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1.
Midwifery ; 82: 102594, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31874317

RESUMO

OBJECTIVE: To explore the experiences of women living with Obstetric Fistula in Ghana. DESIGN: A descriptive qualitative design involving face-to-face semi-structured interviews following institutional ethical approval. SETTING: Urban and rural setting in the Mfantseman Municipal Area (MMA) in the Central Region (CR) of Ghana PARTICIPANTS: A purposive sample of thirty- two women who had experienced obstetric fistula (OBF) FINDINGS: Three core themes emerged and these were i) Women's perceptions of OBF, ii) Experiences of women living with OBF iii) Coping strategies of women living with OBF CONCLUSION AND IMPLICATIONS FOR PRACTICE: There is a need for a multi-agency coordinated approach to the treatment and management of OBF in Ghana. The findings support the need for a dedicated specialist fistula centre to treat women and to meet the educational needs of health care professionals with strategies to prevent as well as support women with OBF. The hub and spoke organisation design for health care systems has proved beneficial in other health settings providing a level of quality that would not be possible otherwise. It is time to end the suffering of women living with obstetric fistula.


Assuntos
Efeitos Psicossociais da Doença , Fístula Vaginal/complicações , Adulto , Idoso , Feminino , Gana , Humanos , Entrevistas como Assunto/métodos , Pessoa de Meia-Idade , Pesquisa Qualitativa , Fístula Retovaginal/complicações , Fístula Retovaginal/psicologia , Estigma Social , Fístula Vaginal/psicologia , Fístula Vesicovaginal/complicações , Fístula Vesicovaginal/psicologia
2.
PLoS One ; 14(11): e0216763, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31675379

RESUMO

BACKGROUND: There is dearth of data regarding the treatment-seeking practice of women living with vaginal fistula. The paper describes the health-seeking behaviour of fistula cases in the sub-Saharan Africa (SSA) where the burden of the problem is high. METHODS: The data of 1,317 women who ever experienced fistula-related symptom were extracted from 16 national Demographic and Health Surveys carried out in SSA between 2010 and 2017. The association between treatment-seeking and basic socio-demographic characteristics was analysed via mixed-effects logistic regression and the outputs are provided using adjusted odds ratio (AOR) with 95% confidence intervals (CI). RESULTS: Among all women who had fistula-related symptom, 67.6% encountered the problem soon after delivery, possibly implying obstetric fistula. Fewer identified sexual assault (3.8%) and pelvic surgery (2.7%) as the underlying cause. In 25.8% of the cases clear-cut causes couldn't be ascertained and, excluding these ambiguous causes, 91.2% of the women possibly had obstetric fistula. Among those who ever had any kind of fistula, 60.3% (95% CI: 56.9-63.6%) sought treatment and 28.5% (95% CI: 25.3-31.6%) underwent fistula-repair surgery. The leading reasons for not seeking treatment were: unaware that it can be repaired (21.4%), don't know where to get the treatment (17.4%), economic constraints (11.9%), the fistula healed by itself (11.9%) and feeling of embarrassment (7.9%). The regression analysis indicated, teenagers as compared to adults 35 years or older [AOR = 0.31 (95% CI: 0.20-47)]; and women without formal education compared to women with formal education [AOR = 0.69 (95% CI: 0.51-0.93)], had reduced odds of treatment-seeking. In 25.9% of the women who underwent fistula-repair surgery, complete continence after surgery was not achieved. CONCLUSION: Treatment-seeking for fistula remains low and it should be improved through addressing health-system, psycho-social, economic and awareness barriers.


Assuntos
Aceitação pelo Paciente de Cuidados de Saúde , Fístula Vaginal/psicologia , Fístula Vaginal/terapia , Adolescente , Adulto , África ao Sul do Saara , Demografia , Distocia/psicologia , Distocia/terapia , Feminino , Humanos , Modelos Logísticos , Pessoa de Meia-Idade , Razão de Chances , Gravidez , Fatores Socioeconômicos , Fístula Vaginal/etiologia , Adulto Jovem
3.
BMJ Open ; 9(10): e027991, 2019 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-31619418

