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Paluku JL, Bartels SA, Kataliko BK, Furaha CM, Aksanti BK, Kalole BK, Kamabu EM, Lwanzo CM, Kasereka JML, Mukuku O, Tsongo ZK, Wembonyama SO, Mpoy CW, Juakali JS. Access to High Quality Surgical Repair Services is a Fundamental Right of Patients with Obstetric Fistulas: A Study on Quality of Life Data in the Democratic Republic of the Congo. Int J Womens Health 2024; 16:645-653. [PMID: 38645984 PMCID: PMC11032678 DOI: 10.2147/ijwh.s451929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 04/10/2024] [Indexed: 04/23/2024] Open
Abstract
Purpose The aim of this study was to assess quality of life (QoL) using the WHOQOL-BREF questionnaire among obstetric fistula (OF) patients before and after surgical repair of OF (SROF). Methods A longitudinal cohort study was conducted between November 2022 and October 2023 in the Democratic Republic of the Congo (DRC) among OF patients to assess their QoL before and after SROF. A systematic sampling technique was used to recruit a total of 158 OF patients. The WHOQOL-BREF questionnaire assessed general health, life experience, as well as physical, social, psychological, and environmental domains. Results The mean age among the 158 respondents was 33.51 ± 9.63 years, and 77.85% of them lived in rural areas. In terms of surgical outcomes, 80.38% had closure of the OF with regained continence, 5.7% had closure of the OF with persistent incontinence, and 13.9% had a failed surgical repair. Overall mean QoL scores were higher after OF surgical repair (3.83, standard deviation [SD]=0.89) in comparison to pre-operative (1.58, SD=0.63) (p<0.001). These QoL improvements included physical (mean score 66.32 post-surgery versus 28.37 before, p<0.001), social (mean score 64.92 post-surgery versus 27.90 before, p<0.001), psychological (mean score 68.09 post-surgery versus 21.28 before, p<0.001), environmental (mean score 48.41 post-surgery versus 16.91 before p<0.001), and general domains. Patients with a successful OF repair had a better QoL score than those with a closed fistula but ongoing incontinence or those for whom surgery failed to close the fistula. Conclusion The present study showed that among OF patients, all QoL domains were impaired before surgical repair and significantly improved after surgery. Successful OF closure alleviates the consequences of OF and helps to restore patients' wellbeing. Our findings call for improved access to high-quality surgical repair services as a fundamental right for OF patients.
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Affiliation(s)
- Justin Lussy Paluku
- Department of Obstetrics and Gynecology, University of Goma, Goma, Democratic Republic of the Congo
- Department of Obstetrics and Gynecology, HEAL Africa Hospital, Goma, Democratic Republic of the Congo
| | - Susan A Bartels
- Department of Emergency Medicine, Queen’s University, Kingston, Canada
- Department of Public Health Sciences, Queen’s University, Kingston, Canada
| | | | - Cathy Mufungizi Furaha
- Department of Obstetrics and Gynecology, University of Goma, Goma, Democratic Republic of the Congo
- Department of Obstetrics and Gynecology, HEAL Africa Hospital, Goma, Democratic Republic of the Congo
| | - Barthelemy Kasi Aksanti
- Department of Obstetrics and Gynecology, HEAL Africa Hospital, Goma, Democratic Republic of the Congo
| | - Benjamin Kambale Kalole
- Department of Obstetrics and Gynecology, HEAL Africa Hospital, Goma, Democratic Republic of the Congo
| | - Eugénie Mukekulu Kamabu
- Department of Internal Medicine, HEAL Africa Hospital, Goma, Democratic Republic of the Congo
| | - Chrispin Musubao Lwanzo
- Department of Obstetrics and Gynecology, HEAL Africa Hospital, Goma, Democratic Republic of the Congo
