Obstetric Fistula Is a “Neglected Tropical Disease”

Wall, L. Lewis

doi:10.1371/journal.pntd.0001769

Cited by 50 publications

(36 citation statements)

References 14 publications

(18 reference statements)

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“…This emerging concept has been alluded to by other authors [31]. However, based on the findings of this study we contend that the chronicity of fistula illness is beyond the time spent during the care process as suggested by Maulet., et al [28].…”

Section: Discussionsupporting

confidence: 59%

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‘I stayed with my illness’: a grounded theory study of health seeking behaviour and treatment pathways of patients with obstetric fistula in Kenya

et al. 2017

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BackgroundObstetric fistula classic symptoms of faecal and urinary incontinence cause women to live with social stigma, isolation, psychological trauma and lose their source of livelihoods. There is a paucity of studies on the health seeking behaviour trajectories of women with fistula illness although women live with the illness for decades before surgery. We set out to establish the complete picture of women’s health seeking behaviour using qualitative research. We sought to answer the question: what patterns of health seeking do women with obstetric fistula display in their quest for healing?MethodsWe used grounded theory methodology to analyse data from narratives of women during inpatient stay after fistula surgery in 3 hospitals in Kenya. Emergent themes contributed to generation of substantive theory and a conceptual framework on the health seeking behaviour of fistula patients.ResultsWe recruited 121 participants aged 17 to 62 years whose treatment pathways are presented. Participants delayed health seeking, living with fistula illness after their first encounter with unresponsive hospitals. The health seeking trajectory is characterized by long episodes of staying home with illness for decades and consulting multiple actors. Staying with fistula illness entailed health seeking through seven key actions of staying home, trying home remedies, consulting with private health care providers, Non-Governmental organisations, prayer, traditional medicine and formal hospitals and clinics. Long treatment trajectories at hospital resulted from multiple hospital visits and surgeries. Seeking treatment at hospital is the most popular step for most women after recognizing fistula symptoms.ConclusionsWe conclude that the formal health system is not responsive to women’s needs during fistula illness. Women suffer an illness with a chronic trajectory and seek alternative forms of care that are not ideally placed to treat fistula illness. The results suggest that a robust health system be provided with expertise and facilities to treat obstetric fistula to shorten women’s treatment pathways.Electronic supplementary materialThe online version of this article (10.1186/s12905-017-0451-6) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 59%

“…Wall [31] has suggested that obstetric fistula is a neglected tropical condition. Our findings support this author’s position, and even go further to demonstrate that neglect of obstetric fistula patients has led to the chronicity of fistula illness.…”

Section: Discussionmentioning

confidence: 99%

‘I stayed with my illness’: a grounded theory study of health seeking behaviour and treatment pathways of patients with obstetric fistula in Kenya

et al. 2017

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“…It is also responsible for a significant short and long term maternal morbidities such as sepsis, uterine rupture, hemorrhage, secondary infertility, obstetric fistulae and other neurologic and skeletal complications (Arrowsmith et al, 1996, Wall, 2012. Moreover, the impact of obstructed labor on the lives of the fetuses is very significant and it is responsible for high proportion of perinatal death.…”

Section: Introductionmentioning

confidence: 99%

Feto-maternal outcomes in obstructed labor in Suhul General Hospital, North Ethiopia

Ukke¹,

Gudayu²,

Gurara³

et al. 2017

Int. J. Nurs. Midwifery

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Ethiopia is one of the countries with the highest maternal mortality rates, obstructed labor and its complications being the leading causes of maternal deaths in the country. This study was aimed at assessing feto-maternal outcomes in obstructed labor in Suhul General Hospital, North Ethiopia. Institution based cross-sectional study was carried out from May 1 to August 31, 2014 in Suhul General Hospital. All mothers who had given birth in the hospital during the study period were included in the study. Data were collected by using a pre tested structured questionnaire and checklists, entered into Epi Info version 7.1.2.0 and finally transported in to SPSS version 20 software package for analysis. A total of 660 mothers had given birth in the hospital during the study period out of which 44(6.7%) were diagnosed as obstructed labor cases. More than 89% of the mothers with obstructed labor and about 93% of the babies born to them had developed at least one complication. Eighteen (40.9%) of the babies were stillbirths or had died immediately after delivery. Postpartum hemorrhaged and puerperal sepsis 25(56.8%) each and uterine rupture 11(25%) were the main maternal complications among the mothers with obstructed labor. Cesarean birth (68%), hysterectomy (20%), destructive delivery (7%) and repair of the ruptured uterus with bilateral tubal ligation in 5% were interventions done for the mothers with obstructed labor. Inaccessibility of vehicle road and time the women stayed at health centers before they were referred to the hospital have shown association with poor maternal outcomes in Fisher's Exact test. Prevalence of obstructed labor in Suhul general hospital is high with high rate of maternal and fetal complications. Improving vehicle road accessibility and giving training for health centers delivery case teams on when to refer laboring mother to the hospitals is needed in order to decease proportion of Obstructed labor and it sequels.