RESUMO

INTRODUCTION: Female genital fistula is a debilitating traumatic injury, largely birth-associated, globally affecting up to 2 million women, mostly in sub-Saharan Africa. Fistula has significant physical, psychological and economic consequences. Women often face challenges in reintegrating and resuming prior roles despite successful surgery. Synthesising the evidence on services adjunct to fistula surgery and their outcomes is important for developing the evidence base for best practices and identifying research priorities. This scoping review seeks to examine the range of rehabilitation and reintegration services provided as adjunct to genital fistula surgery, map the existing programming and outcomes, and identify areas for additional research. METHODS AND ANALYSIS: Our scoping review is informed by existing methodological frameworks and will be conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses-ScR guidelines. The search strategy will be applied to nine biomedical, public health and social science databases. The initial search was completed on 27 September 2018. Grey literature will be identified through targeted Google searches and from organisational websites identified as relevant by the United Nations Population Fund (UNFPA) Campaign to End Fistula. We will iteratively build our search strategy through term harvesting and review, and search reference lists of reports and articles to identify additional studies. Two reviewers will independently screen titles and abstracts, followed by full-text screening of all potentially relevant articles and standardised data extraction. Articles eligible for inclusion will discuss research or programmatic efforts around service provision in adjunct to surgery among females with genital fistula. Data will be presented in summary tables accompanied by narrative description. ETHICS AND DISSEMINATION: Ethics approval is not required for a scoping review. Our results can be used to inform policy, serve as support for funding and development of reintegration programmes and highlight areas for subsequent research. Results will be disseminated at relevant conferences and published in a peer-reviewed journal.


Assuntos
Complicações do Trabalho de Parto/cirurgia , Fístula Vaginal/reabilitação , Fístula Vaginal/cirurgia , Incontinência Fecal/etiologia , Incontinência Fecal/psicologia , Feminino , Humanos , Infertilidade Feminina/etiologia , Infertilidade Feminina/psicologia , Dor/etiologia , Dor/psicologia , Gravidez , Projetos de Pesquisa , Literatura de Revisão como Assunto , Estigma Social , Incontinência Urinária/etiologia , Incontinência Urinária/psicologia , Fístula Vaginal/psicologia
4.
Neurourol Urodyn ; 38(7): 1994-2000, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31321812

RESUMO

AIMS: The Urogenital Distress Inventory (UDI-6) and the Incontinence Impact Questionnaire (IIQ-7) are both well-known. In obstetric fistula (OF) repair outcome is usually assessed by the surgical team. The patient perspective is often neglected. Therefore we translated both questionnaires in Lingala and Kikongo, official languages in DR Congo. Secondly used the questionnaires in an OF population to assess the real life continence status and the impact of fistula repair surgery. METHODS: UDI-6 and IIQ-7 were translated and underwent content validity checks using focus groups. The final versions were tested in a normal population and in an OF population (33 for Kikongo, 35 for Lingala) for internal consistency and test-retest reliability. The responsiveness was tested in an OF population and effect sizes were calculated. RESULTS: Both questionnaires showed good internal consistency and reliability. The Cronbach's α for UDI-6 in both languages was 0.47 for the IIQ-7, 0.96 for Lingala and 0.94 for Kikongo in an OF population. The test-retest reliability was high in all cohorts. Both questionnaire scores improved significantly after fistula repair. The effect size for UDI-6 was -1.09 and -1.6 for IIQ-7. CONCLUSION: Both IIQ-7 and UDI-6 questionnaires have been translated in Lingala and Kikongo, two languages of DR Congo. The questionnaires have been validated in an obstetrical fistula population, showing good content validity and test-retest reliability. The questionnaires show a highly significant effect size, demonstrating the dramatic positive effect of fistula surgery on urogenital symptoms and on the quality of live in an obstetric fistula population.


Assuntos
Qualidade de Vida/psicologia , Incontinência Urinária/psicologia , Fístula Vaginal/psicologia , Congo , Feminino , Humanos , Idioma , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Inquéritos e Questionários , Incontinência Urinária/diagnóstico , Fístula Vaginal/diagnóstico
5.
BMC Womens Health ; 19(1): 93, 2019 07 10.
Artigo em Inglês | MEDLINE | ID: mdl-31291928

RESUMO

BACKGROUND: Obstetric fistula is among the serious and distressing maternal morbidities in Tanzania. Obstetric fistula is a childbirth-related injury caused by prolonged and obstructed labor which has a devastating impact on affected women and their families. The aim of this study was to explore reasons why women with obstetric fistula admitted to the Comprehensive Community- Based Rehabilitation in Tanzania (CCBRT) hospital delayed seeking fistula treatment. METHODS: This exploratory study incorporated qualitative approach. In-depth interviews were used to collect data from 18 women with obstetric fistula admitted to CCBRT hospital. The interviews were conducted in Kiswahili and lasted for 40-45 min. Audio-recordings of the interviews were transcribed verbatim and translated into English. Thematic analysis was used to extract reasons for the delay in seeking treatment for obstetric fistula. RESULTS: The study sample (n = 18) ranged in age from 20 to 57 (µ = 37; SD = 11.67), married (n = 14), unemployed (n = 15), and very low level education (n = 15) with primary education. Delay in seeking treatment for obstetric fistula was related to the following themes: inadequate knowledge about the causes and treatment of obstetric fistula, distance and transport cost to a health facility, stigma, community isolation, social isolation and use of traditional and cultural. CONCLUSION: The Tanzanian Ministry of Health in collaboration with private institutions should strengthen education programmes on the nature and causes of obstetric fistula, and increase the availability of treatment to decrease the effect of this condition for women in Tanzania.


