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Zeleke LB, Welsh A, Abeje G, Khajehei M. Treatment outcomes of obstetrical fistula surgical repair in low- and middle-income countries: A scoping review. Int J Gynaecol Obstet 2024. [PMID: 38881203 DOI: 10.1002/ijgo.15724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 05/21/2024] [Accepted: 05/26/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND Obstetrical fistula is an abnormal opening between the reproductive tract and lower urinary and/or gastrointestinal tract resulting from obstetrical complications, affecting nearly two million women worldwide. It imposes physical, economic, social, and mental consequences on the affected women. Treatment outcomes vary and, mostly, surgical treatment results in improved quality of life and successful subsequent pregnancy for survivors. OBJECTIVES The review aimed to chart and examine the treatment outcomes of obstetrical fistula surgical repair in low- and middle-income countries. SEARCH STRATEGY This is a scoping review study to identify treatment outcomes of obstetrical fistula surgical repair in low- and middle-income countries. The search was conducted from databases (PUBMED, Embase, CINAHL, Scopus, and Web of Science), and gray literature (Google Scholar, Google, and conference proceedings). SELECTION CRITERIA The eligibility criteria were constructed using a participant, concept, and context framework and included study types of primary research, reviews, and reports. Studies without full text and in languages other than English were excluded. DATA COLLECTION AND ANALYSIS The relevant characteristics of the included studies were extracted on an Excel spreadsheet and analyzed to chart treatment outcomes. MAIN FINDINGS The review examined the full text of 57 studies on the treatment outcomes of obstetrical fistula. The findings were grouped into two themes: early and late outcomes. The early outcomes included incontinence, surgical-site infection, urine retention, hemorrhage, and retained catheter. The late outcomes included fistula recurrence, residual incontinence, quality of life, reproductive issues, mental health, family and social support, and financial status. CONCLUSION The treatment outcomes of obstetrical fistula can be grouped into short-term and long-term outcomes. Although this review found adequate studies for the analysis, most study designs were poor. Stronger studies are recommended in the future to guide policy and decision-making. We would like to suggest that researchers conduct systematic reviews and meta-analyses independently for short-term and long-term outcomes.
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Affiliation(s)
- Liknaw Bewket Zeleke
- College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
- School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Alec Welsh
- School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Gedefaw Abeje
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Marjan Khajehei
- School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
- Westmead Hospital, Westmead, New South Wales, Australia
- Westmead Clinical School, University of Sydney, Sydney, Australia
- Western Sydney University, Sydney, Australia
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Zeleke LB, Welsh A, Abeje G, Khejahei M. Proportions and determinants of successful surgical repair of obstetric fistula in low- and middle-income countries: A systematic review and meta-analysis. PLoS One 2024; 19:e0303020. [PMID: 38722847 PMCID: PMC11081269 DOI: 10.1371/journal.pone.0303020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 04/17/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Obstetric fistula is a serious and debilitating problem resulting from tissue necrosis on the reproductive and urinary and/or lower gastrointestinal tract organs due to prolonged labor. Primary studies of the treatment of obstetric fistulae report significantly variable treatment outcomes following surgical repair. However, no systematic review and meta-analysis has yet estimated the pooled proportion and identified the determinants of successful obstetric fistula surgical repair. OBJECTIVE To estimate the proportion and identify the determinants of successful surgical repair of obstetric fistulae in low- and middle-income countries. METHODS The protocol was developed and registered at the International Prospective Register of Systematic Reviews (ID CRD42022323630). Searches of PubMed, Embase, CINAHL, Scopus databases, and gray literature sources were performed. All the accessed studies were selected with Covidence, and the quality of the studies was examined. Finally, the data were extracted using Excel and analyzed with R software. RESULTS This review included 79 studies out of 9337 following the screening process. The analysis reveals that 77.85% (95%CI: 75.14%; 80.56%) of surgical repairs in low and middle-income countries are successful. Women who attain primary education and above, are married, and have alive neonatal outcomes are more likely to have successful repair outcomes. In contrast, women with female genital mutilation, primiparity, a large fistula size, a fistula classification of II and above, urethral damage, vaginal scarring, a circumferential defect, multiple fistulae, prior repair and postoperative complications are less likely to have successful repair outcomes. CONCLUSION The proportion of successful surgical repairs of obstetric fistula in low and middle-income countries remains suboptimal. Hence, stakeholders and policymakers must design and implement policies promoting women's education. In addition, fistula care providers need to reach and manage obstetric fistula cases early before complications, like vaginal fibrosis, occur.
