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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; 35:1527-1547. [PMID: 38913128 PMCID: PMC11315714 DOI: 10.1007/s00192-024-05814-3] [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: 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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Pollaczek L, Rajagopal K, Chu J. Patient characteristics, surgery outcomes, presumed aetiology and other characteristics of fistula surgeries and related procedures supported by Fistula Foundation from 2019 to 2021: a multicentre, retrospective observational study. BMJ Open 2024; 14:e078426. [PMID: 38485171 PMCID: PMC10941128 DOI: 10.1136/bmjopen-2023-078426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 02/20/2024] [Indexed: 03/17/2024] Open
Abstract
OBJECTIVES Obstetric fistula is a devastating childbirth injury primarily caused by prolonged, obstructed labour. It leaves women incontinent, severely stigmatised and isolated. Fistula repair surgery can restore a woman's health and well-being. Fistula Foundation, a non-profit organisation, works in partnership with local hospitals and community organisations in Africa and Asia to address key barriers to treatment and to increase the number of women receiving surgical care. This paper presents data on fistula and fistula repair surgery across a large global network of hospitals supported by Fistula Foundation. The data were collected between 2019 and 2021. DESIGN Multicentre, retrospective, observational, descriptive study. SETTING AND PARTICIPANTS The study analysed deidentified data from 24 568 surgical repairs supported by Fistula Foundation to treat women with obstetric fistula at 110 hospitals in 27 countries. RESULTS The data highlight patient characteristics and key trends and outcomes from obstetric fistula repair surgeries and related procedures. Of those surgeries, 87% resulted in a successful outcome (fistula dry and closed) at the time of discharge, highlighting the effectiveness of fistula repair in restoring continence and improving quality of life. Over the period studied, the number of supported surgeries increased by 14%, but there remains an urgent need to strengthen local surgical capacity and improve access to treatment. Women suffered an average of 5.7 years before they received surgery and only 4% of women sought care independently. This underscores the importance of enhancing community awareness and strengthening referral networks. CONCLUSIONS This research provides essential insight from a vast, global network of hospitals providing highly effective fistula repair surgery. Further investment is needed to strengthen surgical capacity, increase awareness of fistula and remove financial barriers to treatment if stakeholders are to make significant progress towards the United Nations' ambitious vision of ending fistula by 2030.
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Affiliation(s)
| | | | - Jesse Chu
- Fistula Foundation, San Jose, California, USA
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El Ayadi AM, Alway J, Matityahu D, Kichwen C, Wilson S, Mabeya H. Impact of Beyond Fistula programming on economic, psychosocial and empowerment outcomes following female genital fistula repair: A retrospective study. Int J Gynaecol Obstet 2024; 164:1064-1073. [PMID: 37746937 DOI: 10.1002/ijgo.15133] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 08/25/2023] [Accepted: 08/29/2023] [Indexed: 09/26/2023]
Abstract
OBJECTIVE To retrospectively assess changes in economic status, psychosocial status and empowerment among women who participated in Beyond Fistula reintegration programming following fistula repair. METHODS We conducted a retrospective study among 100 Beyond Fistula program participants capturing sociodemographic characteristics, obstetric and fistula history, program participation, and our primary outcomes: economic status, psychosocial status, and empowerment via quantitative survey at two time points: before program participation and currently. Data were collected from November 2020 to July 2021 from 2013 to 2019 program participants. We compared outcomes across these two time points using paired t tests or McNemar's tests. RESULTS The proportion of individuals owning property (28.0% vs. 38.0%, P = 0.006), having a current source of income (19.0% vs. 56.0%, P < 0.001), and saving or investing income (11.0% vs. 37.0%, P < 0.001) increased significantly from pre- to post-programming. We also identified statistically significant increases from pre- to post-programming in self-esteem (5.0 [IQR 4.0-5.0] vs. 5.0 [IQR 5.0-5.0], P < 0.001), reintegration (53.0 [IQR 43.0-69.0] vs. 65.0 [IQR 51.0-72.0], P < 0.001) and level of input into household economic decision making (2.0 [SD 1.0] vs. 2.3 [SD 1.0], P = 0.004). CONCLUSION Beyond Fistula programming likely improved economic status, psychosocial status, and empowerment of participants. Post-surgical interventions incorporating a holistic approach can advance recovery through supporting psychosocial and economic wellbeing and should be offered to women undergoing genital fistula repair.
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Affiliation(s)
- Alison M El Ayadi
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Jessica Alway
- School of Public Health, University of California, Berkeley, California, USA
| | - Debra Matityahu
- Beyond Fistula, Eldoret, Kenya
- The Permanente Medical Group, Redwood City, California, USA
| | | | | | - Hillary Mabeya
- Beyond Fistula, Eldoret, Kenya
- Moi University School of Medicine, Eldoret, Kenya
- Gynocare Women's and Fistula Hospital, Eldoret, Kenya
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El Ayadi AM, Obore S, Kirya F, Miller S, Korn A, Nalubwama H, Neuhaus J, Getahun M, Eyul P, Twine R, Andrew EVW, Barageine JK. Identifying opportunities for prevention of adverse outcomes following female genital fistula repair: protocol for a mixed-methods study in Uganda. Reprod Health 2024; 21:2. [PMID: 38178156 PMCID: PMC10768188 DOI: 10.1186/s12978-023-01732-7] [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: 04/30/2023] [Accepted: 12/28/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Female genital fistula is a traumatic debilitating injury, frequently caused by prolonged obstructed labor, affecting between 500,000-2 million women in lower-resource settings. Vesicovaginal fistula causes urinary incontinence, and other morbidity may occur during fistula development. Women with fistula are stigmatized, limit social and economic engagement, and experience psychiatric morbidity. Improved surgical access has reduced fistula consequences yet post-repair risks impacting quality of life and well-being include fistula repair breakdown or recurrence and ongoing or changing urine leakage or incontinence. Limited evidence on risk factors contributing to adverse outcomes hinders interventions to mitigate adverse events. This study aims to quantify these adverse risks and inform clinical and counseling interventions to optimize women's health and quality of life following fistula repair through: identifying predictors and characteristics of post-repair fistula breakdown and recurrence (Objective 1) and post-repair incontinence (Objective 2), and to identify feasible and acceptable intervention strategies (Objective 3). METHODS This mixed-methods study incorporates a prospective cohort of women with successful vesicovaginal fistula repair at approximately 12 fistula repair centers in Uganda (Objectives 1-2) followed by qualitative inquiry among key stakeholders (Objective 3). Cohort participants will have a baseline visit at the time of surgery followed by data collection at 2 weeks, 6 weeks, 3 months and quarterly thereafter for 3 years. Primary predictors to be evaluated include patient-related factors, fistula-related factors, fistula repair-related factors, and post-repair behaviors and exposures, collected via structured questionnaire at all data collection points. Clinical exams will be conducted at baseline, 2 weeks post-surgery, and for outcome confirmation at symptom development. Primary outcomes are fistula repair breakdown or fistula recurrence and post-repair incontinence. In-depth interviews will be conducted with cohort participants (n ~ 40) and other key stakeholders (~ 40 including family, peers, community members and clinical/social service providers) to inform feasibility and acceptability of recommendations. DISCUSSION Participant recruitment is underway. This study is expected to identify key predictors that can directly improve fistula repair and post-repair programs and women's outcomes, optimizing health and quality of life. Furthermore, our study will create a comprehensive longitudinal dataset capable of supporting broad inquiry into post-fistula repair health. Trial Registration ClinicalTrials.gov Identifier: NCT05437939.