Assuntos
Complicações do Trabalho de Parto/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Isolamento Social , Estigma Social , Fístula Vaginal/psicologia , Adulto , Feminino , Acesso aos Serviços de Saúde , Humanos , Estado Civil , Pessoa de Meia-Idade , Gravidez , Pesquisa Qualitativa , Tanzânia , Fístula Vaginal/etiologia , Adulto Jovem
6.
BMC Public Health ; 19(1): 696, 2019 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-31170958

RESUMO

BACKGROUND: Obstetrical fistula (OF) is a public health challenge that is among the previously neglected components of maternal health in the developing world. The condition, which in the recent past has increasingly drawn more attention from the public, has a devastating impact on the health and wellbeing of both women and girls worldwide. The most common cause of obstetric fistula in developing countries is prolonged obstructed labor affecting approximately 2 million women and girls across Africa and Asia. The objective of this study was to examine the post-effects of fistula and reintegration strategies of fistula survivors in Uganda. METHODS: A descriptive case study design was used to collect data from women aged 15-49 years who had experienced OF and been successfully treated/repaired. Data collection was aided by in-depth interview guides designed for collecting qualitative data which was analyzed using thematic and content analysis. RESULTS: The study results showed that 45.6% were aged 18-24 years, 43% had only primary level education and 55.7% of the women were married. Fistula survivors continue to suffer from shame, rejection, isolation and stigma, trauma and disgrace among other effects even after successful repair/surgery. Some of the reintegration strategies for fistula survivors include; seeking for successful repair, remarriage and relocation from their parent communities to new environments. CONCLUSION: In addition to capacity building, changing attitudes and strengthening the health system, a comprehensive and holistic fistula care approach is required to facilitate the reintegration process and restoration of women dignity.


Assuntos
Complicações do Trabalho de Parto/psicologia , Estigma Social , Sobreviventes/psicologia , Fístula Vaginal/psicologia , Adolescente , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Período Pós-Parto/psicologia , Gravidez , Projetos de Pesquisa , Uganda , Fístula Vaginal/etiologia , Adulto Jovem
7.
Afr J Prim Health Care Fam Med ; 11(1): e1-e9, 2019 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-31038345

RESUMO

BACKGROUND: In sub-Saharan African countries, women face a high risk of obstetric fistulas. In Malawi, the prevalence rate is 1 per 1000 women. Studies suggest that several obstacles exist that prevent obstetric fistula patients from getting timely treatment for their condition. AIM: The aim of this article was to find out the factors that delay the timely treatment of obstetric fistula patients at Malawian hospitals. SETTING: The study was conducted at the Queen Elizabeth Central Hospital, a referral hospital, situated in Blantyre, Malawi, and the findings have been generalised to all the hospitals in Malawi. METHODS: An exploratory case study, employing key interview questions, was used to provide insights into why there are delays in providing treatment and care for fistula patients. Purposive sampling technique was used to identify study respondents. Key informant interviews were conducted with 16 health care personnel at a hospital in Malawi. RESULTS: The presence of numerous cases of complicated obstetric fistula cases overwhelms the health care system in Malawi. In addition, the severe shortage of staff, lack of obstetric fistula surgery training, low staff morale, inadequate infrastructure or equipment and water scarcity in the city of Blantyre contribute towards delayed treatment of fistulas at the hospitals. CONCLUSION: The presence of numerous cases of obstetric fistulas is overwhelming health services, and hence there is a need for devising and implementing health policies that will motivate Malawian health personnel to undertake obstetric fistula surgery and care.


