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Vogel JP, Jung J, Lavin T, Simpson G, Kluwgant D, Abalos E, Diaz V, Downe S, Filippi V, Gallos I, Galadanci H, Katageri G, Homer CSE, Hofmeyr GJ, Liabsuetrakul T, Morhason-Bello IO, Osoti A, Souza JP, Thakar R, Thangaratinam S, Oladapo OT. Neglected medium-term and long-term consequences of labour and childbirth: a systematic analysis of the burden, recommended practices, and a way forward. Lancet Glob Health 2024; 12:e317-e330. [PMID: 38070535 PMCID: PMC10805007 DOI: 10.1016/s2214-109x(23)00454-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 08/29/2023] [Accepted: 09/19/2023] [Indexed: 01/22/2024]
Abstract
Over the past three decades, substantial progress has been made in reducing maternal mortality worldwide. However, the historical focus on mortality reduction has been accompanied by comparative neglect of labour and birth complications that can emerge or persist months or years postnatally. This paper addresses these overlooked conditions, arguing that their absence from the global health agenda and national action plans has led to the misconception that they are uncommon or unimportant. The historical limitation of postnatal care services to the 6 weeks after birth is also a contributing factor. We reviewed epidemiological data on medium-term and long-term complications arising from labour and childbirth beyond 6 weeks, along with high-quality clinical guidelines for their prevention, identification, and treatment. We explore the complex interplay of human evolution, maternal physiology, and inherent predispositions that contribute to these complications. We offer actionable recommendations to change the current trajectories of these neglected conditions and help achieve the targets of Sustainable Development Goal 3. This paper is the third in a Series of four papers about maternal health in the perinatal period and beyond.
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Affiliation(s)
- Joshua P Vogel
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia.
| | - Jenny Jung
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia
| | - Tina Lavin
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Grace Simpson
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia
| | - Dvora Kluwgant
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia
| | - Edgardo Abalos
- Centro de Estudios de Estado y Sociedad (CEDES), Buenos Aires, Argentina
| | - Virginia Diaz
- Centro Rosarino de Estudios Perinatales (CREP), Rosario, Argentina
| | - Soo Downe
- School of Nursing and Midwifery, University of Central Lancashire, Preston, UK
| | - Veronique Filippi
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Ioannis Gallos
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Hadiza Galadanci
- Africa Center of Excellence for Population Health and Policy, Bayero University, Kano, Nigeria
| | - Geetanjali Katageri
- S Nijalingappa Medical College and HSK Hospital & Research Centre, Bagalkot, India
| | - Caroline S E Homer
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia
| | - G Justus Hofmeyr
- Department of Obstetrics and Gynaecology, University of Botswana, Gaborone, Botswana; University of the Witwatersrand and Walter Sisulu University, East London, South Africa
| | - Tippawan Liabsuetrakul
- Department of Epidemiology and Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Imran O Morhason-Bello
- Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences and Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Alfred Osoti
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya
| | - João Paulo Souza
- Department of Social Medicine, Ribeirao Preto Medical School, University of São Paulo, São Paulo, Brazil
| | | | - Shakila Thangaratinam
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Olufemi T Oladapo
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Strassmann V, Silva-Alvarenga E, Emile SH, Garoufalia Z, DaSilva G, Wexner SD. Gracilis Muscle Interposition: A Valuable Tool for the Treatment of Failed Repair of Post-partum Rectovaginal Fistulas-A Single-Center Experience. Am Surg 2023; 89:6366-6369. [PMID: 37216694 DOI: 10.1177/00031348231175481] [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] [Indexed: 05/24/2023]
Abstract
INTRODUCTION Rectovaginal fistulas (RVFs) account for approximately 40% of anorectal complications from obstetrical trauma. Treatment can be challenging requiring multiple surgical repairs. Interposition of healthy transposed tissue (lotus or Martius flap or gracilis muscle) has been used for recurrent RVF. We aimed to review our experience with gracilis muscle interposition (GMI) for post-partum RVF. METHODS A retrospective analysis of patients who underwent GMI for post-partum RVF from February 1995 to December 2019 was undertaken. Patient demographics, number of prior treatments, comorbidities, tobacco use, postoperative complications, additional procedures, and outcome were assessed. Success was defined as absence of leakage from the repair site after stoma reversal. RESULTS Six of 119 patients who underwent GMI did so for recurrent post-partum RVF. Median age was 34.2 (28-48) years. All patients had at least 1 previously failed procedure [median: 3 (1-7)] including endorectal advancement flap, fistulotomy, vaginoplasty, mesh interposition, and sphincteroplasty. All patients underwent fecal diversion prior to or at initial procedure. Success was achieved in 4/6 (66.7%) patients; 2 underwent further procedures (1 fistulotomy and 1 rectal flap advancement) for a final 100% success rate as all ileostomies were reversed. Morbidity was reported in 3 (50%) patients, including wound dehiscence, delayed rectoperineal fistula, and granuloma formation in one each, all managed without surgery. There was no morbidity related to stoma closure. CONCLUSIONS Gracilis muscle interposition is a valuable tool for recurrent post-partum RVF. Our ultimate success rate in this very small series was 100% with a relatively low morbidity rate.
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Affiliation(s)
- Victor Strassmann
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA
| | - Emanuela Silva-Alvarenga
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA
- Cleveland Clinic Florida, Martin Health, Port St. Lucie, Florida
| | - Sameh Hany Emile
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA
- Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Mansoura, Egypt
| | - Zoe Garoufalia
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA
| | - Giovanna DaSilva
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA
| | - Steven D Wexner
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA
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Alemu SS, Agago MT, Ukumo EY, Hadero TS. Knowledge and practice of obstetric care providers on prevention of obstetric fistula 2023: an institution-based cross-sectional study. Front Glob Womens Health 2023; 4:1234013. [PMID: 38099271 PMCID: PMC10720897 DOI: 10.3389/fgwh.2023.1234013] [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: 07/13/2023] [Accepted: 11/09/2023] [Indexed: 12/17/2023] Open
Abstract
Background Obstetric fistula is a preventable devastating condition that is mostly caused by obstructed labour. About 22% of obstructed labor is complicated by obstetric fistula. Skilled birth attendants during delivery are essential for the prevention of obstetric fistula. However, little is known about the status of the knowledge and practice of obstetric fistula prevention in the Gamo zone. Objective We aimed to assess the knowledge, practice, and associated factors of obstetric caregivers on the prevention of obstetric fistula in public health facilities of the Gamo zone in southwest Ethiopia 2023. Method A cross-sectional study was employed among 372 obstetric caregivers in selected public health facilities of the Gamo zone in southwest Ethiopia from 1 December 2022 to 30 January 2023. Study participants were selected by a simple random sampling technique, and data were collected by using a pre-tested and self-administered questionnaire. The collected data were coded and entered into Epi-Data version 4.6 computer software and exported to SPSS version 27 for analysis purposes. Bivariable and Multivariable Logistic analyses were applied. The level of significance was declared at a P-value ≤0.05 and a 95% confidence interval. Results About 57% [95% CI (53.00-62.00)] of participants had good knowledge, and about 55.4% [95% CI (50.00-60.00)] of obstetric caregivers showed good practice for obstetric fistula prevention. The factors significantly associated with knowledge were service year [AOR = 2.50, 95% CI = (1.12-6.73)], types of a health facility [AOR = 1.99, 95% CI = (1.01-3.92)], age [AOR = 2.38, 95% CI = (1.03-5.49)], and in-service training [AOR = 4.61, 95% CI = (2.35-9.05)]. In-service training [AOR = 14.86, 95% CI = (12.75-18.73)], service year [AOR = 3.58, 95% CI = (1.24-10.29)], and knowledge [AOR: 13.24, 95% CI = (6.18-14.34)] were factors which were significantly associated with the practice of obstetric caregivers towards obstetric fistula prevention. Conclusion The knowledge and practice of obstetric caregivers on the prevention of obstetric fistula was low in public health facilities of the Gamo zone. In this study, practicing at a hospital was a factor significantly associated with the knowledge of obstetric caregivers. Having in-service training, advanced service year, and age were factors significantly associated with the knowledge and practice of obstetric caregivers. Regular in-service training of health professionals can enhance their knowledge and practice of obstetric fistula prevention.
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Affiliation(s)
- Solomon Seyife Alemu
- Department of Midwifery, Shashemenne Campus College of Health Science, Madda Walabu University, Shashemenne, Ethiopia
| | - Mahlet Tesfaye Agago
- Department of Midwifery, College of Health Science, Mattu University, Mattu, Ethiopia
| | - Eshetu Yisihak Ukumo
- Department of Midwifery, College of Medicine and Health Science, Arba Minch University, Arbaminch, Ethiopia
| | - Tesfahun Simon Hadero
- Department of Midwifery, College of Medicine and Health Science, Arba Minch University, Arbaminch, Ethiopia
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Hareru HE, Wtsadik DS, Ashenafi E, Debela BG, Lerango TL, Ewunie TM, Abebe M. Variability and awareness of obstetric fistula among women of reproductive age in sub-Saharan African countries: A systematic review and meta-analysis. Heliyon 2023; 9:e18126. [PMID: 37560629 PMCID: PMC10407677 DOI: 10.1016/j.heliyon.2023.e18126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 07/06/2023] [Accepted: 07/07/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Obstetric fistula among women of reproductive age is a significant public health issue in developing countries, including Sub-Saharan Africa. However, the pooled awareness of obstetric fistula among women of reproductive age in Sub-Saharan Africa and its variation between countries have not yet been studied. Hence, the review aims to assess variability and awareness of obstetric fistula among women of reproductive age in Sub-Saharan African Countries. METHOD Articles were searched using different electronic databases, such as PubMed, Web of science, science direct (Scopus), Google scholar, and HINARI and manual search without regard to publication date. A random-effects model was used to ascertain the pooled prevalence of obstetric fistula awareness among women of reproductive age in Sub-Saharan Africa. Publication bias was checked by using funnel plot and Egger's test at a 5% level of significance. I2 test statistics was performed to evaluate heterogeneity among included studies. In addition, to identify the possible reason for the potential heterogeneity between the studies, sub-group and meta-regression analyses were conducted. A sensitivity analysis was performed to determine the impact of individual research on the overall results. The data were extracted by using Microsoft excel and analyzed using statistical software STATA/SE version 17. RESULT A total of 22 studies with 79,693 women of reproductive age were included in this systematic review and meta-analyses. In Sub-Saharan Africa, the pooled prevalence of awareness towards obstetric fistula among women of reproductive age was 40.85% (95% CI: 33.48, 48.22%). Analysis of the subgroups by specific countries revealed significant variation. The highest awareness of obstetric fistula was found among Tanzanian women of reproductive age (61.10%, 95% CI: 55.87-66.33%), whereas the lowest awareness was found in research from the Gambia (12.80%, 95% CI: 12.20-13.40%).The likelihood of obstetric fistula awareness were lower by a factor of 0.424 among studies with sample sizes greater than 3542 (β = -0.424 (95% CI: -0.767 to 0.081), p -value <0.05). CONCLUSION According to the current review, there is a low level of awareness about obstetric fistula among women of reproductive age in sub-Saharan Africa, and the results of the sub-group analysis by country showed wide variations. Therefore, we emphasize the need for country-specific public health initiatives to raise awareness about obstetric fistula among women of reproductive age, which could reduce the risk of delayed treatment.
