Obstetric fistulae: a study of women managed at the Monze Mission Hospital, Zambia

Abstract

Objective The objective of this study was to describe and compare characteristics of women with obstetric fistula.Design Retrospective cross-sectional study.Setting Zambia's primary fistula repair centre, Monze Mission Hospital. Sample All women, August 2003 to December 2005.Method Review of case notes to obtain data on sociodemographic and obstetric characteristics, causative pregnancy, clinical details, and treatment. Comparison of characteristics with national data was undertaken.Results Of 259 women, 239 had socio-demographic and obstetric records and 254 had surgical records. Educational status and height of women were significantly below the national averages, while antenatal care uptake (97.5%) and proportion from the Northern Province were significantly above. Most women (77.9%) weighed £50 kg. Median age at marriage was 18 and at development of fistula was 22 years. 15.1% of women were divorced, 49.0% were primiparous, and 27.6% were parity four +. 67.5% of women had spent 2 days or longer in labour. Delays in receiving emergency obstetric care (EmOC) were experienced at home (67.5%) and at clinics (49.4%), usually due to transport difficulties. 89.1% delivered in a health facility, 50.2% of deliveries were by caesarean section, and 78.1% of babies were stillborn. 72.9% of repairs were successful, 17.3% resulted in residual stress incontinence, and 9.8% failed. Failure was significantly associated with previous repair.Conclusion More obstetric fistulae occur in areas where early marriage and pregnancy before pelvic maturity is attained is common and where obstetric care is inaccessible. In this study, age at marriage and fistula development was older than usually found, which may indicate that poor access to EmOC contributes more to this problem within Zambia.

High loss to follow-up following obstetric fistula repair surgery in rural Burundi: is there a way forward?

“…First, the conventional approach until now has been to report fi stula treatment outcomes at the time of hospital discharge only, and not beyond this time. Such outcomes are generally reported to be good, with fi stula closure rates of 73-93% reported from various other African settings, [13][14][15][16][17] compared to 87% in our setting. However, repair breakdowns are known to occur in the 6-month post-operative period, 8 invalidating these hospital discharge outcomes.…”

Determinants and Heterogeneity of Time -to- Recovery from Obstetric Fistula Patients; Comparison of Acceleration Failure Time and Parametric Shared Frailty Models.

“…Lack of money, lack of family support and long distance to health facilities were some of the reason that made women delivery at other places than health facilities. Holme et al, 2007 conducted a retrospective cross-sectional study at a hospital in Lusaka, Zambia. Of the 259 women with OBF, one-quarter were below age 20 years.…”

Predictors of Time to Recovery from a Surgical Repair of Obstetric Fistula at Mekelle Hamlin Fistula Center, Tigray, Ethiopia

“…Harmful traditional practices such as early marriage and home delivery are other potential factors for the development of obstetric fistula [8][9][10]. Globally, nine to 84% of obstetric fistula patients gave birth at home and more than 2 million women are currently living with this problem.…”

“…These predispose laboring mothers to suffer unrelieved obstructed labor and end up with obstetric fistula [1,[6][7][8] …”