The Promise and Neglect of Follow-up Care in Obstetric Fistula Treatment in Uganda

Considered the most severe of maternal morbidities, obstetric fistula is a debilitating childbirth injury that results in complete incontinence with severe physical and psychosocial consequences.The primary intervention for women with obstetric fistula is surgical repair, and success rates for repair are reported between 80% and 97%. However, successful treatment is commonly defined solely by the closure of the fistula defect and often fails to capture women who continue to experience urinary incontinence after repair. Residual incontinence post-fistula repair is both underreported and under-examined in the literature. Through a novel mixed-method study that examined clinical, quantitative, and qualitative aspects of residual incontinence post-repair, this chapter draws on in-depth interviews with women suffering with residual incontinence and fistula surgeons, participant observation, and a desk review of fistula policies and guidelines to argue that an inadequate model of fistula treatment that neglects follow-up care exists. We found that obstetric fistula policy has been determined in large part over the years by international development agencies and funding organizations, such as international nongovernmental organizations (INGOs). We argue that the neglect in follow-up care is evident in fistula policy and can be traced to a donor-funded treatment model that fails to prioritize and fund follow-up care as an essential component of fistula treatment, instead focusing on a “narrative of success” in fistula treatment. As a result, poor outcomes are underreported and women who experience poor outcomes are largely erased from the fistula narrative. This erasure has limited the attention, resources, research, and dedicated to residual incontinence, leaving out women suffering from residual incontinence largely without alternative treatment options.

Awareness of obstetric fistula and its associated factors among reproductive-age women in Ethiopia: a multilevel analysis of Ethiopian Demographic and Health Survey data: a cross-sectional study

ObjectiveThis study aimed to determine the magnitude and associated factors of obstetric fistula (OF) awareness among reproductive-age women in Ethiopia.MethodsThis community-based cross-sectional study was conducted among 15 683 reproductive-aged women in Ethiopia. Following the presentation of a case vignette, women’s OF awareness was measured by asking if they had ever heard of OF. A multilevel multivariable logistic regression analysis was employed. A 95% CI and p<0.05 were used to declare statistical significance.ResultThe magnitude of women’s awareness of OF was 38% (95% CI 0.37 to 0.39). Individual level variables including being in the age group of 20–25 (adjusted OR, AOR 1.17; 95% CI 1.02 to 1.35), 26–30 (AOR 1.50; 95% CI 1.27 to 1.76) and >30 (AOR 1.76; 95% CI 1.50 to 2.07), being Muslim (AOR 0.83; 95% CI 0.73 to 0.94), having primary (AOR 1.70; 95% CI 1.53 to 1.89), secondary (AOR 3.43; 95% CI 2.95 to 3.99) and tertiary education (AOR 5.88; 95% CI 4.66 to 7.42), history of pregnancy termination (AOR 1.31; 95% CI 1.13 to 1.51), media exposure (AOR 1.33; 95% CI 1.2 to 1.49), internet use (AOR 2.25; 95% CI 1.84 to 2.75), medium (AOR 1.17; 95% CI 1.02 to 1.34) and rich house hold wealth (AOR 1.50; 95% CI 1.31 to 1.72) and community level factors including high community media exposure (AOR 1.30; 95% CI 1.05 to 1.61), high community antenatal care rate (AOR 1.66; 95% CI 1.37 to 2.02) and low health facility distance problem (AOR 1.49; 95% CI 1.23 to 1.81) were significantly associated with women’s awareness of OF.Conclusions and recommendationsThe magnitude of women’s awareness of OF was very low in Ethiopia. Awareness of OF was influenced by sociodemographic, economic, obstetric and community-related factors. Thus, tailored public health education is required at the national level to enhance women’s awareness of OF.

“Counting those never bubble over” Estimated prevalence and its determinants of obstetric fistula among childbearing women in 14 African countries: Multilevel Analysis

Background Obstetric fistula is a leakage between genital tract and urinary tract and/or between genital tract and rectum. The commonest cause of obstetric fistula is prolonged labour which magnify in the areas of poor prenatal and emergency obstetric care. In Africa, there is poor of quality of obstetric care and poor social support for those who faced fistula. Obstetric fistula shatters the life of the women and the consequence is nasty while multicounty level estimate on the magnitude and determinates of fistula were nil. Multicounty level of estimate of the magnitude of fistula is important to design and fill the gaps of quality of obstetric care and design the appropriate corrective intervention mechanisms of obstetric fistula. Therefore, this study aimed the estimate the magnitude of obstetric fistula and its determinants among childbearing women in 14 Africa countries based on recent demographic and health survey data. Methods Secondary data were used from 14 African demographic and health survey database. The data were extracted based on the objective the study and previous literatures. Data were weighted using sampling weight before any statistical analysis to account the sampling design. STATA version 15 was used for extracting, recoding, and for further multilevel analysis. The appropriateness of multilevel analysis were checked by Median odds ratio (MOR), proportional change in Variance (PCV), Intraclass correlation coefficient (ICC), and Akaike Information Criteria (AIC). Four model was build and the best model was selected based on the smallest Akaike Information Criteria (AIC). Both bivariable and multivariable multilevel analysis was done accordingly. Variables with p-value ≤0.05 declared as statistical significant with outcome variable for the study. The adjusted odds ratio with 95% confidence interval was used as measure of association. Results The magnitude of obstetric fistula was 0.84 [95%CI: 0.79, 0.88]. Maternal age >=41 years [AOR=1.38; 95% CI:1.01,1.93], urban residence [AOR=0.69; 95%CI: 0.53,0.89], women who attended secondary education [AOR=0.59; 95% CI: 0.45,0.77], women who attended higher education [AOR=0.40; 95% CI: 0.25,0.65], female household head [AOR=0.78; 95% CI: 0.64,0.95], husbands who attended primary education [AOR=0.80; 95% CI: 0.65, 0.98], women who give their first birth 16-20years [AOR=0.78; 95% CI: 0.66,0.92], 21-25 years [AOR=0.66; 95% CI: 0.53,0.84], ≥26 years [AOR=0.67; 95% CI: 0.48, 0.92], history of terminating pregnancy [AOR=1.51; 95% CI: 1.29, 1.77] and awareness on fistula [AOR=0.35; 95% CI: 0.26,0.45) were the determinants of obstetric fistula identified in this study. Conclusion The magnitude of obstetric fistula in 14 African countries were high as compared with the world health organization estimate. Maternal age, residence, educational status, husband’s educational status, sex of household head, age at first birth, history of terminating pregnancy and awareness on obstetric fistula were the determinants identified in this study. Therefore, health interventions that reduce the occurrence of obstetric fistula could be designed to address the women who lives in rural area, no formal education, male-headed household, husbands who never attended formal education, and women who had terminated pregnancy should be addressed in advance. Policies and programs of fistula should be tailored the women which characterized as living in rural area, non-educated, young age at first birth and no awareness on fistula as well as male headed households. Evidence based multicounty interventions were highly recommended to eliminate obstetric fistula and to achieve sustainable development goal.

