A retrospective review of genital fistula occurrence in nine African countries

Ngongo, Carrie; Raassen, Thomas J. I. P.; Mahendeka, Marietta; Lombard, Ladeisha; Roosmalen, Jos van; Temmerman, Marleen

doi:10.1186/s12884-022-05051-w

Cited by 3 publications

(5 citation statements)

References 19 publications

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“…The causes of genital fistulas include obstetric trauma, Crohn’s disease, secondary to cryptogenic gland abscess, and radiation injury [ 43 , 44 ]. Ischemic damage to the soft tissues of the pelvis caused by the baby’s head during prolonged labor is the leading cause of genital fistula, especially in countries with poor health care, where up to 5.6 per 1,000 women develop genital fistula after childbirth [ 45 ]. Although a survey of patients with Crohn’s disease showed management of rectovaginal fistulas in 9% of all fistulas [ 43 ], there was a lack of history regarding whether the patient had a previous obstetric injury.…”

Section: Discussionmentioning

confidence: 99%

Causal Link between Inflammatory Bowel Disease and Fistula: Evidence from Mendelian Randomization Study

Tan

Zhu

Liu

et al. 2023

JCM

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Background: Previous observational studies have found that fistulas are common in Crohn’s disease (CD) and less common in ulcerative colitis (UC). However, some patients have a fistula before diagnosis. Based on retrospective analysis, it was not possible to determine whether there was a bi-directional causal relationship between inflammatory bowel disease (IBD) and fistulas. Methods: Data were extracted from the open GWAS database; 25,042 cases and 34,915 controls were included for IBD, and 6926 cases and 30,228 controls were included for fistula. Two-sample Mendelian randomization and multivariable Mendelian randomization were used in combination to determine the causal relationship between IBD and fistula. Results: Forward MR showed that IBD increased the risk of colonic or urogenital fistula (FISTULA) (OR: 1.09, 95% CI: 1.05 to 1.13, p = 1.22 × 10−6), mainly associated with fissure and fistula of the anal and rectal regions (FISSANAL) (OR:1.10, 95% CI:1.06 to 1.14, p = 6.12 × 10−8), but not with fistulas involving the female genital tract (FEMGENFISTUL) (OR:0.97, 95% CI: 0.85 to 1.11, p = 0.669). Furthermore, both UC and CD increased the risk of FISTULA. However, after adjusting by MVMR, only CD increased the risk of FISTULA (OR: 1.06, 95% CI: 1.02 to 1.11, p = 0.004), and UC did not increase the risk of FISTULA (OR: 1.01, 95% CI: 0.95 to 1.06, p = 0.838). Reverse MR showed that fistulas did not increase the risk of IBD. Conclusion: Our study confirms it is CD, rather than UC, that casually leads to an increased risk of fistula, but fistulas do not increase the risk of IBD.

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Section: Discussionmentioning

confidence: 99%

Causal Link between Inflammatory Bowel Disease and Fistula: Evidence from Mendelian Randomization Study

Tan

Zhu

Liu

et al. 2023

JCM

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“…This retrospective records review evaluated the frequency of cesarean-associated iatrogenic fistulas by cadre among 1290 women who presented with fistula-related incontinence after cesarean birth in Tanzania and Malawi. These women are a subset of a larger group of 6787 women who presented for fistula repair in nine countries [ 25 , 26 ]. As detailed elsewhere, TJIPR, MM, and their colleagues collected data between June 1994 and December 2017 [ 27 ].…”

Section: Methodsmentioning

confidence: 99%

Equivalence between physicians and associate clinicians in the frequency of iatrogenic urogenital fistula following cesarean section in Tanzania and Malawi

