Obstetric Fistula in Burundi: a comprehensive approach to managing women with this neglected disease

Abstract

BackgroundIn Burundi, the annual incidence of obstetric fistula is estimated to be 0.2-0.5% of all deliveries, with 1000–2000 new cases per year. Despite this relatively high incidence, national capacity for identifying and managing obstetric fistula is very limited. Thus, in July 2010, Medecins Sans Frontieres (MSF) set up a specialised Obstetric Fistula Centre in Gitega (Gitega Fistula Centre, GFC), the only permanent referral centre for obstetric fistula in Burundi. A comprehensive model of care is offered including psychosocial support, conservative and surgical management, post-operative care and follow-up. We describe this model of care, patient outcomes and the operational challenges.MethodsDescriptive study using routine programme data.ResultsBetween July 2010 and December 2011, 470 women with obstetric fistula presented for the first time at GFC, of whom 458 (98%) received treatment. Early urinary catheterization (conservative management) was successful in four out of 35 (11%) women. Of 454 (99%) women requiring surgical management, 394 (87%) were discharged with a closed fistula, of whom 301 (76%) were continent of urine and/or faeces, while 93 (24%) remained incontinent of urine and/or faeces. In 59 (13%) cases, the fistula was complex and could not be closed. Outcome status was unknown for one woman. Median duration of stay at GFC was 39 days (Interquartile range IQR, 31–51 days).The main operational challenges included: i) early case finding and recruitment for conservative management, ii) national capacity building in obstetric fistula surgical repair, and iii) assessing the psychosocial impact of this model.ConclusionIn a rural African setting, it is feasible to implement a comprehensive package of fistula care using a dedicated fistula facility, and satisfactory surgical repair outcomes can be achieved. Several operational challenges are discussed.

Rehabilitation experiences after obstetric fistula repair: systematic review of qualitative studies

“…Across the included studies, priorities of rehabilitation included access to community health education and counselling services post-repair for women and their families. Our findings concur with other studies where counselling is highlighted as a useful rehabilitative intervention [7,[33][34][35][36]. Group psychological therapy relieves feelings of depression and increases self-esteem where the act of fellowship with other affected women contributes to feelings of hope [35].…”

Identifying Patients With Vesicovaginal Fistula at High Risk of Urinary Incontinence After Surgery

“…This proportion is similar to what has been reported in other sub-Saharan African settings. (28) However, there is no agreed upon time after surgery for reporting the prevalence of residual incontinence and estimates vary widely by study, from 5% (9) to nearly 40%. (10) The somewhat higher prevalence of residual incontinence in our study likely reflects the fact that complicated cases or cases where previous surgery has failed (24% in our study population) are frequently referred to our center.…”

Good clinical outcomes from a 7‐year holistic programme of fistula repair in Guinea

“…While immediate post-operative closure rates for obstetric fistula can be as high as 90% [11,12], this rate varies by repair centre and other factors such as the size of fistula, surgeon's experience, pre-operative bladder size, degree of vaginal scarring, degree of urethral involvement and number of previous repairs [13,14]. Although urinary continence is not always achieved immediately after surgical repair even with closure of the fistula, residual incontinence can improve or be resolved with time [15].…”