Reasons for delay in accessing free treatment of obstetric fistula in South-East Nigeria - A qualitative study.

Obstetric fistula continues to be a menace in Nigeria and other low- and middle-income countries. The national policy for its elimination makes surgical repair free in dedicated national centres. However, the majority of the clients present late for repair. The aim of the study was to explore the reasons for this delay in seeking treatment. It was a qualitative (exploratory) study carried out at the National Obstetric Fistula Centre (NOFIC), Abakaliki, Nigeria among obstetric fistula patients who presented for treatment with a duration of leakage of over six months. A consecutive sampling technique was used for patient recruitment. Data was collected from twenty patients using in-depth interviews. Thematic analysis of the responses and recurring patterns was done, with themes illustrated using the word cloud. The mean age of the participants was 37.1 years (range = 21-75 years) while the mean duration of leakage was 64.3 months (range = 8-564 months). Reasons for delay in accessing treatment of obstetric fistula were lack of awareness of the availability of free treatment in a specialized centre, delay in referral from index health care facilities, wrong information from health care workers, failed repairs at other health facilities, secondary delay due to transportation challenges, cultural beliefs and other issues peculiar to the patients. The commonest reason for the delay in accessing treatment for obstetric fistula is a lack of awareness on the part of patients, the public, and health workers. We recommend improved campaigns, advocacy, and community mobilization.

Reasons for delay in accessing free treatment of obstetric fistula in South-East Nigeria ­ A qualitative study

Obstetric fistula continues to be a menace in Nigeria and other low- and middle-income countries. The national policy for its elimination makes surgical repair free in dedicated national centres. However, the majority of the clients present late for repair. The aim of the study was to explore the reasons for this delay in seeking treatment. It was a qualitative (exploratory) study carried out at the National Obstetric Fistula Centre (NOFIC), Abakaliki, Nigeria among obstetric fistula patients who presented for treatment with a duration of leakage of over six months. A consecutive sampling technique was used for patient recruitment. Data was collected from twenty patients using in-depth interviews. Thematic analysis of the responses and recurring patterns was done, with themes illustrated using the word cloud. The mean age of the participants was 37.1 years (range = 21-75 years) while the mean duration of leakage was 64.3 months (range = 8-564 months). Reasons for delay in accessing treatment of obstetric fistula were lack of awareness of the availability of free treatment in a specialized centre, delay in referral from index health care facilities, wrong information from health care workers, failed repairs at other health facilities, secondary delay due to transportation challenges, cultural beliefs and other issues peculiar to the patients. The commonest reason for the delay in accessing treatment for obstetric fistula is a lack of awareness on the part of patients, the public, and health workers. We recommend improved campaigns, advocacy, and community mobilization.

Predictors of late presentation for obstetric fistula repair in Abakaliki, South-East Nigeria.

Late presentation is a challenge to reducing the backlog of obstetric fistulas. We aimed to identify characteristics of women presenting late for repair in order to improve patient recruitment. It was a cross-sectional comparative study. Data was collected from the women and the hospital notes using proforma and analysed using SPSS. Associations between categorical variables were determined using Chi-square. Predictors of late presentation were determined using logistic regression. A P-value of <0.05 was statistically significant. The mean time of presentation was 42.3 months. Late presentation was significantly associated with age >35 years, parity < 3, not having a spouse, and trauma. On logistic regression, women aged 35 years and above were five times more likely to present late compared with younger ones (AOR= 5.192, 95%CI 1.839-14.660, P=0.002), while women with parity >3 were five times less likely to present late compared with those <3 (AOR= 0.208, 95%CI 0.073-0.587, P=0.003). In conclusion, most patients presented late. Although age, parity, having a spouse, and aetiology were associated with time of presentation, age >35 years and parity < 3 were the significant predictors of late presentation. Recruitment for early repair should be a priority area of the national policy for the elimination of obstetric fistula.

A Clinicopathological Study of 236 Cystic Ovarian Lesions at Jos University Teaching Hospital, Jos, Nigeria.