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Affiliation(s)
- Liknaw Bewket Zeleke
- College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
- Faculty of Medicine, School of Women’s and Children’s Health, University of New South Wales Sydney, Kensington, Australia
| | - Alec Welsh
- Faculty of Medicine, School of Women’s and Children’s Health, University of New South Wales Sydney, Kensington, Australia
| | - Gedefaw Abeje
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Marjan Khejahei
- Faculty of Medicine, School of Women’s and Children’s Health, University of New South Wales Sydney, Kensington, Australia
- Women’s and Newborn Health, Westmead Hospital, Westmead, New South Wales, Australia
- Westmead Clinical School, University of Sydney, Sydney, Australia
- Western Sydney University, Sydney, Australia
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Hareru HE, Ashuro Z, Debela BG, Abebe M. Obstetric fistula repair failure and its associated factors among women who underwent repair in sub-Saharan Africa. A systematic review and meta-analysis. PLoS One 2024; 19:e0295000. [PMID: 38315695 PMCID: PMC10843137 DOI: 10.1371/journal.pone.0295000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 11/14/2023] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Obstetric fistula repair failure can result in increased depression, social isolation, financial burden for the woman, and fistula care programs. However, there is limited, comprehensive evidence on obstetric fistula repair failure in Sub-Saharan African countries. This systematic review and meta-analysis aimed to determine the pooled prevalence of obstetric fistula repair failure and associated factors among women who underwent surgical repair in Sub-Saharan African countries. METHODS To identify potential articles, a systematic search was done utilizing online databases (PubMed, Hinari, and Google Scholar). The Preferred Reporting Items for Systematic Review and Meta-Analysis Statement (PRISMA) guideline was used to report the review's findings. I2 test statistics were employed to examine study heterogeneity. A random-effects model was used to assess the pooled prevalence of obstetric fistula repair failure, and the association was determined using the log odds ratio. Publication bias was investigated using the funnel plot and Egger's statistical test at the 5% level of significance. Meta-regression and subgroup analysis were done to identify potential sources of heterogeneity. The data were analyzed using STATA version 17 statistical software. RESULTS A total of 24 articles with 9866 study participants from 13 Sub-Saharan African countries were included in this meta-analysis. The pooled prevalence of obstetric fistula repair failure in sub-Saharan Africa was 24.92% [95% CI: 20.34-29.50%]. The sub-group analysis by country revealed that the highest prevalence was in Angola (58%, 95% CI: 53.20-62.80%) and the lowest in Rwanda (13.9, 95% CI: 9.79-18.01%). Total urethral damage [OR = 3.50, 95% CI: 2.09, 4.91], large fistula [OR = 3.09, 95% CI: (2.00, 4.10)], duration of labor [OR = 0.45, 95% CI: 0.27, 0.76], and previous fistula repair [OR = 2.70, 95% CI: 1.94, 3.45] were factors associated with obstetric fistula repair failure. CONCLUSION Women who received surgical treatment for obstetric fistulas in Sub-Saharan African countries experienced more repair failures than the WHO standards. Obstetric fistula repair failure was affected by urethral damage, fistula size, duration of labor, types of fistula, and history of previous repairs. Therefore, we suggest policy measures specific to each country to provide special attention to the prevention of all risk factors, including poor nutrition, multiparty, obstructed labor, and maternal age, which can result in conditions like large fistulas, urethral damage, and repeat repair, in order to reduce obstetric fistula repair failure.
