Treatment Of Obstetric Fistula Research Articles

Experiences of community reintegration after obstetric fistula repair at Jean Paul 2 hospital, Conakry, Guinea.

The study explored women's experiences of their community reintegration process after surgical repair of obstetric fistula at Jean Paul 2 Hospital in Conakry, Guinea. The study examined how lived experiences of the disease impacted on the community reintegration of treated women. Using a qualitative research methodology, ten women participated after giving informed consent. Semi- structured interviews, lasting an average of 30 to 60 minutes were guided by an interview guide. The main themes covered were experiences with the disease, perceived social support and reintegration into the community. According to the participants, delays in obstetric care were the main cause of obstetric fistula. Socio- economic, cultural and medical factors such as early marriage, lack of education and poverty contributed to these delays. Even after surgical repair, women continued to endure the physical and psychosocial consequences of the disease, exposing them to stigma, discrimination and even rejection within the community. Study participants also reported a lack of social support. The little support perceived by these women concerned food and medical needs. This made the women dependent on their families. Reintegration into the community also proved difficult due to the persistent silence and stigma surrounding their situation. The study results highlight the complexity of the challenges faced by women with obstetric fistula in their journey towards integration. Effective management of obstetric fistula requires a holistic approach victims, their communities, health professionals and decision-makers in solving this problem. So, to improve women's reintegration after treatment for obstetric fistula, it is vital to raise awareness of the causes and consequences of the disease among the women concerned and their families, and to provide rapid access to emergency obstetric care, reinforce social support and set up economic empowerment programs.

Knowledge, attitude, and perception of obstetric fistula in some divisions in the far north region of Cameroon

Obstetric fistula is a condition caused by neglected, prolonged obstructed labor. All societies have different customs and beliefs which are unique to them and, these customs and beliefs make them to have different regard to obstetric fistula. Since no two individuals are the same, as even identical twins do not reason in the same manner has given rise to so many different regards to obstetric fistula in the Far North Region. A qualitative, exploratory, descriptive, and contextual approach coupled with primary and secondary data were used in this study. The data collection techniques convoked were interviews, life history, direct observation, and literature review from relevant documents. The data collection tools consisted of a pen, notebook and a dicta phone. A total of 40 informants were interviewed of which 28 were fistula cases, social workers and other resource persons. A content analysis of the data was done wherein relevant data was represented on tables, in figures and percentages in order to give an in-depth interpretation of the results obtained. The community generally have very little knowledge about obstetric fistula and a very negative attitude and perception towards the cause and treatment of obstetric fistula as the fistula cases were stigmatized and also maginalised. From the various knowledge and perceptions on the causes of obstetric fistula outlined in this study, it has greatly influenced the attitude of the community towards obstetric fistula patients as there are both negative and positive attitudes towards them.

Outcome and predictors of failure of abdominal surgical repair of high vesico-vaginal and vesico-uterine fistulae at Gezira Hospital for Renal Disease and Surgery

BackgroundUrogenital fistula can arise from various causes, leading to the development of diverse surgical procedures. The prevention and treatment of obstetric fistula continue to pose challenges in low-income countries.AimTo assess the outcomes and predictors of failure of surgical repair for urogenital fistulas, specifically high vesico-vaginal fistula (VVF) and vesico-uterine fistula (VUF), within our context.MethodsConducted a prospective hospital-based study involving 100 female patients with urogenital fistula (95 VVF and 5 VUF) who underwent abdominal surgical repair at Gezira Hospital for Renal Diseases and Surgery from 2018 to 2023. Collected data encompassing demographics, obstetric history, fistula etiologies, Swab test, cystoscopy findings, urine diversion, ureteric re-implantation, and repair outcomes.ResultsThe majority of women were aged 20–29 years (39%), illiterate (62%), and had a low socio-economic status (87%). Lack of antenatal care was noted in 77% of patients. Fistula etiologies were predominantly obstetric (70%), mainly due to spontaneous vaginal delivery (SVD), with the remaining 30% attributed to gynecological causes (hysterectomy). In terms of fistula characteristics, all patients had a high-level fistula, 95% had a single fistula, and 69% had a posterior wall fistula. Successful closure was achieved in 84% of cases, with 11% experiencing ureteric involvements. The analysis of failures pointed to recurrent fistulae (50%), larger fistula size (31%), and the presence of multiple fistulae (19%) as notable predictors of unsuccessful repair.ConclusionVVF was the prevalent type of urogenital fistula in our population. Risk factors included being in the third decade of life, illiteracy, low socioeconomic status, and a lack of prenatal care. Obstetric causes, particularly prolonged and obstructed labor through SVD, dominated the etiology. Surgical procedures resulted in successful closure in 84% of cases. Recurrent fistulae, larger size, and multiple occurrences emerged as predictors of surgical repair failure.