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Affiliation(s)
- Habtamu Endashaw Hareru
- School of Public Health, College of Health Sciences and Medicine, Dilla University, Dilla, Ethiopia
| | - Daniel Sisay Wtsadik
- School of Public Health, College of Health Sciences and Medicine, Dilla University, Dilla, Ethiopia
| | - Eden Ashenafi
- Department of Reproductive Health, College of Health Sciences and Medicine, Dilla University, Dilla, Ethiopia
| | - Berhanu Gidisa Debela
- School of Public Health, College of Health Sciences and Medicine, Dilla University, Dilla, Ethiopia
| | - Temesgen Leka Lerango
- School of Public Health, College of Health Sciences and Medicine, Dilla University, Dilla, Ethiopia
| | - Temesgen Muche Ewunie
- Department of Human Nutrition, College of Health Sciences and Medicine, Dilla University, Dilla, Ethiopia
| | - Mesfin Abebe
- Department of Midwifery, College of Health Sciences and Medicine, Dilla University, Dilla, Ethiopia
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Ejigu N, Seyoum K, Kene C, Gomora D, Mengistu S, Geta G, Eshetu D, Tadesse S, Mesfin T, Tekalign Y, Atlaw D. Prevalence and associated risk factors for failed obstetric fistula repair in East African countries: A systematic review and meta-analysis. SAGE Open Med 2023; 11:20503121231187742. [PMID: 37492647 PMCID: PMC10363902 DOI: 10.1177/20503121231187742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 06/26/2023] [Indexed: 07/27/2023] Open
Abstract
Objective Obstetric fistula repair failure is a combination of unsuccessful fistula closure and/or incontinence following a successful closure. There is an inconsistent finding on the failure of obstetric fistula repair in East Africa. Therefore, this systematic review and meta-analysis aimed to determine the pooled prevalence of failed obstetric fistula repair and its associated factors among women who have undergone fistula repair in East Africa. Methods This systematic review and meta-analysis were written following the PRISMA guideline protocol. A web-based electronic search of PubMed, Google Scholar, and HINARI was performed to find primary studies. Additional articles were searched by cross-referencing references. A random-effects model was used to estimate the pooled prevalence of failed obstetric fistula repair. The heterogeneity of studies was weighed using I2 test statistics. Publication bias was assessed by Eggers and funnel plot test. Results The 16 studies that met the inclusion criteria for this systematic review and meta-analysis of failed obstetric fistula repair were included. Nonetheless, one study was used for factor analysis but not in pooled prevalence analysis. The pooled prevalence of obstetric fistula repair failure in East Africa was 26.89% (95% confidence interval: 21.71, 32.07). Labor duration > 48 h (Pooled odds ratio = 2.46; 95% confidence interval 1.58, 3.82), fistula size >3 cm (Pooled odds ratio = 3.92; 95% confidence interval 2.19, 7.05), previous fistula repair (Pooled odds ratio = 3.20; 95% confidence interval 1.94, 5.29), Goh Type 4 fistulas (Pooled odds ratio = 6.07; 95% confidence interval 2.50, 14.75), completely destructed urethra (Pooled odds ratio = 3.35; 95% confidence interval 1.69, 6.65), and severe vaginal scaring (Pooled odds ratio = 3.89; 95% confidence interval 1.99, 7.62) were significantly associated with obstetric fistula repair failure. Conclusions One in four women with obstetric fistula repair experienced repair failure. To fight the problem The Ministry of Health in every part of the country, in collaboration with obstetric care providers, shall intervene on factors affecting obstetric fistula repair failure to reduce or prevent the failure of obstetric fistula repair.
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Affiliation(s)
- Neway Ejigu
- Department of Midwifery, College of Medicine and Health Sciences, Madawalabu University, Robe, Bale Goba, Ethiopia
| | - Kenbon Seyoum
- Department of Midwifery, College of Medicine and Health Sciences, Madawalabu University, Robe, Bale Goba, Ethiopia
| | - Chala Kene
- Department of Midwifery, College of Medicine and Health Sciences, Madawalabu University, Robe, Bale Goba, Ethiopia
| | - Degefa Gomora
- Department of Midwifery, College of Medicine and Health Sciences, Madawalabu University, Robe, Bale Goba, Ethiopia
| | - Shelema Mengistu
- Department of Midwifery, College of Medicine and Health Sciences, Madawalabu University, Robe, Bale Goba, Ethiopia
| | - Girma Geta
- Department of Midwifery, College of Medicine and Health Sciences, Madawalabu University, Robe, Bale Goba, Ethiopia
| | - Derese Eshetu
- Department of Midwifery, College of Medicine and Health Sciences, Madawalabu University, Robe, Bale Goba, Ethiopia
| | - Shimelis Tadesse
- Department of Midwifery, College of Health Sciences, Mattu University, Ethiopia
| | - Telila Mesfin
- Department of Medicine, College of Medicine and Health Sciences, Madawalabu University, Ethiopia
| | - Yohannes Tekalign
- Department of Public Health, College of Medicine and Health Sciences, Madawalabu University, Ethiopia
| | - Daniel Atlaw
- Department of Human Anatomy, College of Medicine and Health Sciences, Madawalabu University, Ethiopia
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Hurissa BF, Koricha ZB, Dadi LS. Understanding Healthcare-Seeking Pathways and Dilemmas Among Women with Obstetric Fistulas in Ethiopia: A Qualitative Inquiry. Int J Womens Health 2023; 15:135-150. [PMID: 36761117 PMCID: PMC9904232 DOI: 10.2147/ijwh.s395064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 01/18/2023] [Indexed: 02/05/2023] Open
Abstract
Background Obstetric fistula is a public health problem with a damaging effect on the health of women around the world. The path to medical care is an integral part of women's experience of illness that may have an impact on their health. Studies have addressed the experiences of patients after fistula repair, but fistula victims' care-seeking pathways and dilemmas are still poorly understood in low-income countries, particularly Ethiopia. Objective This study aimed to explore the care-seeking pathways and dilemmas among women with fistulas in Ethiopia. Methods An exploratory phenomenological study was carried out from April 1 to August 1, 2019, through in-depth interviews and supplementary informant interviews. Data were obtained from 21 purposively selected women with fistulas who survived with morbidity for one and more years and 12 supplementary interviewees at fistula treatment centers in Oromia Region and Addis Ababa. Data were analyzed assisted by ATLAS. ti 8.4 software. Results Respondents gave their testimony that most of the women with fistulas first sought care from traditional care places and finally from fistula treatment centers. The reasons for care-seeking path dilemmas were a wrong perception about fistula, its causes, and treatment; families' pressure and lack of decision-making power on where to seek treatment, and a lack of knowledge on where modern treatments are available for fistula. They received psychological, companionship, and transport support from a family and a community; referral and counseling support from health care providers during their care-seeking pathways. Conclusion A myriad of reasons inhibits the right care-seeking pathways among women with fistulas. Communities and women with fistula awareness creation on the right places for fistula treatment and psychological support programs are required. Additionally, developing and implementing tactics for community-level screening programs for targeted victims and early admission to treatment centers can minimize the tragic sequela of the fistula.
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Affiliation(s)
- Bekana Fekecha Hurissa
- School of Midwifery, Institute of Health, Jimma University, Jimma, Ethiopia,Correspondence: Bekana Fekecha Hurissa, Email
| | - 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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Maroyi R, Moureau MK, Brown HW, Ajay R, Byabene G, Mukwege DM. Etiology and factors associated with urogenital fistula among women who have undergone cesarean section: a cross-sectional study. BMC Pregnancy Childbirth 2023; 23:54. [PMID: 36690977 PMCID: PMC9869501 DOI: 10.1186/s12884-023-05357-3] [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: 07/18/2022] [Accepted: 01/06/2023] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND The prevalence and impact of fistulas are more common in developing countries with limited access to emergency obstetric care. As a result, women in these settings often experience adverse psychosocial factors. The purpose of this study was to describe the characteristics of Congolese women who developed urogenital fistula following Cesarean sections (CS) to determine the characteristics associated with two etiologies: (1) prolonged obstructed labor; and (2) a complication of CS following obstructed labor. METHODS We performed a cross-sectional study on abstracted data from all patients with urogenital fistula following CS who received care during a surgical campaign in a remote area of the Democratic Republic of the Congo (DRC). Descriptive analyses characterized patients with fistula related to obstructed labor versus CS. Univariate and multivariate logistic regression models identified factors associated with obstetric fistula after cesarean delivery following obstructed labor. Variables were included in the logistic regression models based upon biological plausibility. RESULTS Among 125 patients, urogenital fistula etiology was attributed to obstructed labor in 77 (62%) and complications following CS in 48 (38%). Women with a fistula, attributed to obstructed labor, developed the fistula at a younger age (p = .04) and had a lower parity (p = .02). Attempted delivery before arriving at the hospital was associated with an increased risk of obstetric fistula after cesarean delivery following obstructed labor (p < .01). CONCLUSION CS are commonly performed on women who arrive at the hospital following prolonged obstructed labor and fetal demise, and account for almost 40% of urogenital fistula. Obstetric providers should assess maternal status upon arrival to prevent unnecessary CS and identify women at risk of developing a fistula.
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Affiliation(s)
- Raha Maroyi
- Department of Urogynecology, Panzi General Referral Hospital, Bukavu, Democratic Republic of the Congo ,Faculty of Medicine, Evangelical University in Africa, Bukavu, Democratic Republic of the Congo ,Mushununu, Panzi, Bukavu, Democratic Republic of the Congo
| | - Madeline K. Moureau
- grid.14003.360000 0001 2167 3675Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, USA
| | - Heidi W. Brown
- grid.14003.360000 0001 2167 3675Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, USA
| | - Rane Ajay
- grid.1011.10000 0004 0474 1797Department of Obstetrics and Gynecology, James Cook University, Townsville, Australia
| | - Gloire Byabene
- Department of General Surgery, Panzi General Referral Hospital, Bukavu, Democratic Republic of the Congo
| | - Denis M. Mukwege
- Faculty of Medicine, Evangelical University in Africa, Bukavu, Democratic Republic of the Congo ,Department of Gynecology and Obstetrics, Panzi General Referral Hospital, Bukavu, Democratic Republic of the Congo
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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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Hurissa BF, Koricha ZB, Dadi LS. Challenges and coping mechanisms among women living with unrepaired obstetric fistula in Ethiopia: A phenomenological study. PLoS One 2022; 17:e0275318. [PMID: 36174094 PMCID: PMC9522016 DOI: 10.1371/journal.pone.0275318] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 09/14/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction Obstetric fistula remains a debilitating complication of childbirth and maternal morbidity in developing countries. Few studies document the challenges and coping mechanisms among women living with obstetric fistula in Ethiopia. Therefore, this study aimed to explore the challenges and coping mechanisms among women with obstetric fistula in Ethiopia. Methods A phenomenological study was employed among purposively selected eleven women with obstetric fistula and three key informants at five fistula treatment centers in Ethiopia. An in-depth interview was conducted, audio-recorded, and transcribed into a Microsoft Word document. The transcripts were imported into Atlas. ti version 8.4 for thematic analyses. Results Painful social life, consequences of fistula, and coping mechanisms with fistula problems were the main themes in this study. Difficult social life, stigma, discrimination, impaired marital status; psychological, physical, sexual, and reproductive health problems were the major challenges for women with obstetric fistulas. Women with fistulas used coping mechanisms such as—going to spiritual sites and drinking alcohol to cope with their fistula disease; separating themselves from community participation and living alone in the forest to cope with a painful social life; restricting the amount of drinking water and wearing many clothes at a time to cope with wetness and odors, and allowing their husband to marry a new wife to cope with the impaired marital responsibilities. Conclusion Women with obstetric fistulas encountered challenges such as a painful social life, impaired marital status, psychological, physical, sexual, and reproductive health problems; and used coping mechanisms with their fistula condition, difficult social life, and impaired marital responsibility that may have an added negative effect on their overall health. Therefore, policymakers need to prioritize the availability and early utilization of obstetric fistula surgery in all settings for all women living with obstetric fistulas to restore their holistic health.
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Affiliation(s)
| | - 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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10
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Hurissa BF, Koricha ZB, Dadi LS. The Predictors of Intent to Prevent Obstetric Fistula Recurrence Among Women with Fistula in Ethiopia: A Facility-Based Cross-Sectional Study. Int J Womens Health 2022; 14:1323-1335. [PMID: 36134389 PMCID: PMC9484077 DOI: 10.2147/ijwh.s378162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 08/25/2022] [Indexed: 11/23/2022] Open
Abstract
Background Obstetric fistula recurrence predisposes to a decreasing success rate of fistula repair and accounts for the continued incidence of obstetric fistulas in low-income countries. Evidence has revealed that there are women’s intent gaps in the prevention of obstetric fistula recurrence. Assessments of predictors of intent to prevent obstetric fistula recurrence among women with fistula are scarce. Objective This study assessed the intent to prevent obstetric fistula recurrence and its predictive factors among women with obstetric fistula in Ethiopia. Methods Facility-based cross-sectional study was conducted from April 01, 2019, to August 01, 2019, with consecutively selected 478 women with fistulas in five fistula treatment centers in Addis Ababa and Oromia regions. Data were collected using an interviewer-administered structured questionnaire and analyzed using SPSS 23 software. Simple and multiple linear regression models were fitted for data analysis. Results Mean score of intent to prevent obstetric fistula recurrence among women with obstetric fistula was 27.72 ± 5.06. Living in a rural setting (β =−2.27; 95% CI: −3.62, −0.93), being married (β =1.71, 95% CI: 0.56, 2.85), having one previous repair (β =2.14, 95% CI: 0.19, 4.08), high self-esteem (β =1.42, 95% CI: 0.09, 2.74), psychological health (β =0.05, 95% CI: 0.26, 3.79), living with fistula ≥5 years (β =1.82, 95% CI: 0.44, 3.21), high knowledge of risk factors (β =3.12, 95% CI: 1.99, 4.25), and a positive attitude (β =2.33, 95% CI: 1.12, 3.54) were significant predictors of the intent to prevent obstetric fistula recurrence. Conclusion Intent to prevent obstetric fistula recurrence among women with obstetric fistula was low. This indicates an urgent need to create awareness among women with an obstetric fistula on the risk factors of obstetric fistula recurrence, attitudinal changes towards prevention of obstetric fistula recurrence, and the availability of prevention measures.