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Affiliation(s)
- Habtamu Endashaw Hareru
- School of Public Health, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
| | - Zemachu Ashuro
- Department of Environmental Health, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
| | - Berhanu Gidisa Debela
- School of Public Health, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
| | - Mesfin Abebe
- Department of Midwifery, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
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Kumsa H, Mislu E, Arage MW, Abera A, Hailu T, Tenaw LA. Successful surgical closure and continence rate of obstetric fistula in Africa: systematic review and meta-analysis. Front Glob Womens Health 2023; 4:1188809. [PMID: 37854165 PMCID: PMC10579803 DOI: 10.3389/fgwh.2023.1188809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 09/13/2023] [Indexed: 10/20/2023] Open
Abstract
Background A female genital fistula is an abnormal connection between a woman's reproductive tract and her urinary tract or rectum. While numerous studies have aimed to determine the success rate of obstetric fistula closure in different health settings, there remains a significant scarcity of data on closure success rates and incontinence rates for various types of fistulas at the regional and sub-regional levels. The success rate reflects the continent's healthcare setup in regard to the World Health Organization standards. Thus, this study aims to determine the success of surgical closure and the continence rate of obstetric fistula in Africa. Methods This systematic review and meta-analysis review includes studies conducted up to February 2023. Search engines like EMBBASE, Medline, Google, PubMed, Google Scholar, African Journals Online, and ScienceDirect databases were utilized to find articles. The Joanna Briggs Institute critical evaluation checklist was used to evaluate the quality of our review, which was conducted in accordance with PRISMA criteria. Heterogeneity was indicated by a p-value for I2 statistics of less than 0.05. Publication bias was assessed using the Egger regression asymmetry test. Data were entered into Microsoft Excel and analyzed using STATA 16. Result This review includes 85 studies. A total of 24 countries from East, West, Central, North, and Southern African sub-regions were included. The overall pooled estimated rate of successful obstetric fistula closure is 86.15 (95% CI: 83.88-88.42). Moreover, the pooled estimated rate of successfully closed vesico-vaginal fistulas but with ongoing or residual incontinence (wet) was revealed as 13.41% (95% CI: 11.15-15.68). The pooled estimated rate of successfully closed rectovaginal fistulas and combined VVF and RVF are 91.06% (95% CI: 86.08-96.03) and 62.21% (95% CI: 48.94-75.49), respectively. Conclusions The rate of successful obstetric fistula closure in Africa is 86.15, which is higher than the WHO target. However, the surgical closure rate of a combined VVF and RVF is 62.2%, which is significantly lower than the WHO target.
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Affiliation(s)
- Henok Kumsa
- School of Midwifery, College of Midwifery, Woldia University, Woldia, Ethiopia
| | - Esuyawkal Mislu
- School of Midwifery, College of Midwifery, Woldia University, Woldia, Ethiopia
| | | | - Atitegeb Abera
- School of Public Health, College of Midwifery, Woldia University, Woldia, Ethiopia
| | - Tilahun Hailu
- School of Public Health, College of Midwifery, Woldia University, Woldia, Ethiopia
| | - Lebeza Alemu Tenaw
- School of Public Health, College of Midwifery, Woldia University, Woldia, Ethiopia
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Ejigu N, Seyoum K, Kene C, Gomora D, Mengistu S, Geta G, Eshetu D, Tadesse S, Mesfin T, Tekalign Y, Atlaw D. Prevalence and associated risk factors for failed obstetric fistula repair in East African countries: A systematic review and meta-analysis. SAGE Open Med 2023; 11:20503121231187742. [PMID: 37492647 PMCID: PMC10363902 DOI: 10.1177/20503121231187742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 06/26/2023] [Indexed: 07/27/2023] Open
Abstract
