Panzi Hospital Research Articles

Correlates of fertility desires in women with urogenital fistula in the Democratic Republic of Congo: a cross-sectional study of 1,646 women

BackgroundStudies on fertility desires among fistula patients in the Democratic Republic of Congo (DRC) have been conducted on fewer patients. Furthermore, these studies have adopted a univariate descriptive approach. This study aims to examine the determinants of fertility desires among patients with fistula in the DRC.MethodsThis cross-sectional study included women aged 15–49 whose fistulas were repaired by the Panzi Hospital mobile team in seven DRC regions between 2013 and 2018. Univariate and bivariate descriptive analyses were performed using the frequency distribution table and the chi-square test. Adjusted odds ratios with their 95 confidence intervals from logistic regression were used to analyze factors associated with fertility desire after fistula repair. All analyses were stratified by parity level for all women aged 15–49 and 20–34 years.ResultsOf the 1,646 women aged 15–49 and 808 aged 20–34, 948 (57.6%) and 597 (73.8%), respectively, wanted to have children after fistula repair. Among women aged 15–49 and 20–34 years, the desire to have children was parity-specific. It was negatively associated with age at all parity levels. In women with low parity, the desire for children was significantly negatively associated with a high number of surgeries, abortions, and fistula duration. It tended to decrease with time, but was particularly high in 2014 and 2017. It was high among the Protestant women. Among medium-parity women, it was significantly lower in urban areas and among widows, but higher among women who had more than two abortions. Among high-parity women, it was negatively associated with education level.ConclusionTo help women with fistula achieve or approach their desired number of children, our findings suggest that (1) counseling is needed for women with a high desire for children; (2) the human, material, and financial resources needed to eliminate fistula in the DRC should be made available; and (3) medical and nursing staff should be sufficiently and effectively trained to minimize the number of unsuccessful surgeries performed on women with fistula.

Complete Hydatidiform Mole at Menopause: A Case Report from Panzi Hospital, Bukavu, Democratic Republic of Congo

Complete Hydatidiform Mole at Menopause: A Case Report from Panzi Hospital, Bukavu, Democratic Republic of Congo

Epidemiological, clinical, and therapeutic features of ptosis in Bukavu, Democratic Republic of the Congo

Introduction: Ptosis is a fall of the upper eyelid caused by a defect in the levator. The aim of the study was to describe epidemiological, clinical, and therapeutic features of ptosis in Bukavu. Methodology: This is a prospective study conducted on 77 patients admitted for ptosis in ophthalmology departments of the Panzi Hospital and the CBM-CELPA Ophthalmological Clinic in Bukavu (Democratic Republic of the Congo) during a period of 3 years, from 1 January 2018 to 31 December 2021. Results: The median age at management was 14 years, with a male predominance (57.1%). This was congenital ptosis in 77.9%, and acquired ptosis in 22.1%. Ptosis was major in 24.1%, and moderate in 61.0% of cases. Amblyopia was present in 63.6% of the cases. Resection of the levator muscle of the upper eyelid was the most common surgical technique (56.4%), followed by suspension of the upper eyelid from the frontal muscle (43.6%). Functional and aesthetic results were satisfactory in 17 eyes (30.9%). Among the postoperative complications, we noted the suture thread release (16.4%) and the inflammatory granuloma (12.7%). Conclusion: Ptosis is a pathology encountered in Bukavu. It is unilateral in the majority of cases. Congenital ptosis is the most common form. Surgical treatment gives good results in our context.

The roles and ethics of psychosocial support workers in integrated health services for sexual and gender-based violence survivors

Summary Mental Health and Psychosocial Support are integral components of the multisectoral programs addressing wartime sexual violence. In the Democratic Republic of Congo, an integrated framework known as the one-stop centre model was implemented at Panzi Hospital for delivering medical, legal, psychosocial, and socioeconomic support services for wartime sexual violence survivors. While recent developments broadly described this model with more focus on its medical pillar, there is limited knowledge on how its psychosocial support component can be harnessed in addressing wartime sexual violence. This article explored the roles and ethics of psychosocial support in integrated health services based on the research data from 11 in-depth interviews with the psychosocial support workers and desk reviews. Findings The findings of this study indicated that the roles and ethics of psychosocial workers in addressing wartime sexual violence are limited by the lack of adequately trained staff members, low professional status, and complex ethical challenges. In this case, psychosocial support draws more from virtue ethics and moral constructivism and less from professional utilitarianism and deontology. While both approaches are integral to providing support services, combining them is necessary for the complementarity and consistency of therapeutic processes. The study's findings also demonstrated the lack of professional social work and mental health interventions in the Congo and suggested coordinated actions engaging social work education, policy, and research developments. Applications We conclude that the roles and ethics of psychosocial support should be of serious concern to decision-makers, practitioners, and educators.

