1
|
Kopp DM, Tang JH, Bengtson AM, Chi BH, Chipungu E, Moyo M, Wilkinson J. Continence, quality of life and depression following surgical repair of obstetric vesicovaginal fistula: a cohort study. BJOG 2018; 126:926-934. [PMID: 30461170 DOI: 10.1111/1471-0528.15546] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVE We evaluated residual incontinence, depression, and quality of life among Malawian women who had undergone vesicovaginal fistula (VVF) repair 12 or more months previously. DESIGN Prospective cohort study. SETTING Fistula Care Centre in Lilongwe, Malawi. POPULATION Women who had undergone VVF repair in Lilongwe, Malawi at least 12 months prior to enrolment. METHODS Self-report of urinary leakage was used to evaluate for residual urinary incontinence; depression was evaluated with the Patient Health Questionnaire-9; quality of life was evaluated with the King's Health Questionnaire. MAIN OUTCOME MEASURES Prevalence and predictors of residual incontinence, quality of life scores, and prevalence of depression and suicidal ideation. RESULTS Fifty-six women (19.3%) reported residual urinary incontinence. In multivariable analyses, predictors of residual urinary incontinence included: pre-operative Goh type 3 [adjusted risk ratio (aRR) 2.82; 95% confidence interval (CI) 1.61-5.27) or Goh type 4 1.08-2.78), positive postoperative cough stress test (aRR = 2.42; 95% CI 1.24-4.71) and the positive 1-hour postoperative pad test (aRR = 2.20; 95% CI 1.08-4.48). Women with Goh types 3 and 4 VVF reported lower quality of life scores. Depressive symptoms were reported in 3.5% of women; all reported residual urinary incontinence. CONCLUSIONS While the majority of women reported improved outcomes in the years following surgical VVF repair, those with residual urinary incontinence had a poorer quality of life. Services are needed to identify and treat this at-risk group. TWEETABLE ABSTRACT Nearly one in five women reported residual urinary incontinence at follow up, 12 or months after vesicovaginal fistula repair.
Collapse
Affiliation(s)
- D M Kopp
- UNC Project-Malawi, Lilongwe, Malawi.,Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA
| | - J H Tang
- UNC Project-Malawi, Lilongwe, Malawi.,Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA
| | - A M Bengtson
- Department of Epidemiology, Brown University, Rhode Island, USA
| | - B H Chi
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA
| | - E Chipungu
- Fistula Care Center, Lilongwe, Malawi.,Department of Obstetrics and Gynaecology, Malawi College of Medicine, Blantyre, Malawi
| | - M Moyo
- Fistula Care Center, Lilongwe, Malawi
| | - J Wilkinson
- Fistula Care Center, Lilongwe, Malawi.,Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
| |
Collapse
|
2
|
Baker Z, Bellows B, Bach R, Warren C. Barriers to obstetric fistula treatment in low‐income countries: a systematic review. Trop Med Int Health 2017; 22:938-959. [DOI: 10.1111/tmi.12893] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Zoë Baker
- Department of Epidemiology UCLA Fielding School of Public Health Los Angeles CA USA
| | | | - Rachel Bach
- Department of Indigenous Studies University of Winnipeg Winnipeg Manitoba Canada
| | | |
Collapse
|
3
|
Ouedraogo I, Payne C, Nardos R, Adelman AJ, Wall LL. Obstetric fistula in Niger: 6-month postoperative follow-up of 384 patients from the Danja Fistula Center. Int Urogynecol J 2017; 29:345-351. [PMID: 28600757 PMCID: PMC5847061 DOI: 10.1007/s00192-017-3375-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 07/28/2016] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The impoverished West African country of Niger has high rates of obstetric fistula. We report a 6-month postoperative follow-up of 384 patients from the Danja Fistula Center and assess factors associated with operative success or failure. METHODS The medical records of 384 women who had completed a 6-month follow-up after fistula surgery were reviewed. Cases were categorized as "easy," "of intermediate complexity," or "difficult" based on a preoperative points system. Data were analyzed using simple chi-squared statistics and logistic regression. RESULTS The patients were predominantly of Hausa ethnicity (73%), married young (average 15.9 years), had teenage first pregnancies (average first delivery 16.9 years), and experienced prolonged labor (average 2.3 days) with poor outcomes (89% stillbirth rate). The average parity was four. Patients commonly developed their fistula during their first delivery (43.5%), but over half sustained a fistula during a subsequent delivery (56.5%). Prior fistula surgery elsewhere (average 1.75 operations) was common. The overall surgical success ("closed and dry") was 54%. When the 134 primary operations were analyzed separately, the overall success rate was 80%. Increasing success was seen with decreasing surgical difficulty: 92% success for "easy" cases, 68% for "intermediate" cases, and 57% success for "difficult" cases. Success decreased with increasing numbers of previous attempts at surgical repair. CONCLUSIONS These data provide further evidence that clinical outcomes are better when primary fistula repair is performed by expert surgeons in specialist centers with the support of trained fistula nurses.