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Affiliation(s)
- Alison M El Ayadi
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, 550 16Th Street, San Francisco, CA, 94158, USA.
| | - Susan Obore
- Department of Urogynecology, Mulago Specialized Women and Neonatal Hospital, Kampala, Uganda
| | - Fred Kirya
- School of Health Sciences, Soroti University, Soroti, Uganda
| | - Suellen Miller
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, 550 16Th Street, San Francisco, CA, 94158, USA
| | - Abner Korn
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, 550 16Th Street, San Francisco, CA, 94158, USA
| | - Hadija Nalubwama
- Department of Obstetrics and Gynecology, College of Health Sciences, Makerere University, Kampala, Uganda
| | - John Neuhaus
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Monica Getahun
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Patrick Eyul
- Infectious Disease Research Collaboration, Kampala, Uganda
| | - Robert Twine
- Infectious Disease Research Collaboration, Kampala, Uganda
| | | | - Justus K Barageine
- Department of Urogynecology, Mulago Specialized Women and Neonatal Hospital, Kampala, Uganda
- Department of Obstetrics and Gynecology, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Obstetrics and Gynaecology, Kampala International University, Kampala, Uganda
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Bigley R, Barageine J, Nalubwama H, Neuhaus J, Mitchell A, Miller S, Obore S, Byamugisha J, Korn A, El Ayadi AM. Factors associated with reintegration trajectory following female genital fistula surgery in Uganda. AJOG GLOBAL REPORTS 2023; 3:100261. [PMID: 37719642 PMCID: PMC10502369 DOI: 10.1016/j.xagr.2023.100261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND A female genital fistula, primarily caused by prolonged obstructed labor or after cesarean delivery in resource-limited countries, affects 500,000 to 2,000,000 women worldwide. Fistula is preventable with timely access to high-quality obstetrical care. Access to surgical repair of a female genital fistula has greatly increased over time. However, research surrounding postrepair reintegration, the process of returning to an individual's normal life, remains limited, and further efforts are needed to understand the factors shaping women's ability to rebuild their relationships and lives following repair. OBJECTIVE This study aimed to characterize the 12-month reintegration trajectory after female genital fistula repair by participant sociodemographic and clinical characteristics. STUDY DESIGN This study analyzed quantitative survey and medical record data of women (N=60) participating in a longitudinal cohort study assessing recovery after genital fistula repair in Uganda, with baseline and 4 quarterly follow-up assessments in 12 months. The primary outcome of reintegration was assessed using a 19-item postfistula repair reintegration instrument (range, 0-100) where a higher score represents better reintegration. Predictors of interest included parity and living children, quality of life, depressive symptoms at baseline, self-esteem, stigma, trauma, physical symptoms, and social support. We described participant baseline characteristics using means and proportions and estimated a series of mixed-effects linear regression models, including interactions of characteristics with time to understand how these characteristics influence reintegration trajectory in the 12 months after repair. RESULTS The participants' physical and psychosocial morbidities at baseline were high; more than 80% of participants reported fistula-related physical symptoms, 82% of participants described their general health as poor, and measures of self-esteem, overall social support, and overall quality of life were low. The mean reintegration score at baseline was 33 (standard deviation, 20), which increased to 78 (standard deviation, 19) at 12 months after fistula repair. The participant sociodemographic characteristics statistically associated with reintegration included any living children (β, 1.08; 95% confidence interval, -0.08 to 2.23). Moreover, psychosocial factors significantly affected reintegration with steeper trajectories for women with depressive symptoms (β, 0.89; 95% confidence interval, 0.02-1.75) or women experiencing internalized stigma (β, 0.05; 95% confidence interval, -0.00 to 0.11) and less steep for those with higher self-esteem (β, -0.11; 95% confidence interval, -0.24 to 0.01), overall social support (β, -0.06; 95% confidence interval, -0.12 to -0.01), and partner support (β, -0.21; 95% confidence interval, -0.35 to -0.07). CONCLUSION Understanding the prominent factors associated with differences in reintegration trajectories across the year after genital fistula surgery has the potential to inform interventions that mitigate challenges and improve women's postrepair recovery experiences.
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Affiliation(s)
- Rachel Bigley
- University of California, San Francisco, School of Medicine, San Francisco, CA (Dr Bigley)
| | - Justus Barageine
- Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda (Drs Barageine, Ms Nalubwama, and Dr Byamugisha)
- Mulago Specialised Women and Neonatal Hospital, Kampala, Uganda (Drs Barageine and Obore)
| | - Hadija Nalubwama
- Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda (Drs Barageine, Ms Nalubwama, and Dr Byamugisha)
| | - John Neuhaus
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA (Drs Neuhaus and El Ayadi)
| | - Ashley Mitchell
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA (Ms Mitchell)
| | - Suellen Miller
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA (Drs. Miller, Korn, and El Ayadi)
| | - Susan Obore
- Mulago Specialised Women and Neonatal Hospital, Kampala, Uganda (Drs Barageine and Obore)
| | - Josaphat Byamugisha
- Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda (Drs Barageine, Ms Nalubwama, and Dr Byamugisha)
| | - Abner Korn
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA (Ms Mitchell)
| | - Alison M. El Ayadi
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA (Drs Neuhaus and El Ayadi)
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA (Ms Mitchell)
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El Ayadi AM, Obore S, Kirya F, Miller S, Korn A, Nalubwama H, Neuhaus J, Getahun M, Eyul P, Twine R, Andrew EVW, Barageine JK. Identifying Opportunities for Prevention of Adverse Outcomes Following Female Genital Fistula Repair: Protocol for a Mixed-Methods Study in Uganda. RESEARCH SQUARE 2023:rs.3.rs-2879899. [PMID: 37205399 PMCID: PMC10187434 DOI: 10.21203/rs.3.rs-2879899/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Background Female genital fistula is a traumatic debilitating injury, frequently caused by prolonged obstructed labor, affecting between 500,000-2 million women in lower-resource settings. Vesicovaginal fistula causes urinary incontinence. Other gynecologic, neurologic and orthopedic morbidity may occur during fistula development. Women with fistula are stigmatized; limit engagement in social, economic, or religious activities; and report high psychiatric morbidity. Improved global surgical access has reduced fistula consequences yet post-repair risks impacting quality of life and well-being include fistula repair breakdown or recurrence and ongoing or changing urine leakage or incontinence. Limited evidence on risk factors contributing to adverse outcomes hinders interventions to mitigate adverse events, protecting health and quality of life after surgery. This study seeks to identify predictors and characteristics of post-repair fistula breakdown and recurrence (Aim 1) and post-repair incontinence (Aim 2), and to identify feasible and acceptable intervention strategies (Aim 3). Methods This mixed-methods study incorporates a prospective cohort study of women with successful vesicovaginal fistula repair at approximately 12 fistula repair centers and affiliated care sites in Uganda (Aims 1-2) followed by qualitative inquiry among key stakeholders (Aim 3). Cohort participants will have a baseline visit at the time of surgery followed by data collection at 2 weeks, 6 weeks, 3 months and quarterly thereafter for 3 years. Primary predictors to be evaluated include patient-related factors, fistula-related factors, fistula repair-related factors, and post-repair behaviors and exposures, collected via structured questionnaire at all data collection points. Clinical exams will be conducted at baseline, 2 weeks post-surgery, and for outcome confirmation at symptom development. Primary outcomes are fistula repair breakdown or fistula recurrence and post-repair incontinence. In-depth interviews will be conducted with cohort participants (n ~ 40) and other key stakeholders (~ 40 including family, peers, community members and clinical/social service providers) to develop feasible and acceptable intervention concepts for adjustment of identified risk factors. Discussion Participant recruitment is underway. This study is expected to identify key predictors that can directly improve fistula repair and post-repair programs and women's outcomes, optimizing health and quality of life. Furthermore, our study will create a comprehensive longitudinal dataset capable of supporting broad inquiry into post-fistula repair health. Trial Registration ClinicalTrials.gov Identifier: NCT05437939.