Identified Bacteria and Virus in the Cerebrospinal Fluid of under Five Years Hospitalized Children for Clinical Meningitis at Panzi Hospital in the Eastern Part of DRC

Identified Bacteria and Virus in the Cerebrospinal Fluid of under Five Years Hospitalized Children for Clinical Meningitis at Panzi Hospital in the Eastern Part of DRC

Epidemiological, Clinical, Paraclinical and Therapeutic Profile of Prostate Tumors at Panzi Hospital, Democratic Republic of the Congo

Epidemiological, Clinical, Paraclinical and Therapeutic Profile of Prostate Tumors at Panzi Hospital, Democratic Republic of the Congo

Associated Factors with Vaginal Delivery on a Uni- or Bi-Scar Uterus in a Low-Resource Setting

Introduction: Delivery in a scar uterus is one of the most debated topics in obstetrics. The objective was to determine the uterine test and the maternal-fetal outcome in patients with uni- and bi-scared uterus who received the uterine test at Panzi General Referral Hospital. Methodology: This is a cross-sectional study with a prospective collection of patients who delivered on a uni- or bi-scareduterus at Panzi Hospital, between January 1, 2021 and August 1, 2022. Results: The average age of the patients was 27.09 years, with an age range of 25 - 34 years, they were mostly married (88.3%), with secondary educational level (60.4%). Pauciparous women, with a history of previous caesarean delivery once, represented respectively 52.2%; 7.2% of parturients with an intergenital space equal to 18 months. 63.9% were overweight, 58.6% had undergone more than three ANC sessions. We noted statistically significant associations between modes of admission, water sac, type of membranes rupture, uterine height and success of uterine test (p 0.05). We did not find significant associations between parturient age, gestational age, intergestational interval, pregnancy term, surgical history, number of ANC performed, number of previous caesarean sections, number of newborns. We did not record any cases of maternal death but one case of perinatal death with 0.9% in this study. Conclusion: A good selection of patients with uni- or bi-scared uterus would allow the reduction of the fetomaternal morbidity during the uterine test.

Profile of Pregnant Women and Success of the Uterine Test on a Uni- or Bi-Scar Uterus at the Maternity Ward of Panzi Hospital, in the Democratic Republic of the Congo

Profile of Pregnant Women and Success of the Uterine Test on a Uni- or Bi-Scar Uterus at the Maternity Ward of Panzi Hospital, in the Democratic Republic of the Congo

Sexual and gender-based violence victims’ satisfaction of the support services through the holistic model of care in the Democratic Republic of Congo

BackgroundThe quality-of-care assessment is an important indicator of the efficiency of a healthcare system. In the Democratic Republic of the Congo (DRC), despite the implementation of the holistic care model for the treatment of sexual and gender-based violence (SGBV) victims, little is known about the client’s perception of this model and its outcome. This study aimed to examine the expected and perceived satisfaction of service recipients through the One-Stop-Center model of health care in eastern DRC.MethodologyThis descriptive and analytical cross-sectional study was conducted at Panzi Hospital (PH), in eastern DRC. Data were collected by a mixed-methods approach, 64 Victims of Sexual Violence participated in individual (in-depth) interviews and 150 completed the Survey. The Kruskal–Wallis test was used to compare the mean item scores of sexual violence victims’ satisfaction.ResultsThe findings from our qualitative analysis demonstrated that the victims admitted at PH had various expectations and needs on arrival depending on their social identity and residence locations. For instance, the VSVs coming from remote areas with ongoing armed conflicts mentioned concerns related to their security in the post-treatment period and the risks of re-victimization that this could incur. Conversely, those who came from the urban neighborhood, with relative security raised various concerns related to their legal reparation and ongoing access to other support services. With scores above 4, victims of sexual violence were extremely satisfied with the overall care provided and wished that PH could continue to support them mentally and financially for an effective reintegration into their communities. The Kruskal–Wallis analysis confirmed statistically significant differences (p < 0.1) in satisfaction with legal support based on the victims' residential locations, social support based on their age groups, occupational therapy based on their religious denominations, and accommodation based on their professional activity.ConclusionsResults of this study suggest that victims’ satisfaction with support services is based on either the organizational frameworks of clinical or support services within the hospital and the victims’ social environment.

