Addressing the fistula treatment gap and rising to the 2030 challenge

Abstract

Obstetric fistula is a neglected public health and human rights issue. It occurs almost exclusively in low-resource regions, resulting in permanent urinary and/or fecal incontinence. Although the exact prevalence remains unknown, it starkly outweighs the limited pool of skilled fistula surgeons needed to repair this childbirth injury. Several global movements have, however, enabled the international community to make major strides in recent decades. FIGO's Fistula Surgery Training Initiative, launched in 2012, has made significant gains in building the capacity of local fistula surgeons to steadily close the fistula treatment gap. Training and education are delivered via FIGO and partners' Global Competency-based Fistula Surgery Training Manual and tailored toward the needs and skill level of each trainee surgeon (FIGO Fellow). There are currently 62 Fellows from 22 fistula-affected countries on the training program, who have collectively performed over 10 000 surgical repairs. The initiative also contributes to the UN's Sustainable Development Goals (1, 3, 5, 8, 10, and 17). The UN's ambitious target to end fistula by 2030 will be unobtainable unless sufficient resources are mobilized and affected countries are empowered to develop their own sustainable eradication plans, including access to safe delivery and emergency obstetric services. K E Y W O R D S

Training and capacity building in obstetric fistula repair: A scoping review

“…Through systematic database and gray literature searches, 405 records were identified (Figure 1). After removing duplicates and screening by title and abstract, there were 64 sources for full‐text screening, of which 24 sources were included in the scoping review 14–37 . Of these, six (25%) sources were from the gray literature, 13 (54.2%) were original articles from LMICs, and five (20.8%) were original articles from HICs (Table S1).…”

“…All of the nine LMIC training articles, highlighted in green in Table S1, are descriptive rather than explicitly prescriptive in that they retrospectively report the number of cases undertaken 26,27,31 or time spent in training. 20,21,24,28,30,32 The only exception is one article's reference to at least 200 to 300 repairs to become a trainer, 20…”

Prevalence and factors associated with the awareness of obstetric fistula among women of reproductive age in The Gambia: a multilevel fixed effects analysis

“…Nevertheless, The Gambia is considered among the 22 high-burdened countries in the world and was selected to train surgeons on obstetric fistula repair as part of the FIGO's Fistula Surgery Training program [ 20 ]. Efforts are also made by the government in collaboration with UNFPA to create awareness of the disease among reproductive-age women and enhance its repair to improve the quality of life of women.…”

“…In May 2022 the Zero Fistula Gambia campaign was launched, to raise public awareness of the condition and call for its eradication [ 9 ]. This campaign was targeted at achieving zero fistula cases in The Gambia by 2030 which collaborates with the international goals of UNFPA in ending obstetric fistula [ 9 , 20 ]. The Gambia currently has three fistula centers, three fistula surgeons, and two FIGO-trained fellows.…”

Interventions for treating obstetric fistula: An evidence gap map

“…Women with obstetric fistula face other barriers to accessing surgical repair procedures. It has been noted that, although surgery is the primary treatment modality, there is a global shortage of skilled fistula surgeons, meaning repair rates are low [13]. Indeed, a qualitative evidence synthesis identified 86 studies that collectively highlighted lack of facilities and expertise as barriers to obstetric fistula repair [14].…”