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Affiliation(s)
| | - 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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11
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Bulndi LB, Ireson D, Adama E, Bayes S. Sub-Saharan African women's views and experiences of risk factors for obstetric fistula: a qualitative systematic review. BMC Pregnancy Childbirth 2022; 22:680. [PMID: 36057559 PMCID: PMC9440544 DOI: 10.1186/s12884-022-05013-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 08/26/2022] [Indexed: 11/14/2022] Open
Abstract
Background Obstetric fistula used as synonymous with VVF in this study, is an abnormal communication/hole between the urinary tract and the genital tract or the gastrointestinal tract and the genital tract, resulting from prolonged obstructed labour. VVF may cause sufferers to experience chronic urinary/faecal incontinence, and the stigma of continuing foul odour. VVF is primarily caused by prolonged obstructed labour, which is brought about by a range of causes. Recently, it has been proposed that women’s groups and fistula survivors should suggest interventions to reduce or prevent the incidence of obstetric fistula. Objective The objective of this review was to synthesise what is reported about women’s views and experiences of the risk factors underlying the causes of VVF. Methods A systematic approach outlined in the Joanna Briggs Institute Manual for Evidence synthesis was followed for this review, articles published since the last 11 years from 2011 to 2021 were selected against several criteria and critically appraised using JBI Critical Appraisal Checklist for qualitative studies. Results Nine studies were retained for inclusion in this review and the data were then synthesised into five themes: (1) Cultural beliefs and practices impeding safe childbirth, (2) Lack of woman’s autonomy in choices of place to birth safely, (3) Lack of accessibility and social support to safe childbirth, (4) Inexperienced birth attendants and, (5) Delayed emergency maternal care (childbirth). Conclusions This review highlights the complexity of risk factors predisposing women to the known causes of VVF. It also illuminates the absence of women’s voices in the identification of solutions to these risks. Women are most directly affected by VVF. Therefore, their knowledge, views, and experiences should be considered in the development and implementation of strategies to address the issue. Exploring women’s views on this issue would enable the identification of gaps in maternity care provision, which would be of interest to community and health service leaders as well as policymakers in Sub-Saharan Africa. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-05013-2.
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Affiliation(s)
- Lydia Babatunde Bulndi
- Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia. .,The Centre Evidence Informed Nursing, Midwifery and Health Care Practice; 270 Joondalup Drive, Joondalup, WA: A JBI Affiliated Group, Joondalup, Australia.
| | - Deborah Ireson
- Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia.,The Centre Evidence Informed Nursing, Midwifery and Health Care Practice; 270 Joondalup Drive, Joondalup, WA: A JBI Affiliated Group, Joondalup, Australia
| | - Esther Adama
- Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia.,The Centre Evidence Informed Nursing, Midwifery and Health Care Practice; 270 Joondalup Drive, Joondalup, WA: A JBI Affiliated Group, Joondalup, Australia
| | - Sara Bayes
- Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia.,The Centre Evidence Informed Nursing, Midwifery and Health Care Practice; 270 Joondalup Drive, Joondalup, WA: A JBI Affiliated Group, Joondalup, Australia.,School of Nursing, Midwifery, and Paramedicine (Melbourne), Australian Catholic University, 115 Victoria Parade Fitzroy, Victoria, Melbourne, 3065, Australia
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12
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Nembunzu D, Mayemba N, Sidibé S, Grovogui FM, Aussak BTT, Banze Kyongolwa DF, Camara BS, Tripathi V, Delamou A. Factors Associated With Persistent Urinary Incontinence Among Women Undergoing Female Genital Fistula Surgery in the Democratic Republic of Congo From 2017 to 2019. Front Glob Womens Health 2022; 3:896991. [PMID: 35814834 PMCID: PMC9263387 DOI: 10.3389/fgwh.2022.896991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 06/02/2022] [Indexed: 11/13/2022] Open
Abstract
Background Despite high closure rates, residual urinary incontinence remains a common problem after successful closure of a vesico-vaginal fistula. The objective of this study was to identify factors associated with residual urinary incontinence in women with successful fistula closure in sites supported by the Fistula Care Plus project in the Democratic Republic of Congo (DRC). Material and Methods This was a retrospective cohort study using routine data extracted from the medical records of women undergoing fistula surgery in three hospitals supported by the Fistula Care Plus project in DRC between 2017 and 2019. We analyzed factors associated with residual urinary incontinence among a subsample of women with closed fistula at discharge. We collected data on sociodemographic, clinical, gynecological-obstetrical characteristics, and case management. Univariate and multivariate analyses were performed to determine the factors associated with residual urinary incontinence. Results Overall, 31 of 718 women discharged with closed fistula after repair (4.3%; 95% CI: 3.1–6.1) had residual incontinence. The leading causes identified in these women with residual incontinence were urethral voiding (6 women), short urethra (6 women), severe fibrosis (3 women) and micro-bladder (2 women). The prevalence of residual incontinence was higher among women who received repair at the Heal Africa (6.6%) and St Joseph's (3.7%) sites compared with the Panzi site (1.7%). Factors associated with increased odds of persistent urinary incontinence were the Heal Africa repair site (aOR: 54.18; 95% CI: 5.33–550.89), any previous surgeries (aOR: 3.17; 95% CI: 1.10–9.14) and vaginal surgical route (aOR: 6.78; 95% CI: 1.02–45.21). Conclusion Prior surgery and repair sites were the main predictors of residual incontinence after fistula closure. Early detection and management of urinary incontinence and further research to understand site contribution to persistent incontinence are needed.
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Affiliation(s)
- Dolores Nembunzu
- Fistula Clinic, Department of Gynecology and Obstetrics, Saint Joseph Hospital, Kinshasa, Democratic Republic of Congo
| | - Naomie Mayemba
- Fistula Clinic, Department of Gynecology and Obstetrics, Saint Joseph Hospital, Kinshasa, Democratic Republic of Congo
| | - Sidikiba Sidibé
- Africa Center of Excellence (CEA-PCMT), University Gamal Abdel Nasser, Conakry, Guinea
- *Correspondence: Sidikiba Sidibé
| | - Fassou Mathias Grovogui
- Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea
| | | | | | - Bienvenu Salim Camara
- Africa Center of Excellence (CEA-PCMT), University Gamal Abdel Nasser, Conakry, Guinea
| | | | - Alexandre Delamou
- Africa Center of Excellence (CEA-PCMT), University Gamal Abdel Nasser, Conakry, Guinea
- Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea
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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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Marami D, Abate D, Letta S. Urinary tract infection, antimicrobial susceptibility pattern of isolates, and associated factors among women with a post-fistula at public health facilities, Harar, eastern Ethiopia: A cross-sectional study. SAGE Open Med 2022; 10:20503121221079309. [PMID: 35223031 PMCID: PMC8874165 DOI: 10.1177/20503121221079309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 01/23/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction: Urinary tract infection remains one of the major public health problems among post-fistula patients worldwide, particularly in sub-Saharan Africa. Besides, antimicrobial resistance impedes the effective infection prevention and treatment of ever-increasing bacteria. There was a paucity of data on urinary tract infections and the antimicrobial susceptibility profile of bacteria among post-fistula patients. Objective: To determine the prevalence, antimicrobial susceptibility pattern, and associated factors of urinary tract infections among women with post-fistula attending public health facilities, Harar, eastern Ethiopia. Methods: An institutional-based cross-sectional study was conducted among 146 consecutively enrolled women with post-fistula from February 2017 to December 2018. Risk factors were collected using a structured questionnaire. The midstream urine was collected, cultured and bacteria species were identified by using standard culture methods. Antimicrobial susceptibility testing was done by the disk diffusion technique. The association between independent and outcome variables was computed by using logistic regression analysis. A p-value < 0.05 was considered statistically significant. Results: The prevalence of urinary tract infections was 28.8% (95% confidence interval: 23.4, 33.6). Escherichia coli (19.1%), Pseudomonas aeruginosa (14.3%), and Proteus species (11.9%) were the commonest isolates. E. coli showed (75%) resistance to trimethoprim–sulfamethoxazole, amoxicillin (62.5%), and ciprofloxacin (62.5%). Staphylococcus aureus was shown 80% resistance to amoxicillin and erythromycin. Giving birth to a single baby (adjusted odds ratio: 0.3, 95% confidence interval: 0.1, 0.8), illness by a fistula for less than 3 years (adjusted odds ratio: 0.2, 95% confidence interval: 0.1, 0.6), and lack of a previous history of catheterization (adjusted odds ratio: 0.3, 95% confidence interval: 0.1, 0.9) decrease the odds of having urinary tract infections. Conclusion: Gram-negative organisms were the commonest cause of urinary tract infections in women with post-fistula. E. coli and P. aeruginosa showed higher resistance to most antimicrobials in the panels. Fistula patients need to be screened for urinary tract infections before antimicrobial treatment is indicated.
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Affiliation(s)
- Dadi Marami
- Department of Medical Laboratory Sciences, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Degu Abate
- Department of Medical Laboratory Sciences, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Shiferaw Letta
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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15
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Epidemiology and care pathway of vesicovaginal fistulas managed in France between 2010 and 2018. World J Urol 2022; 40:1027-1033. [PMID: 35050406 DOI: 10.1007/s00345-021-03917-w] [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: 11/07/2021] [Accepted: 12/22/2021] [Indexed: 10/19/2022] Open
Abstract
PURPOSE To evaluate the incidence of vesicovaginal fistula (VVF) in France. METHODS We conducted a retrospective analysis of prospectively and systematically collected data from January 2010 to December 2018 in the French Hospital Discharge Database. We used ICD-10 code "N820" to identify new VVF diagnoses. VVF incidence was calculated using estimations of the French population. We compared age on diagnosis, medical history of pelvic tumoral disease, radiotherapy, hysterectomy and childbirth, according to three subgroups: surgical repair attempt (SRA), long-term catheter and/or nephrostomies (LTC) or immediate surgical urinary diversion (ISUD). We focused on the patients diagnosed in 2017 to better analyse VVF aetiologies and outcomes (7-year hindsight and 1 year of follow-up). Chi-squared and Kruskal-Wallis tests were, respectively, used for qualitative and quantitative data comparisons. RESULTS Of the 196 million hospital stays out of 50 million French citizens hospitalised from 2010 to 2018, 5499 women were hospitalised for VVF. The estimated incidence of VVF was 2.3/100,000 women-year. Approximately half of the patients underwent SRA (48.4%); 39.8% had LTC and 11.9% had ISUD. Patients were younger in the SRA subgroup (53.4 ± 14.7 years p < 0.001) with a lower rate of pelvic cancer (p < 0.001) or radiotherapy (p < 0.001) and a higher rate of hysterectomies (p > 0.001). In 2017, two-thirds of the VVF diagnosed were secondary to pelvic surgery. Mean management time was 9.2 ± 10.6 months. After SRA, 5.4% underwent incontinence surgery and 5.0% underwent secondary surgical urinary diversion. CONCLUSIONS VVF is not a rare pathology in France, mainly due to pelvic surgery. Its management is complex and not well defined.