Factors associated with surgical repair success of female genital fistula in the Democratic Republic of Congo: Experiences of the Fistula Care Plus Project, 2017-2019.

ObjectiveWe sought to document outcomes and factors associated with surgical success in hospitals supported by the Fistula Care Plus Project in the Democratic Republic of Congo (DRC), 2017–2019.MethodsThis was a retrospective cohort study analysing routine repair data on women with Female Genital Fistula. Univariate and multivariate analyses were conducted to determine factors associated with successful fistula repair.ResultsA total of 895 women were included in this study, with a mean age of 34 years (±13 years). The majority were married or in union (57.4%) and living in rural areas (82.0%), while nearly half were farmers (45.9%). The average duration living with fistula was 8 years (±7). Vesicovaginal (70.5%) and complex (59.8%) fistulas were the most common fistula types. Caesarean section (34.7%), obstructed labour (27.0%) and prolonged labour (23.0%) were the main aetiologies, with the causal deliveries resulting in stillbirth in 88% of cases. The vaginal route (74.9%) was the primary route for surgical repair. The median duration of bladder catheterization after surgery was 14 days (interquartile range [IQR] 7–21). Multivariate analysis revealed that Waaldijk type I fistula (adjusted odds ratio [aOR]:2.71, 95% confidence interval [CI]:1.36–5.40), no previous surgery (aOR:2.63, 95% CI:1.43–3.19), repair at Panzi Hospital (aOR: 2.71, 95% CI:1.36–5.40), and bladder catheterization for less than 10 days (aOR:13.94, 95% CI: 4.91–39.55) or 11–14 days (aOR: 6.07, 95% CI: 2.21–15.31) were associated with better repair outcomes.ConclusionThe Fistula Care Plus Project in the DRC recorded good fistula repair outcomes. However, further efforts are needed to promote adequate management of fistula cases.

Obstetric vesico-vaginal fistulas: Midvaginal and juxtacervical fistula repair outcomes in the Democratic Republic of Congo.

This study aims to establish the postoperative success rates of midvaginal versus juxtacervical obstetric vesicovaginal fistula (VVF) repairs. In addition, we aim to quantify the impact of patient sociodemographic variables, fistula classification, and surgical repair techniques associated with postoperative outcomes. A retrospective cohort study was conducted involving 420 women who had undergone a primary obstetric VVF repair. All data were collected from the Panzi Hospital, Democratic Republic of Congo between 2015 and 2017. Patient notes were analyzed to determine sociodemographic variables, symptoms, fistula classification, surgical repair techniques, and postoperative follow up. Binary logistic regression presented as χ2 for trend was used to establish P values. Overall, 95.6% and 96.2% of midvaginal and juxtacervical VVF, respectively, underwent a successful repair. The principal prognostic factor associated with a statistically significant likelihood of a successful repair was the degree of fibrosis noted preoperatively (P=0.004, 95% confidence interval [CI] 2.38-94.61). Furthermore, VVF were more likely to have a successful repair if they were closed in two layers (P=0.004, 95% CI 1.86-25.81) and sutured vertically (P=0.005, 95% CI 1.16-2.52). Overall, high postoperative success rates of obstetric VVF repair can be expected among well-trained surgeons but a complex interplay of factors means that the ability to preoperatively foreshadow individual outcomes remains difficult.

Complications from fractures of limbs treated by traditional medicine in the eastern part of the Democratic Republic of the Congo

Introduction: This study aimed to report fractures complications observed after traditional treatment in Bukavu. Patients and Method: This is a cross-sectional, multicentered and prospective study of a series of 73 cases of fracture complications after traditional treatment collected from 5 hospitals: University clinics of Bukavu; Skyborne Hospital Center, CIRIRI Hospital, Medicure Hospital and Panzi Hospital, from January 1st to December 31st, 2019. Data were collected on a survey form filled by patients and analyzed using Epi Info software 7.2 version. Results: The patients average age was 33.21 ± 18.08 years (range: 4 -74 years) with a sex ratio of 1.7. The group of 21-30 years old was the most affected with 21 patients (28.77%). The traffic accident was the main etiology 42 (57.53%) followed by the fall from a high place with 14 patients (19.18%). Closed fractures represented 44 cases (60.27%). The femur was more affected 18 (24, 66%). The use of traditional medicine was justified by: more effective than modern treatment 26 (35.62%), less expensive 23 (31.51%), socio-cultural beliefs 9 (12.33%) and other reasons 4 (5.48%). 39 patients (53.42%) were coming from urban areas. The complications observed were: 21 skin necrosis (28.77%), 19 vicious calluses (26.03%), 9 non-union (12.33 %), 8 infections (10.96%), 6 limb shortening (8, 22%), 5 gangrene / ischemia (6.85%), 3 joint stiffness (4.11%) and 2 delayed consolidation (2.74%). The modern treatment of these complications was based on osteosynthesis associated with an osteotomy or corticoperiosteal decortication-bone graft 28 (38.36%), skin graft 16 (21.92%) and 23 patients (31.50%) refused modern treatment despite the complication. Conclusion: The fractures traditional treatment based mainly on trial and error, practiced with inadequate means and measures without respecting the fractures treatment principles is a real source of complications that can lead to disabling disabilities.