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Affiliation(s)
| | - Susan Obore
- Mulago Specialized Women and Neonatal Hospital
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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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8
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Hotchkiss E, Nalubwama H, Miller S, Ryan N, Barageine J, Byamugisha J, El Ayadi AM. Social support among women with genital fistula in Uganda. CULTURE, HEALTH & SEXUALITY 2023; 25:320-335. [PMID: 35200098 PMCID: PMC9399301 DOI: 10.1080/13691058.2022.2041098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 02/08/2022] [Indexed: 06/14/2023]
Abstract
Resulting from prolonged obstructed labour, iatrogenic and traumatic aetiologies, female genital fistula in low-resource settings causes a significant physical and psychosocial burden. Social support is an important mechanism to build resilience to health challenges. This study aimed to understand the role of emotional, informational and tangible social support for Ugandan women affected by fistula. Thirty-three participants who had had fistula surgery 6-24 months prior to the study were recruited from Mulago Hospital in Kampala, Uganda. Data from in-depth interviews (n = 16) and 4 focus group discussions were analysed thematically using a social support framework. Various individuals were key providers of social support across the different domains. They included family, friends, community organisations, and other women affected by fistula. Social support was critical in helping women cope with fistula, access fistula care, and post-repair recovery. Women relied heavily on tangible and emotional support to meet their physical and psychological needs. Support-enhancing interventions for women and their families, particularly those offering emotional and tangible support, may be a promising strategy for improving the experiences and quality of life of women affected by fistula.
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Affiliation(s)
- Emily Hotchkiss
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, USA
| | - Hadija Nalubwama
- Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Suellen Miller
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, USA
| | - Nessa Ryan
- Global Health Program, NYU School of Global Public Health, New York, NY
| | - Justus Barageine
- Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Josaphat Byamugisha
- Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Alison M El Ayadi
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, USA
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Hurissa BF, Koricha ZB, Dadi LS. Quality of life and its predictive factors among women with obstetric fistula in Ethiopia: A cross-sectional study. Front Public Health 2022; 10:987659. [PMID: 36388323 PMCID: PMC9650212 DOI: 10.3389/fpubh.2022.987659] [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: 07/06/2022] [Accepted: 10/14/2022] [Indexed: 01/26/2023] Open
Abstract
Objective Living with obstetric fistulas is detrimental to the quality of life of women with fistulas. This study aimed to assess the quality of life and predictive factors among women with obstetric fistula in Ethiopia. Methods A cross-sectional study was employed on consecutively selected 478 women. Linear regressions were used for data analysis. Results The mean quality of life in physical, psychological, social, and environmental health domains and the overall quality of life were 40.59 ± 1.58, 38.10 ± 1.78, 29.59 ± 1.97, 34.21 ± 1.65, and 44.61 ± 3.99 respectively. Repair outcome without urinary inconsistence (β = 5.2; 95% CI = 0.72, 9.64), self-esteem (β = 1.3; 95% CI = 0.96, 1.57), negative attitude (β = 5.1; 95% CI = 1.86, 8.33), waiting treatment (β = -8.4; 95% CI = -15.54, -1.10), and low intention (β = 4.7; 95% CI = 1.52, 7.93) were predictors of the quality of life in physical domain. Repair outcome without urinary inconsistence (β = 5.9; 95% CI = 1.73, 9.99), self-esteem (β = 1.8; 95% CI = 1.47, 2.11), negative attitude (β = -6.4; 95% CI = -9.60, -3.25), fathers at primary school (β = 12.5; 95% CI = 0.08, 24.82), living only with parents (β = 4.9; 95% CI = 0.99, 8.90), time of care-seeking (β = -0.01, 95% CI = -0.02, -0.002), and duration lived with fistula (β = -5.4; 95% CI = -9.12, -1.68) were predictors of psychological domain. Dead birth (β = -5.2; 95% CI = -9.86, -0.51), self-esteem (β = 1.1; 95% CI = 0.72, 1.43), and living only with parents (β = 5.5; 95% CI = 0.30, 10.69), and living only with husband (β = 7.8; 95% CI = 2.01, 13.55) were predictors of social domain. Living in rural (β = -6; 95% CI = -9.22, -2.79), women at secondary school (β = 14.1; 95% CI = 3.67, 24.48), self-esteem (β = 1.3; 95% CI = 0.99, 1.55), negative attitude (β = -5.1; 95% CI = -7.97, -2.29) were predictors of quality of life in environmental domain. Repair outcome without urinary inconsistence (β = 8.3; 95% CI = 0.62, 16.02), self-esteem (β = 2.1; 95% CI = 1.34, 2.79), and living only with parents (β = 2.9; 95% CI = 1.06, 4.76) were significant predictors of the overall quality of life. Conclusions The quality of life of women with obstetric fistula was low. Repair outcomes, self-esteem, negative attitudes, rural residence, living with parents, and time of care-seeking were significant predictors of quality of life. Urgent measures should be taken to address these factors to improve the quality of life of women with fistula.
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Affiliation(s)
- Bekana Fekecha Hurissa
- School of Midwifery, Institute of Health, Jimma University, Jimma, Ethiopia,*Correspondence: Bekana Fekecha Hurissa ;
| | - Zewdie Birhanu Koricha
- Department of Health, Behavior, and Society, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Lelisa Sena Dadi
- Department of Epidemiology, Faculty of Public Health, Jimma University, Jimma, Ethiopia
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McCammon MA, Otondo NA, Kay N. Economic empowerment of the pilot reintegration program for female genital fistula survivors in Kenya during the COVID-19 pandemic. Front Glob Womens Health 2022; 3:966390. [PMID: 36106142 PMCID: PMC9464944 DOI: 10.3389/fgwh.2022.966390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 08/03/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveTo determine whether a pilot reintegration program for female genital fistula survivors that included a combination of financial support, psychosocial support, and mentoring would result in their long-term economic empowerment during the COVID-19 pandemic.ResultsNine fistula survivors participated in a 29-month pilot reintegration program offered by Kenya Quilts for Empowerment (KQFE), a registered Community Based Organization in Kenya. Originally, the program was intended to last for 18 months, but as a result of the pandemic, this was extended to achieve the long-term economic empowerment of women. The program was based on best practices for poverty alleviation that included multiple sources of income, psychosocial support, and mentoring, sustained over the entire 29-month period. All the women were severely impoverished at the baseline assessment, with one having some savings, and a few having productive assets, which were primarily chickens. Financial training and an initial non-refundable cash transfer provided start-up funds for small businesses; these initially flourished before floundering during the pandemic and eventually recovering. Funds were also used to buy livestock. A key component of the program was the provision of national health insurance for each woman and her family, which helped them stay healthy without having to sell any income-generating livestock. Other key components were the psychosocial support and mentoring provided within their support group. After 29 months, every woman had achieved long-term economic empowerment and “graduated” to become a KQFE ambassador, tasked with identifying fistula survivors within their communities, and referring them for surgery and participation in a reintegration support group.
