Obstetric fistula management and predictors of successful closure among women attending a public tertiary hospital in Rwanda: a retrospective review of records.

Tekle G Egziabher,Ngoga Eugene,Kateera Fredrick,Karenzi Ben

doi:10.1186/s13104-015-1771-y

Abstract

BackgroundGlobally, 50,000–100,000 women develop obstetric fistula annually. At least 33,000 of these women live in Sub-Saharan Africa where limitations in quality obstetric care and fistula corrective repairs are prevalent. Among women with fistula seeking care at public health facilities in resource-limited settings, there is paucity of data on quality of care received. The aim of this study was to characterize obstetric fistula among Rwandan women managed at a public tertiary hospital and evaluate for predictors of successful fistula closures.MethodsA retrospective review of records for all obstetric fistula women managed at a public referral health facility between 2007 and 2013 was performed. Patient socio-demographics, obstetric characteristics and fistula repair outcomes data were reviewed. A multivariate logistic regression model was used to analyse for predictors of successful fistula repair outcomes.ResultsA total of 272 women aged between 16 to 78 years and with a mean age of 34.6 years were included. Of these, 93 (34.2 %), 48 (17.6 %), 65 (24 %) and 64 (23 %) women had vesico-vaginal fistula, recto-vaginal fistula, urethro-vaginal fistula and vesico-uteral fistula types, respectively. Successful fistula closure was achieved among 86.3 %. Women with fistula who reported being in labour for ≥3 days, having ≥1 previous fistula repair attempt, and having lived with the fistula for >1 year, had significantly lower odds of successful repair outcomes.ConclusionsAmong 272 women with obstetric fistula managed in this study, 69.5 and 26.5 % of their fistula were causally associated with obstructed labour complications and iatrogenic factors, respectively. Successful fistula closure rates of about 89 % among women of index repair attempt were achieved. Conversely, reported histories of ≥3 days in labour, ≥1 previous failed attempts at repair and a fistula duration of >1 year, were significant determinants of failed fistula closures. To effectively mitigate obstetric fistula burden in Rwanda, a comprehensive package of services including quality emergency obstetric care, increased availability of and access to quality fistula repair, active surveillance to identify community-based women with fistula and a strong political will towards effective fistula care, are recommended.

Highlights

An obstetric fistula is a hole between the vagina and bladder or the vagina and rectum that is caused by prolonged obstructed labour, leaving a woman incontinent of urine or faeces, respectively [4]
Data on the burden of obstetric fistula are scarce with the available information generally drawn from self-reports, personal communications from surgical teams, data aggregated from advocacy groups and organizations like Engender Health and United Nations Population Fund (UNFPA) and record reviews of hospital services
All women whose fistula repairs were conducted elsewhere but who reported for outpatient evaluation only or those whose repairs were done at Rwanda Military Hospitals (RMH) but outside the stated study period, and those who did not return for post-operative review 6–8 weeks after surgical management, were excluded from the analysis

Summary

Introduction

At least 33,000 of these women live in Sub-Saharan Africa where limitations in quality obstetric care and fistula corrective repairs are prevalent. Obstructed labour affects more than 6 million women annually with over 90 % of these women living in the world’s poorest areas with limited access to emergency obstetric care and quality fistula corrective services [1, 2]. The World Health Organization (WHO) estimates that about 50,000–100, 000 women develop obstetric fistula annually with at least 33,000 of these located in sub-Saharan Africa (SSA) [5,6,7]. In a recent review that aimed at estimating the global prevalence and incidence of obstetric fistula, only 19 studies were selected: Most of these studies did not have a nationally representative sample and very few had been conducted in South Asia. This review estimated the total number of fistula and number of new fistula cases in the two most affected regions of SSA and South Asia to be just over one million and an estimated 6000 cases per year, respectively [8]

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