Prevention Of Obstetric Fistula Research Articles

Using interpretive description to facilitate women's contributions to maternity care: experiences and views of obstetric fistula prevention

Background/Aims Interpretive description is a qualitative methodology that combines detailed descriptions with thoughtful interpretation. This approach is especially effective for producing practical insights and deepening the understanding of phenomena in clinical or practice-based settings. The aims of this study were to explore how interpretive description could be used to research the experiences and views of women with obstetric fistula. Methods Interpretive description was used to explore the experiences and views of 15 purposively selected women affected by obstetric fistula. Participants were recruited via the Evangel Vesico Vaginal Fistula Centre of Bingham University Teaching Hospital. Data were collected via in-depth interviews and concurrently analysed thematically. Results Interpretive description provided women with a unique opportunity to share their experiences of the causes and avoidable risk factors of obstetric fistula. The approach yielded qualitative findings and allowed for the representation of different views, leading to an understanding of how to mitigate obstetric fistula in the community. Conclusions Interpretive description was used to listen to the voices of women affected by obstetric fistula, learn from their experiences and highlight the interventions that may alter risk factors for the condition in the community. This is the first study to use interpretive description to facilitate under-represented women's contributions to maternity care by listening to their experiences and views. This enabled identification of gaps in maternity care provision, which would be of interest to the community and health service leaders as well as policymakers in sub-Saharan Africa. Implications for practice Interpretive description allows for deep capture of women's perspectives, allowing implementation of interventions designed to target issues as perceived by those most affected. This also ensures that under-represented groups are included in the research process.

Women's knowledge of symptoms of obstetric fistula, experiences, and associated factors in Sierra Leone.

Obstetric fistula is a devastating childbirth condition that results from prolonged obstructed labour without timely medical intervention, leading to a tear between the birth canal and the bladder or rectum. It is a public health issue, particularly in low-income countries with limited access to quality maternal healthcare. This study aims to assess knowledge of fistula symptoms among women who had a fistula and its associated factors in Sierra Leone. Cross-sectional data from the 2019 Sierra Leone Demographic and Health Survey was used for the study. Our study comprised 15,574 reproductive women aged 15 to 49. Using a four-modelled approach, a mixed-effect multilevel binary logistic regression analysis was performed to assess the factors associated with knowledge of fistula symptoms among women who had a fistula. The results were presented as adjusted odds ratios with a 95% confidence interval. The proportion of knowledge of fistula symptoms among women who had a fistula was 57.5% [55.3,59.7] in Sierra Leone. Women aged 20-49, particularly those between 40-44 [aOR = 2.82; 95% CI: 2.13, 3.73], were more likely to be aware of knowledge of fistula symptoms among women who had a fistula compared to teenagers (15-19). Women with higher levels of education [aOR = 2.07; 95% CI: 1.49, 2.88] were more likely to be aware of knowledge of fistula symptoms among women who had a fistula than those without education. Working women [aOR = 1.33; 95% CI: 1.14, 1.56], those who listened to the radio [aOR = 1.47; 95% CI: 1.30, 1.67] or used the internet [aOR = 1.64; 95% CI: 1.32, 2.05], and those with a high number of lifetime births [aOR = 2.00; 95% CI: 1.57, 2.54] were more likely to be aware of knowledge of fistula symptoms among women who had a fistula. Women who had ever had sex [aOR = 2.19; 95% CI: 1.73, 2.77], were pregnant [aOR = 1.37; 95% CI: 1.13, 1.66] or had terminated a pregnancy [aOR = 1.30; 95% CI: 1.07, 1.59] were more likely to be aware of knowledge of fistula symptoms among women who had a fistula. A female household head [aOR = 1.20; 95% CI: 1.05, 1.38] was associated with a higher likelihood of knowledge of fistula symptoms among women who had a fistula. On the other hand, larger household sizes [aOR = 0.86; 95% CI: 0.75, 0.97] and living in the Western region [aOR = 0.48; 95% CI: 0.31, 0.75] were associated with a lower likelihood of knowledge of fistula symptoms among women who had a fistula. Most reproductive-aged women in Sierra Leone have knowledge of fistula symptoms among women who had a fistula. Factors such as age, education, occupation, media exposure, parity, sexual activity, pregnancy status, abortion history, ethnicity, household structure, and geographic location influence the knowledge of fistula symptoms among women who had a fistula. Based on these findings, the government and partner organisations in Sierra Leone should implement comprehensive health education programs targeting reproductive-aged women, with a specific focus on obstetric fistula prevention, symptoms, and available treatment options.