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“…More rarely, fistula may be caused by genital cutting such as yankan gishiri, sexual violence, iatrogenic reasons (from c-section, hysterectomy or poorly performed abortions), pelvic fractures, and malignancy or radiation [3][4][5]. Female genital fistula is no longer prevalent in the developed world, but remains a common public health concern in developing countries [6,7]. There are no good estimates of the burden of fistula, but the most recent estimates of its prevalence range from one to two million worldwide, based on reviews by Stanton et al and Adler et al [8,9].…”

Section: Introductionmentioning

confidence: 99%

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

Délamou

Diallo

Béavogui

et al. 2015

Tropical Med Int Health

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ObjectivesFemale genital fistula remains a public health concern in developing countries. From January 2007 to September 2013, the Fistula Care project, managed by EngenderHealth in partnership with the Ministry of Health and supported by USAID, integrated fistula repair services in the maternity wards of general hospitals in Guinea. The objective of this article was to present and discuss the clinical outcomes of 7 years of work involving 2116 women repaired in three hospitals across the country.MethodsThis was a retrospective cohort study using data abstracted from medical records for fistula repairs conducted from 2007 to 2013. The study data were reviewed during the period April to August 2014.ResultsThe majority of the 2116 women who underwent surgical repair had vesicovaginal fistula (n = 2045, 97%) and 3% had rectovaginal fistula or a combination of both. Overall 1748 (83%) had a closed fistula and were continent of urine immediately after surgery. At discharge, 1795 women (85%) had a closed fistula and 1680 (79%) were dry, meaning they no longer leaked urine and/or faeces. One hundred and fifteen (5%) remained with residual incontinence despite fistula closure. Follow-up at 3 months was completed by 1663 (79%) women of whom 1405 (84.5%) had their fistula closed and 80% were continent. Twenty-one per cent were lost to follow-up.ConclusionRoutine programmatic repair for obstetric fistula in low resources settings can yield good outcomes. However, more efforts are needed to address loss to follow-up, sustain the results and prevent the occurrence and/or recurrence of fistula.ObjectifsLa fistule génitale féminine reste un problème de santé publique dans les pays en développement. De janvier 2007 à septembre 2013, le projet Fistula Care, géré par Engender Health en partenariat avec le Ministère de la Santé et soutenu par l’USAID, a intégré les services de réparation de fistules dans les maternités des hôpitaux généraux en Guinée. L'objectif de cet article est de présenter et de discuter les résultats cliniques de sept années de travail impliquant 2116 femmes traitées dans trois hôpitaux à travers le pays.MéthodesIl s'agit d'une étude de cohorte rétrospective utilisant des données extraites des dossiers médicaux de réparations de fistules menées de 2007 à 2013. Les données de l’étude ont été analysées au cours de la période allant d'avril à août 2014.RésultatsLa majorité des 2116 femmes qui ont subi une réparation chirurgicale avaient une fistule vésico vaginale (n = 2 045, 97%) et 3% avaient une fistule recto vaginale ou une combinaison des deux. Au total, 1748 (83%) femmes ont eu leur fistule refermée et sont devenues continentes d'urine immédiatement après la chirurgie. À la sortie, 1795 femmes (85%) avaient une fistule fermée et 1680 (79%) étaient sèches, c'est à dire qu'elles n'avaient plus de fuite d'urine et/ou de matières fécales. 115 (5%) femmes avaient toujours une incontinence résiduelle malgré la fermeture de la fistule. Le suivi à trois mois a été complété par 1663 (79%) femmes dont 1405 (84,5%) on...

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Obstetric Fistula Is a “Neglected Tropical Disease”

Cited by 50 publications

References 14 publications

‘I stayed with my illness’: a grounded theory study of health seeking behaviour and treatment pathways of patients with obstetric fistula in Kenya

‘I stayed with my illness’: a grounded theory study of health seeking behaviour and treatment pathways of patients with obstetric fistula in Kenya

Feto-maternal outcomes in obstructed labor in Suhul General Hospital, North Ethiopia

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

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