Obstetric vesicovaginal fistula as an international public-health problem.

Department of Obstetrics-Gynecology, Washington University School of Medicine, St Louis, MO 63110, USA.
The Lancet (Impact Factor: 39.21). 10/2006; 368(9542):1201-9. DOI: 10.1016/S0140-6736(06)69476-2
Source: PubMed

ABSTRACT Vesicovaginal fistula is a devastating injury in which an abnormal opening forms between a woman's bladder and vagina, resulting in urinary incontinence. This condition is rare in developed countries, but in developing countries it is a common complication of childbirth resulting from prolonged obstructed labour. Estimates suggest that at least 3 million women in poor countries have unrepaired vesicovaginal fistulas, and that 30 000-130 000 new cases develop each year in Africa alone. The general public and the world medical community remain largely unaware of this problem. In this article I review the pathophysiology of vesicovaginal fistula in obstructed labour and describe the effect of this condition on the lives of women in developing countries. Policy recommendations to combat this problem include enhancing public awareness, raising the priority of women's reproductive health for developing countries and aid agencies, expanding access to emergency obstetric services, and creation of fistula repair centres.

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    ABSTRACT: The field of obstetric fistula has historically lacked common definitions for measuring needs and outcomes. This paper recounts the process of developing, refining, and using standardized monitoring indicators as part of a fistula prevention and repair project in fourteen countries—Bangladesh, Benin, Democratic Republic of the Congo, Ethiopia, Ghana, Guinea, Liberia, Mali, Niger, Nigeria, Rwanda, Sierra Leone, Togo, and Uganda. The process included collaborative indicator development, introducing standardized data collection at health facilities, and promoting the integration of fistula indicators into national health management information systems (HMIS) to enable continued measurement and support for fistula treatment services. As monitoring of obstetric fistula continues to become more standardized and routine, the multi-country scope of the project has enabled a wide-ranging effort through which indicators for an emerging maternal health content were introduced and applied.
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    ABSTRACT: To synthesise evidence on women's experiences surrounding rehabilitation and reintegration after obstetric fistula repair in sub-Saharan Africa and explore recommendations from women and health service providers. Systematic literature review of qualitative studies surrounding rehabilitation experiences of women in sub-Saharan Africa who have undergone obstetric fistula repair. Using a pre-defined search strategy, 7 databases, relevant source publications and grey literature were searched for primary qualitative studies. Data from ten studies were collected and thematic analysis based on the framework approach was used to analyse the findings. The most important rehabilitating factor for women was fulfilment of social roles. Health service perspectives were more frequent than women's perspectives. Counselling and health education were the most common recommendations from both perspectives. Little qualitative evidence is available on rehabilitation after obstetric fistula repair in sub-Saharan Africa. Counselling services and community health education are priorities. Further research should emphasise women's perspectives to better inform interventions aimed at addressing the physical and social consequences of obstetric fistula. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Tropical Medicine & International Health 01/2015; DOI:10.1111/tmi.12469 · 2.30 Impact Factor
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    ABSTRACT: Obstetric fistula is a childbirth injury prevalent in sub-Saharan Africa that causes uncontrollable leaking of urine and/or feces. Research has documented the social and psychological sequelae of obstetric fistula, including mental health dysfunction and social isolation. This cross-sectional study sought to quantify the psychological symptoms and social support in obstetric fistula patients, compared with a patient population of women without obstetric fistula. Participants were gynecology patients (N = 144) at the Kilimanjaro Christian Medical Center in Moshi, Tanzania, recruited from the Fistula Ward (n = 54) as well as gynecology outpatient clinics (n = 90). Measures included previously validated psychometric questionnaires, administered orally by Tanzanian nurses. Outcome variables were compared between obstetric fistula patients and gynecology outpatients, controlling for background demographic variables and multiple comparisons. Compared to gynecology outpatients, obstetric fistula patients reported significantly higher symptoms of depression, post-traumatic stress disorder, somatic complaints, and maladaptive coping. They also reported significantly lower social support. Obstetric fistula patients present for repair surgery with more severe psychological distress than gynecology outpatients. In order to address these mental health concerns, clinicians should engage obstetric fistula patients with targeted mental health interventions.
    International Journal of Behavioral Medicine 02/2015; DOI:10.1007/s12529-015-9466-2 · 2.63 Impact Factor

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May 26, 2014