baseline and 4 times postsurgery about sociodemographic characteristics and physical/psychosocial status; we also assessed sexual interest and satisfaction twice. We performed in-depth interviews with a subset of participants. We analyzed quantitative findings via univariate analyses, and qualitative findings were coded and analyzed thematically. OUTCOMES We assessed sexual readiness, fears, and challenges following surgical repair of female genital fistula using quantitative and qualitative measures of sexual activity, pain with sex, sexual interest/disinterest, and sexual satisfaction/dissatisfaction. RESULTS Among the 60 participants, 18% were sexually active at baseline, which decreased to 7% postsurgery and increased to 55% at 1 year after repair. Dyspareunia was reported by 27% at baseline and 10% at 1 year; few described leakage during sex or vaginal dryness. Qualitative findings showed wide variance of sexual experiences. Some reported sexual readiness quickly after surgery, and some were not ready after 1 year. For all, fears included fistula recurrence and unwanted pregnancy. CONCLUSION These findings suggest that postrepair sexual experiences vary widely and intersect meaningfully with marital and social roles following fistula and repair. In addition to physical repair, ongoing psychosocial support is needed for comprehensive reintegration and the restoration of desired sexuality. HIGHLIGHTS
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Affiliation(s)
- Alison M El Ayadi
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA 94158, United States
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA 94158, United States
| | - Hadija Nalubwama
- Department of Obstetrics and Gynaecology, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Suellen Miller
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA 94158, United States
| | - Ashley Mitchell
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA 94158, United States
| | - Abner P Korn
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA 94158, United States
| | - Chi Chiung Grace Chen
- Department of Gynecology and Obstetrics, School of Medicine, Johns Hopkins University, Baltimore, MD 21218, United States
| | - Josaphat Byamugisha
- Department of Obstetrics and Gynaecology, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Caitlyn Painter
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA 94158, United States
- Urogynecology Division, Department of Obstetrics and Gynecology, Kaiser Permanente, Oakland, CA 94611, United States
| | - Susan Obore
- Urogynecology Division, Mulago National Referral and Teaching Hospital, Kampala, Uganda
| | - Justus K Barageine
- Department of Obstetrics and Gynaecology, College of Health Sciences, Makerere University, Kampala, Uganda
- Urogynecology Division, Mulago National Referral and Teaching Hospital, Kampala, Uganda
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