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Affiliation(s)
- Mary Ann McCammon
- US Quilts for Empowerment, Sherwood, OR, United States
- *Correspondence: Mary Ann McCammon
| | | | - Nancy Kay
- US Quilts for Empowerment, Sherwood, OR, United States
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Gladstone TRG, Ugueto AM, Muleta M, Meshesha TM, Ambaafris GG, Patwa MC, Zhong C, Buchholz KR. Development and Pilot Test of a Group Cognitive Behavioral Intervention for Women Recovering From Fistula Repair Surgery in Ethiopia. Front Public Health 2022; 10:862351. [PMID: 35734763 PMCID: PMC9207711 DOI: 10.3389/fpubh.2022.862351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 05/16/2022] [Indexed: 11/13/2022] Open
Abstract
Obstetric fistula is a serious complication that affects thousands of women in low-income countries. Women who suffer from obstetric fistulae are at risk of developing mental health problems, but to date most interventions have focused on repairing the physical consequences of fistulae through surgery. The goal of the current study is to develop an evidence-based intervention targeting symptoms of depression, anxiety, and trauma in women recovering from fistula repair surgery. First, hospital staff and patients awaiting surgery at a fistula hospital in Ethiopia participated in qualitative interviews to provide information on the mental health needs of women with fistulae, how the hospital tends to these women's psychological needs, and the training needs of staff members. Data from these interviews were used to develop the COFFEE intervention (CBT with Obstetric Fistula for Education and Empowerment). COFFEE is a modular, group intervention that teaches psycho-education, behavioral activation, relaxation, problem solving, cognitive restructuring, and includes a trauma narrative. Patients then participated in an open trial of the COFFEE intervention at the University of Gondar Hospital. Five separate groups were conducted with 24 women who were enrolled post-fistula repair surgery. Women completed pre-treatment self-report questionnaires, participated in group sessions conducted by nurses (with 8 sessions delivered across 10–14 days), and were assessed post-treatment and at 3-month follow-up. Results indicate a significant reduction on depression and anxiety symptoms scores across the three time points [F(2, 40) = 68.45, p < 0.001 partial η2 = 0.774]. Additionally, there was a significant decrease in traumatic stress scores from baseline to post-treatment [F(1.10, 21.98) = 100.51, p < 0.001 partial η2 = 0.834]. Feedback forms completed by nurses and patients suggest the intervention was well-received. Results of this open-trial suggest the COFFEE intervention is feasible, acceptable, and clinically beneficial to treat symptoms of depression, anxiety, and traumatic stress in women post-fistula repair surgery in a hospital setting.
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Affiliation(s)
- Tracy R. G. Gladstone
- Wellesley Centers for Women, Wellesley College, Wellesley, MA, United States
- *Correspondence: Tracy R. G. Gladstone
| | - Ana M. Ugueto
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | | | - Tsega M. Meshesha
- MIT Center for Biomedical Innovation, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Genet G. Ambaafris
- Department of Obstetrics and Gynecology, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Mariya C. Patwa
- School of Medicine, Tufts University School of Medicine, Boston, MA, United States
| | - Cordelia Zhong
- Wellesley Centers for Women, Wellesley College, Wellesley, MA, United States
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Pollaczek L, El Ayadi AM, Mohamed HC. Building a country-wide Fistula Treatment Network in Kenya: results from the first six years (2014-2020). BMC Health Serv Res 2022; 22:280. [PMID: 35232440 PMCID: PMC8889651 DOI: 10.1186/s12913-021-07351-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 11/17/2021] [Indexed: 11/28/2022] Open
Abstract
It is estimated that one million women worldwide live with untreated fistula, a devastating injury primarily caused by prolonged obstructed labor when women do not have access to timely emergency obstetric care. Women with fistula are incontinent of urine and/or feces and often suffer severe social and psychological consequences, such as profound stigma and depression. Obstetric fistula affects economically vulnerable women and garners little attention on the global health stage. Exact figures on fistula incidence and prevalence are not known. In Kenya, results from a 2014 population-based survey suggest that 1% of reproductive-aged women have experienced fistula-like symptoms. In collaboration with key stakeholders, Fistula Foundation launched the Fistula Treatment Network (initially known as Action on Fistula) in 2014 to increase access to timely, quality fistula treatment and comprehensive post-operative care for women with fistula in Kenya. The integrated model built linkages between the community and the health system to support women through all parts of their treatment journey and to build capacity of healthcare providers and community leaders who care for these women. Fistula Foundation and its donors provided the program’s funding. Seed funding, representing about 30% of the program budget, was provided by Astellas Pharma EMEA. Over the six-year period from 2014 to 2020, the network supported 6,223 surgeries at seven hospitals, established a fistula training center, trained eleven surgeons and 424 Community Health Volunteers, conducted extensive community outreach, and contributed to the National Strategic Framework to End Female Genital Fistula. At 12 months post fistula repair, 96% of women in a community setting reported that they were not experiencing any incontinence and the proportion of women reporting normal functioning increased from 18% at baseline to 85% at twelve-months. The Fistula Treatment Network facilitated collaboration across hospital and community actors to enhance long-term outcomes for women living with fistula. This model improved awareness and reduced stigma, increased access to surgery, strengthened the fistula workforce, and facilitated post-operative follow-up and reintegration support for women. This integrated approach is an effective and replicable model for building capacity to deliver comprehensive fistula care services in other countries where the burden of fistula is high.
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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, USA
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Rundasa DN, Wolde TF, Ayana KB, Worke AF. Awareness of obstetric fistula and associated factors among women in reproductive age group attending public hospitals in southwest Ethiopia, 2021. Reprod Health 2021; 18:183. [PMID: 34526056 PMCID: PMC8442366 DOI: 10.1186/s12978-021-01228-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Obstetric fistula occurs in all developing countries but it is confined to the "fistula belt" across the northern half of Sub-Saharan Africa from Mauritania to Eritrea and in the developing countries of the Middle East and Asia. Ending obstetric fistula is critical to achieving Sustainable Development by 2030. So creating awareness on obstetrics fistula among women in the reproductive age group have a crucial role in reducing morbidity, mortality, and social stigma. OBJECTIVE To assess awareness on obstetric fistula and its associated factors among reproductive-age women attending governmental hospitals in southwest Ethiopia, 2021. METHODS An Institutional based cross-sectional study design was conducted among 413 women. The sample size was estimated by using a single population proportion formula. The collected data were coded and entered into EPI-data version 3.1 then exported to SPSS version 24 for descriptive and inferential analysis. Adjusted odds ratio (AOR) along with 95% confidence level was estimated to assess the strength of the association and variables with a p-value < 0.05 were considered to declare the statistical significance in the multivariable analysis in this study. RESULTS In this study, a total of 400 clients have participated in the study. The mean ages of participants were 30.26 (SD ± 8.525) years old. Education of women who cannot read and write are 85% less likely to have good awareness than women who are above the secondary level of education [AOR = 0.162; 95% CI (0.081-0.364)]. While Women who have primary education level are 83% less likely to have good awareness than women who are above the secondary level of education [AOR = 0.170; 95% CI (0.085-0.446)]. In addition, This study shows women who have not heard about obstetric complications are 54% less likely to have awareness of obstetric fistula than those who heard about obstetric complications [AOR = 0.458; 95% CI (0.368-0.643)]. CONCLUSION This study identifies that the educational level of women, history of pregnancy, distance to the nearby health institution, and awareness of obstetrics complications were the factors associated with awareness of reproductive age women on obstetrics fistula. Hence, increasing awareness on obstetric fistula plays a key role in averting this problem.
