Predictors of Obstetric Fistula Repair Outcomes in Lubango, Angola

Bernard, Laurence; Giles, Andrew E.; Fabiano, Sam; Giles, Stacey; Hudgins, Sarah; Olson, Annelise; Shrime, Mark G.; Feldman, Sarah; Riviello, Robert

doi:10.1016/j.jogc.2019.01.025

Cited by 17 publications

(25 citation statements)

References 17 publications

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“…The chance of recovery for patients aged 30 years and older was four times higher than those who were younger than 18 years. This is in line with a study conducted in Angola 19 and could be attributable to the younger age of patients, who might be mentally and physically immature and develop a complication during labor, which leads to complicated fistula. The chance of recovery for patients who give birth at a health facility was 91% higher than those who delivered at home.…”

Section: Discussionsupporting

confidence: 91%

Effect of vaginal scarring on the recovery of surgical repair of obstetric fistula in Northern Ethiopia

Ambese

Gebre

Berhe

et al. 2022

Intl J Gynecology & Obste

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Globally, an estimated 2-3 million women live with untreated obstetric fistula. The World Health Organization (WHO) estimates that approximately 50 000-100 000 women develop obstetric fistula annually, with at least 33 000 of these located in sub-Saharan Africa (SSA). 1 SSA and South Asia are the regions that have the highest burden of obstetric fistula. There are over 6000 new cases per year in these two world regions. In the developing world, the prevalence of obstetric fistula is 29 per 100 000 women of reproductive age, and in SSA and South Asia its prevalence is 16 and 12 per 10 000 women of reproductive age, respectively. 2 Ethiopia is one of the highest burdened countries that constitute the fistula belt in the world and most women are young and married in their early teens to farmers with little or no education. These women are given heavy tasks in the household and have no access to health facilities during pregnancy and labor. 3 The estimated coverage of institutional and home deliveries in Ethiopia is 48% and 52%, respectively. This shows that most women are giving birth at home without any medical care and are exposed to devastating conditions. 4

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Section: Discussionsupporting

confidence: 91%

Effect of vaginal scarring on the recovery of surgical repair of obstetric fistula in Northern Ethiopia

Ambese

Gebre

Berhe

et al. 2022

Intl J Gynecology & Obste

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“…Without surgery, the likelihood of fistula resolution is almost null, with exception of the rare cases of early fistula closure by immediate catheterization after fistula occurrence. Studies have reported a range of successful fistula repair from 42% to 86% [7,8]. However, surgical repair outcomes are influenced by individual (type and location of fistula) and health system (staff training, surgical expertise) factors.…”

Section: Introductionmentioning

confidence: 99%

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

Mafu

Kyongolwa

Aussak

et al. 2022

Tropical Med Int Health

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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.

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“…Factors influencing fistula repair outcomes including residual incontinence are the subject of various investigations. Some researchers and clinicans believe that individual characteristics such as history of fistula repair, partial or total damage to the urethra, size of the fistula, residual bladder size, and presence of severe fibrosis negatively influence fistula repair outcomes (22)(23)(24)(25). Other authors argue that structural and organizational factors such as insufficient equipment, inexperience of the surgeon, quality of care and inadequate postoperative monitoring substantially affect fistula repair outcomes (6,26).…”

Section: Introductionmentioning

confidence: 99%

Factors Associated With Persistent Urinary Incontinence Among Women Undergoing Female Genital Fistula Surgery in the Democratic Republic of Congo From 2017 to 2019

Nembunzu

Mayemba²,

Sidibé³

et al. 2022

Front. Glob. Womens Health

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BackgroundDespite high closure rates, residual urinary incontinence remains a common problem after successful closure of a vesico-vaginal fistula. The objective of this study was to identify factors associated with residual urinary incontinence in women with successful fistula closure in sites supported by the Fistula Care Plus project in the Democratic Republic of Congo (DRC).Material and MethodsThis was a retrospective cohort study using routine data extracted from the medical records of women undergoing fistula surgery in three hospitals supported by the Fistula Care Plus project in DRC between 2017 and 2019. We analyzed factors associated with residual urinary incontinence among a subsample of women with closed fistula at discharge. We collected data on sociodemographic, clinical, gynecological-obstetrical characteristics, and case management. Univariate and multivariate analyses were performed to determine the factors associated with residual urinary incontinence.ResultsOverall, 31 of 718 women discharged with closed fistula after repair (4.3%; 95% CI: 3.1–6.1) had residual incontinence. The leading causes identified in these women with residual incontinence were urethral voiding (6 women), short urethra (6 women), severe fibrosis (3 women) and micro-bladder (2 women). The prevalence of residual incontinence was higher among women who received repair at the Heal Africa (6.6%) and St Joseph's (3.7%) sites compared with the Panzi site (1.7%). Factors associated with increased odds of persistent urinary incontinence were the Heal Africa repair site (aOR: 54.18; 95% CI: 5.33–550.89), any previous surgeries (aOR: 3.17; 95% CI: 1.10–9.14) and vaginal surgical route (aOR: 6.78; 95% CI: 1.02–45.21).ConclusionPrior surgery and repair sites were the main predictors of residual incontinence after fistula closure. Early detection and management of urinary incontinence and further research to understand site contribution to persistent incontinence are needed.

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Predictors of Obstetric Fistula Repair Outcomes in Lubango, Angola

Cited by 17 publications

References 17 publications

Effect of vaginal scarring on the recovery of surgical repair of obstetric fistula in Northern Ethiopia

Effect of vaginal scarring on the recovery of surgical repair of obstetric fistula in Northern Ethiopia

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

Factors Associated With Persistent Urinary Incontinence Among Women Undergoing Female Genital Fistula Surgery in the Democratic Republic of Congo From 2017 to 2019

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