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Chen CCG, Long A, Rwabizi D, Mbabazi G, Ndizeye N, Dushimiyimana B, Ngoga E. Validation of an obstetric fistula screening questionnaire: a case-control study with clinical examination. Reprod Health 2022; 19:12. [PMID: 35042512 PMCID: PMC8764794 DOI: 10.1186/s12978-021-01317-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 12/26/2021] [Indexed: 11/10/2022] Open
Abstract
Background Obstetric fistula (OF) is a significant cause of maternal morbidity in lower resource settings where women experience obstructed labor without timely access to skilled obstetric care. The true prevalence of OF is unknown; however, it is estimated to affect 2 to 3.5 million women globally. The Demographic and Health Surveys’ (DHS) Fistula Module includes the OF symptom questions most frequently used for prevalence estimates, but these questions have not been validated. The aim of this study is to validate a symptom-based screening questionnaire for OF, including a question in the DHS’ Fistula Module. Methods With an international panel of fistula surgeons, we developed and face-validated a screening questionnaire that assessed for symptoms of lower urinary tract fistula (LUTF) and lower gastrointestinal tract fistula (LGTF), as well as urinary and fecal incontinence (UI, FI). We evaluated the discriminative ability of the questionnaire using a case–control study design in a 1:2:2 ratio: cases were parous women with fistula confirmed on examination, controls included parous women without fistula on examination, with and without UI symptoms. All women underwent screening for fistula symptoms and a physical examination, with examiners blinded to screening results. Results Of the 367 Rwandan women who completed the questionnaires and underwent clinical examination, 59 women had LUTFs and 34 had LGTFs, 274 women were classified as controls with and without symptoms of UI. All LUTF screening questions performed well, including the DHS fistula question. The combination of two LUTF screening questions had the highest sensitivity (100%; 95% CI 94%, 100%), specificity (96%; 95% CI 93%, 98%), and area under the curve (AUC) (0.98). The combination of a LGTF screening question and FI question demonstrated the highest sensitivity (97%; 95% CI 85%, 100%), specificity (98%; 95% CI 95%, 99%) and AUC (0.98). Conclusions Our OF screening questionnaire, including the DHS fistula question, demonstrated high sensitivities, specificities, and AUC. Supplementary Information The online version contains supplementary material available at 10.1186/s12978-021-01317-2. Obstetric fistula (OF) is a birth injury which may occur in women living in lower resource settings who experience obstructed labor (not progressing normally) without access to skilled obstetric care. This injury causes a woman to constantly leak urine and/or feces from her birth canal. As OF affects poor women who live far from healthcare it is difficult to fully understand how many women worldwide have an OF. Furthermore, although some Demographic and Health Surveys (DHS) include OF symptom questions, the accuracy of these questions in identifying women with OF has not been studied. To more accurately determine which women may have an OF, we developed an OF screening questionnaire after consulting OF experts worldwide, which included a DHS OF question. We asked women from Rwanda this questionnaire and then examined these women to see if they have OF. Through this process we identified 59 women with a LUTF, 34 with a LGTF, and 274 without an OF. The best performing questions were able to identify women with LUTF 100% of the time and women with LGTF 97% of the time. We also showed that one DHS question detects women with LUTF and LGTF 100% and 85% of the time, respectively. Public health officials can now use the questions we studied to more accurately estimate how many women worldwide have OF, and best direct resources and skilled health care workers to the areas with the greatest need.
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Affiliation(s)
- Chi Chiung Grace Chen
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, 4940 Eastern Ave, Baltimore, MD, 21231, USA.
| | - Annelise Long
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, 4940 Eastern Ave, Baltimore, MD, 21231, USA
| | - Denis Rwabizi
- Department of Obstetrics and Gynecology, University of Rwanda, Kigali, Rwanda
| | - Gerard Mbabazi
- Department of Obstetrics and Gynecology, University of Rwanda, Kigali, Rwanda
| | - Ntwali Ndizeye
- Department of Obstetrics and Gynecology, University of Rwanda, Kigali, Rwanda
| | | | - Eugene Ngoga
- Rwanda Society of Obstetricians and Gynecologists, Kigali, Rwanda
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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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Chimamise C, Munjanja SP, Machinga M, Shiripinda I. Health seeking behaviors of women living with obstetric fistula in Zimbabwe: A qualitative cross sectional study. SOCIAL WORK IN PUBLIC HEALTH 2021; 36:548-557. [PMID: 34130610 DOI: 10.1080/19371918.2021.1931617] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
A cross-sectional qualitative study was conducted using in-depth interview guides at Chinhoyi Provincial Hospital, Zimbabwe to explore and understand health-seeking behaviors of women affected by obstetric fistula and to determine reasons why women lived with fistula. Study participants were women who had come for fistula repair between November and December 2019, who consented to participate in the study. In-depth interviews were conducted and analyzed using NVivo 10. Of the 29 women who came for the camp, 21 were enrolled. Mean period with fistula was 4.7 years (SD±12). Participants sought help from spiritual healers first before medical treatment but all sought medical care at one time during or after delivery. Reasons for staying with fistula included lack of knowledge of availability of repair services, lack of resources, and powerlessness in decision making. This study concluded that barriers to access should be addressed so that women get the treatment they require.
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Affiliation(s)
- Chipo Chimamise
- Department of Health Sciences, College of Health, Agriculture and Natural Sciences, Africa University, Mutare, Zimbabwe
| | - Stephen P Munjanja
- Department of Obstetrics and Gynecology, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Mazvita Machinga
- Department of Health Sciences, College of Health, Agriculture and Natural Sciences, Africa University, Mutare, Zimbabwe
| | - Iris Shiripinda
- Department of Health Sciences, College of Health, Agriculture and Natural Sciences, Africa University, Mutare, Zimbabwe
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Abstract
Urinary incontinence shortly after childbirth or gynecologic surgery can be the result of obstetric or iatrogenic fistula formation. This can be a confusing and challenging diagnosis for medical providers. While the number of iatrogenic fistula cases is rising worldwide, obstetric fistulas are an issue uniquely particular to resource poor settings. Appropriate treatment of genitourinary fistulas spans beyond surgical intervention of leakage, and includes re-integration into the community, widespread education and counseling, and battling social stigma and cultural biases. Current and future research must focus on rigorous, unified efforts to set evidence-based practices to help the millions of women affected.
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Affiliation(s)
- Megan Abrams
- Department of Female Pelvic Medicine and Reconstructive Surgery, University Hospitals Cleveland Medical Center
| | - Rachel Pope
- Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio
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Wakefield A. Use of indwelling catheters and preventing catheter-associated urinary tract infections. Nurs Stand 2021; 36:77-82. [PMID: 33787158 DOI: 10.7748/ns.2021.e11594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2021] [Indexed: 06/12/2023]
Abstract
Indwelling urinary catheters are considered an important healthcare intervention for many patients. However, these devices must be used with caution because they are associated with a risk of various potential complications such as catheter-associated urinary tract infections (CAUTIs), as well as a financial burden for healthcare organisations. This article outlines the various types of indwelling catheter that are available, explains the reasons for their use, and details the care required to prevent associated complications, particularly CAUTIs.
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Affiliation(s)
- Ann Wakefield
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, England
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21
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Kim HJ, Pyun JH, Park TY, Yoon SG, Maeng SW, Choi HS, Joo KI, Kang SH, Cha HJ. Preclinical evaluation of a regenerative immiscible bioglue for vesico-vaginal fistula. Acta Biomater 2021; 125:183-196. [PMID: 33652167 DOI: 10.1016/j.actbio.2021.02.037] [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: 11/30/2020] [Revised: 02/19/2021] [Accepted: 02/23/2021] [Indexed: 10/22/2022]
Abstract
Currently, there are no clinically available tissue adhesives that work effectively in the fluid-rich and highly dynamic environments of the human body, such as the urinary system. This is especially relevant to the management of vesico-vaginal fistula, and developing a high-performance tissue adhesive for this purpose could vastly expand urologists' surgical repertoire and dramatically reduce patient discomfort. Herein, we developed a water-immiscible mussel protein-based bioadhesive (imWIMBA) with significantly improved properties in all clinical respects, allowing it to achieve rapid and strong underwater adhesion with tunable rheological properties. We evaluated in vivo potential of imWIMBA for sealing thermally injured fistula tracts between the bladder and vagina. Importantly, the use of imWIMBA in the presence of prolonged bladder drainage resulted in perfect closure of the vesico-vaginal fistula in operated pigs. Thus, imWIMBA could be successfully used for many surgical applications and improve treatment efficacy when combined with conventional surgical methods. STATEMENT OF SIGNIFICANCE: Vesico-vaginal fistula (VVF) is an abnormal opening between the bladder and the vagina, which is a stigmatized disease in many developing countries. Leakage of urine into internal organs can induce serious complications and delay wound repair. Conventional VVF treatment requires skillful suturing to provide a tension-free and watertight closure. In addition, there is no clinically approved surgical glue that works in wet and highly dynamic environments such as the urinary system. In this work, for potential clinical VVF closure and regeneration, we developed an advanced immiscible mussel protein-based bioglue with fast, strong, wet adhesion and tunable rheological properties. This regenerative immiscible bioglue could be successfully used for sealing fistulas and further diverse surgical applications as an adjuvant for conventional suture methods.
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Abstract
Rectovaginal fistula (RVF), defined as any abnormal connection between the rectum and the vagina, is a complex and debilitating condition. RVF can occur for a variety of reasons, but frequently develops following obstetric injury. Patients with suspected RVF require thorough evaluation, including history and physical examination, imaging, and objective evaluation of the anal sphincter complex. Prior to attempting repair, sepsis must be controlled and the tract allowed to mature over a period of 3 to 6 months. All repair techniques involve reestablishing a healthy, well-vascularized rectovaginal septum, either through reconstruction with local tissue or tissue transfer via a pedicled flap. The selection of a specific repair technique is determined by the level of the fistula tract and the status of the anal sphincter. Despite best efforts, recurrence is common and should be discussed with patients prior to repair. As the ultimate goal of RVF repair is to minimize symptoms and maximize quality of life, patients should help to direct their own care based on the risks and benefits of available treatment options.
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Affiliation(s)
- Aaron J Dawes
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota
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23
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Kpatcha TM, Wangala P, Botcho G, Tchandana M, Nembuzu D, Aboubakari AS. [Epidemiologic, anatomoclinic and therapeutic profil of urogenital and rectovaginal fistula in TOGO]. Prog Urol 2020; 30:597-603. [PMID: 32675016 DOI: 10.1016/j.purol.2020.06.008] [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: 03/17/2020] [Revised: 05/18/2020] [Accepted: 06/19/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To describe epidemiologic, anatomic and clinical characteristics of urogenital and rectovaginal fistula and the issue of their surgical management in Togo. MATERIAL AND METHODS A retrospective study permit us to collect the operated cases during five years in the national center of obstetrical fistula. The parameters evaluated were sociodemographic aspects of patients, clinical characteristics and the issue of surgical repair. RESULTS The number of patients who enderwent surgery was 197, during 217 surgical interventions. The middle age of patients was 40,7 years with extrems of 18 and 70 years. The main causes of fistula were obstetrical (95%) and 3,5% were caused by surgery. Concerning anatomoclinic characteristic, vesicovaginal fistula was the most comon type representing 87,3%, where vesicouterine fistula represented 4,1%. Multiparity has been a risk factor for obstetrical fistula and ceasarien section was necessary in 70% with a high rate of fœtal mortality (88,2%). Surgical management was late in majority of cases, estimated at 10 years between occurrence of fistula and its reparation. The recovry rate was 78,1%. CONCLUSION Urogenital fistula are principaly caused by obstetric conditions in Togo and multiparity is a risk factor. Treatment is often late but has a good rate of recovery. Their prevention goes through the fight against dystocia. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- T M Kpatcha
- Service d'urologie, CHU de Kara, Togo; Centre national de référence de prise en charge de fistules, Togo.
| | - P Wangala
- Centre national de référence de prise en charge de fistules, Togo
| | - G Botcho
- Service d'urologie, CHU de Kara, Togo
| | - M Tchandana
- DSMI/PF, Ministère de la santé et de l'hygiène publique, Togo
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Swain D, Parida SP, Jena SK, Das M, Das H. Prevalence and risk factors of obstetric fistula: implementation of a need-based preventive action plan in a South-eastern rural community of India. BMC Womens Health 2020; 20:40. [PMID: 32131799 PMCID: PMC7055058 DOI: 10.1186/s12905-020-00906-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 02/14/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The study was conducted to estimate the prevalence and risk factors of obstetric fistula in the rural area of the south eastern community of India and the training of community health workers for its prevention. METHODS A population-based cross-sectional analytical study was conducted in the south eastern rural community of India. A total of 3939 women were included in the study and Probability proportional to size sampling was used in the study. Frequency distribution and logistic regression were computed to analyse the data using STATA version 11.2. RESULTS Out of 3939 participants interviewed, 23.7% women reported obstetric fistula symptoms whereas after clinical diagnosis and speculum examination the obstetric morbidity pattern was: Obstetric fistula 0.3%, stress urinary incontinence 20.0%, pelvic inflammatory diseases 1.2%, uterine prolapse 1.4% and urinary tract infection 3.8%. The awareness level of the rural women regarding the obstetric fistula was assessed by a structured knowledge questionnaire and found to be very poor, hence community based fistula training was implemented among community health workers as a health system based strategy for its prevention. Obstetric fistula found to be more prevalent among women of poor educational level, low socioeconomic status, less no of antenatal visits, delay in accessing the emergency obstetric care and prolonged labour (p ≤ 0.05). CONCLUSION Finding of the study indicated that the prevalence and risk of developing obstetric fistula was associated with less number of antenatal visits, prolonged labour, delay in timely intervention, delay in accessing emergency obstetric care and more number of movements from home to the delivery place. Finally, our study suggests that emphasis needs to be placed on training of community health workers to facilitate early screening for identification and referral of women with obstetric fistula.