| | - Jonathan M L Kasereka
- Department of Orthopedics and Trauma, HEAL Africa Hospital, Goma, Democratic Republic of the Congo
| | - Olivier Mukuku
- Department of Maternal and Child Health, High Institute of Medical Techniques, Lubumbashi, Democratic Republic of the Congo
| | | | - Stanis Okitotsho Wembonyama
- Department of Pediatrics, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo
- Department of Public Health, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo
| | - Charles Wembonyama Mpoy
- Department of Obstetrics and Gynecology, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo
| | - Jeannot Sihalikyolo Juakali
- Department of Obstetrics and Gynecology, University of Kisangani, Kisangani, Democratic Republic of the Congo
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Paluku JL, Aksanti BK, Clemmer WC, Furaha CM, Kamabu EM, Kasereka JML, Kalole BK, Mukuku O, Tsongo ZK, Wembonyama SO, Mpoy CW, Juakali JS. Determinants and predictive model of failure of surgical repair of obstetric vesico-vaginal fistula in the Democratic Republic of the Congo. Reprod Health 2024; 21:42. [PMID: 38561789 PMCID: PMC10986004 DOI: 10.1186/s12978-024-01779-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 03/21/2024] [Indexed: 04/04/2024] Open
Abstract
INTRODUCTION Surgical repair of obstetric fistula aims to restore the anatomical and functional integrity of the urinary tract, enabling affected women to regain their dignity and quality of life. However, such repairs can end in a failure. The aim of this study is to develop a predictive score to identify factors influencing failure of surgical repair of obstetric vesico-vaginal fistula (FSROVVF) in the Democratic Republic of the Congo. METHODS This was an analytical cross-sectional study of 318 women with obstetric vesico-vaginal fistula (OVVF) who had undergone surgical management. A bivariate and then a multivariate analysis were performed. Score discrimination was assessed using the ROC curve and C-index, and score calibration using the Hosmer-Lemeshow test. RESULTS Surgical repair of OVVF was unsuccessful in 16.98% of cases (54/318). After logistic modeling, six criteria emerged as predictive factors for FSROVVF: the presence of fibrosis (AOR = 5.01; 95% CI:1.73-14.49), the presence of 2 or more fistulas (AOR = 9.04; 95% CI:3.01-27.13), the association of OVVF with another anatomoclinical entity of fistula (AOR = 3.16; 95% CI:1.09-9.13), the fistula size > 3 cm (AOR = 3.65; 95% CI:1.36-9.76), the peri-operative hemorrhage (AOR = 7.01; 95% CI:2.33-21.03), and the post-operative infection (AOR = 178.89; 95% CI:26.09-1226.64). A score ranging from 0 to 13 points was obtained, of which a value ≤ 5 points defines a low risk of FSROVVF, a value between 6 and 8 points defines a moderate risk and value ≥ 9 points corresponds to a high risk of FSROVVF. The area under the ROC curve of the score is 0.925 with a sensitivity of 61.11%, a specificity of 96.59%, a positive predictive value of 78.57% and a negative predictive value of 92.39%. CONCLUSION This study demonstrated that the number of fistulas ≥ 2, fistula size > 3 cm, fibrosis, association of OVVF with other types of fistulas, peri-operative hemorrhage, and post-operative infection are factors predictive of FSROVVF. These six factors are key contributors to the score used to predict FSROVVF. Once validated, this score will inform and enable preoperative counseling regarding the prognosis and the chances of a successful outcome of surgical repair of OVVF.
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Affiliation(s)
- Justin Lussy Paluku
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Goma, Goma, Democratic Republic of the Congo.