The reintegration of obstetric fistula survivors in Malawi: Perspectives of healthcare providers

ObjectiveIn Malawi, women face a high risk of obstetric fistulas. There are many socio-cultural implications for women suffering from the condition, many of which continue to affect them even after they have undergone treatment and attempt to reintegrate into their lives. The focus of this study was to explore the socio-cultural factors that influence the reintegration of obstetric fistula survivors in Malawi from the perspectives of healthcare providers. DesignThis qualitative study was conducted at a hospital in Central Malawi, which houses a non-governmental organization (NGO) that is wholly dedicated to the treatment and reintegration of obstetric fistula patients and survivors. In total, in-depth interviews was conducted with 15 healthcare providers. FindingsAfter surgery, survivors are given economic and social empowerment assistance to allow them to gain independence from their families. Counselling interventions help patients overcome their isolation and depression so they may begin to interact with others. In some circumstances, the initial surgeries may be unsuccessful, causing anxiety and doubt among the women. Some survivors no longer desired to bear children in the future, which negatively impacted their marriages and social status. Key conclusionIt is imperative to overcome the socio-cultural beliefs that impact the treatment of obstetric fistula. The perspectives of healthcare providers involved in obstetric fistula treatment can assist policy makers to conceptualize and implement effective policies and programmes that will improve the quality of care offered to obstetric fistula survivors after their treatment. Implications for practicesThese first-hand experiences and knowledge of healthcare providers are significant in identifying challenges and barriers that fistula survivors encounter during the reintegration process.

Associated Morbidities Seen in Women with Obstetric Fistula

Background: Obstetric fistula continues to be a source of misery for women in developing countries. It usually occurs in association with other morbidities. The study was carried out to determine the morbidities that co-exist with obstetric fistula. Methodology: It was a cross-sectional descriptive study carried out among women seeking treatment of obstetric fistula in Cross River State of Nigeria. A combined purposive and proportionate sampling technique was used to select 210 participants. Ethical approval was obtained. A semi-structured interviewer-administered questionnaire was used to obtain information on biodata, obstetric characteristics and morbidties associated with obstetric fistula. Data was analyzed with SPSS version 20. Chi-square was used to compare categorical variables. A P-value of less than 0.05 was considered significant. Results: Among the 210 women, 59 (28.1%) were aged 30 and 39 years. Eighty-one women (38.6%) were grandmultipara and 80 (38.1%) had no living child. Majority (178; 84.8%) of the women delivered stillbirths. At presentation, 175 women (83.3%) had depression, 138 (65.7%) had sexual dysfunction, 97 women (46.2%) had amenorrhoea, 138 (65.7%) had secondary infertility, 128 (61%) had obstetric palsy (foot drop), 171 (81.4%) had urine dermatitis, while 49(23.3%) had features of urinary tract infection. Fifteen women 15 (7.1%) had co-existing rectovaginal fistula. Increased duration of leakage was significantly associated with development of urine dermatitis (P=0.001). Also, increased duration of labour was significantly associated with development of obstetric palsy (P=0.000). Conclusion: Morbidities associated with obstetric fistula are depression, sexual dysfunction, amenorhoea, inferlility, urine dermatitis, obstetric palsy and urinary tract infection. Fistula patients should be assessed for these and be managed by a multidisplinary team.

Reasons for delay in accessing free treatment of obstetric fistula in South-East Nigeria - A qualitative study.