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Affiliation(s)
- Dharitri Swain
- College of Nursing, AIIMS Bhubaneswar, Bhubaneswar, Odisha India
| | - Swayam Pragyan Parida
- Department of Community Medicine & Family Medicine, AIIMS Bhubaneswar, Bhubaneswar, Odisha India
| | - Saubhagya Kumar Jena
- Department of Obstetrics & Gynaecology, AIIMS Bhubaneswar, Bhubaneswar, Odisha India
| | - Mahasweta Das
- College of Nursing, ICMR Project, AIIMS Bhubaneswar, Bhubaneswar, Odisha India
| | - Hrushikesh Das
- College of Nursing, DST Project, AIIMS Bhubaneswar, Bhubaneswar, Odisha India
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Nonterah EA, Agorinya IA, Kanmiki EW, Kagura J, Tamimu M, Ayamba EY, Nonterah EW, Kaburise MB, Al-Hassan M, Ofosu W, Oduro AR, Awonoor-Williams JK. Trends and risk factors associated with stillbirths: A case study of the Navrongo War Memorial Hospital in Northern Ghana. PLoS One 2020; 15:e0229013. [PMID: 32084170 PMCID: PMC7034822 DOI: 10.1371/journal.pone.0229013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 01/28/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Maternal and Child health remains at the core of global health priorities transcending the Millennium Development Goals into the current era of Sustainable Development Goals. Most low and middle-income countries including Ghana are yet to achieve the required levels of reduction in child and maternal mortality. This paper analysed the trends and the associated risk factors of stillbirths in a district hospital located in an impoverished and remote region of Ghana. METHODS Retrospective hospital maternal records on all deliveries conducted in the Navrongo War Memorial hospital from 2003-2013 were retrieved and analysed. Descriptive and inferential statistics were used to summarise trends in stillbirths while the generalized linear estimation logistic regression is used to determine socio-demographic, maternal and neonatal factors associated with stillbirths. RESULTS A total of 16,670 deliveries were analysed over the study period. Stillbirth rate was 3.4% of all births. There was an overall decline in stillbirth rate over the study period as stillbirths declined from 4.2% in 2003 to 2.1% in 2013. Female neonates were less likely to be stillborn (Adjusted Odds ratio = 0.62 and 95%CI [0.46, 0.84]; p = 0.002) compared to male neonates; neonates with low birth weight (4.02 [2.92, 5.53]) and extreme low birth weight (18.9 [10.9, 32.4]) were at a higher risk of still birth (p<0.001). Mothers who had undergone Female Genital Mutilation had 47% (1.47 [1.04, 2.09]) increase odds of having a stillbirth compared to non FGM mothers (p = 0.031). Mothers giving birth for the first time also had a 40% increase odds of having a stillbirth compared to those who had more than one previous births (p = 0.037). CONCLUSION Despite the modest reduction in stillbirth rates over the study period, it is evident from the results that stillbirth rate is still relatively high. Primiparous women and preterm deliveries leading to low birth weight are identified factors that result in increased stillbirths. Efforts aimed at impacting on stillbirths should include the elimination of outmoded cultural practices such as FGM.
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Affiliation(s)
- Engelbert A. Nonterah
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana
- Navrongo War Memorial Hospital, Ghana Health Service, Navrongo, Ghana
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Isaiah A. Agorinya
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana
- Swiss Tropical and Public Health Institute, Socinstrasse, Basel, Switzerland, University of Basel, Peterplatz, Basel, Switzerland
| | - Edmund W. Kanmiki
- Regional Institute for Population Studies (RIPS), University of Ghana, Legon, Accra, Ghana
| | - Juliana Kagura
- Department of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
| | - Mariatu Tamimu
- Obstetrics and Gynaecology Department, University of Nairobi, Nairobi, Kenya
| | | | | | - Michael B. Kaburise
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana
- Navrongo War Memorial Hospital, Ghana Health Service, Navrongo, Ghana
| | | | - Winfred Ofosu
- Upper East Regional Health Directorate, Ghana Health Service, PMB, Bolgatanga, Ghana
| | - Abraham R. Oduro
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana
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Boene H, Mocumbi S, Högberg U, Hanson C, Valá A, Bergström A, Sevene E, Munguambe K. Obstetric fistula in southern Mozambique: a qualitative study on women's experiences of care pregnancy, delivery and post-partum. Reprod Health 2020; 17:21. [PMID: 32005268 PMCID: PMC6995132 DOI: 10.1186/s12978-020-0860-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 01/14/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Obstetric fistula is still common in low- and middle-income countries (LMIC) despite the on-going shift to increased facility deliveries in the same settings. The social behavioural circumstances in which fistula, as well as its consequences, still occur are poorly documented, particularly from the perspective of the experiences of women with obstetric fistula. This study sought to describe women's experiences of antenatal, partum and post-partum care in southern Mozambique, and to pinpoint those experiences that are unique to women with fistula in order to understand the care-seeking and care provision circumstances which could have been modified to avoid or mitigate the onset or consequences of fistula. METHODS This study took place in Maputo and Gaza provinces, southern Mozambique, in 2016-2017. Qualitative data were collected through in-depth interviews conducted with 14 women with positive diagnoses of fistula and an equal number of women without fistula. All interviews were audio-recorded and transcribed verbatim prior to thematic analysis using NVivo11. RESULTS Study participants had all attended antenatal care (ANC) visits and had prepared for a facility birth. Prolonged or obstructed labour, multiple referrals, and delays in receiving secondary and tertiary health care were common among the discourses of women with fistula. The term "fistula" was rarely known among participants, but the condition (referred to as "loss of water" or "illness of spillage") was recognised after being prompted on its signs and symptoms. Women with fistula were invariably aware of the links between fistula and poor birth assistance, in contrast with those without fistula, who blamed the condition on women's physiological and behavioural characteristics. CONCLUSION Although women do seek antenatal and peri-partum care in health facilities, deficiencies and delays in birth assistance, referral and life-saving interventions were commonly reported by women with fistula. Furthermore, weaknesses in quality of care, not only in relation to prevention, but also the resolution of the damage, were evident. Quality improvement of birth care is necessary, both at primary and referral level. There is a need to increase awareness and develop guidelines for prevention, early detection and management of obstetric fistula, including early postpartum treatment, availability of fistula repair for complex cases, and rehabilitation, coupled with the promotion of community consciousness of the problem.
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Affiliation(s)
- Helena Boene
- Centro de Investigação em Saúde de Manhiça (CISM), Rua 12, Vila da Manhiça, 1121, Manhiça, Mozambique
| | - Sibone Mocumbi
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universidade Eduardo Mondlane (UEM), Av. Agostinho Neto 679, 1100, Maputo, Mozambique. .,Department of Women's and Children's Health, Women's and Children's Health, Uppsala University, Akademiska sjukhuset, SE-75185, Uppsala, Sweden.
| | - Ulf Högberg
- Department of Women's and Children's Health, Women's and Children's Health, Uppsala University, Akademiska sjukhuset, SE-75185, Uppsala, Sweden
| | - Claudia Hanson
- Department of Public Health Sciences, Karolinska Institutet, Tomtebodavagen 18A, Plan 4, Stockholm, Sweden.,Department of Disease Control, London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT, UK
| | - Anifa Valá
- Centro de Investigação em Saúde de Manhiça (CISM), Rua 12, Vila da Manhiça, 1121, Manhiça, Mozambique
| | - Anna Bergström
- Department of Women's and Children's Health, Women's and Children's Health, Uppsala University, Akademiska sjukhuset, SE-75185, Uppsala, Sweden.,University College London, Institute for Global Health, Gower St, London, WC1E 6BT, UK
| | - Esperança Sevene
- Centro de Investigação em Saúde de Manhiça (CISM), Rua 12, Vila da Manhiça, 1121, Manhiça, Mozambique.,Department of Physiological Science, Clinical Pharmacology, Faculty of Medicine, UEM, Av. Salvador Allende 702 R/C, Maputo, Mozambique
| | - Khátia Munguambe
- Centro de Investigação em Saúde de Manhiça (CISM), Rua 12, Vila da Manhiça, 1121, Manhiça, Mozambique.,Department of Community Health, Faculty of Medicine, UEM, Av. Salvador Allende 702 R/C, Maputo, Mozambique
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Ngongo CJ, Raassen T, Lombard L, van Roosmalen J, Weyers S, Temmerman M. Delivery mode for prolonged, obstructed labour resulting in obstetric fistula: a retrospective review of 4396 women in East and Central Africa. BJOG 2020; 127:702-707. [PMID: 31846206 PMCID: PMC7187175 DOI: 10.1111/1471-0528.16047] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To evaluate the mode of delivery and stillbirth rates over time among women with obstetric fistula. DESIGN Retrospective record review. SETTING Tanzania, Uganda, Kenya, Malawi, Rwanda, Somalia, South Sudan, Zambia and Ethiopia. POPULATION A total of 4396 women presenting with obstetric fistulas for repair who delivered previously in facilities between 1990 and 2014. METHODS Retrospective review of trends and associations between mode of delivery and stillbirth, focusing on caesarean section (CS), assisted vaginal deliveries and spontaneous vaginal deliveries. MAIN OUTCOME MEASURES Mode of delivery, stillbirth. RESULTS Out of 4396 women with fistula, 3695 (84.1%) delivered a stillborn baby. Among mothers with fistula giving birth to a stillborn baby, the CS rate (overall 54.8%, 2027/3695) rose from 45% (162/361) in 1990-94 to 64% (331/514) in 2010-14. This increase occurred at the expense of assisted vaginal delivery (overall 18.3%, 676/3695), which declined from 32% (115/361) to 6% (31/514). CONCLUSIONS In Eastern and Central Africa, CS is increasingly performed on women with obstructed labour whose babies have already died in utero. Contrary to international recommendations, alternatives such as vacuum extraction, forceps and destructive delivery are decreasingly used. Unless uterine rupture is suspected, CS should be avoided in obstructed labour with intrauterine fetal death to avoid complications related to CS scars in subsequent pregnancies. Increasingly, women with obstetric fistula add a history of unnecessary CS to their already grim experiences of prolonged, obstructed labour and stillbirth. TWEETABLE ABSTRACT Caesarean section is increasingly performed in African women with stillbirth treated for obstetric fistula.
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Affiliation(s)
| | | | | | - J van Roosmalen
- Athena Institute VU University Amsterdam, Amsterdam, the Netherlands.,Leiden University Medical Centre, Leiden, the Netherlands
| | - S Weyers
- Department of Obstetrics and Gynaecology, Ghent University Hospital, Ghent, Belgium
| | - M Temmerman
- Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya.,Faculty of Medicine and Health Science, Ghent University, Ghent, Belgium
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Abstract
Although obstetric fistula has likely plagued women since the beginning of time, very little research proportionally exists. This article summarizes the most substantial research on the topic and delineates research gaps and future needs. Existing research demonstrates that access to care is the underlying cause of obstetric fistula and that the first attempt at closure holds the highest chance at success, ranging between 84% and 94%. For simple cases, 10 days of a catheter is sufficient, although what constitutes as simple is unclear. Circumferential fistulas are at high risk for ongoing urethral continence. Psychosocial programs are helpful for all women, but those who are "dry" tend to reintegrate into society, whereas those still leaking need additional support. Prenatal care and scheduled cesarean delivery are recommended to avoid another fistula. Gaps in research include accurate prevalence and incidence, interventions to improve access to care, surgical technique, especially for complex cases, and ways to prevent ongoing incontinence, among many others. In all areas, more rigorous research is needed.