- Department of Obstetrics and Gynecology, HEAL Africa Hospital, Goma, Democratic Republic of the Congo.
| | - Barthelemy Kasi Aksanti
- Department of Obstetrics and Gynecology, HEAL Africa Hospital, Goma, Democratic Republic of the Congo
| | - William C Clemmer
- Department of Family Medicine, American Academy of Family Physicians, Orono, USA
| | - Cathy Mufungizi Furaha
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Goma, Goma, Democratic Republic of the Congo
- Department of Obstetrics and Gynecology, HEAL Africa Hospital, Goma, Democratic Republic of the Congo
| | - Eugénie Mukekulu Kamabu
- Department of Internal Medicine, HEAL Africa Hospital, Goma, Democratic Republic of the Congo
| | - Jonathan M L Kasereka
- Department of Orthopedics and Trauma, HEAL Africa Hospital, Goma, Democratic Republic of the Congo
| | - Benjamin Kambale Kalole
- Department of Obstetrics and Gynecology, HEAL Africa Hospital, Goma, Democratic Republic of the Congo
| | - Olivier Mukuku
- Department of Maternal and Child Health, Institut Supérieur des Techniques Médicales, Lubumbashi, Democratic Republic of the Congo
| | - Zacharie Kibendelwa Tsongo
- Department of Internal Medicine, Faculty of Medicine, University of Kisangani, Kisangani, Democratic Republic of the Congo
| | - Stanis Okitotsho Wembonyama
- Departments of Pediatrics and Public Health, Faculty of Medicine, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo
| | - Charles Wembonyama Mpoy
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo
| | - Jeannot Sihalikyolo Juakali
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Kisangani, Kisangani, Democratic Republic of the Congo
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Paluku JL, Sikakulya FK, Furaha CM, Kamabu EM, Aksanti BK, Tsongo ZK, Wembonyama SO, Mpoy CW, Juakali JS. Epidemiological, anatomoclinical, and therapeutic profile of obstetric fistula in the Democratic Republic of the Congo: About 1267 patients. Trop Med Int Health 2024; 29:266-272. [PMID: 38168056 DOI: 10.1111/tmi.13969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
OBJECTIVE Our aim is to describe the epidemiological, anatomoclinical and therapeutic profile of obstetric fistula (OF) in the Democratic Republic of the Congo (DRC). METHODOLOGY This was a descriptive retrospective study that collected 1416 obstetric fistulas in 1267 patients in seven provinces of the DRC, treated between January 2017 and December 2022. The variables studied were epidemiological, anatomoclinical and therapeutic. RESULTS The mean age of patients at the time of surgical repair was 33.2 years (range: 15 and 77 years) and 32.8% of patients were aged between 20 and 29 years. The mean age of the fistula at repair was 10 years (range: 3.5 months and 56 years). At the time of fistula, 61.7% of patients had delivered vaginally and 28.7% by caesarean section and 8.2% of patients had a haemostasis hysterectomy. Labour lasted at least 3 days in 47.3% of these patients for the fistula birth. Deliveries took place either at home (27.4%) or in a health facility (72.6%); 83.6% of newborns resulting from these births had died. Taken as a whole, urogenital fistulas are more common than genito-digestive fistulas. Urethro-vaginal (26.2%) and vesico-uterine (24.7%) anatomoclinical entities were predominant among urogenital fistulas. A total of 1416 fistulas were surgically repaired in 1267 patients. These repairs were successful for 1226 (86.6%) fistulas. The main surgical route used was transvaginal (68.8%). CONCLUSION In the DRC, obstetric fistula is common in young adult women. It often results from vaginal delivery, after prolonged labour. Fistula births often result in the death of newborns. Uro-genital obstetric fistulas are the most frequent with predominance of urethro-vaginal and vesico-uterine anatomoclinical entities. Fistulas remain untreated for a long time. Mostly done transvaginally, surgical repair gives a good result.