Ngongo,

Raassen,

van Roosmalen

et al. 2024

Hum Resour Health

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Background Physicians and associate (non-physician) clinicians conduct cesarean sections in Tanzania and Malawi. Urogenital fistulas may occur as complications of cesarean section. Location and circumstances can indicate iatrogenic origin as opposed to ischemic injury following prolonged, obstructed labor. Methods This retrospective review assessed the frequency of iatrogenic urogenital fistulas following cesarean sections conducted by either associate clinicians or physicians in Tanzania and Malawi. It focuses on 325 women with iatrogenic fistulas among 1290 women who had fistulas after cesarean birth in Tanzania and Malawi between 1994 and 2017. An equivalence test compared the proportion of iatrogenic fistulas after cesarean sections performed by associate clinicians and physicians (equivalence margin = 0.135). Logistic regression was used to model the occurrence of iatrogenic fistula after cesarean section, controlling for cadre, date, maternal age, previous abdominal surgery and parity. Results Associate clinicians attended 1119/1290 (86.7%) cesarean births leading to fistulas, while physicians attended 171/1290 (13.3%). Iatrogenic fistulas occurred in 275/1119 (24.6%) cesarean births by associate clinicians and in 50/171 (29.2%) cesarean births by physicians. The risk difference and 90% confidence interval were entirely contained within an equivalence margin of 13.5%, supporting a conclusion of equivalence between the two cadres. The odds of iatrogenic fistula after cesarean section were not statistically significantly different between associate clinicians and physicians (aOR 0.90; 95% CI 0.61–1.33). Conclusions Associate clinicians appear equivalent to physicians performing cesarean sections in terms of iatrogenic fistula risk. Lower iatrogenic proportions for associate clinicians could reflect different caseloads. The occurrence of iatrogenic fistulas illustrates the importance of appropriate labor management and cesarean section decision-making, irrespective of health provider cadre. Given the noninferior performance and lower costs of employing associate clinicians, other countries with insufficient and/or unequally distributed health workforces could consider task-shifting cesarean sections to associate clinicians.

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“…We grouped genital fistulas according to the circumstances of fistula development. Fistulas following childbirth or surgery were separately investigated [7]. We divided traumatic fistulas between those related to sexual violence, traditional healers, and accidental trauma.…”

Section: Methodsmentioning

confidence: 99%

“…6 Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya. 7 Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.…”

Section: Supplementary Informationmentioning

confidence: 99%

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Rare causes of genital fistula in nine African countries: a retrospective review

Ngongo

Raassen²,

Mahendeka

et al. 2022

BMC Women's Health

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Background Most genital fistulas result from prolonged, obstructed labor or surgical complications. Other causes include trauma (from accidents, traditional healers, or sexual violence), radiation, carcinoma, infection, unsafe abortion, and congenital malformation. Methods This retrospective records review focuses on rare fistula causes among 6,787 women who developed fistula after 1980 and sought treatment between 1994 and 2017 in Tanzania, Uganda, Kenya, Malawi, Zambia, Rwanda, Ethiopia, Somalia, and South Sudan. We compare fistula etiologies across countries and assess associations between rare causes and type of incontinence (urine, feces, or both). Results Rare fistula accounted for 1.12% (76/6,787) of all fistulas, including traumatic accidents (19/6,787, 0.28%), traumatic sexual violence (15/6,787, 0.22%), traumatic injuries caused by traditional healers (13/6,787, 0.19%), unsafe abortion (10/6,791, 0.15%), radiation (8/6,787, 0.12%), complications of HIV infection (6/6,787, 0.09%), and congenital abnormality (5/6,787, 0.07%). Trauma caused by traditional healers was a particular problem among Somali women. Conclusion Fistulas attributable to rare causes illuminate a variety of risks confronting women. Fistula repair training materials should distinguish trauma caused by traditional healers as a distinct fistula etiology. Diverse causes of fistula call for multi-pronged strategies to reduce fistula incidence.

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A retrospective review of genital fistula occurrence in nine African countries

Cited by 3 publications

References 19 publications

Causal Link between Inflammatory Bowel Disease and Fistula: Evidence from Mendelian Randomization Study

Causal Link between Inflammatory Bowel Disease and Fistula: Evidence from Mendelian Randomization Study

Equivalence between physicians and associate clinicians in the frequency of iatrogenic urogenital fistula following cesarean section in Tanzania and Malawi

Rare causes of genital fistula in nine African countries: a retrospective review

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