Background: Cystic ovarian lesions are defined by an ovarian fluid containing space limited by a membrane. The exact prevalence of the disease is unknown. A proper diagnosis is imperative for the choice of appropriate therapy. The objective of this study is to establish the different histological variants of ovarian cysts diagnosed at the Histopathology Department of Jos University Teaching Hospital between January 1, 2000, and December 31, 2019. Methodology: This is a descriptive study of consecutive cases of ovarian cysts at the Jos University Teaching Hospital, Jos, Nigeria between January 1, 2000, and December 31, 2019. Demographic and histopathologic data were collated from patients' request forms and duplicate copies of histology reports of all histologically diagnosed cases of ovarian cysts at the Histopathology Department during the study period. Result: A total of 236cases of cystic ovarian lesions were seen during the period of the study. Benign and malignant cases constituted 226(95.76%) and 10(4.24%) cases respectively. Corpus luteum cyst was the commonest histological type accounting for 28.33% of cases. Lesions located on the right ovary were 145(61.44%), while those on the left were 95(40.25%). The commonest symptom was abdominal pain. The age range was 4-70years, with a mean, median and mode of 35.02+11.9 years, 33.0 years, and 35.0 years respectively. Conclusion: The vast majority of ovarian cysts in our environment are benign, and commonly occurs in women during their reproductive age. Abdominal pain is the commonest presentation and cysts of the ovary occur more on the right.

Transvaginal Retropubic Urethropexy Versus Pubovaginal Sling for Treatment of Postrepair Urinary Incontinence.

OBJECTIVES: The aim of this study was to compare the success rates of transvaginal retropubic urethropexy with fascia lata pubovaginal sling (PV sling) for treatment of postrepair urinary incontinence at a fistula center in Nigeria. METHODS: This was a retrospective review of 60 patients who had transvaginal retropubic urethropexy and 46 patients who had PV sling on account of postrepair incontinence at National Obstetric Fistula Centre, Abakaliki, Nigeria, between January 2014 and December 2016. Data were retrieved from the hospital records. Success was defined as negative urinary stress test at 3 months after repair. Data were analyzed with SPSS version 20, and P value <0.05 was taken as statistically significant. χ was used to determine the association between the procedures and success rate. RESULTS: The success rate of transvaginal retropubic urethropexy versus PV sling was 53.3% versus 82.6% (χ = 9.95, P = 0.02). Complications occurred in 13.2%. CONCLUSIONS: In conclusion, the efficacy of the fascia lata PV sling was more than that of transvaginal retropubic urethropexy for postrepair urinary incontinence. Urodynamic assessments need to be incorporated into management of these women for better patient's selection for each procedure.

Enterocutaneous Fistula Coexisting with Enterovesical Fistula: A Rare Complication of Ovarian Cystectomy.

Enterocutaneous fistula is an abnormal communication between the intestine and the skin, while enterovesical fistula is an abnormal communication between the intestine and the bladder. Both are not usual complications of ovarian cystectomy. We present a patient with enterovesical fistula coexisting with enterocutaneous fistula following ovarian cystectomy. She is a 24- year-old lady with background immunosupression who presented to the National Obstetric Fistula Centre, Abakaliki South-East Nigeria with a history fecaluria, pneumaturia and passage of feculent fluid through the skin following ovarian cystectomy. Fistulogram was in keeping with rectovesical fistula. She was repaired in a single stage and made an uneventful recovery. Enterovesical fistula and enterocutaneus fistula are uncommon but possible complications of ovarian cystectomy.

Profile and outcome of patients with recurrent urogenital fistula in a fistula centre in Nigeria.

INTRODUCTION AND HYPOTHESIS: Management of a recurrent urogenital fistula is very challenging and requires experienced surgeons. The aim of this study was to describe the characteristics, success rates, and associated factors related to surgical repairs of patients with recurrent urogenital fistulas by an experienced team at a fistula centre in Nigeria. METHODS: This was a retrospective cohort study of 154 patients that had repeat urogenital fistula repairs at the National Obstetric Fistula Centre, Abakaliki, Nigeria, between January 2014 and December 2016. Information was retrieved from their hospital records. Successful repair was defined by continent status at 3 months after repair. Data were analyzed with SPSS version 20 by IBM Inc., and p < 0.05 was taken as statistically significant. Chi-square test was used to determine the association between the factors and successful repair. RESULTS: The mean age was 36.27 ± 12.96 years. Obstetric fistula occurred in 92.2% of the patients. The success rates for the first, second, third, and fourth repeat repairs were 68.8%. 56.2%, 50%, and 0% respectively. Significant factors were the number of previous attempts at repair (χ2 = 20.44, p = 0.002), age group (χ2 = 16.95, p = 0.03), Waaldijk's classification (χ2 = 13.31, p = 0.04), duration of fistula (χ2 = 19.6, p = 0.03), surgeons' experience (χ2 = 7.11, p = 0.04), and place of previous attempt at repair (χ2 = 6.35, p = 0.02). There were no complications in 86.4%. CONCLUSIONS: The success rate was good. Patients who had previous failed repairs at the fistula centre had better outcomes after the repeat surgeries. Centralizing fistula care will enhance optimal outcomes. It may also boost training and research in this specialty.