Knowledge of front-line healthcare-workers on the role of urethral-catheterization for primary prevention of obstetric fistula in selected primary health care centres of north-central, Nigeria

Knowledge of front-line healthcare-workers on the role of urethral-catheterization for primary prevention of obstetric fistula in selected primary health care centres of north-central, Nigeria

Knowledge and practice of obstetric care providers on prevention of obstetric fistula 2023: an institution-based cross-sectional study

BackgroundObstetric 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.ObjectiveWe 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.MethodA 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 aP-value ≤0.05 and a 95% confidence interval.ResultsAbout 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.ConclusionThe 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.

A retrospective review of genital fistula occurrence in nine African countries

BackgroundFemale 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.MethodsThis 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.ResultsMost 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.ConclusionsCharacteristics 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.

Pragmatic estimations of obstetric fistula in Bangladesh

Pragmatic estimations of obstetric fistula in Bangladesh

Successful pregnancy along with prevention of obstetric fistula in a subsequent pregnancy is possible if proper antenatal care and timely elective caesarean delivery are ensured. Keywords: Fistula recurrence; obstetric fistula.

Successful pregnancy along with prevention of obstetric fistula in a subsequent pregnancy is possible if proper antenatal care and timely elective caesarean delivery are ensured. Keywords: Fistula recurrence; obstetric fistula.

\u201cI feel myself incomplete, and I am inferior to people\u201d: experiences of Sudanese women living with obstetric fistula in Khartoum, Sudan

BackgroundObstetric fistula is among the most devastating maternal morbidities that occur as a result of prolonged, obstructed labor. Usually, the child dies in a large number of the cases. Moreover, some of the women become infertile while the majority suffer physical, psychosocial and economic challenges. Approximately 5000 new cases of obstetric fistula occur in Sudan each year. However, their experiences are under documented. Therefore, this study aimed to shed light on their daily lives living with obstetric fistula and how they cope.MethodsUsing a qualitative study design, 19 women living with obstetric fistula were interviewed. The study took place in the fistula ward located in Khartoum hospital and the fistula re-integration center in Khartoum, Sudan. Thematic analysis approach was employed. Stigma and coping theories guided the data collection, analysis, and discussion of the findings.FindingsWomen in our study suffered a challenging physical life due to leakage of urine. In addition, they encountered all forms of stigmatization. Women used both emotion-focused and problem-focused coping techniques to mitigate the consequences of obstetric fistula.ConclusionThe study findings underscore the importance of obstetric fistula prevention programs and the urgency of repair surgeries to alleviate women’s suffering. Community sensitization, rehabilitation and re-integration of women back to their communities are also important strategies on their journey to wholeness.

Knowledge of front-line health workers on the role of urethral catheterization for primary prevention of obstetric fistula in Ibadan, Nigeria.

Obstetric fistula (OF), a preventable debilitating condition is mostly caused by prolonged obstructed labour (POL). The aim of bladder catheterization is to allow for healing process by preventing tension to adjoining tissues and improve blood supply. This study assessed the knowledge of catheterization in the prevention of OF among health workers in Ibadan, Nigeria. A cross sectional study among 147 health workers providing obstetric care in the labour and post-delivery wards using a self-administered questionnaire in 10 selected primary health centres was conducted. The knowledge of catheterization for primary prevention of OF was assessed on a three-point scale. Data was analysed using SPSS version 20. Logistic regression was used to determine the association between health workers socio-demographics and professional characteristics and their knowledge of catheterization for OF prevention. The mean age of participants was 41.6 (SD =8.9) years. Fifty-six (38.1%) of the participants had good knowledge of catheterization for OF prevention. Higher proportion (41.3%) of registered nurses and/or midwives had good knowledge of catheterization for OF prevention compared to those who attended school of hygiene. Health workers who had practiced for between 7-9 years were about seven times more likely to have good knowledge of catheterization compared to those who had worked for less than 3 years (OR =6.929, 95% CI, 1.755-27.357). Majority of health workers had poor knowledge of catheterization in OF prevention. There is need for training and re-training of health workers in primary health care centres (PHC) on the vital role of bladder catheterization following prolonged/obstructed labour so as to reduce the burden of OF.

