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Betrán AP, Torloni MR, Althabe F, Altieri E, Arulkumaran S, Ashraf F, Bailey P, Bonet M, Bucagu M, Clark E, Changizi N, Churchill R, Dominico S, Downe S, Draycott T, Faye A, Feeley C, Geelhoed D, Gherissi A, Gholbzouri K, Grupta G, Hailegebriel TD, Hanson C, Hartmann K, Hassan L, Hofmeyr GJ, Jayathilaka AC, Kabore C, Kidula N, Kingdon C, Kuzmenko O, Lumbiganon P, Mola GDL, Moran A, de Muncio B, Nolens B, Opiyo N, Pattinson RC, Romero M, van Roosmalen J, Siaulys MM, Camelo JS, Smith J, Sobel HL, Sobhy S, Sosa C, Souza JP, ten Hoope-Bender P, Thangaratinam S, Varallo J, Wright A, Yates A, Oladapo OO. A research agenda to improve incidence and outcomes of assisted vaginal birth. Bull World Health Organ 2023; 101:723-729. [PMID: 37961052 PMCID: PMC10630731 DOI: 10.2471/blt.23.290140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 08/15/2023] [Accepted: 09/13/2023] [Indexed: 11/15/2023] Open
Abstract
Access to emergency obstetric care, including assisted vaginal birth and caesarean birth, is crucial for improving maternal and childbirth outcomes. However, although the proportion of births by caesarean section has increased during the last few decades, the use of assisted vaginal birth has declined. This is particularly the case in low- and middle-income countries, despite an assisted vaginal birth often being less risky than caesarean birth. We therefore conducted a three-step process to identify a research agenda necessary to increase the use of, or reintroduce, assisted vaginal birth: after conducting an evidence synthesis, which informed a consultation with technical experts who proposed an initial research agenda, we sought and incorporated the views of women's representatives of this agenda. This process has allowed us to identify a comprehensive research agenda, with topics categorized as: (i) the need to understand women's perceptions of assisted vaginal birth, and provide appropriate and reliable information; (ii) the importance of training health-care providers in clinical skills but also in respectful care, effective communication, shared decision-making and informed consent; and (iii) the barriers to and facilitators of implementation and sustainability. From women's feedback, we learned of the urgent need to recognize labour, childbirth and postpartum experiences as inherently physiological and dignified human processes, in which interventions should only be implemented if necessary. The promotion and/or reintroduction of assisted vaginal birth in low-resource settings requires governments, policy-makers and hospital administrators to support skilled health-care providers who can, in turn, respectfully support women in labour and childbirth.
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Affiliation(s)
- Ana Pilar Betrán
- Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland
| | - Maria Regina Torloni
- EBH Postgraduate Programme, Department of Medicine, Sao Paulo Federal University-UNIFESP, Sao Paulo, Brazil
| | | | - Elena Altieri
- Behavioural Insights Unit, Department of Communications, World Health Organization, Geneva, Switzerland
| | - Sabaratnam Arulkumaran
- St George's University of London, London, United Kingdom of Great Britain and Northern Ireland
| | - Fatema Ashraf
- Department of Obstetrics & Gynaecology, Shaheed Suhrawardy Medical College Hospital, Dhaka, Bangladesh
| | - Patricia Bailey
- Reproductive, Maternal, Newborn and Child Health, FHI360, Durham, North Carolina, United States of America
| | - Mercedes Bonet
- Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland
| | - Maurice Bucagu
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Emma Clark
- Maternal Child Health and Nutrition, USAID Bureau for Global Health, Arlington, United States
| | - Nasrin Changizi
- Maternal, Fetal and Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Robyn Churchill
- Maternal Child Health and Nutrition, USAID Bureau for Global Health, Arlington, United States
| | | | - Soo Downe
- Department of Midwifery, University of Central Lancashire, Preston, United Kingdom
| | - Tim Draycott
- The Chilterns, Southmead Hospital, Bristol, United Kingdom
| | - Arfang Faye
- Reproductive, Maternal, Newborn, Child and Adolescent Health Unit, Ministry of Health, Gambia
| | - Claire Feeley
- School of Community Health and Midwifery, University of Central Lancashire, Preston, United Kingdom
| | | | - Atf Gherissi