Assuntos
Parto Obstétrico/estatística & dados numéricos , Pessoal de Saúde/psicologia , Serviços de Saúde Materna/estatística & dados numéricos , Complicações do Trabalho de Parto/cirurgia , Tempo para o Tratamento/estatística & dados numéricos , Fístula Vaginal/cirurgia , Adulto , Parto Obstétrico/efeitos adversos , Parto Obstétrico/psicologia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/estatística & dados numéricos , Humanos , Malaui , Serviços de Saúde Materna/organização & administração , Complicações do Trabalho de Parto/etiologia , Complicações do Trabalho de Parto/psicologia , Gravidez , Pesquisa Qualitativa , Fatores de Tempo , Fístula Vaginal/etiologia , Fístula Vaginal/psicologia
8.
Int Urogynecol J ; 30(2): 307-312, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30069727

RESUMO

INTRODUCTION AND HYPOTHESIS: Marital disruption is a commonly identified sequela of genital fistula in developing countries. This study is aimed at identifying factors that correlate with marital outcomes. METHODS: All new patients presenting to Evangel VVF Centre in Jos, Nigeria, between August 2015 and August 2017, were retrospectively reviewed with regard to demographics, medical history, and fistula details to identify variables correlating with marital status, particularly whether currently married or presently divorced, separated, or divorced and remarried (cumulatively the "divorce group"). RESULTS: Among 581 new patients, 66% were married and 18% experienced marital disruption. Presence of living children in the home and having attended any level of formal education were found to be protective of marriage (p values <0.0001 and 0.0045 respectively). Patients in the divorce group were more likely to have delivered a baby before the age of 18, be of Muslim background, and have a longer time since fistula formation (p values all <0.0001), as were those married younger than 18 and those whose fistula followed a vaginal delivery (p values 0.0015 and 0.0017 respectively). CONCLUSION: Several factors correlate with disruption of the marriage relationship. Patients at highest risk for marital disruption should be identified early and provided with interventions aimed at protecting their marriage and social support system.


Assuntos
Divórcio/estatística & dados numéricos , Estado Civil/estatística & dados numéricos , Casamento/estatística & dados numéricos , Fístula Vaginal/epidemiologia , Adulto , Países em Desenvolvimento , Divórcio/psicologia , Feminino , Humanos , Casamento/psicologia , Nigéria/epidemiologia , Estudos Retrospectivos , Fístula Vaginal/psicologia
9.
Trop Med Int Health ; 24(1): 53-64, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30372572

RESUMO

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.


Assuntos
Qualidade de Vida/psicologia , Autoimagem , Estigma Social , Fístula Vaginal/psicologia , Saúde da Mulher , Adaptação Psicológica , Feminino , Humanos , Estudos Longitudinais , Fístula Retovaginal/psicologia , Uganda , Fístula Vaginal/cirurgia , Fístula Vesicovaginal/psicologia
10.
BMC Pregnancy Childbirth ; 17(1): 433, 2017 12 21.
Artigo em Inglês | MEDLINE | ID: mdl-29268711

RESUMO

BACKGROUND: The consequences of living with obstetric fistula are multifaceted and very devastating for women, especially those living in poor resource settings. Due to uncontrollable leakages of urine and/or feces, the condition leaves women with peeling of skin on their private parts, and the wetness and smell subject them to stigmatization, ridicule, shame and social isolation. We sought to gain a deeper understanding of lived experiences of women with obstetric fistula in Malawi, in order to recommend interventions that would both prevent new cases of obstetric fistula as well as improve the quality of life for those already affected. METHODS: We conducted semi-structured interviews with 25 women with obstetric fistula at Bwaila Fistula Care Center in Lilongwe and in its surrounding districts. We interviewed twenty women at Bwaila Fistula Care Center; five additional women were identified through snowball sampling and were interviewed in their homes. We also interviewed twenty family members. To analyze the data, we used thematic analysis. Data were categorized using Nvivo 10. Goffman's theory of stigma was used to inform the data analysis. RESULTS: All the women in this study were living a socially restricted and disrupted life due to a fear of involuntary disclosure and embarrassment. Therefore, "anticipated" as opposed to "enacted" stigma was especially prevalent among the participants. Many lost their positive self-image due to incontinence and smell. As a way to avoid shame and embarrassment, these women avoided public gatherings; such as markets, church, funerals and weddings, thus losing part of their social identity. Participants had limited knowledge about their condition. CONCLUSION: The anticipation of stigma by women in this study consequently limited their social lives. This fear of stigma might have arisen from previous knowledge of social norms concerning bowel and bladder control, which do not take into account an illness like obstetric fistula. This misconception might have also arisen from lack of knowledge about causes of the condition itself. There is need therefore to create awareness and educate women and their communities about the causes of obstetric fistula, its prevention and treatment, which may help to prevent fistula as well as reduce all dimensions of stigma, and consequently increase dignity and quality of life for these women.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Qualidade de Vida/psicologia , Autoimagem , Estigma Social , Fístula Vaginal/psicologia , Adolescente , Adulto , Idoso , Incontinência Fecal/etiologia , Incontinência Fecal/psicologia , Feminino , Humanos , Malaui , Pessoa de Meia-Idade , Odorantes , Pesquisa Qualitativa , Vergonha , Incontinência Urinária/etiologia , Incontinência Urinária/psicologia , Fístula Vaginal/complicações , Adulto Jovem
11.
BMC Womens Health ; 17(1): 92, 2017 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-28962566

