Understanding the lived experience of women before and after fistula repair: a qualitative study in Kenya

Khisa, Weston; Wakasiaka, Sabina; McGowan, Linda; Campbell, Malcolm; Lavender, Tina

doi:10.1111/1471-0528.13902

Cited by 47 publications

(40 citation statements)

References 15 publications

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“…Our results suggest that the greatest overall physical health benefits occur during the first 6 months following surgery, with concurrent psychosocial health improvement. The stagnation in physical and psychosocial health indicators that we observed at about 6 months is consistent with qualitative work conducted Kenya by Khisa et al [64]. Khisa describes a 'miracle phase' in the immediate post-surgical period among women with successful repair.…”

Section: Discussionsupporting

confidence: 90%

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

Ayadi

Barageine

Korn

et al. 2018

Tropical Med Int Health

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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.

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Section: Discussionsupporting

confidence: 90%

“…The stagnation in physical and psychosocial health indicators that we observed at about 6 months is consistent with qualitative work conducted Kenya by Khisa et al . . Khisa describes a ‘miracle phase’ in the immediate post‐surgical period among women with successful repair.…”

Section: Discussionmentioning

confidence: 99%

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

Ayadi

Barageine

Korn

et al. 2018

Tropical Med Int Health

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“…It has been stated that women with a previous traumatic birth experience had fewer pregnancies post‐repair than women without such an experience . Women treated for OF are usually advised to wait for 3–6 months before resuming sexual intercourse to allow for complete healing. In addition, the fear of fistula recurrence might delay the resuming of sexual activities .…”

Section: Discussionmentioning

confidence: 99%

“…Women treated for OF are usually advised to wait for 3–6 months before resuming sexual intercourse to allow for complete healing. In addition, the fear of fistula recurrence might delay the resuming of sexual activities . Divorce and mental trauma, but also urinary infections or iatrogenic amenorrhoea, which are common among fistula women, might reduce the probability of getting pregnant .…”

Section: Discussionmentioning

confidence: 99%

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Pregnancy and childbirth after repair of obstetric fistula in sub‐Saharan Africa: Scoping Review

Délamou

Utz

Delvaux

et al. 2016

Tropical Med Int Health

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Abstractobjective To synthesise the evidence on pregnancy and childbirth after repair of obstetric fistula in sub-Saharan Africa and to identify the existing knowledge gaps.methods A scoping review of studies reporting on pregnancy and childbirth in women who underwent repair for obstetric fistula in sub-Saharan Africa was conducted. We searched relevant articles published between 1 January 1970 and 31 March 2016, without methodological or language restrictions, in electronic databases, general Internet sources and grey literature.results A total of 16 studies were included in the narrative synthesis. The findings indicate that many women in sub-Saharan Africa still desire to become pregnant after the repair of their obstetric fistula. The overall proportion of pregnancies after repair estimated in 11 studies was 17.4% (ranging from 2.5% to 40%). Among the 459 deliveries for which the mode of delivery was reported, 208 women (45.3%) delivered by elective caesarean section (CS), 176 women (38.4%) by emergency CS and 75 women (16.3%) by vaginal delivery. Recurrence of fistula was a common maternal complication in included studies while abortions/miscarriage, stillbirths and neonatal deaths were frequent foetal consequences. Vaginal delivery and emergency C-section were associated with increased risk of stillbirth, recurrence of the fistula or even maternal death.conclusion Women who get pregnant after repair of obstetric fistula carry a high risk for pregnancy complications. However, the current evidence does not provide precise estimates of the incidence of pregnancy and pregnancy outcomes post-repair. Therefore, studies clearly assessing these outcomes with the appropriate study designs are needed.

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The Promise and Neglect of Follow-up Care in Obstetric Fistula Treatment in Uganda

Ruder¹,

Emasu²

2022

Global Maternal and Child Health

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Considered the most severe of maternal morbidities, obstetric fistula is a debilitating childbirth injury that results in complete incontinence with severe physical and psychosocial consequences.The primary intervention for women with obstetric fistula is surgical repair, and success rates for repair are reported between 80% and 97%. However, successful treatment is commonly defined solely by the closure of the fistula defect and often fails to capture women who continue to experience urinary incontinence after repair. Residual incontinence post-fistula repair is both underreported and under-examined in the literature. Through a novel mixed-method study that examined clinical, quantitative, and qualitative aspects of residual incontinence post-repair, this chapter draws on in-depth interviews with women suffering with residual incontinence and fistula surgeons, participant observation, and a desk review of fistula policies and guidelines to argue that an inadequate model of fistula treatment that neglects follow-up care exists. We found that obstetric fistula policy has been determined in large part over the years by international development agencies and funding organizations, such as international nongovernmental organizations (INGOs). We argue that the neglect in follow-up care is evident in fistula policy and can be traced to a donor-funded treatment model that fails to prioritize and fund follow-up care as an essential component of fistula treatment, instead focusing on a “narrative of success” in fistula treatment. As a result, poor outcomes are underreported and women who experience poor outcomes are largely erased from the fistula narrative. This erasure has limited the attention, resources, research, and dedicated to residual incontinence, leaving out women suffering from residual incontinence largely without alternative treatment options.

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Understanding the lived experience of women before and after fistula repair: a qualitative study in Kenya

Abstract: Fistula surgery alone is insufficient for women's physical, social and psychological recovery.

Cited by 47 publications

References 15 publications

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

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

Pregnancy and childbirth after repair of obstetric fistula in sub‐Saharan Africa: Scoping Review

The Promise and Neglect of Follow-up Care in Obstetric Fistula Treatment in Uganda

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