Collapse
Affiliation(s)
- Itengre Ouedraogo
- The Danja Fistula Center, Danja, Niger
- The Worldwide Fistula Fund, Chicago, IL, USA
| | | | - Rahel Nardos
- The Worldwide Fistula Fund, Chicago, IL, USA
- Department of Obstetrics and Gynecology, Oregon Health and Sciences University, Portland, OR, USA
| | - Avril J Adelman
- Division of Biostatistics, Washington University School of Medicine, St. Louis, MO, USA
| | - L Lewis Wall
- The Worldwide Fistula Fund, Chicago, IL, USA.
- Department of Anthropology, Washington University in St. Louis, Campus Box 1114, One Brookings Drive, St. Louis, MO, 63110, USA.
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA.
| |
Collapse
|
4
|
Sullivan G, O'Brien B, Mwini-Nyaledzigbor P. Sources of support for women experiencing obstetric fistula in northern Ghana: A focused ethnography. Midwifery 2016; 40:162-8. [PMID: 27449325 DOI: 10.1016/j.midw.2016.07.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 06/16/2016] [Accepted: 07/03/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE we explored how women in northern Ghana who have or have had obstetric fistula and those close to them perceive support. DESIGN focused ethnography, that includes in-depth interviews, participant observation, and scrutiny of relevant records. SETTING a fistula treatment centre in a regional urban centre and three remote villages located in northern Ghana. PARTICIPANTS the sources of data included in-depth interview (n=14), non-participant observation and interaction, as well as scrutiny of relevant health records and documents. Participants for in-depth interviews and observation included women affected by obstetric fistula, their partners, parents, relatives, nurses and doctors. FINDINGS presentation of obstetric fistula information, particularly by Non-Governmental Organisations was not in a format that was readily understandable for many women and their families. Food and other basic requirements for daily living were not necessarily available in the fistula treatment centre. Travelling for care was costly and frequently not easily accessed from their communities. Fistula repair surgery was available at unpredictable times and only for a few days every one to two months. CONCLUSIONS women perceived support from spouses/partner, family members, and other relatives but much of this is limited to tangible support. Perceptions of support were particularly focused on access to information and finances. IMPLICATIONS FOR PRACTICE the implementation of strategies to increase support for women living with obstetric fistula include improving access to fistula repair treatment, directing resources to create a dedicated specialist fistula centre located where most cases of OF occur and providing education to front-line workers. Strategies to prevent fistula as well as identify and support safe motherhood practices are needed for women affected by obstetric fistula.
Collapse
Affiliation(s)
- Ginger Sullivan
- University of Alberta, Faculty of Nursing, 5th Floor, Edmonton, Alberta, Canada T6G 1C9.
| | - Beverley O'Brien
- University of Alberta, Faculty of Nursing, 5th Floor, Edmonton, Alberta, Canada T6G 1C9.
| | | |
Collapse
|
5
|
Cowgill KD, Bishop J, Norgaard AK, Rubens CE, Gravett MG. Obstetric fistula in low-resource countries: an under-valued and under-studied problem--systematic review of its incidence, prevalence, and association with stillbirth. BMC Pregnancy Childbirth 2015; 15:193. [PMID: 26306705 PMCID: PMC4550077 DOI: 10.1186/s12884-015-0592-2] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 07/15/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Obstetric fistula (OF) is a serious consequence of prolonged, obstructed labor in settings where emergency obstetric care is limited, but there are few reliable, population-based estimates of the rate of OF. Stillbirth (SB) is another serious consequence of prolonged, obstructed labor, yet the frequency of SB in women with OF is poorly described. Here, we review these data. METHODS We searched electronic databases and grey literature for articles on OF in low-resource countries published between January 1, 1995, and November 16, 2014, and selected for inclusion 19 articles with original population-based OF incidence or prevalence data and 44 with reports of frequency of SB associated with OF. RESULTS OF estimates came from medium- and low-HDI countries in South Asia and Africa, and varied considerably; incidence estimates ranged from 0 to 4.09 OF cases per 1000 deliveries, while prevalence estimates were judged more prone to bias and ranged from 0 to 81.0 OF cases per 1000 women. Reported frequency of SB associated with OF ranged from 32.3 % to 100 %, with estimates from the largest studies around 92 %. Study methods and quality were inconsistent. CONCLUSIONS Reliable data on OF and associated SB in low-resource countries are lacking, underscoring the relative invisibility of these issues. Sound numbers are needed to guide policy and funding responses to these neglected conditions of poverty.
Collapse
Affiliation(s)
- Karen D Cowgill
- College of Nursing, Seattle University, Seattle, WA, USA.
- Department of Global Health, University of Washington, Seattle, WA, USA.
| | | | | | - Craig E Rubens
- Global Alliance to Prevent Prematurity and Stillbirth, Seattle Children's, Seattle, WA, USA.
| | - Michael G Gravett
- Global Alliance to Prevent Prematurity and Stillbirth, Seattle Children's, Seattle, WA, USA.