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Matanda DJ, Sripad P, Ndwiga C. Is there a relationship between female genital mutilation/cutting and fistula? A statistical analysis using cross-sectional data from Demographic and Health Surveys in 10 sub-Saharan Africa countries. BMJ Open 2019; 9:e025355. [PMID: 31362960 PMCID: PMC6678015 DOI: 10.1136/bmjopen-2018-025355] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES Literature on associations between female genital mutilation/cutting (FGM/C) and fistula points to a common belief that FGM/C predisposes women to developing fistula. This study explores this association using nationally representative survey data. DESIGN A secondary statistical analysis of cross-sectional data from Demographic and Health Surveys was conducted to explore the association between FGM/C and fistula. SETTING Sub-Saharan Africa. PARTICIPANTS Women aged 15-49 years in Burkina Faso (n=17 087), Chad (n=17 719), Côte d'Ivoire (n=10 060), Ethiopia (n=14 070), Guinea (n=9142), Kenya (n=31 079), Mali (n=10 424), Nigeria (n=33 385), Senegal (n=15 688) and Sierra Leone (n=16 658). MAIN OUTCOME MEASURES Fistula symptoms. RESULTS Multivariate logit modelling using pooled data from 10 countries showed that the odds of reporting fistula symptoms were 1.5 times (CI 1.06 to 2.21) higher for women whose genitals were cut and sewn closed than those who had undergone other types of FGM/C. Women who attended antenatal care (ANC) (adjusted odds ratio (AOR) 0.51, CI 0.36 to 0.71) and those who lived in urban areas (AOR 0.62, CI 0.44 to 0.89) were less likely to report fistula symptoms than those who did not attend ANC or lived in rural areas. CONCLUSIONS Severe forms of FGM/C (infibulation) may predispose women to fistula. Contextual and socioeconomic factors may increase the likelihood of fistula. Multisectoral interventions that concurrently address harmful traditional practices such as FGM/C and other contextual factors that drive the occurrence of fistula are warranted. Promotion of ANC utilisation could be a starting point in the prevention of fistulas.
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Affiliation(s)
| | - Pooja Sripad
- Department of Reproductive Health, Population Council, New York, New York, USA
| | - Charity Ndwiga
- Department of Reproductive Health, Population Council Kenya, Nairobi, Kenya
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30
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Belayihun B, Mavhandu-Mudzusi AH. Effects of surgical repair of obstetric fistula on severity of depression and anxiety in Ethiopia. BMC Psychiatry 2019; 19:58. [PMID: 30732591 PMCID: PMC6367812 DOI: 10.1186/s12888-019-2045-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 01/30/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The surgical repair of fistula can address the physical symptoms, but may not end the psychological challenges that women with fistula face. There are a few studies that focus on women with this condition in Ethiopia. Hence, the aim of this study was to determine the effects of surgical repair of obstetric fistula on the severity of depression and anxiety in women with obstetric fistula in Ethiopia. METHOD The study employed a longitudinal study design to investigate the changes in 219 women with obstetric fistula admitted to six fistula management hospitals in Ethiopia. The data were collected on admission of the patients for obstetric fistula surgical repair and at the end of six-month post repair. A structured questionnaire was used to obtain socio-demographic information and medical history of the respondents. Depression and anxiety symptoms were measured using the Patient Health Questionnaire (PHQ-9) and General Anxiety Disorder (GAD-7) scales. The data was entered using Epi-Data software and then exported to SPSS for further analysis. The Mann-Whitney-U test, the Kruskal-Wallis test and Paired t-test were performed to measure the change in psychological symptoms after surgical repair. RESULT Though 219 respondents were interviewed pre-obstetric fistula surgical repair, only 200 completed their follow up. On admission, the prevalence of depression and anxiety symptoms were 91 and 79% respectively. After surgical repair, the prevalence rate was 27 and 26%. The differences in the prevalence of screen-positive women were statistically significant (P < 0.001). CONCLUSION The study concluded that the severity of depression and anxiety symptoms decrease post-obstetric fistula surgical repair. However, a woman with continued leaking after surgery seems to have higher psychological distress than those who are fully cured. Clinicians should manage women with obstetric fistula through targeted and integrated mental health interventions to address their mental health needs.
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Affiliation(s)
- Bekele Belayihun
- Department of Health Studies, University of South Africa, Addis Ababa, Ethiopia.
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31
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Masenga GG, Shayo BC, Msuya S, Rasch V. Urinary incontinence and its relation to delivery circumstances: A population-based study from rural Kilimanjaro, Tanzania. PLoS One 2019; 14:e0208733. [PMID: 30673696 PMCID: PMC6343883 DOI: 10.1371/journal.pone.0208733] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 11/22/2018] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To investigate the prevalence and risk factors of urinary incontinence (UI), the different UI subtypes and the association between UI and delivery circumstances. DESIGN Cross-sectional population-based study conducted in Kilimanjaro Region, Tanzania. PARTICIPANTS AND SETTINGS 1048 women aged 18-90 women living in rural Kilimanjaro. Simple random sampling was done to select villages, households and participants. Community health workers helped in identifying eligible women and trained nurses/midwives conducted face-to-face interviews. Data were analysed using descriptive statistics and Univariate and Multivariate logistic regression modelling. RESULTS The overall prevalence rate of UI was 42%. When focusing on the different types of UI, 17% of the women had stress UI, 9% had urge UI and 16% had mixed UI. Only one woman (0.1%) with vesico-vaginal fistula was identified. UI was found to be significantly associated with increasing parity (OR = 2.41 (1.55-3.74). In addition, women who in relation to their first delivery had delivered at home or had been in labour for more than 24 hours, had increased adjusted ORs of 1.70(1.08-2.68) and 2.10(1.08-4.10), respectively, for having UI. CONCLUSION UI is common in rural Tanzania and of the subtypes of UI, Stress Urinary Incontinence (SUI) is the commonest followed by Mixed Urinary Incontinence (MUI). Home delivery, prolonged labour and increasing parity especially having 5 or more deliveries are associated with increased risk for developing UI.
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Affiliation(s)
- Gileard G. Masenga
- Kilimanjaro Christian Medical University College, Moshi, Klimanjaro, Tanzania
- Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical Centre, Moshi, Kilimanjaro, Tanzania
- * E-mail:
| | - Benjamin C. Shayo
- Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical Centre, Moshi, Kilimanjaro, Tanzania
| | - Sia Msuya
- Kilimanjaro Christian Medical University College, Moshi, Klimanjaro, Tanzania
| | - Vibeke Rasch
- Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Kopeć-Godlewska K, Pac A, Różańska A, Wójkowska-Mach J. Is Vaginal Birth without an Episiotomy a Rarity in the 21st Century? Cross-Sectional Studies in Southern Poland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E2462. [PMID: 30400584 PMCID: PMC6266457 DOI: 10.3390/ijerph15112462] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 11/01/2018] [Indexed: 11/17/2022]
Abstract
Purpose: The objective of this study was to analyze the birth methods (vaginal, with medical intervention, or by Cesarean Section, CS) predominant in the Malopolska province, to describe the risk factors for non-physiologically normal births, and to characterize the demographics of women who give birth and selected parameters of maternity care. Methods: The retrospective analysis was conducted on data collected in 2013⁻2014 in the framework of the current activity of the Polish National Health Fund and encompassed 68,894 childbirths from 29 hospitals in 21 towns in the south of Poland. Results: In the study period, 38,366 (56.5%) of the births in Malopolska were vaginal, and only 22,839 (22.9%) of births were considered 'normal', without an episiotomy. The remaining were births by CS (29,551; 43.5%). Factors increasing the chances of having a normal childbirth in comparison with birth by CS were as follows: days free from work, living in a village, woman's age > 35 years, and the hospital's referral level (primary or secondary). Women aged 18⁻34 years and those living in a village/town were more frequently admitted directly into the birth room without a stay in the maternity units. There was a high level of medicalization of births in Malopolska: natural labour and childbirth were rare. It seems that efforts to increase natural birth rates should be directed toward both reducing the CS rate as well as increasing vaginal birth without an episiotomy.
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Affiliation(s)
- Katarzyna Kopeć-Godlewska
- Faculty of Health Sciences, Jagiellonian University Medical College, ul. Michałowskiego 12, 31-126 Krakow, Poland.
| | - Agnieszka Pac
- Institute of Epidemiology, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, ul. Kopernika 7a, 31-034 Krakow, Poland.
| | - Anna Różańska
- Chair of Microbiology, Jagiellonian University Medical College, ul. Czysta 18, 31-121 Kraków, Poland.
| | - Jadwiga Wójkowska-Mach
- Chair of Microbiology, Jagiellonian University Medical College, ul. Czysta 18, 31-121 Kraków, Poland.
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Gon G, Leite A, Calvert C, Woodd S, Graham WJ, Filippi V. The frequency of maternal morbidity: A systematic review of systematic reviews. Int J Gynaecol Obstet 2018; 141 Suppl 1:20-38. [PMID: 29851116 PMCID: PMC6001670 DOI: 10.1002/ijgo.12468] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background Estimates of the burden of maternal morbidity are patchy. Objective To conduct a systematic review of systematic reviews of maternal conditions to: (1) make available the most up‐to‐date frequency estimates; (2) identify which conditions do not have reliable estimates; and (3) scrutinize the quality of the available reviews. Search strategy We searched Embase, MEDLINE, and CINAHL, combining terms for pregnancy, frequency (e.g. prevalence, incidence), publication type, and specific terms for each of 121 conditions. Selection criteria We included peer‐reviewed systematic reviews aiming to estimate the frequency of at least one of the conditions in WHO's list of maternal morbidities, with estimates from at least two countries. Data collection and analysis We present the frequency estimates with their uncertainty bounds by condition, region, and pregnancy/postpartum period. We also assess and present information on the quality of the systematic reviews. Main results Out of 11 930 found, 48 reviews were selected and one more was added. From 49 reviews we extracted 34 direct and 60 indirect frequency estimates covering 35 conditions. No review was available for 71% of the conditions on the WHO list. The extracted estimates show substantial maternal morbidity, spanning the time before and beyond childbirth. There were several gaps in the quality of the reviews. Notably, one‐third of the estimates were based only on facility‐based studies. Conclusions Good‐quality systematic reviews are needed for several conditions, as a research priority. This study highlights that substantial maternal morbidity occurs along the pregnancy–postpartum continuum, and that conducting quality systematic reviews is a priority research gap.
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Affiliation(s)
- Giorgia Gon
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Andreia Leite
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Clara Calvert
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Susannah Woodd
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Wendy J Graham
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Veronique Filippi
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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Beardmore-Gray A, Greenwell T. Vesico-vaginal fistulae in the resource-limited setting: current status and the challenges that lie ahead, all you need to know for those practicing in a well-resourced setting. JOURNAL OF CLINICAL UROLOGY 2018. [DOI: 10.1177/2051415818764593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In this review we examine the incidence, aetiology, pathology and classification of vesico vaginal fistulae (VVF) in the resource poor setting. We compare the diagnosis, management and outcomes of VVF repair in resource-poor countries to current practice in the well-resourced setting, finally looking ahead to the future and the changes we need to make on a global scale in order to prevent this debilitating condition. There is a clear need for more accurate data collection and classification systems appropriate to the setting. Lack of facilities such as radiology limit diagnostic capabilities and options for repair, however outcome data from resource poor countries is promising. Most importantly, a holistic approach, which examines not just the physical aspects of the condition but the social and cultural factors predisposing women to VVF, needs to be adopted when considering prevention and management of this injury. Level of evidence: Not applicable as this is a review article.
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Abstract
Kitovu Hospital in Masaka, Uganda, is a leading obstetric fistula repair centre in the country with the highest rates of fistula in the world. In this retrospective case review, the regional incidence and causative factors were studied in patients with vesicovaginal fistula (VVF) who were admitted at Kitovu Hospital. Fistula history included severity (ICIQ score), causes and outcomes of VVF were measured. Women suffered with symptoms of VVF for an average of 4.97 years with an average ICIQ severity score of 7.21. Patients travelled an average distance of 153 km and the majority travelled by public transport. Rates of prolonged labour were high. 69% of fistula-causing delivery resulted in stillbirth and 12% resulted in early neonatal death. Following surgery, 94% of patients were dry on discharge. Impact statement What is already known on this subject? Vesicovaginal fistula (VVF) is a severe, life-changing injury. Although largely eradicated from the Western world thanks to modern obstetric practice, VVF is still highly prevalent in developing countries where factors such as young childbearing age and poor access to emergency obstetric care increase the incidence (Wall et al. 2005 ). At the current rate of fistula repair, it is estimated that it would take 400 years to treat those already suffering with fistula, providing that no new cases emerged (Browning and Patel 2004 ). What do the results of this study add? The Ugandan women in this study reiterate tales of foetal loss, social isolation and epic journeys in search of fistula repair, as previously described in the literature. The study offers some hope for prompt help-seeking during labour and after fistulas are developed. It demonstrates the success of fistula repairs at Kitovu Hospital but highlights the paucity of service provision across Uganda. What are the implications of these findings for clinical practice and/or further research? Further epidemiological research is required to quantify the true burden of the disease. Only by raising the profile of VVF in both developing and developed countries, can there be a collaborative effort to make universal change. To embark upon the prevention and cure of the disease it is necessary to continue tackling issues of poverty and gender inequality.