RESUMO

BACKGROUND: Obstetric fistula classic symptoms of faecal and urinary incontinence cause women to live with social stigma, isolation, psychological trauma and lose their source of livelihoods. There is a paucity of studies on the health seeking behaviour trajectories of women with fistula illness although women live with the illness for decades before surgery. We set out to establish the complete picture of women's health seeking behaviour using qualitative research. We sought to answer the question: what patterns of health seeking do women with obstetric fistula display in their quest for healing? METHODS: We used grounded theory methodology to analyse data from narratives of women during inpatient stay after fistula surgery in 3 hospitals in Kenya. Emergent themes contributed to generation of substantive theory and a conceptual framework on the health seeking behaviour of fistula patients. RESULTS: We recruited 121 participants aged 17 to 62 years whose treatment pathways are presented. Participants delayed health seeking, living with fistula illness after their first encounter with unresponsive hospitals. The health seeking trajectory is characterized by long episodes of staying home with illness for decades and consulting multiple actors. Staying with fistula illness entailed health seeking through seven key actions of staying home, trying home remedies, consulting with private health care providers, Non-Governmental organisations, prayer, traditional medicine and formal hospitals and clinics. Long treatment trajectories at hospital resulted from multiple hospital visits and surgeries. Seeking treatment at hospital is the most popular step for most women after recognizing fistula symptoms. CONCLUSIONS: We conclude that the formal health system is not responsive to women's needs during fistula illness. Women suffer an illness with a chronic trajectory and seek alternative forms of care that are not ideally placed to treat fistula illness. The results suggest that a robust health system be provided with expertise and facilities to treat obstetric fistula to shorten women's treatment pathways.


Assuntos
Comportamentos Relacionados com a Saúde , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Estigma Social , Fístula Vaginal/psicologia , Fístula Vaginal/terapia , Adolescente , Adulto , Feminino , Teoria Fundamentada , Humanos , Quênia , Pessoa de Meia-Idade , Gravidez , Pesquisa Qualitativa , Adulto Jovem
12.
Reprod Health ; 14(1): 109, 2017 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-28865473

RESUMO

BACKGROUND: Obstetric fistula is a debilitating and traumatic birth injury affecting 2-3 million women globally, mostly in sub-Saharan Africa and Asia. Affected women suffer physically, psychologically and socioeconomically. International efforts have increased access to surgical treatment, yet attention to a holistic outcome of post-surgical rehabilitation is nascent. We sought to develop and pilot test a measurement instrument to assess post-surgical family and community reintegration. METHODS: We conducted an exploratory sequential mixed-methods study, beginning with 16 in-depth interviews and four focus group discussions with 17 women who underwent fistula surgery within two previous years to inform measure development. The draft instrument was validated in a longitudinal cohort of 60 women recovering from fistula surgery. Qualitative data were analyzed through thematic analysis. Socio-demographic characteristics were described using one-way frequency tables. We used exploratory factor analysis to determine the latent structure of the scale, then tested the fit of a single higher-order latent factor. We evaluated internal consistency and temporal stability reliability through Raykov's ρ and Pearson's correlation coefficient, respectively. We estimated a series of linear regression models to explore associations between the standardized reintegration measure and validated scales representing theoretically related constructs. RESULTS: Themes central to women's experiences following surgery included resuming mobility, increasing social interaction, improved self-esteem, reduction of internalized stigma, resuming work, meeting their own needs and the needs of dependents, meeting other expected and desired roles, and negotiating larger life issues. We expanded the Return to Normal Living Index to reflect these themes. Exploratory factor analysis suggested a four-factor structure, titled 'Mobility and social engagement', 'Meeting family needs', 'Comfort with relationships', and 'General life satisfaction', and goodness of fit statistics supported a higher-order latent variable of 'Reintegration.' Reintegration score correlated significantly with quality of life, depression, self-esteem, stigma, and social support in theoretically expected directions. CONCLUSION: As more women undergo surgical treatment for obstetric fistula, attention to the post-repair period is imperative. This preliminary validation of a reintegration instrument represents a first step toward improving measurement of post-surgical reintegration and has important implications for the evidence base of post-surgical reintegration epidemiology and the development and evaluation of fistula programming.


