Background: Clinical officers perform much of major emergency surgery in Malawi, in the absence of medical officers. The aim of this study was to validate the advantages and disadvantages of delegation of major obstetric surgery to non-doctors.

This study from Southern Malawi reports on 407 patients with 408 vaginal fistulas (1 patient had 2 successive fistulas). There were 29 patients (7.6%) with a combined urogenital and recto-vaginal fistula. Obstructed labor was the cause of 379 fistulas and the remaining 29 were not of obstetric origin. Although the actual incidence of vaginal fistulas is unknown, the incidence is probably much lower in Malawi than in other African countries. The rate of closure at first repair was 94.1% for urogenital fistulas but it reached 98.5% overall. For recto-vaginal fistulas, closure at first repair was 78.8% but the overall rate of successful closure was 87.9%. Stress incontinence was seen in 16.2% of the patients immediately after repair and in 6.2% after 6 months. The latter rate is certainly too low, however, as 26 of 63 patients were lost to follow-up. A national fistula task force has been set up in Malawi.

No abstract