Knowledge on Genitourinary Fistula among Nurses in a Tertiary Hos-pital of Eastern Nepal

Background: Genitourinary fistula, occurs most commonly due to preventable obstetric causes in developing countries. Women with obstetric fistula are at risk of infection, neglected from family and bear psychological distress due to stigma and social isolation. They require supportive care through multidisciplinary approach. Nurses occupying the larger workforce among the health-personnel are the frontier to care them throughout their life. Their knowledge on obstetric fistula will help to manage patients effectively. The aim of this research was to assess the knowledge on genitourinary fistula among nurses working in maternity wards of B. P. Koirala Institute of Health Sciences, Nepal.
 Methods: AHospital based cross-sectional study was conducted from May 2018 to January 2019 using self-administered questionnaire among nurses working in antenatal, intranatal, postnatal and gynecology ward of B. P. Koirala Institute of Health Sciences, Nepal. Forty nurses were enrolled after having informed consent. Collected data were entered in Microsoft excel and analysed using SPSS.
 Results: Only 42.5 % nurses had adequate knowledge on genitourinary fistula. Majority of them (90%) had correct response on definition of genitourinary fistula. Almost 83% correctly responded vesicovaginal fistula is the most common type. About 37.5% stated obstetric causes are main causes of genitourinary fistula in developing countries. Only 20% correctly responded the possible sign and symptoms of genitourinary fistula. Adequate knowledge on prevention of obstetric fistula (35%), surgical repair (20%), pre-operative management (12.5%) and discharge advice (20%) was found.
 Conclusions: This study concludes that majority of nurses working at antenatal, intranatal, postnatal and gynecology wards of B. P. Koirala Institute of Health Sciences, Nepal had moderate knowledge on genitourinary fistula.

Quality of life of Ethiopian women after fistula repair: implications on rehabilitation and social reintegration policy and programming

Despite growing recognition of the importance of linking obstetric fistula prevention and treatment strategies with rehabilitation and social reintegration programmes, little research and programming has been oriented toward this goal. Using in-depth interviews, this study aimed to examine the experiences of 51 Ethiopian women after fistula repair surgery to identify priority post-repair interventions that could maximise their quality of life. The results showed that the majority of women felt a dramatic sensation of relief and happiness following repair, yet some continued to experience mental anguish, stigma, and physical problems regardless of the outcome of the procedure. All women suffered intense fear of developing another fistula, most commonly from sex or childbirth. Despite this, the majority of women had sex or planned to do so, while a smaller cohort avoided intercourse and childbearing, thus subjecting them to isolation, marital conflict, and/or economic vulnerability. Our findings suggest that obstetric fistula programmes should integrate (1) post-repair counselling about fistula and risk factors for recurrence, (2) community-based follow-up care, (3) linkages to income-generating opportunities, (4) engagement of women affected by fistula for community outreach, and (5) metrics for evaluating rehabilitation and social reintegration efforts to ensure women regain healthy, productive lives.

Knowledge of Obstetric Fistula Prevention amongst Young Women in Urban and Rural Burkina Faso: A Cross-Sectional Study