Obstetric fistula continues to be a menace in Nigeria and other low- and middle-income countries. The national policy for its elimination makes surgical repair free in dedicated national centres. However, the majority of the clients present late for repair. The aim of the study was to explore the reasons for this delay in seeking treatment. It was a qualitative (exploratory) study carried out at the National Obstetric Fistula Centre (NOFIC), Abakaliki, Nigeria among obstetric fistula patients who presented for treatment with a duration of leakage of over six months. A consecutive sampling technique was used for patient recruitment. Data was collected from twenty patients using in-depth interviews. Thematic analysis of the responses and recurring patterns was done, with themes illustrated using the word cloud. The mean age of the participants was 37.1 years (range = 21-75 years) while the mean duration of leakage was 64.3 months (range = 8-564 months). Reasons for delay in accessing treatment of obstetric fistula were lack of awareness of the availability of free treatment in a specialized centre, delay in referral from index health care facilities, wrong information from health care workers, failed repairs at other health facilities, secondary delay due to transportation challenges, cultural beliefs and other issues peculiar to the patients. The commonest reason for the delay in accessing treatment for obstetric fistula is a lack of awareness on the part of patients, the public, and health workers. We recommend improved campaigns, advocacy, and community mobilization.

Survival Modeling on the Determinants of Time to Recovery from Obstetric Fistula: The Case of Mekelle Hamlin Fistula Center, Ethiopia

An obstetric fistula is an abnormal opening between the vagina, rectum, and/or bladder. Obstetric fistula has a devastating impact on women's physical, social, and psychological health. Despite the numerous health consequences in developing countries, including Ethiopia, there have been few studies on the determinants of time to recovery from obstetric fistula. Therefore, this study is aimed at addressing the gap. A retrospective cohort study was employed to include 328 randomly selected records of women admitted for obstetric fistula treatment at Mekelle Hamlin Fistula Center from January 2015 to 2020. Data collected from the medical records was coded and entered into SPSS software version 20 and exported to STATA 10 and R statistical software for data cleaning and data analysis. The Kaplan-Meier and log-rank tests were computed to explore the data. The log-logistic inverse Gaussian shared frailty model was employed using a 95% CI, and variables with a p value < 0.05 were declared as determinants of recovery time. Of 328 fistula patients, 293 (89.33%) were physically cured. The Kaplan-Meier result showed that the overall mean and median survival time of time to recovery from obstetric fistula patients at Mekelle Hamlin Fistula Center is 42 and 33 days, respectively. In a log-logistic inverse Gaussian shared frailty model analysis, extensive fistula size (AHR : 1.282; 95% CI = 1.175-1.388), secondary and above education level (AHR : 0.830; 95% CI = 0.693-0.967), rural residence (AHR : 1.357; 95% CI = 1.236-1.479), and physiotherapy use (AHR : 0.801, 95% CI = 0662-0.940, 95% CI = 1.175-1.388) were statistically significant predictors of recovery from obstetrics fistula. Rural place of residence, home delivery, and large and extensive size of the fistula prolong the timing of healing from the obstetric fistula. However, having tall height, physiotherapy treatment, secondary and above-educated women, and RVF type of fistula has a short time of healing for obstetric fistula in Mekelle Hamlin Fistula Center. Therefore, we recommend that health professionals promote institutional delivery and physiotherapy, shorten the duration of catheterization, and manage urine incontinence. In addition, we recommend that the regional health bureau promotes female education and pregnancy after 18 years. The survival probability of patients with obstetric fistulas is better predicted by the log-logistic inverse Gaussian shared frailty model. Therefore, it would be good for future researchers to take this model into account.

Determinants of health seeking behaviour of women with obstetric fistula in south- south and south east, Nigeria: A review of the impact of availability and quality of health care services through a cross-sectional study

Background: Obstetric fistula is a condition that results from obstructed labour, which occurs when the baby cannot pass through the mother’s birth canal because it either does not come head first or is too large for her pelvis. Prompt medical intervention, often including Caesarean section, permits a safe delivery for both mother and child. Despite this possibility, yearly, thousands of women across the country receive no such aid and their labour is a futile agony lasting between three and five days, with uterine contractions constantly forcing the baby, usually head first, against the organs of the pelvic and unyielding pelvic bone resulting in Vesico Vaginal Fistula (VVF). The main thrust of this study was to examine how health system factors affect health seeking behaviour of women with obstetric fistula in Akwa Ibom and Ebonyi States, Nigeria. Methods: Qualitative and descriptive research approaches were adopted for the study and a total sample of two hundred and sixteen (216) respondents comprising of one hundred and fifty (150) post fistula repair operative patients and sixty six (66) health workers were purposively selected using simple random techniques. The data were analyzed using thematic analysis and tables of frequency. Results: The respondents views showed that availability of treatment centre and quality of health care services influenced health seeking behaviour of women with obstetric fistula in Nigeria. Conclusion: The study indicated that health seeking behaviour of women with obstetric fistula is a major challenge in Nigeria. Establishment and proper equipment of obstetric fistula treatment centres as well as subsidization of the cost of treatment to allow women with this health problem to access health care services are strongly recommended. Therefore, government at all level and non-governmental organizations need to educate the women and create awareness on the causes and dangers of VVF.

