Factors associated with surgical repair success of female genital fistula in the Democratic Republic of Congo: Experiences of the Fistula Care Plus Project, 2017–2019

Abstract

Objective: We sought to document outcomes and factors associated with surgical success in hospitals supported by the Fistula Care Plus Project in the Democratic Republic of Congo (DRC), 2017-2019. Methods: This was a retrospective cohort study analysing routine repair data on women with Female Genital Fistula. Univariate and multivariate analyses were conducted to determine factors associated with successful fistula repair. Results: A total of 895 women were included in this study, with a mean age of 34 years (AE13 years). The majority were married or in union (57.4%) and living in rural areas (82.0%), while nearly half were farmers (45.9%). The average duration living with fistula was 8 years (AE7). Vesicovaginal (70.5%) and complex (59.8%) fistulas were the most common fistula types. Caesarean section (34.7%), obstructed labour (27.0%) and prolonged labour (23.0%) were the main aetiologies, with the causal deliveries resulting in stillbirth in 88% of cases. The vaginal route (74.9%) was the primary route for surgical repair. The median duration of bladder catheterization after surgery was 14 days (interquartile range [IQR] 7-21). Multivariate analysis revealed that Waaldijk type I fistula (adjusted odds ratio [aOR]:2.71, 95% confidence interval [CI]:1.36-5.40), no previous surgery (aOR:2.63, 95% CI:1.43-3.19), repair at Panzi Hospital (aOR: 2.71, 95% CI:1.36-5.40), and bladder catheterization for less than 10 days (aOR:13.94, 95% CI: 4.91-39.55) or 11-14 days (aOR: 6.07, 95% CI: 2.21-15.31) were associated with better repair outcomes. Conclusion:The Fistula Care Plus Project in the DRC recorded good fistula repair outcomes. However, further efforts are needed to promote adequate management of fistula cases.

Epidemiological, anatomoclinical, and therapeutic profile of obstetric fistula in the Democratic Republic of the Congo: About 1267 patients

“…In the present study, there was a high success rate of OFs repair which was similar to a study reported by other Congolese (71.7%-89.2%) [2,15,24,26,27] and African (77.9%-84.76%) [18,22,28] studies. The success rate after surgical fistula repair varies from centre to centre and is determined by many factors such as fistula site, degree of healing, previous repair attempts, surgical repair technique, surgeon's expertise, equipment and post-operative nursing among others.…”

“…Several factors can explain this observation in the DRC such as the low proportion of obstetricians who are poorly distributed over the vast territory, the low investment in the continuing education of young doctors who find themselves alone in isolated places, the poor equipment of public hospitals, road infrastructure in continuous deterioration, the inadequate health referencing system, the continuous deterioration of the socio-sanitary conditions of the Congolese population, etc. [2,8].…”

“…Obstetric fistula (OF) is defined as an abnormal communication between the urinary tract and the genital tract (urogenital fistula) or between a woman's anorectal tract and genital tract (genito-digestive fistula), resulting primarily from prolonged and obstructed labour resulting in uncontrolled loss of urine and/or stool through the vagina [1][2][3]. It is currently a real public health problem in developing countries [2]. It mainly affects women living in poor countries in sub-Saharan Africa (SSA) and Asia, with insufficient access to prenatal and intrapartum health care [1,3].…”

“…In the Democratic Republic of the Congo (DRC), the estimated prevalence was 1.8 per 1000 women of reproductive age and the estimated number of fistula cases was 14,200 [6]. The national prevalence and incidence of OFs are not known in the DRC [2] and the available estimates are from the 2007 Demographic and Health Survey [7] which estimated that about 0.3% of Congolese women reported having already experienced symptoms suggestive of a fistula. In reality, these values probably underestimate the true occurrence of OFs because many patients certainly remain unidentified due to their social and geographical isolation.…”

Repair failure and associated factors among women who underwent obstetric fistula surgery in Southwest Ethiopia: A retrospective study

“…15,16 Evidence shows that most attributes of OF repair failure are confined to the characteristics of the fistula rather than that of the patient. 9,16 For instance, it is associated with the fistula size, 11,13,14,17,18 duration of bladder catheterization, 14,17 dura tion of labor, 13,14,19 repair site, 17 previous repair attempts, 12,[17][18][19] type of fistula, 14 post-operation infection, 13 duration of fistula, 19 and bladder destruction. 13 OF repair procedures have been conducted for centuries; 20 however, little attention has been paid globally.…”