Trajectories of women's physical and psychosocial health following obstetric fistula repair in Uganda: a longitudinal study

Abstract

Objectives To explore trajectories of physical and psychosocial health, and their interrelationship, among women completing fistula repair in Uganda for 1 year post‐surgery. Methods We recruited a 60‐woman longitudinal cohort at surgical hospitalisation from Mulago Hospital in Kampala Uganda (Dec 2014–June 2015) and followed them for 1 year. We collected survey data on physical and psychosocial health at surgery and at 3, 6, 9 and 12 months via mobile phone. Fistula characteristics were abstracted from medical records. All participants provided written informed consent. We present univariate analysis and linear regression results. Results Across post‐surgical follow‐up, most women reported improvements in physical and psychosocial health, largely within the first 6 months. By 12 months, urinary incontinence had declined from 98% to 33% and general weakness from 33% to 17%, while excellent to good general health rose from 0% to 60%. Reintegration, self‐esteem and quality of life all increased through 6 months and remained stable thereafter. Reported stigma reduced, yet some negative self‐perception remained at 12 months (mean 17.8). Psychosocial health was significantly impacted by the report of physical symptoms; at 12 months, physical symptoms were associated with a 21.9 lower mean reintegration score (95% CI −30.1, −12.4). Conclusions Our longitudinal cohort experienced dramatic improvements in physical and psychosocial health after surgery. Continuing fistula‐related symptoms and the substantial differences in psychosocial health by physical symptoms support additional intervention to support women's recovery or more targeted psychosocial support and reintegration services to ensure that those coping with physical or psychosocial challenges are appropriately supported.

Rehabilitation and reintegration programming adjunct to female genital fistula surgery: A systematic scoping review

“…In Guinea, 16% experienced fistula recurrence by 24 months . In Uganda, by 12 months following repair, one‐third had persistent urinary incontinence, 17% weakness, and 9% general pain . In Malawi, only one‐fifth of women with reproductive potential became pregnant in the year following surgery .…”

“…In Malawi, only one‐fifth of women with reproductive potential became pregnant in the year following surgery . Experience of persistent physical adversity correlates with substantially lower psychosocial health . Such factors limit women's ability to resume previous roles despite successful surgery, particularly in conjunction with economic hardship, resulting in additional reintegration needs …”

Association of socio-demographic and obstetric factors with obstetric fistula patients’ perceptions towards life fulfillment in Kitovu Hospital, Uganda

“…27 A study that investigated trajectories post repair noted a decline in social stigma, and negative perceptions with time. 8 Bomboka's study in Uganda also noted restoration of hope, dignity, joy and recovery of marriages among those who had successful repair and those with social support. 3 Similar patterns were reported by a study in Tanzania by Denis, et al, where patients who were joyfully welcomed home after repair easily reintegrated and reported optimism towards a number of life domains.…”

“…Therefore, if negative perceptions should be reversed among obstetric fistula patients, timely and effective repair of the fistula should be the initial step. 3,8 Individualized counseling should also be done. It should acknowledge and address the negative impact of fistula especially towards relationships, feelings, and thought processes.…”

“…5 The repair of fistula is life renewing, restores joy, hope and dignity. 3,8 It is largely possible with up to 90% success rate especially for uncomplicated fistula. Nonetheless, the backlog is very high.…”