A comparison of quality of life of obstetric fistula survivors in Zimbabwe before and after surgical treatment

BackgroundIn Zimbabwe, repair of obstetric fistula was established as a public health intervention in 2015. The aim of this study was to assess the quality life of obstetric fistula survivors before and after surgical repair of the fistula.MethodsA longitudinal, before and after cohort study was conducted using the WHOQOL-BREF tool to assess quality of life before and after surgical treatment of obstetric fistula. The tool assess general health, experience of life in general, physical health, psychological health, social and environmental health. Data were analyzed using SPSS version 16.0 for descriptive measures and significance.ResultsOf the 29 women who came for obstetric fistula repair at the center in November and December 2019, 26 were enrolled into the study. All participants had transvaginal fistula repair and 24 had successful repair i.e. the fistulas were closed. Two of them still had stress incontinence by the time of data collection. The post treatment mean scores, using the WHOQOL assessment tool, on physical, psychological, social, environmental and general health significantly improved from the pretreatment mean scores. There was no significant change in some facets of the quality of life domains such as financial resources, opportunities for participation in leisure activities and dependence on medicines.ConclusionsThis study concluded that surgical treatment of obstetric fistula improves the quality of life of survivors significantly and recommends that untreated fistula survivors be identified and linked to care and treatment.

The relational dynamics of women with obstetric fistula in Africa: a narrative review

Background/Aims Obstetric fistula has profound psychological effects on women and influences how they are treated by their family members. This study aimed to identify the relational dynamics of women that had experienced fistula through a narrative review, and determine the extent to which treatment recommendations in the studies reviewed targeted the identified dynamics. Methods This study was a narrative review using a systematic approach, which analysed treatment and care of obstetric fistula patients in Africa. The search was conducted between January and May 2020 for studies published in English between 2006 and 2020. The search used five electronic journal databases: BioMed, SAGE, ScienceDirect, Taylor and Francis Online and Wiley Online. Results Obstetric fistula commonly resulted in unhealthy relational dynamics that had negative effects both on women and their family systems. Despite these findings, most studies did not recommend interventions specific to the family systems of the women. Conclusions It is important to expand the focus of obstetric fistula treatment from an individual to a systemic level. Increased collaboration between mental health practitioners and medical staff in the treatment of obstetric fistula is needed, in order to improve quality of care.

Catherine Hamlin: internationally renowned humanitarian and fistula surgeon

Credit: Kate Geraghty Thanks to Australian obstetrician and gynaecologist Catherine Hamlin (nee Nicholson), the lives and health of more than 60 000 Ethiopian teenage girls and women, and countless others...

Impact of health education on knowledge and behaviours toward obstetric fistula among women of reproductive age in Uganda

Obstetric fistula is among the most severe maternal morbidities. It is caused directly by obstructed labour, and indirectly by social, political, and economic factors. Effects of obstetric fistula include chronic urinary incontinence. Urinary incontinence often leads to isolation and death if left untreated. Death of women during childbirth is detrimental to both social economic transformation and shift of poor economies to middle income status. In this study, we estimate the burden of obstetric fistula on Ugandan women, and the effect of educating these women on its causes. We hypothesise that symptomatic women seek treatment after interactions with a treated woman. We consider one cycle of fistula and seek to determine how many women will eventually seek treatment, when one woman is treated in a population. We further assume that each treated woman becomes the educational resource for more symptomatic women. We then invest in getting women into treatment, providing treatment, or educating them about prevention and treatment of obstetric fistula. Results show that for each investment strategy, there exists a unique maximal solution that remains bounded. It is also shown from the model that high investment rates leads to high treatments rates. However, the highest treatment output is obtained when the level of investment is 44.9%. We also see from the results that for every one woman treated, 17 more seek treatment. However, as investment increases, the number of women that are eventually treated reduces due to lack of further investment into treatment and therefore no more women to treat. Results also show that educating women reduced fistula prevalence although the magnitude of reduction depended on the level of education coverage. These results show that an optimal strategy to reduce fistula prevalence would require achieving a balance between the two desirable but incompatible health outcomes. This will help maximise the total return or effectiveness under given circumstances such as continued women that develop fistula due to lack of skilled healthcare or lifetime incontinence due to lack of treatment. From this study we conclude that improving access to quality health education will contribute to the elimination of obstetric fistula in Uganda.