Objective Obstetric fistula repair failure is a combination of unsuccessful fistula closure and/or incontinence following a successful closure. There is an inconsistent finding on the failure of obstetric fistula repair in East Africa. Therefore, this systematic review and meta-analysis aimed to determine the pooled prevalence of failed obstetric fistula repair and its associated factors among women who have undergone fistula repair in East Africa. Methods This systematic review and meta-analysis were written following the PRISMA guideline protocol. A web-based electronic search of PubMed, Google Scholar, and HINARI was performed to find primary studies. Additional articles were searched by cross-referencing references. A random-effects model was used to estimate the pooled prevalence of failed obstetric fistula repair. The heterogeneity of studies was weighed using I2 test statistics. Publication bias was assessed by Eggers and funnel plot test. Results The 16 studies that met the inclusion criteria for this systematic review and meta-analysis of failed obstetric fistula repair were included. Nonetheless, one study was used for factor analysis but not in pooled prevalence analysis. The pooled prevalence of obstetric fistula repair failure in East Africa was 26.89% (95% confidence interval: 21.71, 32.07). Labor duration > 48 h (Pooled odds ratio = 2.46; 95% confidence interval 1.58, 3.82), fistula size >3 cm (Pooled odds ratio = 3.92; 95% confidence interval 2.19, 7.05), previous fistula repair (Pooled odds ratio = 3.20; 95% confidence interval 1.94, 5.29), Goh Type 4 fistulas (Pooled odds ratio = 6.07; 95% confidence interval 2.50, 14.75), completely destructed urethra (Pooled odds ratio = 3.35; 95% confidence interval 1.69, 6.65), and severe vaginal scaring (Pooled odds ratio = 3.89; 95% confidence interval 1.99, 7.62) were significantly associated with obstetric fistula repair failure. Conclusions One in four women with obstetric fistula repair experienced repair failure. To fight the problem The Ministry of Health in every part of the country, in collaboration with obstetric care providers, shall intervene on factors affecting obstetric fistula repair failure to reduce or prevent the failure of obstetric fistula repair.
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Affiliation(s)
- Neway Ejigu
- Department of Midwifery, College of Medicine and Health Sciences, Madawalabu University, Robe, Bale Goba, Ethiopia
| | - Kenbon Seyoum
- Department of Midwifery, College of Medicine and Health Sciences, Madawalabu University, Robe, Bale Goba, Ethiopia
| | - Chala Kene
- Department of Midwifery, College of Medicine and Health Sciences, Madawalabu University, Robe, Bale Goba, Ethiopia
| | - Degefa Gomora
- Department of Midwifery, College of Medicine and Health Sciences, Madawalabu University, Robe, Bale Goba, Ethiopia
| | - Shelema Mengistu
- Department of Midwifery, College of Medicine and Health Sciences, Madawalabu University, Robe, Bale Goba, Ethiopia
| | - Girma Geta
- Department of Midwifery, College of Medicine and Health Sciences, Madawalabu University, Robe, Bale Goba, Ethiopia
| | - Derese Eshetu
- Department of Midwifery, College of Medicine and Health Sciences, Madawalabu University, Robe, Bale Goba, Ethiopia
| | - Shimelis Tadesse
- Department of Midwifery, College of Health Sciences, Mattu University, Ethiopia
| | - Telila Mesfin
- Department of Medicine, College of Medicine and Health Sciences, Madawalabu University, Ethiopia
| | - Yohannes Tekalign
- Department of Public Health, College of Medicine and Health Sciences, Madawalabu University, Ethiopia
| | - Daniel Atlaw
- Department of Human Anatomy, College of Medicine and Health Sciences, Madawalabu University, Ethiopia
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Ambese TY, Gebre H, Berhe A, Fisseha G, Gufue ZH, Hailu NA, Ebrahim MM, Abraha HE. Effect of vaginal scarring on the recovery of surgical repair of obstetric fistula in Northern Ethiopia. Int J Gynaecol Obstet 2023; 160:915-925. [PMID: 36031398 DOI: 10.1002/ijgo.14425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 08/04/2022] [Accepted: 08/17/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To determine the effect of vaginal scarring on the recovery from surgical repair of obstetric fistula in Northern Ethiopia from 2015 to 2020. METHODS A hospital-based retrospective cohort study was conducted among 224 women who had obstetric fistula repair surgery in Northern Ethiopia from March 1 to March 31, 2020. Cox proportional hazards regression model was used to determine the adjusted predictors of recovery for each main baseline predictor variable, using 95% confidence interval (CI) and P < 0.05 to declare statistical significance. RESULTS The overall recovery rate was 57 of 1000 women (43 of 1000 and 73 of 1000 for women with and without vaginal scar, respectively), with an overall median time to recovery from obstetric fistula repair surgery of 15 days. Vaginal scarring (adjusted hazard ratio [aHR], 1.58 [95% CI, 1.13-2.21]), age of the patient (aHR, 4.05 [95% CI, 1.56-10.5]), mode of delivery (aHR, 2.14 [95% CI, 1.31-3.49]), place of delivery (aHR, 1.91 [95% CI, 1.17-3.12]), prior repair (aHR, 1.90 [95% CI, 1.08-3.35]), and duration of catheterization (aHR, 12.91 [95% CI, 7.21-23.13]) were independent predictors of recovery. CONCLUSIONS In the present study, we found that women who had no vaginal scar, age older than 30 years, facility and spontaneous vaginal delivery, first attempt repair, and shorter duration of catheterization had a shorter recover time.