Obstetric fistula is a sequela of complicated labour, which, if untreated, leaves women handicapped and socially excluded. In Burkina Faso, incidence of obstetric fistula is 6/10,000 cases amongst gynaecological patients, with more patients affected in rural areas. This study aims to evaluate knowledge on obstetric fistula among young women in a health district of Burkina Faso, comparing rural and urban communities. This cross-sectional study employed multi-stage sampling to include 121 women aged 18-20 years residing in urban and rural communities of Boromo health district. Descriptive statistics and multiple logistic regression analysis were used to compare differences between the groups and to identify predictors of observed knowledge levels. Rural women were more likely to be married (p<0.000) and had higher propensity to teenage pregnancy (p=0.006). The survey showed overall poor obstetric fistula awareness (36%). Rural residents were less likely to have adequate preventive knowledge than urban residents [OR=0.35 (95%-CI, 0.16–0.79)]. This effect was only slightly explained by lack of education [OR=0.41 (95%-CI, 0.18–0.93)] and only slightly underestimated due to previous pregnancy [OR=0.27 (95%-CI, 0.09–0.79)]. Media were the most popular source of awareness amongst urban young women in contrast to their rural counterparts (68% vs. 23%). Most rural young women became ‘aware’ through word-of-mouth (68% vs. 14%). All participants agreed that the hospital was safer for emergency obstetric care, but only 11.0% believed they could face pregnancy complications that would require emergency treatment. There is urgent need to increase emphasis on neglected health messages such as the risks of obstetric fistula. In this respect, obstetric fistula prevention programs need to be adapted to local contexts, whether urban or rural, and multi-sectoral efforts need to be exerted to maximise use of other sectoral resources and platforms, including existing routine health services and schools, to ensure sustainability of health literacy efforts.

Obstetric Fistula: What About Gender Power?

Despite over 40 years of research there has been little progress in the prevention of obstetric fistula and women continue to suffer in unacceptable numbers. Gender power imbalance has consistently been shown to have serious implications for women's reproductive health and is known to persist in regions where obstetric fistula occurs. Yet, there is limited research about the role gender power imbalance plays in childbirth practices that put women at risk for obstetric fistula. This information is vital for developing effective maternal health interventions in regions affected by obstetric fistula.

Overcoming phase 1 delays: the critical component of obstetric fistula prevention programs in resource-poor countries

BackgroundAn obstetric fistula is a traumatic childbirth injury that occurs when labor is obstructed and delivery is delayed. Prolonged obstructed labor leads to the destruction of the tissues that normally separate the bladder from the vagina and creates a passageway (fistula) through which urine leaks continuously. Women with a fistula become social outcasts. Universal high-quality maternity care has eliminated the obstetric fistula in wealthy countries, but millions of women in resource-poor nations still experience prolonged labor and tens of thousands of new fistula sufferers are added to the millions of pre-existing cases each year. This article discusses fistula prevention in developing countries, focusing on the factors which delay treatment of prolonged labor.DiscussionObstetric fistulas can be prevented through contraception, avoiding obstructed labor, or improving outcomes for women who develop obstructed labor. Contraception is of little use to women who are already pregnant and there is no reliable screening test to predict obstruction in advance of labor. Improving the outcome of obstructed labor depends on prompt diagnosis and timely intervention (usually by cesarean section). Because obstetric fistulas are caused by tissue compression, the time interval from obstruction to delivery is critical. This time interval is often extended by delays in deciding to seek care, delays in arriving at a hospital, and delays in accessing treatment after arrival. Communities can reasonably demand that governments and healthcare institutions improve the second (transportation) and third (treatment) phases of delay. Initial delays in seeking hospital care are caused by failure to recognize that labor is prolonged, confusion concerning what should be done (often the result of competing therapeutic pathways), lack of women’s agency, unfamiliarity with and fear of hospitals and the treatments they offer (especially surgery), and economic constraints on access to care.SummaryWomen in resource-poor countries will use institutional obstetric care when the services provided are valued more than the competing choices offered by a pluralistic medical system. The key to obstetric fistula prevention is competent obstetrical care delivered respectfully, promptly, and at affordable cost. The utilization of these services is driven largely by trust.