Reasons for delay in seeking treatment among women with obstetric fistula in Tanzania: a qualitative study

BackgroundObstetric fistula is among the serious and distressing maternal morbidities in Tanzania. Obstetric fistula is a childbirth-related injury caused by prolonged and obstructed labor which has a devastating impact on affected women and their families. The aim of this study was to explore reasons why women with obstetric fistula admitted to the Comprehensive Community- Based Rehabilitation in Tanzania (CCBRT) hospital delayed seeking fistula treatment.MethodsThis exploratory study incorporated qualitative approach. In-depth interviews were used to collect data from 18 women with obstetric fistula admitted to CCBRT hospital. The interviews were conducted in Kiswahili and lasted for 40–45 min. Audio-recordings of the interviews were transcribed verbatim and translated into English. Thematic analysis was used to extract reasons for the delay in seeking treatment for obstetric fistula.ResultsThe study sample (n = 18) ranged in age from 20 to 57 (μ = 37; SD = 11.67), married (n = 14), unemployed (n = 15), and very low level education (n = 15) with primary education. Delay in seeking treatment for obstetric fistula was related to the following themes: inadequate knowledge about the causes and treatment of obstetric fistula, distance and transport cost to a health facility, stigma, community isolation, social isolation and use of traditional and cultural.ConclusionThe Tanzanian Ministry of Health in collaboration with private institutions should strengthen education programmes on the nature and causes of obstetric fistula, and increase the availability of treatment to decrease the effect of this condition for women in Tanzania.

How Operation Fistula uses data visualization to help women with obstetric fistula

Aims: To enable all parts of Operation Fistula to make data-driven decisions in their work and to use data visualisation to simplify complex processes. Moreover, to effectively use data visualisation to educate the public about Obstetric Fistula and other issues of gender inequality.&#x0D; Methods: An experienced visual design analyst was hired full time to lead the analytics setup at the organisation and provide training for the team in the use of Tableau Desktop software.&#x0D; Results: Using a visual representation of data has spread information about Obstetric Fistula in an entirely new way to new audiences. One of our analyses has received over 10,000 views at this time. The use of data visualisation has created powerful partnerships for the organisation that have allowed Operation Fistula to raise significant funds and improve visibility of the cause. Staff members are now empowered to use data in their everyday work to make data-driven decisions. &#x0D; Conclusions: In a world that is driven by data, it is important that evidence-driven actions are implemented not only in the treatment of obstetric fistula but that we make data central to the everyday operation of our workplaces. Data visualisation is a powerful technique to make unfamiliar topics accessible, gain clarity on complex processes, and garner interest from otherwise unengaged actors. With new developments in commercial tools, data visualisation has become more accessible to every level of the business and is no longer exclusively the realm of data analysts.

Establishing Depression Levels among Women Seeking Obstetric Fistula Treatment at Fistula CarePlus Supported Sites in Uganda

Aims:This paper reports on the magnitude of depression among women with Obstetric Fistula.&#x0D; Methods: Between June 2016 and December 2017, 10 nurses and midwives at four hospitals in Uganda (Hoima, Kamuli, Kitovu, and Jinja) were trained to evaluate depression among obstetric fistula clients using the PHQ-9 tool. The tool was scored at admission and at two weeks after surgery. Psychotherapy was provided after surgery. Depression severity was categorized from mild to severe and frequencies were tabulated. Scores from before and after treatment were compared in a subset of clients from Kamuli.&#x0D; Results:Obstetric Fistula clients (180) were assessed preoperatively for depression at Hoima (55), Kamuli (59), Kitovu (22), and Jinja (44). All clients at Hoima (15.2% mild, 24.5% moderate, 28.3% moderate to severe and 32% severe) and Kamuli (23.7% mild, 13.6% moderate, 27.1% moderate to severe and 35.6% severe) had depression before treatment and pyschotherapy. At Kitovu and Jinja depression levels were 81% (13.6% Minimal, 4.5% moderate, 36.4% moderately severe, 45.5% severe) and 84% (Mild 36.5%, Moderate -36.5%, Moderate to Severe-9.7%, severe depression-17.3%) respectively. Post treatment screening was conducted at Kamuli and all clients still had depression but of less severity (Mild -94.9%, Moderate -3.4%%, Moderate to Severe 1.7%, severe depression - 0).&#x0D; Conclusions:Clients with obstetric fistula have high levels of depression. Psychotherapy and surgery can mitigate depression symptoms.&#x0D; Keywords: depression, fistula, psychotherapy, surgery

