BackgroundObstetric fistula is a debilitating childbearing injury that results from poorly managed obstructed labour, leading to the development of holes between the vagina and bladder and/or rectum. Effects of this injury are long-lasting, as women become incontinent and are often marginalised from their communities. Despite continuous occurrence of this injury in lower-income countries, it is preventable, as evidenced in high-income countries. This systematic review aims to identify and understand barriers and facilitators to interventions aimed at the prevention of obstetric fistulas in sub-Saharan African women.MethodsElectronic databases and grey literature were searched. We included studies written in English that discussed interventions to prevent obstetric fistulas implemented in sub-Saharan Africa, and their associated barriers and facilitators. Quality of the studies was assessed, and data including: country of implementation, preventive interventions, and barriers and facilitators to the interventions were extracted. They were then categorised based on the Three Phase Delay Model.ResultsOur search yielded 537 studies, of which 18 were included from sub-Saharan countries including Ethiopia, Nigeria, and Zambia. The most noted barrier to prevention addressed the first phase of delay: the decision to seek care, particularly lack of awareness of the dangers of unsupervised labours. The most noted facilitator addressed the decision to seek care and the quality of care received at a facility, through partnerships between health facilities and governments, and other organisations that provided both financial and resource support.ConclusionDespite being categorised by the three phases of the delay model, barriers and facilitators were found to play a role in multiple phases. The topic of obstetric fistula needs to be researched more extensively, particularly the effectiveness of preventive interventions.Electronic supplementary materialThe online version of this article (10.1186/s12884-018-1787-0) contains supplementary material, which is available to authorized users.

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ObjectivesRisk stratification is needed for patients referred to hospital eye services by Diabetic Eye Screening Programme UK. This requires a set of candidate predictors. The literature contains a large number of predictors. The objective of this research was to arrive at a small set of clinically important predictors for the outcome of the progression of diabetic retinopathy (DR). They need to be evidence based and readily available during the clinical consultation.Methods and analysisInitial list of predictors was obtained from a systematic review of prediction models. We sought the clinical expert opinion using a formal qualitative study design. A series of nominal group technique meetings to shorten the list and to rank the predictors for importance by voting were held with National Health Service hospital-based clinicians involved in caring for patients with DR in the UK. We then evaluated the evidence base for the selected predictors by critically appraising the evidence.ResultsThe source list was presented at nominal group meetings (n=4), attended by 44 clinicians. Twenty-five predictors from the original list were ranked as important predictors and eight new predictors were proposed. Two additional predictors were retained after evidence check. Of these 35, 21 had robust supporting evidence in the literature condensed into a set of 19 predictors by categorising DR.ConclusionWe identified a set of 19 clinically meaningful predictors of DR progression that can help stratify higher-risk patients referred to hospital eye services and should be considered in the development of an individual risk stratification model.Study designA qualitative study and evidence review.SettingSecondary eye care centres in North East, Midlands and South of England.

Obstetric fistulas are childbearing injuries that present a major public health issue, especially in the developing context. This study brings together the literature on the causes of these injuries in sub-Saharan Africa, as well as suggested interventions aimed at its prevention. Furthermore, it also aims to identify gaps in the research that need to be addressed. A systematic search of PubMed, Embase, Web of Science, and Scopus identified that extensive research has been carried out on the factors causing this injury, the main factors being complications during labour, three phases of delay, and culture. Nonetheless, there remains a dearth of literature detailing preventive measures. While few studies discussed preventive interventions that had been implemented, the literature does well to suggested preventive interventions. Suggested preventive measures target the community, as well as healthcare facilities. The literature also highlights the need for increased governmental support, as a means of preventing the development of fistulas. Using narrative review methods, we identify that the research focus remains primarily on the causes of obstetric fistula and ways of managing the injury, while paying less attention to means of preventing this injury. We therefore recommend further exploration of preventive measures. RésuméLes fistules obstétricales sont des blessures d'accouchement qui présentent un problème considérable de santé publique, en particulier dans le contexte des pays en voie de développement. Cette étude rassemble la documentation sur les causes de ces blessures en Afrique subsaharienne, ainsi que les interventions proposées visant à sa prévention. En outre, il vise également à identifier les lacunes dans la recherche qui doivent être abordées. Une recherche systématique sur les bases de données PubMed, Embase, Web of Science, et Scopus a révélé que des recherches approfondies ont été menées sur les causes de cette blessure, les principaux facteurs étant les complications pendant l'accouchement, les trois étapes de retard, et la culture. Néanmoins, il reste encore un manque de documentation détaillant les mesures préventives. Malgré que peu d'études aient discuté des interventions préventives qui avaient été mises en oeuvre, la documentation a bienfait de proposer des interventions préventives. Ces mesures proposées ciblent la communauté, ainsi que les centres médicaux. La documentation met également en évidence la nécessité d'un soutien accru de la part du gouvernement, comme un moyen d'empêcher le développement des fistules. En utilisant des méthodes de recherche pour les examens narratifs, nous identifions que la documentation se concentre principalement sur les causes de la fistule obstétricale et les moyens de traiter cette blessure, tout en accordant moins d'attention à la prévention de cette blessure. Par conséquent, nous recommandons une exploration plus approfondi sur les mesures de prévention. (Afr J Reprod Health 2016 (Edition Spéciale); 20[3]: 118-126).