Assuntos
Parto Obstétrico/efeitos adversos , Apoio Social , Fístula Vaginal/cirurgia , Feminino , Humanos , Modelos Lineares , Qualidade de Vida , Fatores Socioeconômicos , Uganda , Fístula Vaginal/psicologia
13.
Birth ; 44(3): 238-245, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28464510

RESUMO

OBJECTIVE: To understand patients' perspectives on the causative factors and preventive measures of obstetric fistula; and the effect of fistula on the victims' psycho-social, sexual, and economic well being. METHODS: A questionnaire-based interview of 215 women with obstetric fistula admitted for treatment in 17 hospitals in India was carried out during 2010-2011. Responses of participants from poor, medium, and better performing states were categorized into pre-coded themes and compared. RESULTS: The majority of the women were from rural areas (75.3%), multiparous (68.8%), and with less than high school education (82.2%). The majority (70.7%) of the women reported attempt at home delivery by untrained persons. Poor awareness of where and when to seek care when faced with a difficult delivery, and poor quality of care in facilities were perceived as important causative factors. Delivery by trained providers and early referral of women with problems during labor were identified as important preventive factors. Spouses and families were supportive of treatment in spite of economic hardships, but most (79.5%) patients felt socially isolated after developing fistula. CONCLUSION: Poor awareness regarding delivery care among the women indicates a need for increasing birth preparedness in the community. Patients' perceptions of poor quality of care in facilities need to be addressed urgently. Psychological evaluation and counseling should be offered to fistula patients, to help them cope with adverse psycho-social and economic circumstances. The results of this study may provide insights for prevention and management of fistula, and may help to improve patient care and services.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Qualidade da Assistência à Saúde , Fístula Vaginal/psicologia , Adulto , Parto Obstétrico/efeitos adversos , Feminino , Humanos , Índia , Inquéritos e Questionários , Fístula Vaginal/etiologia , Adulto Jovem
14.
Anthropol Med ; 24(1): 81-95, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28140615

RESUMO

Obstetric fistula, a maternal childbirth injury that results in chronic incontinence, affects an estimated one million women in the global south. In the course of media and donor coverage on this condition, fistula sufferers have been branded as 'child brides' who, following the onset of their incontinence, become social pariahs and eventually find physical and social redemption through surgical repair. This narrative framing pits the violence of 'culture' against the potency of biomedical salvation. Based on over two years of ethnographic research at fistula repair centres in Niger and Ethiopia, this paper challenges this narrative and argues that most women with obstetric fistula remain embedded in social relations, receive continued familial support, and, unexpectedly, experience ambiguous surgical outcomes. This paper interrogates the existing logics of the fistula narrative that have had the unintended effects of obscuring global structural inequalities and diverting attention away from systemic health access reforms.


Assuntos
Acesso aos Serviços de Saúde , Disparidades em Assistência à Saúde , Complicações do Trabalho de Parto/etnologia , Incontinência Urinária/etnologia , Fístula Vaginal/etnologia , Adolescente , Adulto , Antropologia Médica , Etiópia , Feminino , Reforma dos Serviços de Saúde , Humanos , Masculino , Níger , Complicações do Trabalho de Parto/psicologia , Complicações do Trabalho de Parto/cirurgia , Gravidez , Autocuidado/psicologia , Apoio Social , Fatores Socioeconômicos , Resultado do Tratamento , Incontinência Urinária/etiologia , Incontinência Urinária/psicologia , Incontinência Urinária/cirurgia , Fístula Vaginal/etiologia , Fístula Vaginal/psicologia , Fístula Vaginal/cirurgia , Adulto Jovem
15.
BJOG ; 124(3): 503-510, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-26892879

RESUMO

OBJECTIVE: To gain understanding of the first-hand experience of women prior to and following repair of a vaginal fistula, to determine the most effective support mechanisms. DESIGN: Qualitative phenomenological study using a series of in-depth semi-structured interviews at two time points: prior to fistula repair and 6 months post-surgery. Data were analysed thematically. SETTING: Three fistula clinics in three districts in Kenya. POPULATION: A purposive sample of 16 women suffering with vaginal fistula who were seeking fistula repair. METHODS: Thrity-two semi-structured interviews were conducted. RESULTS: The two main themes represented the women's journeys from social isolation to social reintegration. Women felt euphoric following fistula repair, believing that a 'miracle' had occurred. However, the 'post-miracle phase' demonstrated that the social and psychological impact of fistula leaves scars that are not easily healed, even when fistula repair is successful. CONCLUSION: Women's experiences of living with fistula have an impact beyond that which can be repaired solely by surgery. The findings from this study support the need for more active psychological assessment in the management of women with fistula, and the role of targeted psychological support in any package of care given in the post repair phase. The format of this support requires further study. Engagement by health professionals with the wider community could raise awareness of the causes of fistula, and provide support for significant others who may also be feeling vulnerable. It is likely that the collaborative efforts from health professionals and community members will provide the most effective support. TWEETABLE ABSTRACT: Fistula surgery alone is insufficient for women's physical, social and psychological recovery.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/psicologia , Qualidade de Vida/psicologia , Comportamento Social , Fístula Vaginal/psicologia , Feminino , Humanos , Quênia , Estudos Longitudinais , Pesquisa Qualitativa , Fístula Vaginal/cirurgia
17.
J Clin Nurs ; 26(11-12): 1445-1457, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27680693