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Affiliation(s)
| | | | - Kenbon Bayisa Ayana
- Department of Midwifery, College of Health Sciences, Mettu University, Metu, Ethiopia
| | - Abeya Fufa Worke
- Department of Midwifery, College of Health Sciences, Mettu University, Metu, Ethiopia
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Wella K, Chilemba E, Namathanga A, Chakhame B. Social support for women after fistula repair: A scoping review. SEXUAL & REPRODUCTIVE HEALTHCARE 2021; 29:100649. [PMID: 34329967 DOI: 10.1016/j.srhc.2021.100649] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 05/21/2021] [Accepted: 07/19/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Obstetric fistula (OF) is a birth complication that largely affects women in developing countries. These women suffer constant incontinence, shame, social segregation, and health problems. Reconstructive surgery can usually repair OF, enabling the women to reintegrate back into their communities. However, pro repair does not necessarily equate with emotional recovery. Our objective was to explore women's experiences of social support after first time OF repair. METHODS An evidence synthesis was performed based on a systematic search of literature done between January and March 2020 in PubMed, CINAHL, ProQuest, and EMBASE databases using keywords including "obstetric fistula", "vesicovaginal fistula", "vesicovaginal", "fistula", and "social support". Inclusion criteria were primary peer reviewed articles addressing one or more study objectives, in English, on OF support, regardless of location. Two reviewers independently assessed eligibility of the studies and extracted the data. Disagreement between the reviewers were resolved by a third reviewer. The scoping review was based on a framework proposed by Arksey and O'Malley (2015). RESULTS The search resulted in 246 articles, of which 14 met inclusion/exclusion criteria. The synthesis of the studies was theoretically guided by Berkman's Model which emphasizes a link between social resources, social support, and disease. We found that support was either internal or external. Internal support constituted self-efficacy resulting in strengthened internal locus of control. Externally, women were supported by friends and family with material and financial resources. In some cases, the women were supported with educational opportunities and/or business start-up capital. Our review identified the need to support women with information about OF. Most post-OF repair women who were successfully re-integrated into their communities choose to support other women suffering from OF. CONCLUSIONS Social networks make a significant contribution to emotional and psychological recovery of women after a successful OF surgical repair. Lack of social networks were also found to be detrimental to emotional and psychological recovery of women. Most women were abandoned and not supported by their husbands. Restorative surgery is not sufficient making supportive and well organised social networks an integral component of full recovery post-OF repair.
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Affiliation(s)
- Kondwani Wella
- Kamuzu University of Health Sciences, Private Bag 1, Lilongwe, Malawi.
| | - Evelyn Chilemba
- Kamuzu University of Health Sciences, Private Bag 1, Lilongwe, Malawi
| | - Anne Namathanga
- Kamuzu University of Health Sciences, Private Bag 1, Lilongwe, Malawi
| | - Bertha Chakhame
- Kamuzu University of Health Sciences, Private Bag 1, Lilongwe, Malawi
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El Ayadi AM, Barageine JK, Neilands TB, Ryan N, Nalubwama H, Korn A, Turan JM. Validation of an adapted instrument to measure female genital fistula-related stigma. Glob Public Health 2021. [PMID: 32878568 DOI: 10.4324/9781003142089-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Female genital fistula results in severe physical, psychological, and social sequelae. Qualitative research confirms stigma pervasiveness; however, no quantitative instrument exists to measure fistula-related stigma. We adapted an existing HIV-related stigma instrument to fistula-related stigma and assessed its reliability and validity. We recruited 60 Ugandan women seeking genital fistula surgery (December 2014-June 2015). We used exploratory factor analysis to explore the scale's latent structure and evaluated internal consistency reliability with Raykov's ρ statistic. We assessed construct validity through linear regression of stigma with quality of life, depressive symptoms and self-esteem. We retained 15 items across factors 'enacted stigma' and 'internalised stigma' (ρ = 0.960 and ρ = 0.748, respectively). Stigma was inversely associated with all quality of life domains; effect sizes were largest for environmental (enacted stigma, 0.69-point reduction) and psychological (internalised stigma, 0.67-point reduction) domains. Both stigma domains were associated positively with depressive symptoms and inversely with self-esteem, with 0.75 and 1.05-point increases in depressive symptoms and 0.45 and 0.77-point decreases in self-esteem for enacted and internalised stigma, respectively. Results suggest the reliability and validity of the adapted fistula stigma instrument. This instrument may help us understand stigma levels, compare stigma across individuals and communities, prioritise stigma-reduction strategies, and assess intervention impact.
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Affiliation(s)
- Alison M El Ayadi
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Justus K Barageine
- Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda
- Save the Mothers, Uganda Christian University, Mukono, Uganda
- Urogynecology Division, Mulago National Referral and Teaching Hospital, Kampala, Uganda
| | - Torsten B Neilands
- Division of Prevention Sciences, Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, CA, USA
| | - Nessa Ryan
- New York University College of Global Public Health, NYU-HHC Clinical and Translational Science Institute, New York University, New York, NY, USA
| | - Hadija Nalubwama
- Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Abner Korn
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Janet M Turan
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
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Roa L, Caddell L, Ganyaglo G, Tripathi V, Huda N, Romanzi L, Alkire BC. Toward a complete estimate of physical and psychosocial morbidity from prolonged obstructed labour: a modelling study based on clinician survey. BMJ Glob Health 2021; 5:bmjgh-2020-002520. [PMID: 32636314 PMCID: PMC7342481 DOI: 10.1136/bmjgh-2020-002520] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 05/19/2020] [Accepted: 05/22/2020] [Indexed: 01/30/2023] Open
Abstract
Introduction Prolonged obstructed labour often results from lack of access to timely obstetrical care and affects millions of women. Current burden of disease estimates do not include all the physical and psychosocial sequelae from prolonged obstructed labour. This study aimed to estimate the prevalence of the full spectrum of maternal and newborn comorbidities, and create a more comprehensive burden of disease model. Methods This is a cross-sectional survey of clinicians and epidemiological modelling of the burden of disease. A survey to estimate prevalence of prolonged obstructed labour comorbidities was developed for prevalence estimates of 27 comorbidities across seven categories associated with prolonged obstructed labour. The survey was electronically distributed to clinicians caring for women who have suffered from prolonged obstructed labour in Asia and Africa. Prevalence estimates of the sequelae were used to calculate years lost to disability for reproductive age women (15 to 49 years) in 54 low- and middle-income countries that report any prevalence of obstetric fistula. Results Prevalence estimates were obtained from 132 participants. The median prevalence of reported sequelae within each category were: fistula (6.67% to 23.98%), pelvic floor (6.53% to 8.60%), genitourinary (5.74% to 9.57%), musculoskeletal (6.04% to 11.28%), infectious/inflammatory (5.33% to 9.62%), psychological (7.25% to 24.10%), neonatal (13.63% to 66.41%) and social (38.54% to 59.88%). The expanded methodology calculated a burden of morbidity associated with prolonged obstructed labour among women of reproductive age (15 to 49 years old) in 2017 that is 38% more than the previous estimates. Conclusions This analysis provides estimates on the prevalence of physical and psychosocial consequences of prolonged obstructed labour. Our study suggests that the burden of disease resulting from prolonged obstructed labour is currently underestimated. Notably, women who suffer from prolonged obstructed labour have a high prevalence of psychosocial sequelae but these are often not included in burden of disease estimates. In addition to preventative and public health measures, high quality surgical and anaesthesia care are urgently needed to prevent prolonged obstructed labour and its sequelae.