The mobile surgical outreach program for management of patients with genital fistula in the Democratic Republic of Congo.

ObjectiveTo describe components of the mobile surgical outreach (MSO) program as a model of care delivery for women with genital fistula; present program results; and discuss operational strengths and challenges.MethodsA retrospective observational study of routinely collected health data from women treated via the MSO program (2013–2018). The program was developed at Panzi Hospital in the Democratic Republic of Congo to meet the needs of women with fistula living in remote provinces, where travel is prohibited. It includes healthcare delivery, medico‐surgical training, and community sensitization components.ResultsThe MSO team cared for 1517 women at 41 clinic sites across 18 provinces over the study period. Average age at presentation was 31 years (range, 1–81 years). Most women (n=1359, 89.6%) presented with vesicovaginal fistula. Most surgeries were successful, and few women reported residual incontinence postoperatively. Local teams were receptive and engaged in clinical skills training and public health education efforts.ConclusionThe MSO program addresses the backlog of patients awaiting fistula surgery and provides a template for a national strategic plan to treat and ultimately end fistula in DRC. It offers a patient‐centered approach that brings medico‐surgical care and psychosocial support to women with fistula in their own communities.

Delivering integrated care after sexual violence in the Democratic Republic of the Congo

In the eastern Democratic Republic of the Congo, ongoing armed conflict increases the incidence of gender-based violence (GBV) and presents a distinct and major barrier to care delivery for all...

Implementing physiotherapy services into fistula care at Panzi Hospital, Bukavu, DRC

Aims: To describe implementation of physiotherapy services in the context of fistula care and report early program observations.&#x0D; Methods: Process evaluation of treatment pathway/protocol implementation and presentation of provider observations of treatment results since January 2016.&#x0D; Results: Dedicated physician, nursing, social work and physiotherapy staff provide various aspects of rehabilitative care to women with fistula, pre- and post-operatively. Following variations in hospital census, 5-50 women participate in group exercise sessions 2-3x/week. Targeted individual physiotherapy is selectively provided to 1-15 women 1-5x/week. Staffing priorities reflect perceived importance and impact of physiotherapy services. Providers offer clinical observations of program successes, including improved post-surgical functional outcomes, and express interest in further training to cultivate advanced clinical skills.&#x0D; Conclusions: Early results indicate value of physiotherapy-informed care in a comprehensive approach to fistula care services. Improving and expanding upon these skills may prove equally useful in addressing the physical impairments associated with other reproductive morbidities, such as POP. In the future, systematic use of standardized tools, such as WHODAS 2.0 is recommended, both to quantify the burden of disability in this population, as well as to measure change with therapeutic interventions, including surgery and rehabilitation.

Panzi score as a parsimonious indicator of urogenital fistula severity derived from Goh and Waaldijk classifications.

To derive a comprehensive system that allows a single score to define relative fistula severity. The present observational study included women with urogenital fistula treated at the Panzi Hospital, Democratic Republic of Congo, or its outreach clinics across the Democratic Republic of Congo between September 1, 2013, and December 31, 2014. Fistula severity was assessed by Goh and Waaldijk classifications and surgical success was ascertained. Logistic regression was used to select fistula characteristics predictive of surgical failure, and to preliminarily verify the newly derived Panzi score. Overall, 837 women were included in the analysis. Goh or Waaldijk fistula descriptors associated with a higher probability of poor surgical outcomes in the unadjusted bivariate analysis were circumferential defect (P=0.007), proximity to the external urethral orifice (P=0.001), and size (P=0.001). These fistula characteristics were used to construct the Panzi score, which varied from 3 (most severe) to 0 (minor fistula). For each increase above 0, the odds of surgical failure increase by a factor of 1.65 (P<0.001). The Panzi score of urogenital fistula provided a data-driven, simple, comprehensive, and parsimonious score. It could be used to report group data, to provide continuous level data for use in higher order statistics, and to resolve issues such as the cut-off point for referring women to hospital in accordance with fistula complexity.