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Affiliation(s)
- Tesfay Yohannes Ambese
- Department of Public Health Surveillance, Ethiopian Public Health Institute Tigray Branch, Mekelle, Ethiopia
| | - Hagazi Gebre
- Department of Biostatistics, School of Public Health, College of Health Science, Mekelle University, Mekelle, Ethiopia
| | - Awtachew Berhe
- Department of Biostatistics, School of Public Health, College of Health Science, Mekelle University, Mekelle, Ethiopia
| | - Girmatsion Fisseha
- Department of Reproductive Health, School of Public Health, College of Health Science, Mekelle University, Mekelle, Ethiopia
| | - Zenawi Hagos Gufue
- Department of Public Health, College of Medicine and Health Sciences, Adigrat University, Adigrat, Ethiopia
| | - Nigus Alemu Hailu
- Department of Biomedical Sciences, College of Medicine and Health Sciences, Adigrat University, Adigrat, Ethiopia
| | | | - Hiluf Ebuy Abraha
- Department of Clinical governance and Quality Improvement, Ayder Comprehensive Specialized Hospital, Mekelle University, Mekelle, Ethiopia
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Nembunzu D, Mayemba N, Sidibé S, Grovogui FM, Aussak BTT, Banze Kyongolwa DF, Camara BS, Tripathi V, Delamou A. Factors Associated With Persistent Urinary Incontinence Among Women Undergoing Female Genital Fistula Surgery in the Democratic Republic of Congo From 2017 to 2019. Front Glob Womens Health 2022; 3:896991. [PMID: 35814834 PMCID: PMC9263387 DOI: 10.3389/fgwh.2022.896991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 06/02/2022] [Indexed: 11/13/2022] Open
Abstract
Background Despite high closure rates, residual urinary incontinence remains a common problem after successful closure of a vesico-vaginal fistula. The objective of this study was to identify factors associated with residual urinary incontinence in women with successful fistula closure in sites supported by the Fistula Care Plus project in the Democratic Republic of Congo (DRC). Material and Methods This was a retrospective cohort study using routine data extracted from the medical records of women undergoing fistula surgery in three hospitals supported by the Fistula Care Plus project in DRC between 2017 and 2019. We analyzed factors associated with residual urinary incontinence among a subsample of women with closed fistula at discharge. We collected data on sociodemographic, clinical, gynecological-obstetrical characteristics, and case management. Univariate and multivariate analyses were performed to determine the factors associated with residual urinary incontinence. Results Overall, 31 of 718 women discharged with closed fistula after repair (4.3%; 95% CI: 3.1–6.1) had residual incontinence. The leading causes identified in these women with residual incontinence were urethral voiding (6 women), short urethra (6 women), severe fibrosis (3 women) and micro-bladder (2 women). The prevalence of residual incontinence was higher among women who received repair at the Heal Africa (6.6%) and St Joseph's (3.7%) sites compared with the Panzi site (1.7%). Factors associated with increased odds of persistent urinary incontinence were the Heal Africa repair site (aOR: 54.18; 95% CI: 5.33–550.89), any previous surgeries (aOR: 3.17; 95% CI: 1.10–9.14) and vaginal surgical route (aOR: 6.78; 95% CI: 1.02–45.21). Conclusion Prior surgery and repair sites were the main predictors of residual incontinence after fistula closure. Early detection and management of urinary incontinence and further research to understand site contribution to persistent incontinence are needed.