Preventing Obstetric Fistulas in Low-Resource Countries

An obstetric fistula is classically regarded as an "accident of childbirth" in which prolonged obstructed labor leads to destruction of the vesicovaginal/rectovaginal septum with consequent loss of urinary and/or fecal control. Obstetric fistula is highly stigmatizing and afflicted women often become social outcasts. Although obstetric fistula has been eliminated from advanced industrialized nations, it remains a major public health problem in the world's poorest countries. Several million cases of obstetric fistula are currently thought to exist in sub-Saharan Africa and south Asia. Although techniques for the surgical repair of such injuries are well known, it is less clear which strategies effectively prevent fistulas, largely because of the complex interactions among medical, social, economic, and environmental factors present in those countries where fistulas are prevalent. This article uses the Haddon matrix, a standard tool for injury analysis, to examine the factors influencing obstetric fistula formation in low-resource countries. Construction of a Haddon matrix provides a "wide angle" overview of this tragic clinical problem. The resulting analysis suggests that the most effective short-term strategies for obstetric fistula prevention will involve enhanced surveillance of labor, improved access to emergency obstetric services (particularly cesarean delivery), competent medical care for women both during and after obstructed labor, and the development of specialist fistula centers to treat injured women where fistula prevalence is high. The long-term strategies to eradicate obstetric fistula must include universal access to emergency obstetric care, improved access to family planning services, increased education for girls and women, community economic development, and enhanced gender equity. Successful eradication of the obstetric fistula will require the mobilization of sufficient political will at both the international and individual country levels to ensure that adequate resources are devoted to this problem and that maternal health becomes a high priority on national political agendas. Obstetricians & Gynecologists and Family Physicians. After participating in this CME activity, physicians should be better able to apply the Haddon matrix, a tool commonly used for injury analysis, to the field of obstetrics and gynecology; analyze the problem of obstructed labor and obstetric fistula formation in low-resource countries using the Haddon matrix, and implement possible strategies for the prevention of obstetric fistulas and the mitigation of harm in cases of obstructed labor that arise from the use of the Haddon matrix.

Prevention of Obstetric Fistula

Prevention of Obstetric Fistula

Reopening Of A Previously Repaired Fistula Following Obstructed Labour: A Case Commentary

Background: Obstetric fistula is a common problem in Tanzania, with an incidence of about 1200 cases per year. Case: A 25 year-old female, para 2 with no living children, presented with a history of total urinary incontinence following a difficult vaginal delivery. Prior to this delivery she had a previous history of an obstructed labour complicated by vesico-vaginal fistula (VVF), for which she had had a caesarean section and then a vesical vaginal fistula repair in 2006. A repeat fistula was repaired successfully. Conclusion: Improvement in a patient’s socio-economic status and improvement to infrastructure would contribute greatly to prevention of obstetric fistula.

Finding a balance in the treatment and prevention of obstetric fistula

With curly lashes and soft, full eyebrows, Almaz looks younger than her 20 years, even more so when she starts to cry. “I'm scared,” she says in Amharic, digging her nails into the palms of her hands. “I don't want to die.” She is about to undergo surgery in the sleek, gleaming white

Improving community knowledge of obstetric fistula prevention and treatment

In recent years, information has emerged in the scientific literature regarding the experience of physicians and clinical staff who try to prevent and treat obstetric fistulas at health facilities in developing countries. However, little is known about attempts to match the services they provide with policy and programmatic interventions in the communities they serve. To determine what is known about community involvement in the prevention and treatment of obstetric fistulas, the authors inquired into experiments carried out by EngenderHealth and partners in 15 African and Asian countries. From raw data, gray literature, and personal communications with those working in the field, they learned that engaging the community may be the keystone in the eradication of fistulas in low-resource settings, and they learned how to engage the community.

Obstetric vesico-vaginal fistulas at the National Hospital of Niamey, Niger

Objective To determine the epidemiologic and therapeutic characteristics of obstetric vesico-vaginal fistulas at the National Hospital of Niamey, Niger. Methods From December 2003 to February 2005, 111 consecutive patients with vesico-vaginal fistulas presenting for treatment were included and prospectively followed up. Demographic and clinical data were collected. The patients were re-evaluated 3 months after surgery. Results Among the 104 patients treated surgically 87% were aged between 15 and 36 years; 84% were married before they were 19 years old; 51% were divorced; and 80% did not live with their husbands. The fistula was caused by the first delivery in 43% of the patients; 93% were in labor for more than 24 hours; 35% were delivered at home; and perinatal death was 100%. The overall cure rate was 73%. Conclusion These epidemiologic characteristics provide data towards the development of an obstetric fistula prevention program in Niger.