Obstetric Fistula Repair: Experience with Hospital-Based Outreach Approach in Nigeria

Abstract

Background:The huge back-log of obstetric fistula and the increasing incidence of the condition in Nigeria is a cause for concern for all stake-holders. This worrisome trend requires concerted effort with innovative strategies to redress the situation.Methods:Hospital-based outreach programs sponsored by a non-governmental organization with volunteer medical and health personnel were used to repair selected cases of obstetric fistula in Nigeria.Results:Fifty-two relatively simple obstetric fistulas were selected out of 68 (selection rate 76.5%) that presented for repair at 12 outreach programs in 5 different states of Nigeria. All the cases were repaired by one trained gynecological surgeon with a cure rate of 100%. The majority (50.0%) of the women were aged between 16 and 20 years with a mean age of 23.8 years ± 3.6. Most (80.9%) of the women in the study population were primiparous. The majority (50.0%) of the women were divorced at the time of their presentation for repair. A vast majority (76.9%) of the women had either primary level of education or no formal education. There was a preponderance (53.8%) of juxtacervical VVF among women in the study population.Conclusion:The use of hospital- based outreach approach to repair simple cases of obstetric fistula if multiplied could help reduce the large number of women living with unrepaired VVF in Nigeria.

Outcome of using a modified surgical technique for the repair of complex vesicovaginal fistulas in Nigeria

“…9,11 The majority of patients in this study population were para 2 with primary level of education, confirming the profile of victims of VVF to be women of low education and parity. 6,9,10 The life of women with VVF is often characterized by the triad of illiteracy, ignorance and poverty, which set the stage for this preventable maternal injury with its debilitating consequences. 11,12 In many of the studies that focus on vesicovaginal fistula-associated factors, affected women are usually primiparous with primary level of education or no formal education.…”

“…The justification of this study is the fact that at present, success rate following repair ranges between 75.0 to 88.0% in series where patient selection based on available level of surgical expertise were not performed before repair, and prognosis of vesicovaginal fistula worsens with repeated failed attempts at repair. 4,[6][7][8] We hope that the results of this study would make its contribution to the efforts targeted at reducing the burden of obstetric fistula in the world.…”

“…5 The eradication of this menace in a country like Nigeria, where it is endemic requires concerted effort with innovative strategies targeted at all-three levels of prevention-primary, secondary and tertiary. 6 While government, medical and health workers as well as other relevant stake holders have roles to play in the primary and secondary levels of prevention of the occurrence of especially obstetric fistula, the VVF surgeon is primarily preoccupied with prevention at level three-successful fistula repair.…”

Obstetric fistula in a district hospital in DR Congo: Fistula still occur despite access to caesarean section

“…Most papers on etiology report on large series from dedicated fistula centres in Nigeria or Ethiopia . The centralized fistula care as it is being organized in those countries has been very successful in treating large numbers of women, but is inefficient in organizing prevention.…”

“…7 Most papers on etiology report on large series from dedicated fistula centres in Nigeria or Ethiopia. [8][9][10][11][12][13][14] The centralized fistula care as it is being organized in those countries has been very successful in treating large numbers of women, but is inefficient in organizing prevention. The organization of fistula centres in other countries can differ significantly from those large-scale dedicated fistula centres.…”