Enterocutaneous fistula coexisting with enterovesical fistula: a rare complication of ovarian cystectomy

Enterocutaneous fistula is an abnormal communication between the intestine and the skin, while enterovesical fistula is an abnormal communication between the intestine and the bladder. Both are not usual complications of ovarian cystectomy. We present a patient with enterovesical fistula coexisting with enterocutaneous fistula following ovarian cystectomy. She is a 24-year-old lady with background immunosupression who presented to the National Obstetric Fistula Centre, Abakaliki South-East Nigeria with a history fecaluria, pneumaturia and passage of feculent fluid through the skin following ovarian cystectomy. Fistulogram was in keeping with rectovesical fistula. She was repaired in a single stage and made an uneventful recovery. Enterovesical fistula and enterocutaneus fistula are uncommon but possible complications of ovarian cystectomy

Intravenous urography findings in women with ureteric fistula.

INTRODUCTION: Ureteric fistula is one of the major morbidities that can arise from pelvic surgeries. It mainly results from gynaecological and obstetric procedures. Intravenous urography is an imaging modality for the upper urinary tract. Its features may be suggestive of ureteric fistula and it is of great value when medicolegal issues arise. It is however expensive and requires expertise. There are other useful and cheap methods for evaluating ureteric fistula including the use of dye test. There is need to determine if IVU (Intravenous urography) should be recommended for women with this disease. The aim of this study was to determine the features of intravenous urography among women with ureteric fistula and therefore determine its relevance in the management of such patients. METHODS: This was a retrospective study conducted at the National Obstetric Fistula Centre, Abakaliki between January 2012 and March 2017. All patients with ureteric fistula during the study period who were assessed with intravenous urography before surgery were included in this study. RESULTS: The mean age was 38 ± 16 years. Twelve (92.3%) were Christians. IVU showed hydroureters in 46.15% hydronephrosis in 53.85%, non-functioning kidney in 46.15% and ureteric stricture in 7.69%. IVU gave an insight into the side with ureteric fistula except in one who had normal result. CONCLUSION: Hydronephrosis, hydroureters and silent (non-functioning) kidneys are features of IVU in women with ureteric fistulas, however these features are not pathognomonic for the disease.

Full-scale Raman imaging for dental caries detection.

Early detection of dental caries is critical for avoiding more invasive and advanced treatment at a later stage. However, currently available techniques are unsatisfactory for early detection. Raman spectroscopy is known to have both high sensitivity and specificity in the analysis of mineral content in a tooth; but translating Raman spectroscopy to clinical caries detection remains a challenge. In this study, we report a full-scale Raman imaging system that can provide fast full-scale (~7 mm in diameter) tooth mineral analysis which could be feasible for clinical application. The results show that the Raman imaging system could not only confirm carious lesions that are obvious to the naked eye but also identify those which are not conclusive to traditional visual examination and probing.

Bladder spasm following urogenital fistula repair.

OBJECTIVE: To examine the occurrence of bladder spasms following surgical repair of urogenital fistula. METHODS: The present retrospective study included data from patients who underwent surgical repair of urogenital fistula at the National Obstetric Fistula Centre, Abakaliki, Nigeria, between June 1, 2015, and May 31, 2016. Patients who underwent rectovaginal fistula repair and those who experienced persistent postoperative pain requiring high doses of analgesia were excluded. Bladder spasm was defined as the sudden onset of intermittent pain in the region of the bladder lasting for short periods of time in patients who were previously comfortable with routine postoperative analgesia. The incidence of bladder spasm was calculated and the presence of an association between repair outcome and bladder spasms was investigated. RESULTS: There were 133 patients included in the present study with a mean age of 36 ± 11 years. Bladder spasms were experienced by 60 (45.1%) patients during the study period; of these patients, failed fistula repair was recorded for 13 (22%). Good surgical outcome (closed fistula) was associated with not experiencing postsurgical bladder spasms (P=0.044). CONCLUSION: The incidence of bladder spasm following surgical repair of urogenital fistula appeared high. The occurrence of bladder spasms could influence repair outcomes.