Urogenital and recto‐vaginal fistulas in southern Malawi: A report on 407 patients

Abstract

This study from Southern Malawi reports on 407 patients with 408 vaginal fistulas (1 patient had 2 successive fistulas). There were 29 patients (7.6%) with a combined urogenital and recto-vaginal fistula. Obstructed labor was the cause of 379 fistulas and the remaining 29 were not of obstetric origin. Although the actual incidence of vaginal fistulas is unknown, the incidence is probably much lower in Malawi than in other African countries. The rate of closure at first repair was 94.1% for urogenital fistulas but it reached 98.5% overall. For recto-vaginal fistulas, closure at first repair was 78.8% but the overall rate of successful closure was 87.9%. Stress incontinence was seen in 16.2% of the patients immediately after repair and in 6.2% after 6 months. The latter rate is certainly too low, however, as 26 of 63 patients were lost to follow-up. A national fistula task force has been set up in Malawi.

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

“…1,9,11 This is different from the severe disruption of the social wellbeing of affected women, which occurs when VVF becomes protracted or suffers repeated repair failures. 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.…”

“…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 majority (75.9% and 86.2% respectively) of patients in the study and control groups were married, in agreement with a similar study in Malawi where over half (57.0%) of the women in that series remained married, even though 20.9% of the women in that series were divorced. 9 These findings give credence to the fact that where VVF repair is performed early, the duration of the distressing symptoms is limited and the disruption of the health of affected women is minimal; while such women therefore continue to enjoy spousal and family support. 1,9,11 This is different from the severe disruption of the social wellbeing of affected women, which occurs when VVF becomes protracted or suffers repeated repair failures.…”

“…The mean age of patients in the study and control groups were 23.9+9.6 years and 24.4+2.1 years respectively, with a modal age of 26-30 years, comparable to results from a similar study in southern Malawi, where a mean age of 22.8 years and a modal age group of 20-29 years were obtained. 9 Another study in Malawi comprising a larger proportion of VVF patients revealed a modal age group of 20-24 years with the vast majority in the 15-29 years age bracket. 10 These results are indicative of the fact that vesicovaginal fistula is a problem of young women of reproductive age who sustain this devastating maternal injury in their prime.…”

Obstetric fistula repair: a guide to patient selection

“…The success rate of 88% with these complex cases measured favourably with the success rates of 88%, 87.9% and 81.3% obtained in studies done in Ethiopia, Malawi and Benin city (Nigeria), respectively, for unselected cases. [13][14][15] Even lower success rates of 73% was obtained in Niger republic and 75% in Maiduguri, Nigeria. 16 The reasons for this disparity in success rates from different centres have not been adduced, however, it is probable that the cure rates obtained in different studies are a reflection of available surgical skill and experience at those centres.…”