RESUMO

AIMS AND OBJECTIVES: To review literature on the experiences of women with obstetric fistula, their lived experiences after treatment; and to provide evidence for future research. BACKGROUND: Obstetric fistula is an injury most commonly resulting from a prolonged labour. Long eradicated in developed countries, obstetric fistula remains a public health issue in sub-Saharan Africa and Asia. This is a highly stigmatised health condition, and an understanding of the women's experience is required to inform holistic approaches for care and prevention. DESIGN: A search of literature was conducted on databases of EBSCO host (Academic Search Premier, MEDLINE, PsychINFO, CINAHL), Web of Science; and websites of international organizations such as Women's Dignity Project and EngenderHealth. Keywords, Inclusion and exclusion criteria were defined and 25 articles published between 2004 to January 2015 were identified. METHODS: An integrative review of 25 articles was carried out. RESULTS: Three broad themes were identified: Challenges of living with fistula; treatment and care experiences; and reintegration experiences of women after fistula repair. CONCLUSIONS: Living with a fistula presents multidimensional consequences affecting women, families and communities. Accessing treatment is difficult and there are no standardised treatment packages. Surgical repairs were variable in their success rate. Some authors claim women resume normal lives irrespective of their continence status, whilst others claim they face discrimination despite being continent thereby hindering reintegration. Quality of life is diminished for those remaining incontinent. Post repair psychosocial support services are beneficial for reintegration, but research on programme benefits is limited. Therefore further research is required to support its benefits; and for policy development to meet care provision for women with fistula. RELEVANCE TO CLINICAL PRACTICE: The review provides insights into avenues of improving care provision and delivery by health professionals and policy makers. It also exposes areas that need further research for quality care provision.


Assuntos
Parto Obstétrico/efeitos adversos , Qualidade de Vida , Estereotipagem , Fístula Vaginal/psicologia , África ao Sul do Saara , Ásia , Feminino , Humanos , Gravidez , Apoio Social , Fístula Vaginal/terapia
18.
Int Urogynecol J ; 28(6): 893-897, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27822885

RESUMO

INTRODUCTION AND HYPOTHESIS: High levels of mental health dysfunction have been identified in women with genital tract fistula. The aim of this study was to use the General Health Questionnaire-28 (GHQ-28) to screen women in western Uganda with severe pelvic organ prolapse, chronic fourth-degree obstetric tear and genital tract fistula for risk of mental health dysfunction. METHODS: Women undergoing surgery for severe pelvic organ prolapse, chronic fourth-degree obstetric tear, and genital tract fistula were interviewed using the GHQ-28 to screen for the risk of mental health dysfunction. RESULTS: A total of 125 women completed the GHQ-28, including 22 with pelvic organ prolapse, 47 with fourth-degree obstetric tear, 21 with genital tract fistula, and 35 controls. Nearly all women with these serious gynaecological conditions were positive for the risk of mental health dysfunction. In the domain assessing symptoms of severe depression, women with fourth-degree obstetric tear and genital tract fistula scored higher than women with pelvic organ prolapse. CONCLUSIONS: A significant risk of mental health dysfunction was identified in women with severe pelvic organ prolapse and chronic fourth-degree obstetric tear. These rates are similar to the high rates of mental health dysfunction in women with genital tract fistula. Identification and management of mental health dysfunction in women with these conditions should be a priority.