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Affiliation(s)
- Justin Lussy Paluku
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Goma, Goma, Democratic Republic of the Congo
- Department of Obstetrics and Gynecology, HEAL Africa Hospital, Goma, Democratic Republic of the Congo
| | - Franck Katembo Sikakulya
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus, Ishaka-Bushenyi, Uganda
- Department of Surgery, Faculty of Medicine, Université Catholique du Graben, Butembo, Democratic Republic of the Congo
| | - Cathy Mufungizi Furaha
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Goma, Goma, Democratic Republic of the Congo
- Department of Obstetrics and Gynecology, HEAL Africa Hospital, Goma, Democratic Republic of the Congo
| | - Eugénie Mukekulu Kamabu
- Department of Internal Medicine, HEAL Africa Hospital, Goma, Democratic Republic of the Congo
| | - Barthelemy Kasi Aksanti
- Department of Obstetrics and Gynecology, HEAL Africa Hospital, Goma, Democratic Republic of the Congo
| | - Zacharie Kibendelwa Tsongo
- Department of Internal Medicine, Faculty of Medicine, University of Kisangani, Kisangani, Democratic Republic of the Congo
| | - Stanis Okitotsho Wembonyama
- Departments of Pediatrics and Public Health, Faculty of Medicine, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo
| | - Charles Wembonyama Mpoy
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo
| | - Jeannot Sihalikyolo Juakali
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Kisangani, Kisangani, Democratic Republic of the Congo
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Paluku JL, Bartels SA, Kasereka JM, Aksanti BK, Kamabu EM, Mukuku O, Tsongo ZK, Wembonyama SO, Mpoy CW, Juakali JS. HEAL Africa score to predict failure of surgical repair of obstetric urethro-vaginal fistula in the Democratic Republic of the Congo. BMC Womens Health 2024; 24:111. [PMID: 38341554 PMCID: PMC10858488 DOI: 10.1186/s12905-024-02948-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 02/01/2024] [Indexed: 02/12/2024] Open
Abstract
INTRODUCTION Obstetric fistula (OF) repair surgery aims to restore the anatomical and functional integrity of the urinary tract, allowing affected women to regain their dignity and quality of life. However, in some cases, this surgical repair may fail. The objective of this study was to develop a predictive score to identify factors associated with the failure of surgical repair of obstetric urethro-vaginal fistula (FSROUVF) in the Democratic Republic of the Congo (DRC). METHODS This is an analytical cross-sectional study of 358 patients with obstetric urethro-vaginal fistula (OUVF) who received surgical repair. We conducted bivariate and multivariate analyses. Score discrimination was assessed using the receiver operating characteristic (ROC) curve, C-index, and score calibration according to the Hosmer-Lemeshow test. RESULTS Surgical repair of OUVF failed in 24.86% of cases (89/358). After logistic modelling, 6 criteria predicted FSROUVF: the use of intravaginal indigenous products (AOR = 3.59; 95% CI: 1.51-8.53), the presence of fibrosis (AOR = 6.37; 95% CI: 1.70-23.82), the presence of 2 or more fistulas in the same patient (AOR = 7.03; 95% CI: 3.14-15.72), the total urethral damage (AOR = 3.29; 95% CI: 1.36-7.95), the fistula size > 3 cm (AOR = 5.65; 95% CI: 2.12-15.01), and the postoperative infection (AOR = 351.10; 95% CI: 51.15-2409.81). A score of 0 to 14 was obtained, with a value ≤5 points indicating a low risk of FSROUVF, a value between 6 and 8 indicating a moderate risk, and a value ≥9 points corresponding to a high risk of FSROUVF. The area under the ROC curve of the score is 0.938 with a sensitivity of 60.67%, a specificity of 96.28%, a positive predictive value of 84.38%, and a negative predictive value of 88.10%. CONCLUSION We report a FSROUVF rate in the DRC approaching a quarter of operative patients. Predictors of failure included fibrosis, presence of 2 or more fistulas, total urethral involvement, fistula size greater than 3 cm, postoperative infection, and use of intravaginal indigenous products. These factors are constitutive of the HEAL Africa score, which once validated, may have value in pre-operative counselling of patients. This study could be valuable for policy and strategies to address the problem of OUVF in the DRC and in resource limited settings more generally.