Development and preliminary validation of a post-fistula repair reintegration instrument among Ugandan women

BackgroundObstetric fistula is a debilitating and traumatic birth injury affecting 2–3 million women globally, mostly in sub-Saharan Africa and Asia. Affected women suffer physically, psychologically and socioeconomically. International efforts have increased access to surgical treatment, yet attention to a holistic outcome of post-surgical rehabilitation is nascent. We sought to develop and pilot test a measurement instrument to assess post-surgical family and community reintegration.MethodsWe conducted an exploratory sequential mixed-methods study, beginning with 16 in-depth interviews and four focus group discussions with 17 women who underwent fistula surgery within two previous years to inform measure development. The draft instrument was validated in a longitudinal cohort of 60 women recovering from fistula surgery. Qualitative data were analyzed through thematic analysis. Socio-demographic characteristics were described using one-way frequency tables. We used exploratory factor analysis to determine the latent structure of the scale, then tested the fit of a single higher-order latent factor. We evaluated internal consistency and temporal stability reliability through Raykov’s ρ and Pearson’s correlation coefficient, respectively. We estimated a series of linear regression models to explore associations between the standardized reintegration measure and validated scales representing theoretically related constructs.ResultsThemes central to women’s experiences following surgery included resuming mobility, increasing social interaction, improved self-esteem, reduction of internalized stigma, resuming work, meeting their own needs and the needs of dependents, meeting other expected and desired roles, and negotiating larger life issues. We expanded the Return to Normal Living Index to reflect these themes. Exploratory factor analysis suggested a four-factor structure, titled ‘Mobility and social engagement’, ‘Meeting family needs’, ‘Comfort with relationships’, and ‘General life satisfaction’, and goodness of fit statistics supported a higher-order latent variable of ‘Reintegration.’ Reintegration score correlated significantly with quality of life, depression, self-esteem, stigma, and social support in theoretically expected directions.ConclusionAs more women undergo surgical treatment for obstetric fistula, attention to the post-repair period is imperative. This preliminary validation of a reintegration instrument represents a first step toward improving measurement of post-surgical reintegration and has important implications for the evidence base of post-surgical reintegration epidemiology and the development and evaluation of fistula programming.

Reasons for delay in decision making and reaching health facility among obstetric fistula and pelvic organ prolapse patients in Gondar University hospital, Northwest Ethiopia

BackgroundObstetric fistula and pelvic organ prolapse remain highly prevalent in sub-Saharan Africa, where women have poor access to modern health care. Women having these problems tend to stay at home for years before getting treatment. However, information regarding the reasons contributing to late presentation to treatment is scarce, especially at the study area.The objective of this study was to assess the reasons whywomen with obstetric fistula and pelvic organ prolapse at Gondar University Hospital delay treatment.MethodA hospital based cross-sectional study was conducted among 384 women. Delay was evaluated by calculating symptom onset and time of arrival to get treatment at Gondar University Hospital. Regression analysis was conducted to elicit predictors of delay for treatment.ResultOf the total 384 participants, 311 (80.9%) had pelvic organ prolapse and 73(19.1%) obstetric fistula. The proportion of women who delayed treatment of pelvic organ prolapse was 82.9% and that of obstetric fistula 60.9%. Fear of disclosing illness due to social stigma (AOR = 2; 1.03, 3.9) and lack of money (AOR = 1.97; 1.01, 3.86) were associated with the delay of treatment for pelvic organ prolapse,while increasing age (AOR =1.12; 1.01, 1.24) and divorce (AOR = 16.9; 1.75, 165.5) were were responsible for delaying treatment forobstetric fistula.ConclusionA large numberof women with pelvic organ prolapse and obstetric fistula delayed treatment. Fear of disclosure due to social stigma and lack of moneywere the major factors that contributed to thedelay to seek treatment for pelvic organ prolapse,while increasing age and divorce were the predictors for delaying treatment for obstetric fistula.

