Reintegration needs of young women following genitourinary fistula surgery in Uganda

Abstract

Introduction and hypothesis Genitourinary fistulas (usually arising following prolonged obstructed labor) are particularly devastating for women in low-income counties. Surgical repair is often difficult and delayed. While much attention has been devoted to technical surgical issues, the challenges of returning to normal personal, family, and community life after surgical treatment have received less scrutiny from researchers. We surveyed young Ugandan women recovering from genitourinary fistula surgery to assess their social reintegration needs following surgery. Methods A cross-sectional survey of 61 young women aged 14–24 years was carried out 6 months postoperatively. Interviews were carried out in local languages using a standardized, interviewer-administered, semistructured questionnaire. Data were entered using EpiData and analyzed using SPSS. Results Ongoing reintegration needs fell into interrelated medical, economic, and psychosocial domains. Although >90% of fistulas were closed successfully, more than half of women had medical comorbidities requiring ongoing treatment. Physical limitations, such as foot drop and pelvic muscle dysfunction impacted their ability to work and resume their marital relationships. Anxieties about living arrangements, income, physical strength, future fertility, spouse/partner fidelity and support, and possible economic exploitation were common. Sexual dysfunction after surgery—including dyspareunia, loss of libido, fear of intercourse, and anxieties about the outcome of future pregnancies—negatively impacted women’s relationships and self-esteem. Conclusions Young women recovering from genitourinary fistula surgery require individualized assessment of their social reintegration needs. Postoperative social reintegration services must be strengthened to do this effectively.

Integrated mental health screening for obstetric fistula patients in Mali: From evidence to policy

“…This data underscores the need for mental health support both prior to and following fistula repair surgery, especially since residual incontinence following surgery is associated with persistent mental health distress [14,35]. Continued poor mental health could hamper community reintegration efforts that are typically part of fistula care and treatment programs [36][37][38]. Though the number of psychosocial impacts endorsed was not significantly associated with depression, it is notable that an overwhelming majority of women reported having disturbing memories of the fistulas (92%), feeling punished by God (82%), and feeling hopeless about the future (79%).…”

Development and Pilot Test of a Group Cognitive Behavioral Intervention for Women Recovering From Fistula Repair Surgery in Ethiopia

“…Another review of the prevalence of depression among women with obstetric fistulae in low-income African countries found a pooled prevalence of 56.2%, with women in Ethiopia reporting the highest prevalence of depression at 74.4% ( 21 ). Although surgical repair of fistulae is associated with improvements in women's quality of life and mental health ( 22 , 23 ), many women still face difficulty re-engaging in family and community life, with a range of medical, psychosexual, economic, and psychosocial issues causing further mental health distress post-surgery ( 24 ). Muleta et al ( 25 ) found, even after being treated surgically to repair the fistula, many women still had difficulty engaging in family and community life, leading the authors to suggest a need for new strategies to address mental health after fistula repair surgery.…”

“…Obstetric fistula is a significant problem in low-income countries that is virtually non-existent in high-income countries ( 1 , 27 ). Unfortunately, few intervention efforts have focused on the psychological impacts of this condition, despite many research groups advocating for integration of mental health care into treatment for women suffering from this condition ( 17 , 18 , 22 , 24 , 28 ). Overall, women and girls are not taught skills they can use to function effectively and contribute to their communities, to cope with trauma and loss, and to manage every day and more significant life events that they are likely to encounter once they leave the secure environment of the fistula hospital and return home.…”

The persistent challenges and strategies for effective rehabilitation among obstetric fistula patients at Kitovu Mission Hospital, Uganda: a qualitative study

“…cut-off, which results in tissue necrosis leaving a "hole" that instigates urine and/or fecal incontinence. 4,5 Alongside the leakage, women get uterine and cervical injuries, develop genital sores, suffer infections, foot drop, nerve damage, and secondary infertility. They are highly stigmatized, have low social standing, are unproductive and unable to participate in social events.…”

“…10 However, returning to a normal life remains a dream to many obstetric fistula patients. 5 Few studies document the challenges and strategies for rehabilitation and social reintegration among the obstetric fistula patients more so in Uganda, which inspired this study. The research question was; what challenges are persistent despite rehabilitation efforts and how can rehabilitation of the obstetric fistula patients be more effective?…”