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Affiliation(s)
- Justin Lussy Paluku
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Goma, Goma, Democratic Republic of the Congo.
- Department of Obstetrics and Gynecology, HEAL Africa Hospital, Goma, Democratic Republic of the Congo.
| | - Susan A Bartels
- Departments of Emergency Medicine and Public Health Sciences, Queen's University, Kingston, Canada
| | - Jonathan Ml Kasereka
- Department of Orthopedics and Trauma, HEAL Africa Hospital, Goma, Democratic Republic of the Congo
| | - Barthelemy Kasi Aksanti
- Department of Obstetrics and Gynecology, HEAL Africa Hospital, Goma, Democratic Republic of the Congo
| | - Eugénie Mukekulu Kamabu
- Department of Internal Medicine, HEAL Africa Hospital, Goma, Democratic Republic of the Congo
| | - Olivier Mukuku
- Institut Supérieur des Techniques Médicales, Lubumbashi, Democratic Republic of the Congo
| | - Zacharie Kibendelwa Tsongo
- Department of Internal Medicine, Faculty of Medicine, University of Kisangani, Kisangani, Democratic Republic of the Congo
| | - Stanis Okitotsho Wembonyama
- Department of Pediatrics, Faculty of Medicine, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo
- Department of Public Health, Faculty of Medicine, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo
| | - Charles Wembonyama Mpoy
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo
| | - Jeannot Sihalikyolo Juakali
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Kisangani, Kisangani, Democratic Republic of the Congo
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Paluku JL, Carter TE, Lee M, Bartels SA. Massive single visit cervical pre-cancer and cancer screening in eastern Democratic Republic of Congo. BMC Womens Health 2019; 19:43. [PMID: 30832697 PMCID: PMC6399865 DOI: 10.1186/s12905-019-0737-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 02/20/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND In the Democratic Republic of Congo (DRC), practical and affordable strategies for cervical cancer screening are needed to detect and treat pre-cancerous and cancerous lesions in a timely fashion. This study presents the results of mass cervical cancer screenings in eastern DRC using a "screen and treat" approach. METHODS In two mass cervical cancer screening campaigns, patients underwent a combination of visual inspection of the cervix with acetic acid, visual inspection of the cervix with Lugol iodine solution, and colposcopy with or without loop electrosurgical excision procedure. Cervical biopsy samples were taken for histology analysis. Marital status, age, history of abnormal bleeding, and number of pregnancies were recorded for each patient and association analyses were performed. RESULTS Of the 644 women who received cervical pre-cancer and cancer screening, 48 had suspicious pre-cancer and cancer lesions that were biopsied (7.45%). On histology analysis cervical intraepithelial neoplasia (CIN) was identified in 15 (2.33%), squamous cell carcinoma (SCC) was identified in 6 (0.93%) and non-neoplastic cervicitis was identified in 11 (1.71%). Abnormal bleeding was significantly associated with CIN/SCC but no significant association was observed for prior pregnancy, patients' home region, or age. CONCLUSION Forty-eight women with suspicious pre-cancerous or cancerous lesions were successfully identified using the "screen and treat" approach in eastern DRC, suggesting that this approach is feasible for reducing cervical cancer morbidity and mortality. However, community awareness would be necessary, providers would have to be properly trained, referral and follow up mechanisms would have to be put in place, and equipment / supplies would have to be secured if the "screen and treat" approach is to be successful on a wider scale. There is ongoing need for HPV vaccination in DRC as a primary prevention strategy against cervical cancer.
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Affiliation(s)
| | - Tamar E Carter
- Bioinformatics and Genomics Department, University of North Carolina, Charlotte, USA
- Department of Biology, Baylor University, Waco, TX, USA
| | | | - Susan A Bartels
- Departments of Emergency Medicine and Public Health Sciences, Queen's University, Kingston, Canada
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