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Affiliation(s)
- Dolores Nembunzu
- Fistula Clinic, Department of Gynecology and Obstetrics, Saint Joseph Hospital, Kinshasa, Democratic Republic of Congo
| | - Naomie Mayemba
- Fistula Clinic, Department of Gynecology and Obstetrics, Saint Joseph Hospital, Kinshasa, Democratic Republic of Congo
| | - Sidikiba Sidibé
- Africa Center of Excellence (CEA-PCMT), University Gamal Abdel Nasser, Conakry, Guinea
- *Correspondence: Sidikiba Sidibé
| | - Fassou Mathias Grovogui
- Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea
| | | | | | - Bienvenu Salim Camara
- Africa Center of Excellence (CEA-PCMT), University Gamal Abdel Nasser, Conakry, Guinea
| | | | - Alexandre Delamou
- Africa Center of Excellence (CEA-PCMT), University Gamal Abdel Nasser, Conakry, Guinea
- Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea
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Mafu MM, Kyongolwa DFB, Aussak BTT, Kolié D, Camara BS, Nembunzu D, Christine AN, Paluku J, Tripathi V, Delamou A. Factors associated with surgical repair success of female genital fistula in the Democratic Republic of Congo: Experiences of the Fistula Care Plus Project, 2017-2019. Trop Med Int Health 2022; 27:831-839. [PMID: 35749231 PMCID: PMC9541372 DOI: 10.1111/tmi.13794] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Objective We sought to document outcomes and factors associated with surgical success in hospitals supported by the Fistula Care Plus Project in the Democratic Republic of Congo (DRC), 2017–2019. Methods This was a retrospective cohort study analysing routine repair data on women with Female Genital Fistula. Univariate and multivariate analyses were conducted to determine factors associated with successful fistula repair. Results A total of 895 women were included in this study, with a mean age of 34 years (±13 years). The majority were married or in union (57.4%) and living in rural areas (82.0%), while nearly half were farmers (45.9%). The average duration living with fistula was 8 years (±7). Vesicovaginal (70.5%) and complex (59.8%) fistulas were the most common fistula types. Caesarean section (34.7%), obstructed labour (27.0%) and prolonged labour (23.0%) were the main aetiologies, with the causal deliveries resulting in stillbirth in 88% of cases. The vaginal route (74.9%) was the primary route for surgical repair. The median duration of bladder catheterization after surgery was 14 days (interquartile range [IQR] 7–21). Multivariate analysis revealed that Waaldijk type I fistula (adjusted odds ratio [aOR]:2.71, 95% confidence interval [CI]:1.36–5.40), no previous surgery (aOR:2.63, 95% CI:1.43–3.19), repair at Panzi Hospital (aOR: 2.71, 95% CI:1.36–5.40), and bladder catheterization for less than 10 days (aOR:13.94, 95% CI: 4.91–39.55) or 11–14 days (aOR: 6.07, 95% CI: 2.21–15.31) were associated with better repair outcomes. Conclusion The Fistula Care Plus Project in the DRC recorded good fistula repair outcomes. However, further efforts are needed to promote adequate management of fistula cases.
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Affiliation(s)
| | | | | | - Delphin Kolié
- Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea
| | - Bienvenu Salim Camara
- Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea.,Africa Center of Excellence, University Gamal Abdel Nasser, Conakry, Guinea
| | - Dolores Nembunzu
- Hôpital Saint Joseph, Kinshasa, République Démocratique du Congo
| | - Amisi Notia Christine
- Hopital Général de Référence de Panzi, Bukavu, République Démocratique du Congo.,Université Evangélique en Afrique, Bukavu, République Démocratique du, Congo Hôpital
| | - Justin Paluku
- Hôpital Heal Africa, Goma, République Démocratique du Congo.,Department of Obstetrics and Gynecology, Université de Goma, Goma, République Démocratique du Congo
| | | | - Alexandre Delamou
- Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea.,Africa Center of Excellence, University Gamal Abdel Nasser, Conakry, Guinea
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