A community‐based long‐term follow up of women undergoing obstetric fistula repair in rural Ethiopia

Abstract

Objectives To assess urinary and reproductive health and quality of life following surgical repair of obstetric fistula.Design Follow-up study.Setting A newly established fistula clinic (2004) at Gimbie Adventist Hospital, a 71-bedded district general hospital in West Wollega Zone, in rural Western Ethiopia.Population Thirty-eight women (86%) of 44 who had undergone fistula repair were identified in their community.Methods Community-based structured interviews 14-28 months following fistula repair, using a customised questionnaire addressing urinary health, reproductive health and quality of life.Main outcome measures Urinary health at follow up was assessed as completely dry, stress or urge incontinence, or fistula. King's Health Questionnaire was modified and used for the quality-oflife assessment.Results At follow up, 21 women (57%) were completely dry, 13 (35%) suffered from stress or urge incontinence and three (8%) had a persistent fistula. Surgery improved quality of life and facilitated social reintegration to a level comparable to that experienced before fistula development for both women who were dry and those with residual incontinence (P = 0.001). For women still suffering from fistula no change was seen (P = 0.1). Four women became pregnant following their surgery, among which there was one maternal death, three stillbirths and one re-occurrence of fistula.Conclusion Community-based, long-term follow up after fistula repair succeeded in Western rural Ethiopia. Despite one-third still suffering stress or urge incontinence, the women reported improved quality of life and social reintegration after fistula closure.Keywords Quality of life, long term follow-up, obstetric fistula, outcomes.Please cite this paper as: Nielsen H, Lindberg L, Nygaard U, Aytenfisu H, Johnston O, Sørensen B, Rudnicki M, Crangle M, Lawson R, Duffy S. A community-based long-term follow up of women undergoing obstetric fistula repair in rural Ethiopia.

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

“…Despite the relatively high rate of completely closed fistula (82%), as in other Ethiopian studies (Kelly 1995;Muleta, Rasmussen, and Kiserud 2010;Nielsen et al 2009) many women continued to struggle with ongoing physical and mental health problems. It is unlikely that most of the reported minor health issues were related to the fistula or its repair, thus additional attention to counselling that can address these concerns during the recovery period may be warranted.…”

Fertility and pregnancy outcomes among women with obstetric fistula in rural Malawi

“…Of the 4 pregnancies among such patients post-repair in an Ethiopian follow-up study, there was 1 maternal death, 3 stillbirths, and 1 reoccurrence of fistula [9]. Furthermore, although Emembolu [10] reported a perinatal mortality rate of 34% in unrepaired women, which decreased to 13% post-repair, there were higher rates of pregnancy and childbearing complications in the present study among women who had undergone repair surgery than among those living with obstetric fistula.…”

“…In a retrospective review of fistula surgery cases in Kenya from 1999 to 2007, 14 (43.8%) of the 32 women who presented at post-operative follow-up were amenorrheic and 11 (34.4%) had vaginal stenosis [8]. Similarly, 7 (25.9%) of 27 women in an obstetric fistula repair study in Ethiopia were amenorrheic at post-operative follow-up [9]. Thus, although surgical repair has the potential to improve urologic functioning, the surgery is unlikely to repair infertility among women with obstetric fistula, and in some cases it can exacerbate the underlying etiology.…”

Health‐related quality of life among women in rural Bangladesh after surgical repair of obstetric fistula

“…Among those who have undergone surgical repair, health-related quality of life (QOL) is a key issue; however, most studies conducted to date have focused on QOL before rather than after surgery [4,5,7]. In the studies that have assess postsurgical QOL [6,[10][11][12], surgery has been shown to improve social life, physical activity, and psychological condition. However, some women who underwent obstetric fistula repair remained incontinent [10][11][12], and other health problems (e.g.…”

“…In the studies that have assess postsurgical QOL [6,[10][11][12], surgery has been shown to improve social life, physical activity, and psychological condition. However, some women who underwent obstetric fistula repair remained incontinent [10][11][12], and other health problems (e.g. gynatresia, amenorrhea, and leg weakness) have also been reported [13].…”