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Affiliation(s)
- Fiona Katherine McCurdie
- a Swindon Academy , University of Bristol, Great Western Hospitals NHS Foundation Trust , Swindon , UK
| | - Joanne Moffatt
- a Swindon Academy , University of Bristol, Great Western Hospitals NHS Foundation Trust , Swindon , UK
| | - Kevin Jones
- a Swindon Academy , University of Bristol, Great Western Hospitals NHS Foundation Trust , Swindon , UK
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Mocumbi S, Hanson C, Högberg U, Boene H, von Dadelszen P, Bergström A, Munguambe K, Sevene E. Obstetric fistulae in southern Mozambique: incidence, obstetric characteristics and treatment. Reprod Health 2017; 14:147. [PMID: 29126412 PMCID: PMC5681779 DOI: 10.1186/s12978-017-0408-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 10/31/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Obstetric fistula is one of the most devastating consequences of unmet needs in obstetric services. Systematic reviews suggest that the pooled incidence of fistulae in community-based studies is 0.09 per 1000 recently pregnant women; however, as facility delivery is increasing, for the most part, in Africa, incidence of fistula should decrease. Few population-based studies on fistulae have been undertaken in Sub-Saharan Africa, including Mozambique. This study aimed to estimate the incidence of obstetric fistulae in recently delivered mothers, and to describe the clinical characteristics and care, as well as the outcome, after surgical repair. METHODS We selected women who had delivered up to 12 months before the start of the study (June, 1st 2016). They were part of a cohort of women of reproductive age (12-49 years), recruited from selected clusters in rural areas of Maputo and Gaza provinces, Southern Mozambique, who were participating in an intervention trial (the Community Level Interventions for Pre-eclampsia trial or CLIP trial). Case identification was completed by self-reported constant urine leakage and was confirmed by clinical assessment. Women who had confirmed obstetric fistulae were referred for surgical repair. Data were entered into a REDCap database and analysed using R software. RESULTS Five women with obstetric fistulae were detected among 4358 interviewed, giving an incidence of 1.1 per 1000 recently pregnant women (95% CI 2.16-0.14). All but one had Caesarean section and all of the babies died. Four were stillborn, and one died very soon after birth. All of the patients identified and reached the primary health facility in reasonable time. Delays occurred in the care: in diagnosis of obstructed labour, and in the decision to refer to the secondary or third-level hospital. All but one of the women were referred to surgical repair and the fistulae successfully closed. CONCLUSION This population-based study reports a high incidence of obstetric fistulae in an area with high numbers of facility births. Few first and second delays in reaching care, but many third delays in receiving care, were identified. This raises concerns for quality of care.
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Affiliation(s)
- Sibone Mocumbi
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universidade Eduardo Mondlane (UEM), Av. Agostinho Neto 679, 1100, Maputo, Mozambique. .,Department of Women's and Children's Health, Uppsala University, Akademiska sjukhuset, SE-75185, Uppsala, Sweden.
| | - Claudia Hanson
- Department of Public Health Sciences, Karolinska Institutet, Tomtebodavagen 18A, Plan 4, Stockholm, Sweden.,Department of Disease Control, London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT, UK
| | - Ulf Högberg
- Department of Women's and Children's Health, Uppsala University, Akademiska sjukhuset, SE-75185, Uppsala, Sweden
| | - Helena Boene
- Centro de Investigação em Saúde de Manhiça (CISM), Rua 12, Vila da Manhiça, 1121, Manhiça, Mozambique
| | | | - Anna Bergström
- Department of Women's and Children's Health, Uppsala University, Akademiska sjukhuset, SE-75185, Uppsala, Sweden.,University College London, Institute for Global Health, Gower St, London, WC1E 6BT, UK
| | - Khátia Munguambe
- Centro de Investigação em Saúde de Manhiça (CISM), Rua 12, Vila da Manhiça, 1121, Manhiça, Mozambique.,Department of Public Health, Faculty of Medicine, UEM, Av. Salvador Allende 702 R/C, Maputo, Mozambique
| | - Esperança Sevene
- Centro de Investigação em Saúde de Manhiça (CISM), Rua 12, Vila da Manhiça, 1121, Manhiça, Mozambique.,Department of Physiological Science, Clinical Pharmacology, Faculty of Medicine, UEM, Av. Salvador Allende 702 R/C, Maputo, Mozambique
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Al-Omari MH, Hamid AS. Vesico-Adnexal Fistula Treated with Transurethral Embolization Under Fluoroscopic Guidance. AMERICAN JOURNAL OF CASE REPORTS 2017; 18:949-952. [PMID: 28867817 PMCID: PMC5595408 DOI: 10.12659/ajcr.904202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Patient: Female, 27 Final Diagnosis: Vesicoadnexal fistula Symptoms: Dysuria and discharge Medication: — Clinical Procedure: Embolization Specialty: Urology
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Affiliation(s)
- Ma'moon H Al-Omari
- Department of Radiology, Jordan University of Science and Technology (JUST), King Abdullah University Hospital (KAUH), Irbid, Jordan
| | - Aws Shawkat Hamid
- Department of Radiology, University of Michigan Health System, Ann Arbor, MI, USA
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Meurice M, Genadry R, Heimer C, Ruffer G, Kafunjo BJ. Social Experiences of Women with Obstetric Fistula Seeking Treatment in Kampala, Uganda. Ann Glob Health 2017; 83:541-549. [PMID: 29221527 DOI: 10.1016/j.aogh.2017.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Obstetric fistula is a preventable and treatable condition predominately affecting women in low-income countries. Understanding the social context of obstetric fistula may lead to improved prevention and treatment. OBJECTIVES This study investigated social experiences of women with obstetric fistula seeking treatment at Mulago Hospital in Kampala, Uganda. METHODS A descriptive study was conducted among women seeking treatment for obstetric fistula during a surgical camp in July 2011 using a structured questionnaire. Descriptive statistics were computed regarding sociodemographics, obstetric history, and social experience. FINDINGS Fifty-three women participated; 39 (73.58%) leaked urine only. Median age was 29 years (range: 17-58), and most were married or separated. About half (28, 47.9%) experienced a change in their relationship since acquiring obstetric fistula. More than half (27, 50.94%) acquired obstetric fistula during their first delivery, despite almost everyone (50, 94.3%) receiving antenatal care. The median years suffering from obstetric fistula was 1.25. Nearly every participant's social participation changed in at least one setting (51, 96.23%). Most women thought that a baby being too big or having kicked their bladder was the cause of obstetric fistula. Other participants thought health care providers caused the fistula (15, 32.61%; n = 46), with 8 specifying that the bladder was cut during the operation (cesarean section). Knowing someone with obstetric fistula was influential in pursuing treatment. The majority of participants planned to return to family (40, 78.43%; n = 51) and get pregnant after repair (35, 66.04%; n = 53). CONCLUSION Study participants experienced substantial changes in their social lives as a result of obstetric fistula, and there were a variety of beliefs regarding the cause. The complex social context is an important component to understanding how to prevent and treat obstetric fistula. Further elucidation of these factors may bolster current efforts in prevention and holistic treatment.
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Affiliation(s)
| | - Rene Genadry
- Department of OB/GYN, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Carol Heimer
- Department of Sociology, Northwestern University, Evanston, IL
| | - Galya Ruffer
- Department of Political Science, Northwestern University, Evanston, IL
| | - Barageine Justus Kafunjo
- Department of OB/GYN, Makerere University/Mulago National Referral and Teaching Hospital, Kampala, Uganda; Department of Women's Health-Save the Mothers, Uganda Christian University, Mukono, Uganda
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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
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Angell JN, Busingye P, Ganyaglo GYK, Moyer CA. Root causes and social consequences of birth injuries in Western Uganda. Int J Gynaecol Obstet 2017; 139:100-101. [PMID: 28688109 DOI: 10.1002/ijgo.12257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 04/16/2017] [Accepted: 07/05/2017] [Indexed: 11/10/2022]
Affiliation(s)
| | - Priscilla Busingye
- Department of Obstetrics and Gynecology, Holy Family Virika Hospital, Fort Portal, Uganda
| | - Gabriel Y-K Ganyaglo
- Department of Obstetrics and Gynecology, Korle Bu Teaching Hospital, Accra, Ghana
| | - Cheryl A Moyer
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI, USA.,Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI, USA
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Jarvis K, Richter S, Vallianatos H, Thornton L. Reintegration of Women Post Obstetric Fistula Repair: Experience of Family Caregivers. Glob Qual Nurs Res 2017; 4:2333393617714927. [PMID: 28835910 PMCID: PMC5528919 DOI: 10.1177/2333393617714927] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 04/24/2017] [Accepted: 05/01/2017] [Indexed: 11/23/2022] Open
Abstract
In northern Ghana, families traditionally function as the main provider of care. The role of family, however, is becoming increasingly challenged with the social shifts in Ghanaian culture moving from extended kinship to nuclear households. This has implications for the care of women post obstetric fistula (OF) repair and their family members who assist them to integrate back into their lives prior to developing the condition. This research is part of a larger critical ethnographic study which explores a culture of reintegration. For this article, we draw attention to the findings related to the experience of family caregivers who care for women post OF repair in northern Ghana. It is suggested that although family caregivers are pleased to have their family member return home, there are many unanticipated physical, emotional, and economic challenges. Findings lead to recommendations for enhancing the reintegration process and the need for adequate caregiving support.
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Kumar S, Vatsa R, Bharti J, Roy KK, Sharma JB, Singh N, Meena J, Singhal S. Urinary fistula-A continuing problem with changing trends. J Turk Ger Gynecol Assoc 2017; 18:15-19. [PMID: 28506945 PMCID: PMC5450205 DOI: 10.4274/jtgga.2016.0211] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 01/28/2017] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Urinary fistula is a distressing complication after difficult vaginal deliveries, obstetric, and gynecologic surgeries. The present study describes a single center's experience in the management of urinary fistula at a tertiary care hospital. It was performed to analyze the etiology of genitourinary fistula, to assess the outcome after surgical repair, and to determine the changing trends in the etiology and management of urinary fistula. MATERIAL AND METHODS This retrospective study was conducted over 5 years in the department of obstetrics and gynecology, All India Institute of Medical Sciences, New Delhi. Twenty patients who underwent surgical repair of urinary fistula were included in the study and analyzed for their etiology, presentation, site, size, previous failed repair, approach of surgical repair, and outcome. The findings of the present study were compared with a previous study at our center to determine the changing trends of urinary fistula. RESULTS The mean age of the study population was 37.05±8.08 years. The majority (65%) of the fistulae occurred following gynecologic surgeries, whereas 25% were due to obstructed labor, and 10% after cesarean section for other indications. The vaginal approach was used in all except one case of uterovesical fistula, which was repaired abdominally. The outcome was successful in 85% of cases. The success rate was similar in primary versus previous failed repair (p=0.270). CONCLUSION The most common cause of urinary fistula in the present study was gynecologic surgery. The vaginal approach can be used even in cases with previous failed repairs with a high success rate.