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Affiliation(s)
- Lina Roa
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States .,Department of Obstetrics & Gynecology, University of Alberta, Edmonton, Alberta, Canada
| | - Luke Caddell
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States.,Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Gabriel Ganyaglo
- Department of Obstetrics and Gynecology, Korle Bu Teaching Hospital, Accra, Greater Accra, Ghana
| | - Vandana Tripathi
- Fistula Care Plus, EngenderHealth, Washington, District of Columbia, USA
| | | | - Lauri Romanzi
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States.,Fistula Care Plus, EngenderHealth, Washington, District of Columbia, USA
| | - Blake C Alkire
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States.,Center for Global Surgery Evaluation, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States
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Rehabilitative care practices in the management of childbirth-related pelvic fistula: A systematic review. Int Urogynecol J 2021; 32:2311-2324. [PMID: 34089341 DOI: 10.1007/s00192-021-04845-4] [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: 02/24/2021] [Accepted: 05/07/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Childbirth-related pelvic fistula (CRF) often requires surgery, yet even with successful repair, mental health conditions, musculoskeletal impairments, urinary and fecal incontinence and sexual dysfunction persist for many women. Postoperative rehabilitation, (i.e., physiotherapy, mental health counseling) may address these concerns and has been reported for this population. This review aims to summarize the literature and level of evidence of rehabilitative care practices in fistula care to inform clinical practice, research and policy recommendations. METHODS A systematic literature review was conducted using Africa-Wide Information, CINAHL, Cochrane, Embase, Global Health, PAIS Index, PubMed and SCOPUS searching keywords and MeSH terms to identify women with CRF admitted for surgery. Two researchers progressively screened titles, abstracts and full-text articles. Eligible articles were classified primary if intervention details and outcomes were reported or secondary if rehabilitation was described, but no specific outcomes reported. Relevant study details, strengths and limitations, and key findings were extracted. RESULTS Eighteen articles were included: eight primary, ten secondary. Primary articles reported on urethral plugs for postoperative urinary incontinence (UI) (2/8), menstrual cup to manage UI (1/8), physiotherapy and health education (3/8) and mental health counseling (2/8). Secondary articles describe rehabilitation components in the context of program descriptions, qualitative analyses or reviews. All evidence was low or very low quality. CONCLUSIONS Research on rehabilitative care is very limited and highlights inconsistencies in practice. This review provides support for the feasibility of rehabilitation and establishes the need for future interventional studies that involve a comparator and reliable outcome measures.
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Debela TF, Hordofa ZA, Aregawi AB, Sori DA. Quality of life of obstetrics fistula patients before and after surgical repair in the Jimma University Medical Center, Southwest Ethiopia. BMC Womens Health 2021; 21:212. [PMID: 34020632 PMCID: PMC8138984 DOI: 10.1186/s12905-021-01360-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 05/07/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The consequences of obstetric fistula on affected women are more than the medical condition. It has extensive physical, psychological, social, and economic consequences on them. Obstetric fistula affects the entire health and entire life of women. Women suffering from obstetric fistula are often abandoned by her partner, relatives, and the community. This study aimed to determine the quality of life of obstetrics fistula patients before and after surgical repair. METHODS Institutional-based prospective, before and after study design was conducted in the Jimma University Medical Center from November 1, 2019-October 30, 2020. A face-to-face interview was conducted with fistula patients who visited Jimma University Medical center, fistula clinic during the study period. All fistula patients were included in the study. Accordingly, 78 women who underwent surgical repair were interviewed. The means and the standard deviation were computed using conventional statistics formulas. The unpaired t-test was used to compare two independent means, and one-way analysis of variance (ANOVA) was used to compare the quality of life before repair and after a successful repair. Linear regression analysis was done for identifying determinants of quality of life. A P value of 0.05 will be considered statistical significance. RESULT The overall quality of life of women was 58.17 ± 7.2 before the surgical repair and 71.20 ± 10.79 after surgical repair. The result indicates there is a significant difference in the mean value of pre and post-operative (P < 0.001). The overall satisfaction of women with their health status before the surgical repair was 22.5 ± 1.30and it has increased to 53.0 ± .90after surgical repair. The physical health dimension score was 16.51 ± 5.27 before the surgical repair while it has increased to 21.77 ± 5.38 after the surgical repair. The score of the social domain before the surgical repair was 5.19 ± 1.34 and it has increased to 7.13 ± 3.67 after the surgical repair. The score of the environmental health domain was 17.41 ± 2.89 before the surgery while it also increased to 21.65 ± 4.04 after the surgical repair. The results have shown there was a significant difference in the mean values of pre and post-operatives in both social and environmental scores (P < 0.001). The score of the psychological health domain before the surgery was 19.06 ± 1.46 and it was increased to 19.84 ± 3.21 after the surgical repair. The result showed there is a significant difference in mean value pre and post-operative (P = 0.048), though it is a slight improvement compared to other domains. CONCLUSION The overall quality of life of the patient with fistula was improved after successful surgical repair. Although all domains of quality of life had shown significant improvement after successful surgical repair, the psychological domain showed slight improvement.
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Affiliation(s)
- Tilahun Fufa Debela
- Department of Health Policy and Management, Faculty of Public Health, Jimma University, Jimma, Ethiopia.
| | | | - Aster Berhe Aregawi
- Program Analyst, Midwifery United Nations Population Fund, Addis Ababa, Ethiopia
| | - Demisew Amenu Sori
- Department of Obstetrics and Gynecology, Jimma University, Jimma, Ethiopia
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Keyser L, Myer ENB, McKinney J, Maroyi R, Mukwege D, Chen CCG. Function and disability status among women with fistula using WHODAS2.0: A descriptive study from Rwanda and Democratic Republic of Congo. Int J Gynaecol Obstet 2021; 157:277-282. [PMID: 33971022 DOI: 10.1002/ijgo.13740] [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: 01/25/2021] [Revised: 04/27/2021] [Accepted: 05/03/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To assess function and disability among women in Rwanda and Democratic Republic of Congo living with fistula and identify characteristics associated with higher disability scores. METHODS Women presenting for fistula care were recruited. Eligible participants underwent a physical examination to classify fistula type and completed the WHO Disability Assessment Schedule 2.0 questionnaire to ascertain the impact of fistula on function across six domains: cognition, mobility, self-care, getting along, life activities, and participation. Disability scores were calculated (where 0 = no disability and 100 = complete disability). Participants were grouped according to no, low, or high disability status; results were examined to determine the domains most affected. RESULTS Among 69 participants, fistula type included: vesicovaginal (59.4%), ureterovaginal (14.5%), total absence of proximal urethra (11.6%), and rectovaginal (14.5%). Median disability score was 43.0/100 (interquartile range 26.0-67.0); 83% exhibited high disability status. Life activities and participation in society domains were most affected. Women with rectovaginal fistula reported the lowest scores, and those with total absence of proximal urethra reported the highest scores. CONCLUSION WHO Disability Assessment Schedule 2.0 represents a simple, robust measure of global disability status, aligns with research efforts to estimate maternal disability, and may inform health needs and resource allocation for this population. In this study, disability was common, varied by fistula type, and affected physical, mental, and social domains.
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Affiliation(s)
- Laura Keyser
- Andrews University, Berrien Springs, MI, USA.,Mama LLC, Boston, MA, USA
| | | | - Jessica McKinney
- Andrews University, Berrien Springs, MI, USA.,Mama LLC, Boston, MA, USA
| | - Raha Maroyi
- Panzi General Referral Hospital, Bukavu, Democratic Republic of Congo.,Université Evangélique en Afrique, Bukavu, Democratic Republic of Congo
| | - Denis Mukwege
- Panzi General Referral Hospital, Bukavu, Democratic Republic of Congo.,Université Evangélique en Afrique, Bukavu, Democratic Republic of Congo
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20
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Goh J, Romanzi L, Elneil S, Haylen B, Chen G, Ghoniem G, Ijaiya M, Kwon S, Lee J, Mourad S, Ramanah R, Regmi M, Mohsin Rivzi R, Rogers R, Sharp J, Sung V. An International Continence Society (ICS) report on the terminology for female pelvic floor fistulas. Neurourol Urodyn 2021; 39:2040-2071. [PMID: 33068487 DOI: 10.1002/nau.24508] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 09/03/2020] [Indexed: 11/05/2022]
Abstract
INTRODUCTION The terminology for female pelvic floor fistulas (PFF) needs to be defined and organized in a clinically based consensus Report. METHODS This Report combines the input of members of the International Continence Society (ICS) assisted at intervals by external referees. Appropriate core clinical categories and a sub-classification were developed to give a coding to definitions. An extensive process of 19 rounds of internal and external review was involved to examine each definition, with decision-making by collective opinion (consensus). RESULTS A terminology report for female PFF, encompassing 416 (188 NEW) separate definitions, has been developed. It is clinically based with the most common diagnoses defined. Clarity and user-friendliness have been key aims to make it interpretable by practitioners and trainees in different specialty groups involved in female pelvic floor dysfunction and PFF. Female-specific imaging (ultrasound, radiology, and magnetic resonance imaging) and conservative and surgical PFF managements as well as appropriate figures have been included to supplement and clarify the text. Interval (5-10 years) review is anticipated to keep the document updated and as widely acceptable as possible. CONCLUSION A consensus-based terminology report for female PFF has been produced to aid clinical practice and research.