- High School for Health Science and Techniques, University of Tunis El Manar, Tunis, Tunisia
| | | | - Gagan Grupta
- United Nations Children's Fund, New York, United States
| | | | - Claudia Hanson
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Katharina Hartmann
- Mother Hood e.V. - Federal Parents' Initiative for the Protection of Mother and Child during Pregnancy, Bonn, Germany
| | - Lubna Hassan
- Women's Health Intervention and Development Initiative, Islamabad, Pakistan
| | - George Justus Hofmeyr
- Department of Obstetrics and Gyneacology, University of Botswana, Gaborone, Botswana
| | | | - Charles Kabore
- Institut de Recherche en Sciences de la Sante, Ouagadougou, Burkina Faso
| | - Nancy Kidula
- WHO Regional Office for Africa, Brazzaville, Congo
| | - Carol Kingdon
- Research in Childbirth and Health Unit, University of Central Lancashire, Preston, United Kingdom
| | - Oleg Kuzmenko
- Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland
- EBH Postgraduate Programme, Department of Medicine, Sao Paulo Federal University-UNIFESP, Sao Paulo, Brazil
| | - Pisake Lumbiganon
- Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland
- Buenos Aires, Argentina
| | - Glen DL Mola
- Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland
- Behavioural Insights Unit, Department of Communications, World Health Organization, Geneva, Switzerland
| | - Allisyn Moran
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Bremen de Muncio
- Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland
- St George's University of London, London, United Kingdom of Great Britain and Northern Ireland
| | - Barbara Nolens
- Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland
- Department of Obstetrics & Gynaecology, Shaheed Suhrawardy Medical College Hospital, Dhaka, Bangladesh
| | - Newton Opiyo
- Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland
| | - Robert C Pattinson
- Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland
- Reproductive, Maternal, Newborn and Child Health, FHI360, Durham, North Carolina, United States of America
| | - Mariana Romero
- Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Jos van Roosmalen
- Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland
- Maternal Child Health and Nutrition, USAID Bureau for Global Health, Arlington, United States
| | - Monica M Siaulys
- Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland
- Maternal, Fetal and Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Jose Simon Camelo
- Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland
- Thamini Uhai (Value Life), United Republic of Tanzania
| | - Jeffrey Smith
- Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland
- Department of Midwifery, University of Central Lancashire, Preston, United Kingdom
| | - Howard L Sobel
- Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland
- The Chilterns, Southmead Hospital, Bristol, United Kingdom
| | - Soha Sobhy
- Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland
- Reproductive, Maternal, Newborn, Child and Adolescent Health Unit, Ministry of Health, Gambia
| | - Claudio Sosa
- Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland
- School of Community Health and Midwifery, University of Central Lancashire, Preston, United Kingdom
| | - Joao Paulo Souza
- Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland
- Tete, Mozambique
| | - Petra ten Hoope-Bender
- Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland
- High School for Health Science and Techniques, University of Tunis El Manar, Tunis, Tunisia
| | - Shakila Thangaratinam
- Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland
- WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - John Varallo
- Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland
- United Nations Children's Fund, New York, United States
| | - Alison Wright
- Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Ann Yates
- Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland
- Mother Hood e.V. - Federal Parents' Initiative for the Protection of Mother and Child during Pregnancy, Bonn, Germany
| | - Olufemi O Oladapo
- Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland
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Ngongo CJ, Raassen TJ, Mahendeka M, Lombard L, van Roosmalen J, Temmerman M. Rare causes of genital fistula in nine African countries: a retrospective review. BMC Womens Health 2022; 22:497. [PMID: 36474228 PMCID: PMC9724406 DOI: 10.1186/s12905-022-02050-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 11/07/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Most genital fistulas result from prolonged, obstructed labor or surgical complications. Other causes include trauma (from accidents, traditional healers, or sexual violence), radiation, carcinoma, infection, unsafe abortion, and congenital malformation. METHODS This retrospective records review focuses on rare fistula causes among 6,787 women who developed fistula after 1980 and sought treatment between 1994 and 2017 in Tanzania, Uganda, Kenya, Malawi, Zambia, Rwanda, Ethiopia, Somalia, and South Sudan. We compare fistula etiologies across countries and assess associations between rare causes and type of incontinence (urine, feces, or both). RESULTS Rare fistula accounted for 1.12% (76/6,787) of all fistulas, including traumatic accidents (19/6,787, 0.28%), traumatic sexual violence (15/6,787, 0.22%), traumatic injuries caused by traditional healers (13/6,787, 0.19%), unsafe abortion (10/6,791, 0.15%), radiation (8/6,787, 0.12%), complications of HIV infection (6/6,787, 0.09%), and congenital abnormality (5/6,787, 0.07%). Trauma caused by traditional healers was a particular problem among Somali women. CONCLUSION Fistulas attributable to rare causes illuminate a variety of risks confronting women. Fistula repair training materials should distinguish trauma caused by traditional healers as a distinct fistula etiology. Diverse causes of fistula call for multi-pronged strategies to reduce fistula incidence.
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Affiliation(s)
- Carrie J. Ngongo
- grid.62562.350000000100301493Global Health Division, RTI International, Research Triangle Park, USA
| | | | - Marietta Mahendeka
- grid.413123.60000 0004 0455 9733Bugando Medical Centre, Mwanza, Tanzania
| | | | - Jos van Roosmalen
- grid.10419.3d0000000089452978Leiden University Medical Centre and Athena Institute VU University, Amsterdam, the Netherlands
| | - Marleen Temmerman
- grid.470490.eCentre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya ,grid.5342.00000 0001 2069 7798Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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Ngongo CJ, Raassen TJIP, Mahendeka M, Lombard L, van Roosmalen J, Temmerman M. A retrospective review of genital fistula occurrence in nine African countries. BMC Pregnancy Childbirth 2022; 22:744. [PMID: 36195839 PMCID: PMC9531465 DOI: 10.1186/s12884-022-05051-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 09/13/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Female genital fistulas are abnormal communications that lead to urinary and/or fecal incontinence. This analysis compares the characteristics of women with fistulas to understand how countries differ from one another in the circumstances of genital fistula development. METHODS This retrospective records review evaluated demographics and circumstances of fistula development for 6,787 women who sought fistula treatment between 1994 and 2017 in Tanzania, Uganda, Kenya, Malawi, Rwanda, Somalia, South Sudan, Zambia, and Ethiopia. RESULTS Most women developed fistula during childbirth, whether vaginal (3,234/6,787, 47.6%) or by cesarean section (3,262/6,787, 48.1%). Others had fistulas attributable to gynecological surgery (215/6,787, 3.2%) or rare causes (76/6,787, 1.1%). Somalia, South Sudan, and Ethiopia had comparatively high proportions following vaginal birth and birth at home, where access to care was extremely difficult. Fistulas with live births were most common in Kenya, Malawi, Rwanda, Uganda, Tanzania, and Zambia, indicating more easily accessible care. CONCLUSIONS Characteristics of women who develop genital fistula point to geographic differences in obstetric care. Access to care remains a clear challenge in South Sudan, Somalia, and Ethiopia. Higher proportions of fistula after cesarean birth and gynecological surgery in Kenya, Malawi, Rwanda, Uganda, Tanzania, and Zambia signal potential progress in obstetric fistula prevention while compelling attention to surgical safety and quality of care.
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Affiliation(s)
- Carrie J. Ngongo
- Global Health Division, RTI International, Research Triangle Park, USA
| | | | | | | | - Jos van Roosmalen
- Leiden University Medical Centre and Athena Institute VU University, Amsterdam, Netherlands
| | - Marleen Temmerman
- Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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