A Comparison of Postoperative Surgical Outcomes among Women Undergoing Obstetric Fistula Repair with and without HIV

Background and Objective: Obstetric fistula affects approximately 2 million women worldwide, predominantly in places with a high Human Immunodeficiency Virus (HIV) burden. In Malawi, where thousands of women live with fistulas, HIV prevalence is 11-13%. Although repair is usually successful, surgical outcomes among immunocompromised women are poorly understood. Inconsistent guidelines regarding the Cluster of Differentiation 4 (CD4) threshold necessary for repair make it difficult for surgeons to make informed decisions. This study compares the postoperative outcomes of women undergoing obstetric fistula repair with and without HIV, stratified by CD4 count. Methods: This is a retrospective case-control study using a database of women who underwent vesicovaginal fistula repair at the Fistula Care Center from 2010-2018. HIV-positive participants, stratified by CD4<350 and CD4>350, were matched to HIV-negative controls by age within 5 years and Goh classification. Controls were matched to cases in a 3:1 ratio. Bivariate analysis and logistic regression were conducted on indicators based on HIV status and CD4 count stratification. Outcomes included dye test results, pad weights, and continence status at 2 weeks post-repair. Results: 54 seropositive women were matched to 135 seronegative women. Of the 54 HIV positive women, 22.2% (n=12) had a CD4 count < 350. We found no statistically significant difference in surgical outcomes between HIV-positive and negative patients. 93.5% of HIV positive and 90% of HIV negative women healed completely. In our sub-analysis of 12 seropositive women with CD4<350, we found a statically significant difference in successful closure, with 25% of women with CD4<350 having a positive dye test indicating incomplete closure, compared to 2.8% of women with CD4>350 (p=0.024). Conclusion and Global Health Implications: Our analysis confirms previous research indicating that seropositive women with a CD4>350 can safely undergo obstetric fistula repair. Further research is needed to evaluate postoperative outcomes among women with CD4<350. Copyright © 2021 Ganesh et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

Awareness on presentation of obstetric fistula and associated factors among reproductive age women in south eastern zone of tigray,ethiopia,2020.cross sectional study

Background Worldwide, around one million girls and women are currently living with fistula. Less than 20,000 women with obstetric fistula are treated each year. Lack of awareness is a frequently mentioned barrier to seeking fistula treatment; many women suffering from obstetric fistula do not know what fistula is, as it is treatable, or where to get treatment. Even though obstetric fistula has likely weighed down women since the beginning of time, few researches proportionally exists. Methods A community based quantitative cross-sectional survey was undertaken in south eastern zone of Tigray. A multistage random sampling technique was implemented to select total participants of 605 reproductive age women. Two districts were randomly selected and from those districts, 12 kebels were selected randomly and the calculated sample size (605) was proportionally allocated to each selected kebeles. The data were collected by using face to face/interview with structured questionnaire from February 26-March 24/2020 after ensuring that all requirements of ethical considerations were fulfilled. The collected data were entered in to Epidata version 4.2 then exported to SPSS version20 for analysis. Descriptive statistics with frequency, percentage, table and graph and cross tabulation were used for presentation of result. Bivariable and multivariable analysis were used to examine the association. Odds ratios with 95% confidence interval and P-value <0.05 were used to determine the statistical association. Result Overall, about 31.6% of respondents had good awareness on presentation of obstetric fistula. The major determinant factors identified to awareness on presentation of obstetric fistula were educational level (above secondary)[AOR(95%CI=2.9(1.42-9.6)],history of institutional delivery (for the index child)[AOR (95%CI=4.1(1.76-9.56)] and having prior information about obstetric fistula[AOR (95%CI=2.2(1.01-4.75)]. Conclusion In this study majority of reproductive age women in the study area had poor awareness regarding presentation of obstetric fistula. Several interventions like health education and information should be implemented to enhance the awareness of the community towards obstetric fistula.

Awareness of obstetric fistula and associated factors among women in reproductive age group attending public hospitals in southwest Ethiopia, 2021

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.