Magnitude of repair failure and associated factors among women undergone obstetric fistula repair in Bahir Dar Hamlin Fistula Center, Amhara Region, Northwest Ethiopia

Abstract

<p class="abstract"><strong>Background:</strong> Globally, prevention and repair of obstetric fistula remains a challenge, Ethiopia is one of the high-burden countries that constitute to the high fistula belt in the world.</p><p class="abstract"><strong>Methods:</strong> Cross sectional study was conducted from 1st April 2018 to 1st May 2018 on women who had undergone obstetric fistula repair from 1st January 2013 to 30th December 2017. Systematic sampling technique was applied to select a total of 385 study participants. Data were collected by reviewing clients’ cards using pre-tested questionnaire. Binary and multivariate logistic regression was conducted using SPSS version 21.0 statistical software. </p><p class="abstract"><strong>Results:</strong> The magnitude of fistula repair failure was 35.3%. Women weighing <50 kgs (AOR=3.43, 95% CI: 1.89, 6.23), home delivery (AOR=2.40, 95%CI: 1.38, 4.18), labour for >2 days (AOR=3.22, 95%CI: 1.75,5.91), >3 cm width of fistula (AOR=2.30, 95%Cl 1.27, 4.17), grade three fistula (AOR=3.26, 95%CI: 1.29, 8.27), grade four fistula (AOR=9.76, 95%CI: 3.71, 25.67), complete destruction of bladder neck (AOR=2.70, 95%CI: 1.07, 6.66) and post operation infection (AOR=2.98, 95%CI: 1.56, 5.70) were associated factors with fistula repair failure at p value <0.05.</p><p class="abstract"><strong>Conclusions:</strong> Caution should be taken for obstetric fistula repairing women who presented with less than 50 kg, home delivered, greater than two days labour, greater than 3 cm width of fistula, grade 3 and 4 fistulas, complete destruction of the bladder neck and post-operative infection.</p>

Obstetric fistula repair failure and its associated factors among women underwent repair in Yirgalem Hamlin fistula center, Sidama Regional State, Southern Ethiopia, 2021: a retrospective cross sectional study

“…In this study, factors affecting obstetric fistula repair failure demonstrated that women who had a labor duration of more than 48 h were two times more likely to have an obstetric fistula repair failure than women who had a labor duration of less than 48 h. This finding was comparable with previous studies done in Bahir Dar (Ethiopia) [ 18 ] and Rwanda [ 19 ]. The possible explanation might be due to the presence of any type of delay, whether indecision or delay in reaching a health facility or delay in getting the quality of care, which can increase the duration of labor and lead to longer obstructed labor.…”

“…According to the findings of this study, women with Goh Type 4 fistulas were 3.9 times more likely than women with Goh Type 1 fistulas to have obstetric fistula repair failure. This finding is supported by the findings of a study conducted in the Bahir Dar Hamlin fistula center (Ethiopia) [ 18 ]. The possible explanation might be due to the close of the fistula to the external urethral meatus or the hymen, largely affecting the function of the urinary system, which leads to high risk of fistula repair failure [ 35 ].…”

“…On the other hand, the magnitude of this study was lower than the studies done in Bahir Dar (Ethiopia) (35.3%) [ 18 ], Tanzania (42.9%) [ 34 ], and Angola (58%) [ 7 ]. The possible reason might be the difference in the study period.…”

“…Socio-demographic factors such as age at the time of repairs [ 17 ] and weight less than or equal to 50 kg [ 18 ], as well as obstetric factors such as home delivery [ 18 ], vaginal delivery [ 10 ], and labor duration of 2 days or more [ 16 , 17 ] were found to be risk factors for fistula repair failure in various studies. Fistula characteristics such as large fistula size [ 6 , 16 , 18 , 19 ], Goh Type 3, or Type 4 fistulas [ 16 , 18 ], past repair history [ 6 , 17 , 18 ], urethral damage [ 8 , 19 ], and moderate to severe vaginal scarring [ 18 , 19 ] have also been described as risk factors for repair failure. Peri-operative factors such as surgeons’ experience [ 22 ], abdominal repair [ 16 ], bladder catheterization time [ 23 ], and postoperative infection [ 18 ] were also examined as contributing factors to obstetric fistula repair failure.…”

“…Fistula characteristics such as large fistula size [ 6 , 16 , 18 , 19 ], Goh Type 3, or Type 4 fistulas [ 16 , 18 ], past repair history [ 6 , 17 , 18 ], urethral damage [ 8 , 19 ], and moderate to severe vaginal scarring [ 18 , 19 ] have also been described as risk factors for repair failure. Peri-operative factors such as surgeons’ experience [ 22 ], abdominal repair [ 16 ], bladder catheterization time [ 23 ], and postoperative infection [ 18 ] were also examined as contributing factors to obstetric fistula repair failure.…”