A Holistic, Person-Centred Care Model for Victims of Sexual Violence in Democratic Republic of Congo: The Panzi Hospital One-Stop Centre Model of Care.

Denis Mukwege and Marie Berg describe the One Stop Centre at Panzi Hospital in Eastern Democratic Republic of Congo that provides care for girls and women who have been raped in combination with extreme bodily harm.

Healthcare providers’ perspectives on the social reintegration of patients after surgical fistula repair in the eastern Democratic Republic of Congo

ObjectiveTo understand perspectives of local health providers on the social reintegration of patients who have undergone fistula repair in the eastern Democratic Republic of Congo. MethodsIn a qualitative study, semi-structured individual interviews were conducted with patient-care professionals working with women with fistula at HEAL Africa Hospital (Goma) and Panzi Hospital (Bukavu) between June and August 2011. The interviews were transcribed and themes elicited through manual coding. ResultsOverall, 41 interviews were conducted. Successful surgical repair was reported to be the most important factor contributing to patients’ ability to lead a normal life by all providers. Family acceptance—especially from the husband—was deemed crucial for reintegration by 39 (95%) providers, and 29 (71%) believed this acceptance was more important than the ability to work. Forty (98%) providers felt that, on the basis of African values, future childbearing was key for family acceptance. Because of poor access and the high cost of cesarean deliveries, 28 (68%) providers were concerned about fistula recurrence. ConclusionProviders view postsurgical childbearing as crucial for social reintegration after fistula repair. However, cesarean deliveries are costly and often inaccessible. More work is needed to improve reproductive health access for women after fistula repair.

Demographics and Care-Seeking Behaviors of Sexual Violence Survivors in South Kivu Province, Democratic Republic of Congo

One of the most striking features of the ongoing conflict in the Democratic Republic of Congo (DRC) is the use of sexual violence. In spite of the brutality of these crimes, the experiences of women affected by sexual violence in Eastern DRC remain poorly characterized. This analysis aimed to (1) provide detailed demographics of sexual violence survivors presenting to Panzi Hospital; (2) examine how demographic factors might impact patterns of sexual violence; and (3) describe care-seeking behavior among sexual violence survivors. The demographics and care-seeking behavior of sexual violence survivors in South Kivu Province were described from a retrospective registry-based study of sexual violence survivors presenting to Panzi Hospital (2004-2008). A total of 4311 records were reviewed. The mean age of survivors was 35 years. Most women (53%) were married, self-identified with the Bashi tribe (65%), and reported agriculture as their livelihood (74%). The mean time delay between sexual assault and seeking care was 10.4 months. Five reasons were identified to help explain the lengthy delays to seeking care: waiting for physical symptoms to develop or worsen before seeking medical attention, lack of means to access medical care, concerns that family would find out about the sexual assault, stigma surrounding sexual violence, and being abducted into sexual slavery for prolonged periods of time. Many sexual assault survivors have very delayed presentations to medical attention. Promoting timely access of medical care may best be facilitated by reducing stigma and by educating women about the benefits of early medical care, even in the absence of injuries or symptoms.

Militarized Sexual Violence in South Kivu, Democratic Republic of Congo

Eastern DRC has been the site of a protracted conflict in which sexual violence has been a defining feature. The method used was a retrospective registry-based study of sexual violence survivors presenting to Panzi Hospital between 2004 and 2008. This analysis aimed to describe the patterns of sexual violence described by survivors and to analyze perpetrator profiles. As regards results, a total of 4,311 records were analyzed. Perpetrators in this data set were identified as follows: (a) 6% were civilians; (b) 52% were armed combatants; and (c) 42% were simply identified as "assailant(s)" with no further identifying information. Those identified simply as "assailants" perpetrated patterns of sexual violence that were similar to those of armed combatants, suggesting that this group included a large number of armed combatants. Civilian assailants perpetrated a pattern of sexual violence that was distinct from armed combatants. Conclusions are as follows: These data suggest that a high proportion of sexual assaults in South Kivu are perpetrated by armed combatants. Protection of women in South Kivu will require new strategies that take into account the unique nature of sexual violence in DRC. Engaging with local communities, the UN and other aid organizations is necessary to create new context-appropriate protection programs.