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Affiliation(s)
- Judith Goh
- Department of Gynecology, Griffith University, Gold Coast, Queensland, Australia
| | - Lauri Romanzi
- Department of Global Health and Global Medicine, Harvard Medical School, New York, New York, USA
| | - Sohier Elneil
- Department of Urogynecology, University College, London Hospitals, London, UK
| | - Bernard Haylen
- Department of Gynecology, University of New South Wales, Sydney, New South Wales, Australia
| | - Grace Chen
- Department of Gynecology, John Hopkins University, Baltimore, Maryland, USA
| | - Gamal Ghoniem
- Division of Female Urology, UC Irvine Health, Irvine, California, USA
| | - Munir'deen Ijaiya
- Department of Obstetrics and Gynecology, University of IIorin, IIorin, Kwara, Nigeria
| | - Soo Kwon
- Department of Gynecology, Zucker School of Medicine, New York, New York, USA
| | - Joseph Lee
- Department of Gynecology, University of New South Wales, Sydney, New South Wales, Australia
| | - Sherif Mourad
- Department of Gynecology, Ain Shams University, Cairo, Egypt
| | | | - Mohan Regmi
- Department of Obstetrics and Gynecology, BP Koirala Institute, Dharan, Nepal
| | | | - Rebecca Rogers
- Department of Obstetrics and Gynecology, University of Texas, Austin, Texas, USA
| | - Jonothan Sharp
- Department of Women's Health, Fenwek Hospital, Bomet, Kenya
| | - Vivian Sung
- Division of Urogynecology, Woman & Infants Hospital, Providence, Rhode Island, USA
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21
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Lawal OO, Nasir S, Bello OO, Abdus-salam RA, Morhason-Bello IO, El-ladan AM, Ojengbede OA. Autologous rectus fascia sling for post-vesicovaginal fistula repair stress incontinence: case series from a Nigerian experience. AFRICAN JOURNAL OF UROLOGY 2020. [DOI: 10.1186/s12301-020-00060-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Successful outcome of a urinary fistula repair involves a successful closure of the fistula without residual incontinence. However, a few women have post-repair stress urinary incontinence despite closure of the fistula, which requires special surgical technique to achieve total continence.
Case presentation
Four women with post-vesicovaginal fistula repair residual incontinence were selected for sling operation using autologous rectus fascia in a low resource setting. Their ages ranged between 20 and 30 years. None had a fistulous opening on vaginal examination and dye test. Two patients had one previous attempt at repair of post-repair stress incontinence, while the others had two and three attempts, respectively, without success. The patients had none to mild vaginal adhesion. Following the procedure, they were followed up for 6 months and they remained continent of urine.
Conclusion
All patients achieved total urinary continence following autologous rectus fascia slings with minimal complications. This demonstrates the possibility of achieving a successful outcome despite lack of modern equipment for diagnosis and follow-up, a typical problem of low-income country like Nigeria.
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22
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El Ayadi AM, Barageine JK, Neilands TB, Ryan N, Nalubwama H, Korn A, Turan JM. Validation of an adapted instrument to measure female genital fistula-related stigma. Glob Public Health 2020; 16:1057-1067. [PMID: 32878568 DOI: 10.1080/17441692.2020.1813786] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Female genital fistula results in severe physical, psychological, and social sequelae. Qualitative research confirms stigma pervasiveness; however, no quantitative instrument exists to measure fistula-related stigma. We adapted an existing HIV-related stigma instrument to fistula-related stigma and assessed its reliability and validity. We recruited 60 Ugandan women seeking genital fistula surgery (December 2014-June 2015). We used exploratory factor analysis to explore the scale's latent structure and evaluated internal consistency reliability with Raykov's ρ statistic. We assessed construct validity through linear regression of stigma with quality of life, depressive symptoms and self-esteem. We retained 15 items across factors 'enacted stigma' and 'internalised stigma' (ρ = 0.960 and ρ = 0.748, respectively). Stigma was inversely associated with all quality of life domains; effect sizes were largest for environmental (enacted stigma, 0.69-point reduction) and psychological (internalised stigma, 0.67-point reduction) domains. Both stigma domains were associated positively with depressive symptoms and inversely with self-esteem, with 0.75 and 1.05-point increases in depressive symptoms and 0.45 and 0.77-point decreases in self-esteem for enacted and internalised stigma, respectively. Results suggest the reliability and validity of the adapted fistula stigma instrument. This instrument may help us understand stigma levels, compare stigma across individuals and communities, prioritise stigma-reduction strategies, and assess intervention impact.
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Affiliation(s)
- Alison M El Ayadi
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Justus K Barageine
- Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda.,Save the Mothers, Uganda Christian University, Mukono, Uganda.,Urogynecology Division, Mulago National Referral and Teaching Hospital, Kampala, Uganda
| | - Torsten B Neilands
- Division of Prevention Sciences, Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, CA, USA
| | - Nessa Ryan
- New York University College of Global Public Health, NYU-HHC Clinical and Translational Science Institute, New York University, New York, NY, USA
| | - Hadija Nalubwama
- Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Abner Korn
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Janet M Turan
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
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23
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Watt MH, Nguyen TV, Touré C, Traoré D, Wesson J, Baumgartner JN. Integrated mental health screening for obstetric fistula patients in Mali: From evidence to policy. PLoS One 2020; 15:e0238777. [PMID: 32886719 PMCID: PMC7473551 DOI: 10.1371/journal.pone.0238777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 08/24/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Obstetric fistula significantly impacts women's mental health and well-being. Routine screening for mental health in fistula repair programs can be a gateway to link patients to services, and can produce routine data to inform programmatic investments. This study observed the integration of a mental health screening program into an obstetric fistula repair program in Mali, with two specific objectives: 1) to describe the social and mental health well-being of women presenting with obstetric fistulas in Mali, and 2) to document the impact of the mental health screening pilot on policy change in Mali. METHODS Seven fistula repair campaigns were conducted between June 2016 and May 2017. All individuals presenting for fistula repair completed a mental health assessment at intake, including a depression screener (PHQ-9) and an assessment of psycho-social impacts of fistula. The depression screener was repeated three months following inpatient discharge. Findings were shared with stakeholders in Mali and impacts on policy were documented. RESULTS Of 207 women who presented for fistula repair, 167 patients completed the mental health assessment at surgical intake, and 130 patients repeated the screener at 3-month follow-up. At intake, 36.5% of women had moderate or severe depression, decreasing to 16.9% at follow-up. The mean depression score differed significantly by timepoint (9.14 vs. 6.72, p <0.001). Results were shared in a report with stakeholders, and consultations with the Mali Ministry of Health. As a result of advocacy, mental health was a key component of Mali's National Fistula Prevention and Treatment Strategy (2018-2022). CONCLUSION The high prevalence of depression in Malian fistula patients underscores a need for more robust mental health support for patients after surgery. Data on mental health from routine screening informs community reintegration strategies for individual patients, elevates the overall quality of care of fistula repair programs by addressing patients' holistic health needs, and contributes to evidence-informed decision-making and data-driven policy change within the larger health system.