Social Experiences of Women with Obstetric Fistula Seeking Treatment in Kampala, Uganda

BackgroundObstetric fistula is a preventable and treatable condition predominately affecting women in low-income countries. Understanding the social context of obstetric fistula may lead to improved prevention and treatment. ObjectivesThis study investigated social experiences of women with obstetric fistula seeking treatment at Mulago Hospital in Kampala, Uganda. MethodsA descriptive study was conducted among women seeking treatment for obstetric fistula during a surgical camp in July 2011 using a structured questionnaire. Descriptive statistics were computed regarding sociodemographics, obstetric history, and social experience. FindingsFifty-three women participated; 39 (73.58%) leaked urine only. Median age was 29 years (range: 17-58), and most were married or separated. About half (28, 47.9%) experienced a change in their relationship since acquiring obstetric fistula. More than half (27, 50.94%) acquired obstetric fistula during their first delivery, despite almost everyone (50, 94.3%) receiving antenatal care. The median years suffering from obstetric fistula was 1.25. Nearly every participant's social participation changed in at least one setting (51, 96.23%). Most women thought that a baby being too big or having kicked their bladder was the cause of obstetric fistula. Other participants thought health care providers caused the fistula (15, 32.61%; n = 46), with 8 specifying that the bladder was cut during the operation (cesarean section). Knowing someone with obstetric fistula was influential in pursuing treatment. The majority of participants planned to return to family (40, 78.43%; n = 51) and get pregnant after repair (35, 66.04%; n = 53). ConclusionStudy participants experienced substantial changes in their social lives as a result of obstetric fistula, and there were a variety of beliefs regarding the cause. The complex social context is an important component to understanding how to prevent and treat obstetric fistula. Further elucidation of these factors may bolster current efforts in prevention and holistic treatment.

Barriers to obstetric fistula treatment in low-income countries: a systematic review.

To identify the barriers faced by women living with obstetric fistula in low-income countries that prevent them from seeking care, reaching medical centres and receiving appropriate care. Bibliographic databases, grey literature, journals, and network and organisation websites were searched in English and French from June to July 2014 and again from August to November 2016 using key search terms and specific inclusion and exclusion criteria for discussion of barriers to fistula treatment. Experts provided recommendations for additional sources. Of 5829 articles screened, 139 were included in the review. Nine groups of barriers to treatment were identified: psychosocial, cultural, awareness, social, financial, transportation, facility shortages, quality of care and political leadership. Interventions to address barriers primarily focused on awareness, facility shortages, transportation, financial and social barriers. At present, outcome data, though promising, are sparse and the success of interventions in providing long-term alleviation of barriers is unclear. Results from the review indicate that there are many barriers to fistula treatment, which operate at the individual, community and national levels. The successful treatment of obstetric fistula may thus require targeting several barriers, including depression, stigma and shame, lack of community-based referral mechanisms, financial cost of the procedure, transportation difficulties, gender power imbalances, the availability of facilities that offer fistula repair, community reintegration and the competing priorities of political leadership.

Perceptions and experiences of women seeking treatment for obstetric fistula.

To understand patients' perspectives on the causative factors and preventive measures of obstetric fistula; and the effect of fistula on the victims' psycho-social, sexual, and economic well being. A questionnaire-based interview of 215 women with obstetric fistula admitted for treatment in 17 hospitals in India was carried out during 2010-2011. Responses of participants from poor, medium, and better performing states were categorized into pre-coded themes and compared. The majority of the women were from rural areas (75.3%), multiparous (68.8%), and with less than high school education (82.2%). The majority (70.7%) of the women reported attempt at home delivery by untrained persons. Poor awareness of where and when to seek care when faced with a difficult delivery, and poor quality of care in facilities were perceived as important causative factors. Delivery by trained providers and early referral of women with problems during labor were identified as important preventive factors. Spouses and families were supportive of treatment in spite of economic hardships, but most (79.5%) patients felt socially isolated after developing fistula. Poor awareness regarding delivery care among the women indicates a need for increasing birth preparedness in the community. Patients' perceptions of poor quality of care in facilities need to be addressed urgently. Psychological evaluation and counseling should be offered to fistula patients, to help them cope with adverse psycho-social and economic circumstances. The results of this study may provide insights for prevention and management of fistula, and may help to improve patient care and services.