Assuntos
Parto Obstétrico/efeitos adversos , Transtorno Depressivo Maior/etiologia , Fístula/psicologia , Doenças dos Genitais Femininos/psicologia , Prolapso de Órgão Pélvico/psicologia , Adulto , Parto Obstétrico/psicologia , Feminino , Genitália Feminina/lesões , Humanos , Pessoa de Meia-Idade , Gravidez , Estudos Prospectivos , Fatores de Risco , Uganda , Fístula Vaginal/psicologia
19.
Int Urogynecol J ; 28(7): 1091-1100, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28025680

RESUMO

INTRODUCTION AND HYPOTHESIS: Obstetric fistula, caused by traumatic delivery and patient lack of access to obstetric care, is an important public health concern in developing countries, particularly in Sub-Saharan Africa. This research focuses on the experience of women living with obstetric fistula in Burkina Faso as well as their reintegration into community after surgery. METHODS: This project was funded by the Mères du Monde en Santé (MMS) Foundation and conducted in collaboration with the Boromo Hospital. A qualitative approach based on grounded theory and using the principles of participative action research (PAR) was used with semidirected interviews prior to surgery and follow-up interviews 1-2 years after surgery directly in the women's village of origin. Thirty-nine participants were recruited between 2012 and 2015. RESULTS: The results point to circumstances leading to obstetric fistula development: poverty, gender inequality in terms of decision making, healthcare-system deficiencies, and lack of services for referral and treatment of this condition. Our results reinforce the knowledge about the social and psychological repercussions of fistula by exploring the concepts of gossips, shame and self-exclusion as powerful mechanisms of exclusion, but they also show that social support was conserved for several women through their journey with this disease. There was complete social rehabilitation within the community after surgery; however, persistent barriers in term of anxiety regarding obstetric future and economic insecurity were present. CONCLUSIONS: Early recruitment for surgery and prevention are the main objectives when attempting to reduce the impact of obstetric fistula and facilitate patient reintegration. Improvements in local and governmental public health policies are required.


Assuntos
Fístula Vaginal/etnologia , Fístula Vaginal/psicologia , Adulto , Idoso , Burkina Faso , Parto Obstétrico/efeitos adversos , Feminino , Humanos , Pessoa de Meia-Idade , Gravidez , Comportamento Social , Fístula Vaginal/etiologia , Fístula Vaginal/cirurgia , Adulto Jovem
20.
BMC Pregnancy Childbirth ; 16: 2, 2016 Jan 05.
Artigo em Inglês | MEDLINE | ID: mdl-26732574

RESUMO

BACKGROUND: Obstetric fistula affects a woman's life physically, psychosocially, and economically. Although surgery can repair the physical damage of fistula, the devastating consequences that affect a woman's quality of life may persist when she reintegrates into her community. This qualitative study assessed long-term outcomes among women who underwent obstetric fistula repair in Malawi. We explored three domains: overall quality of life before and after repair, fertility and pregnancy outcomes after repair, and understanding of fistula. METHODS: In-depth interviews were conducted in Chichewa with 20 women from seven districts across Central Malawi. All women were interviewed 1 to 2 years after surgical repair for obstetric fistula at the Fistula Care Centre in Lilongwe, Malawi. Interviews were independently coded and analyzed using content analysis. RESULTS: About half of women were married and nine of 20 women reported some degree of urinary incontinence. With the exception of relationship challenges, women's concerns before and after repair were different. Additionally, repair had resolved many of the concerns women had before repair. However, challenges, both directly and indirectly related to fistula, persisted. Improvements in quality of life at the individual level included feelings of freedom, confidence and personal growth, and improved income-earning ability. Interpersonal quality of life improvements included improved relationships with family and friends, reduced stigma, and increased participation with their communities. Nearly half of women desired future pregnancies, but many were uncertain about their ability to bear children and feared additional pregnancies could cause fistula recurrence. Most women were well informed about fistula development but myths about witchcraft and fear of delivery were present. Nearly all women would recommend fistula repair to other women, and many were advocates in their communities. CONCLUSIONS: Nearly all women believed their quality of life had improved at the individual and interpersonal levels since fistula repair, even among women who continued to have urinary incontinence. Contrary to other studies, women reported they were welcomed back by their communities and had limited challenges when reintegrating. Despite the overall improvements in quality of life, many continued to have relationship problems and were concerned about future fertility. These issues need to be further explored in other studies.


Assuntos
Fístula/psicologia , Doenças dos Genitais Femininos/psicologia , Procedimentos Cirúrgicos Obstétricos/psicologia , Adulto , Idoso , Feminino , Fístula/cirurgia , Doenças dos Genitais Femininos/cirurgia , Humanos , Malaui , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Obstétricos/efeitos adversos , Procedimentos Cirúrgicos Obstétricos/métodos , Gravidez , Pesquisa Qualitativa , Qualidade de Vida , Estigma Social , Incontinência Urinária/etiologia , Incontinência Urinária/psicologia , Fístula Vaginal/psicologia , Fístula Vaginal/cirurgia , Adulto Jovem
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