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Affiliation(s)
- Sunesh Kumar
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Richa Vatsa
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Juhi Bharti
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Kallol Kumar Roy
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Jai Bhagwan Sharma
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Neeta Singh
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Jyoti Meena
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Seema Singhal
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
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Maaløe N, Housseine N, Bygbjerg IC, Meguid T, Khamis RS, Mohamed AG, Nielsen BB, van Roosmalen J. Stillbirths and quality of care during labour at the low resource referral hospital of Zanzibar: a case-control study. BMC Pregnancy Childbirth 2016; 16:351. [PMID: 27832753 PMCID: PMC5103376 DOI: 10.1186/s12884-016-1142-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 11/01/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND To study determinants of stillbirths as indicators of quality of care during labour in an East African low resource referral hospital. METHODS A criterion-based unmatched unblinded case-control study of singleton stillbirths with birthweight ≥2000 g (n = 139), compared to controls with birthweight ≥2000 g and Apgar score ≥7 (n = 249). RESULTS The overall facility-based stillbirth rate was 59 per 1000 total births, of which 25 % was not reported in the hospital's registers. The majority of singletons had birthweight ≥2000 g (n = 139; 79 %), and foetal heart rate was present on admission in 72 (52 %) of these (intra-hospital stillbirths). Overall, poor quality of care during labour was the prevailing determinant of 71 (99 %) intra-hospital stillbirths, and median time from last foetal heart assessment till diagnosis of foetal death or delivery was 210 min. (interquartile range: 75-315 min.). Of intra-hospital stillbirths, 26 (36 %) received oxytocin augmentation (23 % among controls; odds ratio (OR) 1.86, 95 % confidential interval (CI) 1.06-3.27); 15 (58 %) on doubtful indication where either labour progress was normal or less dangerous interventions could have been effective, e.g. rupture of membranes. Substandard management of prolonged labour frequently led to unnecessary caesarean sections. The caesarean section rate among all stillbirths was 26 % (11 % among controls; OR 2.94, 95 % CI 1.68-5.14), and vacuum extraction was hardly ever done. Of women experiencing stillbirth, 27 (19 %) had severe hypertensive disorders (4 % among controls; OR 5.76, 95 % CI 2.70-12.31), but 18 (67 %) of these did not receive antihypertensives. An additional 33 (24 %) did not have blood pressure recorded during active labour. When compared to controls, stillbirths were characterized by longer admissions during labour. However, substandard care was prevalent in both cases and controls and caused potential risks for the entire population. Notably, women with foetal death on admission were in the biggest danger of neglect. CONCLUSIONS Intrapartum management of women experiencing stillbirth was a simple yet strong indicator of quality of care. Substandard care led to perinatal as well as maternal risks, which furthermore were related to unnecessary complex, time consuming, and costly interventions. Improvement of obstetric care is warranted to end preventable birth-related deaths and disabilities. TRIAL REGISTRATION This is the baseline analysis of the PartoMa trial, which is registered on ClinicalTrials.org ( NCT02318420 , 4th November 2014).
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Affiliation(s)
- Nanna Maaløe
- Global Health Section, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Building 9, 1353 Copenhagen K, Denmark
| | - Natasha Housseine
- Mnazi Mmoja Hospital, Zanzibar, Tanzania
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ib Christian Bygbjerg
- Global Health Section, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Building 9, 1353 Copenhagen K, Denmark
| | - Tarek Meguid
- Mnazi Mmoja Hospital, Zanzibar, Tanzania
- School of Health & Medical Sciences, State University of Zanzibar, P.O.Box:146, Zanzibar, Tanzania
| | | | | | - Birgitte Bruun Nielsen
- Department of Obstetrics, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - Jos van Roosmalen
- Athena Institute, VU University of Amsterdam, De Boelelaan 1105, 1081 HV Amsterdam, The Netherlands
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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.
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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.
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Maheu-Giroux M, Filippi V, Maulet N, Samadoulougou S, Castro MC, Meda N, Pouliot M, Kirakoya-Samadoulougou F. Risk factors for vaginal fistula symptoms in Sub-Saharan Africa: a pooled analysis of national household survey data. BMC Pregnancy Childbirth 2016; 16:82. [PMID: 27098261 PMCID: PMC4839076 DOI: 10.1186/s12884-016-0871-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 04/14/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Vaginal fistula (VF) is one of the most severe maternal morbidities with the immediate consequence of chronic urinary and/or fecal incontinence. The epidemiological evidence regarding risk factors for VF is dominated by facility-based studies. Our aim is to estimate the effect size of selected risk factors for VF using population-based survey data. METHODS We pooled all available Demographic and Health Surveys and Multiple Indicators Cluster Surveys carried out in sub-Saharan Africa that collected information on VF symptoms. Bayesian matched logistic regression models that accounted for the imperfect sensitivity and specificity of self-reports of VF symptoms were used for effect size estimation. RESULTS Up to 27 surveys were pooled, including responses from 332,889 women. Being able to read decreased the odds of VF by 13% (95% Credible Intervals (CrI): 1% to 23%), while higher odds of VF symptoms were observed for women of short stature (<150 cm) (Odds Ratio (OR) = 1.31; 95% CrI: 1.02-1.68), those that had experienced intimate partner sexual violence (OR = 2.13; 95% CrI: 1.60-2.86), those that reported sexual debut before the age of 14 (OR = 1.41; 95% CrI: 1.16-1.71), and those that reported a first birth before the age of 14 (OR = 1.39; 95% CrI: 1.04-1.82). The effect of post-primary education, female genital mutilation, and having problems obtaining permission to seek health care were not statistically significant. CONCLUSIONS Increasing literacy, delaying age at first sex/birth, and preventing sexual violence could contribute to the elimination of obstetric fistula. Concomitant improvements in access to quality sexual and reproductive healthcare are, however, required to end fistula in sub-Saharan Africa.
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Affiliation(s)
- Mathieu Maheu-Giroux
- Department of Infectious Disease Epidemiology, Imperial College London, St Mary's Hospital, London, UK
| | - Véronique Filippi
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Nathalie Maulet
- Institute of Health and Society, Université Catholique de Louvain, Clos Chapelle-aux-champs, Brussels, Belgium
| | - Sékou Samadoulougou
- Pôle Épidemiologie et Biostatistique, Institute de recherche expérimentale et Clinique, Université Catholique de Louvain, Clos Chapelle-aux-champs, Brussels, Belgium
| | - Marcia C Castro
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Nicolas Meda
- Centre Muraz, Ministry of Health, Bobo-Dioulasso, Burkina Faso.,UFR Sciences de la Santé, Université de Ouagadougou, Ouagadougou, Burkina Faso
| | - Mariève Pouliot
- Institute of Food and Resources Economics, Section for Global Development, University of Copenhagen, Copenhagen, Denmark
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de Bernis L, Kinney MV, Stones W, Ten Hoope-Bender P, Vivio D, Leisher SH, Bhutta ZA, Gülmezoglu M, Mathai M, Belizán JM, Franco L, McDougall L, Zeitlin J, Malata A, Dickson KE, Lawn JE. Stillbirths: ending preventable deaths by 2030. Lancet 2016; 387:703-716. [PMID: 26794079 DOI: 10.1016/s0140-6736(15)00954-x] [Citation(s) in RCA: 243] [Impact Index Per Article: 30.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Efforts to achieve the new worldwide goals for maternal and child survival will also prevent stillbirth and improve health and developmental outcomes. However, the number of annual stillbirths remains unchanged since 2011 and is unacceptably high: an estimated 2.6 million in 2015. Failure to consistently include global targets or indicators for stillbirth in post-2015 initiatives shows that stillbirths are hidden in the worldwide agenda. This Series paper summarises findings from previous papers in this Series, presents new analyses, and proposes specific criteria for successful integration of stillbirths into post-2015 initiatives for women's and children's health. Five priority areas to change the stillbirth trend include intentional leadership; increased voice, especially of women; implementation of integrated interventions with commensurate investment; indicators to measure effect of interventions and especially to monitor progress; and investigation into crucial knowledge gaps. The post-2015 agenda represents opportunities for all stakeholders to act together to end all preventable deaths, including stillbirths.
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Affiliation(s)
| | - Mary V Kinney
- Save the Children, Saving Newborn Lives, Edgemead, South Africa
| | - William Stones
- University of St Andrews, School of Medicine, North Haugh, St Andrews, UK; Department of Obstetrics and Gynaecology, University of Malawi, Blantyre, Malawi; International Federation of Gynecology and Obstetrics, London, UK
| | | | - Donna Vivio
- Global Health Bureau, US Agency for International Development, Washington, DC, USA
| | - Susannah Hopkins Leisher
- Mater Research Institute, University of Queensland, St Lucia, QLD, Australia; International Stillbirth Alliance, NJ, USA
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada; Center of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan; International Paediatric Association, World Health Organization, Geneva, Switzerland
| | - Metin Gülmezoglu
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Matthews Mathai
- Department of Maternal, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Jose M Belizán
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | | | - Lori McDougall
- Partnership for Maternal, Newborn and Child Health, Geneva, Switzerland
| | - Jennifer Zeitlin
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics, Sorbonne Paris Cité, Paris Descartes University, Paris, France
| | - Address Malata
- Kamuzu College of Nursing University of Malawi, Lilongwe, Malawi
| | - Kim E Dickson
- Programmes Division, UNICEF Headquarters, New York, NY, USA
| | - Joy E Lawn
- The Centre for Maternal, Adolescent, Reproductive and Child Health (MARCH) and Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Saving Newborn Lives, Save the Children, Washington, DC, USA
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48
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Lawn JE, Blencowe H, Waiswa P, Amouzou A, Mathers C, Hogan D, Flenady V, Frøen JF, Qureshi ZU, Calderwood C, Shiekh S, Jassir FB, You D, McClure EM, Mathai M, Cousens S. Stillbirths: rates, risk factors, and acceleration towards 2030. Lancet 2016; 387:587-603. [PMID: 26794078 DOI: 10.1016/s0140-6736(15)00837-5] [Citation(s) in RCA: 960] [Impact Index Per Article: 120.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
An estimated 2.6 million third trimester stillbirths occurred in 2015 (uncertainty range 2.4-3.0 million). The number of stillbirths has reduced more slowly than has maternal mortality or mortality in children younger than 5 years, which were explicitly targeted in the Millennium Development Goals. The Every Newborn Action Plan has the target of 12 or fewer stillbirths per 1000 births in every country by 2030. 94 mainly high-income countries and upper middle-income countries have already met this target, although with noticeable disparities. At least 56 countries, particularly in Africa and in areas affected by conflict, will have to more than double present progress to reach this target. Most (98%) stillbirths are in low-income and middle-income countries. Improved care at birth is essential to prevent 1.3 million (uncertainty range 1.2-1.6 million) intrapartum stillbirths, end preventable maternal and neonatal deaths, and improve child development. Estimates for stillbirth causation are impeded by various classification systems, but for 18 countries with reliable data, congenital abnormalities account for a median of only 7.4% of stillbirths. Many disorders associated with stillbirths are potentially modifiable and often coexist, such as maternal infections (population attributable fraction: malaria 8.0% and syphilis 7.7%), non-communicable diseases, nutrition and lifestyle factors (each about 10%), and maternal age older than 35 years (6.7%). Prolonged pregnancies contribute to 14.0% of stillbirths. Causal pathways for stillbirth frequently involve impaired placental function, either with fetal growth restriction or preterm labour, or both. Two-thirds of newborns have their births registered. However, less than 5% of neonatal deaths and even fewer stillbirths have death registration. Records and registrations of all births, stillbirths, neonatal, and maternal deaths in a health facility would substantially increase data availability. Improved data alone will not save lives but provide a way to target interventions to reach more than 7000 women every day worldwide who experience the reality of stillbirth.
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Affiliation(s)
- Joy E Lawn
- Centre for Maternal, Adolescent, Reproductive and Child Health, London School of Hygiene & Tropical Medicine, London, UK; Saving Newborn Lives, Save the Children, Washington, DC, USA.
| | - Hannah Blencowe
- Centre for Maternal, Adolescent, Reproductive and Child Health, London School of Hygiene & Tropical Medicine, London, UK; Saving Newborn Lives, Save the Children, Washington, DC, USA
| | - Peter Waiswa
- Maternal and Newborn Centre of Excellence, Makerere University and INDEPTH Maternal Newborn Working Group, School of Public Health, Kampala, Uganda
| | - Agbessi Amouzou
- Division of Data, Research, and Policy, United Nations Children's Fund, New York, NY, USA
| | - Colin Mathers
- Department of Information, Evidence and Research, World Health Organization, Geneva, Switzerland
| | - Dan Hogan
- Department of Information, Evidence and Research, World Health Organization, Geneva, Switzerland
| | | | - J Frederik Frøen
- Department of International Public Health, Norwegian Institute of Public Health, Oslo, Norway; Center for Intervention Science for Maternal and Child Health, University of Bergen, Bergen, Norway
| | - Zeshan U Qureshi
- Institute of Global Health, University College London, London, UK
| | - Claire Calderwood
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Suhail Shiekh
- Centre for Maternal, Adolescent, Reproductive and Child Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Fiorella Bianchi Jassir
- Centre for Maternal, Adolescent, Reproductive and Child Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Danzhen You
- Division of Data, Research, and Policy, United Nations Children's Fund, New York, NY, USA
| | | | - Matthews Mathai
- Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Simon Cousens
- Centre for Maternal, Adolescent, Reproductive and Child Health, London School of Hygiene & Tropical Medicine, London, UK
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