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Affiliation(s)
- Melissa H. Watt
- Duke University, Durham, NC, United States of America
- University of Utah, Salt Lake City, UT, United States of America
| | | | | | | | - Jennifer Wesson
- IntraHealth International, Inc., Chapel Hill, NC, United States of America
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24
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Bello OO, Morhason-Bello IO, Ojengbede OA. Nigeria, a high burden state of obstetric fistula: a contextual analysis of key drivers. Pan Afr Med J 2020; 36:22. [PMID: 32774599 PMCID: PMC7388624 DOI: 10.11604/pamj.2020.36.22.22204] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 05/01/2020] [Indexed: 12/17/2022] Open
Abstract
Obstetric fistula (OF) remain a source of public health concern and one of the most devastating maternal morbidities afflicting about two million women, mostly in developing countries. It is still prevalent in Nigeria due to the existence of socio-cultural beliefs/practices, socio-economic state and poor health facilities. The country's estimated annual 40,000 pregnancy-related deaths account for about 14% of the global maternal mortality, placing it among the top 10 most dangerous countries in the world for a woman to give birth. However, maternal morbidities including OF account for 20 to 30 times the number of maternal mortalities. This review substantiates why OF is yet to be eliminated in Nigeria as one of the countries with the largest burden of obstetric fistula. There is need for coordinated response to prevent and eliminate this morbidity via political commitment, implementation of evidence-based policy and execution of prevention programs.
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Affiliation(s)
- Oluwasomidoyin Olukemi Bello
- Department of Obstetrics and Gynaecology, College of Medicine, University College Hospital, University of Ibadan, Ibadan, Nigeria
| | - Imran Oludare Morhason-Bello
- Department of Obstetrics and Gynaecology, College of Medicine, University College Hospital, University of Ibadan, Ibadan, Nigeria
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25
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El Ayadi AM, Painter CE, Delamou A, Barr-Walker J, Korn A, Obore S, Byamugisha J, Barageine JK. Rehabilitation and reintegration programming adjunct to female genital fistula surgery: A systematic scoping review. Int J Gynaecol Obstet 2020; 148 Suppl 1:42-58. [PMID: 31943181 PMCID: PMC7003948 DOI: 10.1002/ijgo.13039] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Female genital fistula is associated with significant physical, psychological, and economic consequences; however, a knowledge and practice gap exists around services adjunct to fistula surgery. OBJECTIVES To examine rehabilitation and reintegration services provided adjunct to genital fistula surgery, map existing programming and outcomes, and identify areas for additional research. SEARCH STRATEGY We searched the published and grey literature from January 2000 to June 2019. Two reviewers screened articles and extracted data using standardized methods. SELECTION CRITERIA Research and programmatic articles describing service provision in addition to female genital fistula surgery were included. DATA COLLECTION AND ANALYSIS Of 3047 published articles and 2623 unpublished documents identified, 26 and 55, respectively, were analyzed. MAIN RESULTS Programming identified included combinations of health education, physical therapy, social support, psychosocial counseling, and economic empowerment, largely in sub-Saharan Africa. Improvements were noted in physical and psychosocial health. CONCLUSIONS Existing literature supports holistic fistula care through adjunct reintegration programming. Improving the evidence base requires implementing robust study designs, increasing reporting detail, and standardizing outcomes across studies. Increased financing for holistic fistula care is critical for developing and supporting programming to ensure positive outcomes.
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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, USA
| | - Caitlyn E Painter
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA.,Department of Obstetrics and Gynecology, Urogynecology Division, Kaiser Permanente, Oakland, CA, USA
| | - Alexandre Delamou
- Department of Public Health, Gamal Abdel Nasser University, Conakry, Guinea
| | - Jill Barr-Walker
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA.,ZSFG Library, University of California San Francisco, San Francisco, CA, USA
| | - Abner Korn
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Susan Obore
- Department of Obstetrics and Gynecology, Mulago National Referral and Teaching Hospital, Kampala, Uganda
| | - Josaphat Byamugisha
- Department of Obstetrics and Gynecology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Justus K Barageine
- Department of Obstetrics and Gynecology, Makerere University College of Health Sciences, Kampala, Uganda.,Department of Maternal and Child Health, Uganda Christian University, Mukono, Uganda
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26
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Characteristics of persistent urinary incontinence after successful fistula closure in Ethiopian women. Int Urogynecol J 2020; 31:2277-2283. [DOI: 10.1007/s00192-020-04265-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 02/12/2020] [Indexed: 10/24/2022]
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27
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El Ayadi AM, Painter CE, Delamou A, Barr-Walker J, Obore S, Byamugisha J, Korn A, Barageine JK. Rehabilitation and reintegration programming adjunct to female genital fistula surgery: a scoping review protocol. BMJ Open 2019; 9:e027991. [PMID: 31619418 PMCID: PMC6797431 DOI: 10.1136/bmjopen-2018-027991] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Female genital fistula is a debilitating traumatic injury, largely birth-associated, globally affecting up to 2 million women, mostly in sub-Saharan Africa. Fistula has significant physical, psychological and economic consequences. Women often face challenges in reintegrating and resuming prior roles despite successful surgery. Synthesising the evidence on services adjunct to fistula surgery and their outcomes is important for developing the evidence base for best practices and identifying research priorities. This scoping review seeks to examine the range of rehabilitation and reintegration services provided as adjunct to genital fistula surgery, map the existing programming and outcomes, and identify areas for additional research. METHODS AND ANALYSIS Our scoping review is informed by existing methodological frameworks and will be conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses-ScR guidelines. The search strategy will be applied to nine biomedical, public health and social science databases. The initial search was completed on 27 September 2018. Grey literature will be identified through targeted Google searches and from organisational websites identified as relevant by the United Nations Population Fund (UNFPA) Campaign to End Fistula. We will iteratively build our search strategy through term harvesting and review, and search reference lists of reports and articles to identify additional studies. Two reviewers will independently screen titles and abstracts, followed by full-text screening of all potentially relevant articles and standardised data extraction. Articles eligible for inclusion will discuss research or programmatic efforts around service provision in adjunct to surgery among females with genital fistula. Data will be presented in summary tables accompanied by narrative description. ETHICS AND DISSEMINATION Ethics approval is not required for a scoping review. Our results can be used to inform policy, serve as support for funding and development of reintegration programmes and highlight areas for subsequent research. Results will be disseminated at relevant conferences and published in a peer-reviewed journal.
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Affiliation(s)
- Alison M El Ayadi
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Caitlyn E Painter
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California, USA
- Department of Obstetrics and Gynecology, Urogynecology Division, Kaiser Permanente, Oakland, California, USA
| | - Alexandre Delamou
- Department of Public Health, Gamal Abdel Nasser University, Conakry, Guinea
| | - Jill Barr-Walker
- ZSFG Library, University of California, San Francisco, San Francisco, California, USA
| | - Susan Obore
- Department of Obstetrics and Gynaecology, Mulago National Referral Hospital, Kampala, Uganda
| | - Josaphat Byamugisha
- Department of Obstetrics and Gynaecology, Mulago National Referral Hospital, Kampala, Uganda
- Department of Obstetrics and Gynaecology, Makerere University, Kampala, Uganda
| | - Abner Korn
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Justus K Barageine
- Department of Obstetrics and Gynaecology, Mulago National Referral Hospital, Kampala, Uganda
- Department of Obstetrics and Gynaecology, Makerere University, Kampala, Uganda
- Department of Maternal and Child Health, Uganda Christian University, Mukono, Uganda
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