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA.
| |
Collapse
|
6
|
Shrime MG, Sleemi A, Ravilla TD. Charitable platforms in global surgery: a systematic review of their effectiveness, cost-effectiveness, sustainability, and role training. World J Surg 2015; 39:10-20. [PMID: 24682278 PMCID: PMC4179995 DOI: 10.1007/s00268-014-2516-0] [Citation(s) in RCA: 175] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE This study was designed to propose a classification scheme for platforms of surgical delivery in low- and middle-income countries (LMICs) and to review the literature documenting their effectiveness, cost-effectiveness, sustainability, and role in training. Approximately 28 % of the global burden of disease is surgical. In LMICs, much of this burden is borne by a rapidly growing international charitable sector, in fragmented platforms ranging from short-term trips to specialized hospitals. Systematic reviews of these platforms, across regions and across disease conditions, have not been performed. METHODS A systematic review of MEDLINE and EMBASE databases was performed from 1960 to 2013. Inclusion and exclusion criteria were defined a priori. Bibliographies of retrieved studies were searched by hand. Of the 8,854 publications retrieved, 104 were included. RESULTS Surgery by international charitable organizations is delivered under two, specialized hospitals and temporary platforms. Among the latter, short-term surgical missions were the most common and appeared beneficial when no other option was available. Compared to other platforms, however, worse results and a lack of cost-effectiveness curtailed their role. Self-contained temporary platforms that did not rely on local infrastructure showed promise, based on very few studies. Specialized hospitals provided effective treatment and appeared sustainable; cost-effectiveness evidence was limited. CONCLUSIONS Because the charitable sector delivers surgery in vastly divergent ways, systematic review of these platforms has been difficult. This paper provides a framework from which to study these platforms for surgery in LMICs. Given the available evidence, self-contained temporary platforms and specialized surgical centers appear to provide more effective and cost-effective care than short-term surgical mission trips, except when no other delivery platform exists.
Collapse
Affiliation(s)
- Mark G Shrime
- Harvard Interfaculty Initiative in Health Policy, 14 Story Street, 4th Floor, Cambridge, MA, 02138, USA,
| | | | | |
Collapse
|
7
|
A bill of rights for patients with obstetric fistula. Int J Gynaecol Obstet 2014; 127:301-4. [DOI: 10.1016/j.ijgo.2014.06.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Revised: 06/22/2014] [Accepted: 08/08/2014] [Indexed: 11/22/2022]
|
8
|
Ojengbede OA, Morhason-Bello IO. Vesico-vaginal fistula repair as a day case: is it a worthy venture? Int Urogynecol J 2013; 24:1611-4. [PMID: 23695384 DOI: 10.1007/s00192-013-2122-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Accepted: 04/24/2013] [Indexed: 11/28/2022]
Abstract
Two vesico-vaginal fistula patients who were successfully managed with outpatient care as an alternative approach, to ensure early access to care and integration into their family. The two patients had simple uncomplicated mid-vagina fistulae surgically repaired with local infiltrative anaesthesia. We suggest some selection criteria and clinical guidelines that can facilitate successful treatment by this choice of care.
Collapse
Affiliation(s)
- O A Ojengbede
- Urogynaecology Unit, Department of Obstetrics and Gynaecology, College of Medicine/University College Hospital, University of Ibadan, Ibadan, Oyo State, Nigeria
| | | |
Collapse
|
9
|
Maulet N, Keita M, Macq J. Medico-social pathways of obstetric fistula patients in Mali and Niger: an 18-month cohort follow-up. Trop Med Int Health 2013; 18:524-33. [PMID: 23489380 DOI: 10.1111/tmi.12086] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To gain understanding of care pathways and induced mobility patterns of obstetric fistula patients in French-speaking West African fistula repair centres. METHODS We followed prospectively during 18 months a cohort of obstetric fistula patients in Mali and Niger (2008-2009). 120 patients were recruited at different stages of their care process in 5 reference fistula repair centres. Follow-up was carried out in repair centres and communities. Quantitative data were collected through close-ended questionnaires at three time points. Medico-social pathways were explored through a longitudinal analysis focusing on six indicators: fistula duration, care process duration, patients' mobility, marital status, number of surgeries and continence status. RESULTS Patients' pathways were characterised by their length: fistula duration (median 4 years), care process duration (median 2.7 years), aggregated time spent in repair centres during study (median 7 months). Patients developed four mobility patterns (homebound, itinerant, institutionalised and urbanised). Adverse marital status change continued over time. Sample stratification according to number of previous surgeries revealed differences in care process duration and outcome: 23/31 new cases (≤1 surgery) gained continence with a mean of 1.5 surgeries in a median of 0.6 year while only 17/78 old cases (≥2 surgeries) became continent with a mean of 4 surgeries in a median time of 4.9 years. CONCLUSION The quest for continence does not end with admission to a fistula repair centre. Analysing fistula care experience across time within the varying settings highlights the twofold population and mixed medico-social outcomes that should prompt new development in obstetric fistula care management and research.
Collapse
Affiliation(s)
- Nathalie Maulet
- Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium.
| | | | | |
Collapse
|