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1.
Int J Gynaecol Obstet ; 148 Suppl 1: 3-5, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31943179

RESUMO

The persistence of obstetric fistula-a devastating childbirth injury occurring largely among poor, marginalized women and girls-constitutes a human rights violation and a public health crisis. The Sustainable Development Goals (SDGs) aim to "leave no one behind." Failing to eliminate fistula jeopardizes attainment of several of the SDGs. Member States of the United Nations adopted a UN Resolution on ending fistula in 2018, calling for an end to fistula within a decade. Building upon recommendations of the UN Secretary General's 2018 Report on Obstetric Fistula, the Resolution calls for significantly increased commitments and investments to end fistula. Crucial interventions for eliminating fistula include high-quality, equitable, accessible health systems; implementing costed national strategies for eliminating fistula; integrating fistula into national plans to achieve the SDGs; strengthening national fistula task forces; and significantly increased, sustained financial support. Fistula elimination necessitates protecting women's/girls' human rights and addressing social determinants that affect women's/girls' ability to "survive, thrive and transform," including social and economic inequities; gender-based violence; child marriage and early childbearing; and access to education. Enhanced awareness-raising and advocacy; improved research, data, monitoring and evaluation; holistic social reintegration and survivor empowerment; and community engagement are additional key strategies for realizing this ambitious goal.


Assuntos
Equidade em Saúde/normas , Desenvolvimento Sustentável , Fístula Vesicovaginal/prevenção & controle , Feminino , Objetivos , Humanos , Gravidez , Justiça Social , Nações Unidas , Populações Vulneráveis , Direitos da Mulher
2.
Int J Gynaecol Obstet ; 148 Suppl 1: 16-21, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31943183

RESUMO

OBJECTIVE: To determine obstetric fistula knowledge among prenatal attendees and midwives in Mfantsiman municipality, Ghana. METHODS: An analytical cross-sectional study was conducted among prenatal clinic attendees and midwives in Mfantsiman municipality from March to April, 2016. Women were selected by systematic sampling and consenting midwives were recruited. Respondents were interviewed using a pretested structured questionnaire. Data were analyzed using the χ2 test and Poisson regression with a robust error variance to generate relative risks (RRs) with 95% confidence intervals (CIs). P<0.05 was considered statistically significant. RESULTS: Altogether, 393 prenatal attendees and 45 midwives were studied. Mean age of attendees was 28.1 ± 7.1 years. About 29% of prenatal attendees knew of, 37.2% had poor knowledge of, and 56.6% had some misconceptions about obstetric fistula. Women who had attained some level of education (P trend=0.001), were employed (adjusted RR 4.92; 95% CI, 1.98-12.21), or had given birth before (P trend=0.01) were more likely to have heard of obstetric fistula. All midwives knew of obstetric fistula and its preventive measures; however, up to 73.3% had some misconceptions about it. CONCLUSION: Educating prenatal attendees and organizing regular refresher courses on obstetric fistula for midwives should be a priority in the municipality.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Tocologia/educação , Fístula Vesicovaginal/prevenção & controle , Adolescente , Adulto , Estudos Transversais , Feminino , Gana , Humanos , Complicações do Trabalho de Parto/terapia , Gravidez , Cuidado Pré-Natal/normas , Inquéritos e Questionários , Adulto Jovem
3.
Int J Gynaecol Obstet ; 148 Suppl 1: 6-8, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31943187

RESUMO

Thirteen years after the last supplement on obstetric fistula, the authors challenge the progress achieved. Citing the ongoing need for a standardized classification system, uniform surgical training and certification, evaluation, follow-up, and research, we emphasize the need for improved communication and coordination between government and nongovernment entities invested in ending obstetric fistula. Struck by the call by the United Nations to end obstetric fistula by 2030, we stress the need for increased and targeted funding of programs that are of the highest quality and impact.


Assuntos
Obstetrícia/normas , Fístula Vesicovaginal/cirurgia , Competência Clínica , Parto Obstétrico/efeitos adversos , Feminino , Humanos , Cooperação Internacional , Complicações do Trabalho de Parto , Obstetrícia/educação , Gravidez , Fístula Vesicovaginal/prevenção & controle
4.
Urology ; 117: 137-141, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29704585

RESUMO

OBJECTIVE: To evaluate human acellular dermis (HAD) as an adjunct during bladder neck transection (BNT) by comparing surgical outcomes with other types of tissue interposition. METHODS: A prospectively maintained institutional database of exstrophy-epispadias complex (EEC) patients was reviewed for those who underwent a BNT with at least 6 months follow-up. The primary outcome was the occurrence of BNT-related fistulas. RESULTS: In total, 147 EEC patients underwent a BNT with a mean follow-up time of 6.9 years (range 0.52-23.35 years). There were 124 (84.4%) classic exstrophy patients, 22 (15.0%) cloacal exstrophy patients, and 1 (0.7%) penopubic epispadias patient. A total of 12 (8.2%) BNTs resulted in fistulization, including 4 vesicoperineal fistulas, 7 vesicourethral fistulas, and 1 vesicovaginal fistula. There were 5 (22.7%) fistulas in the cloacal exstrophy cohort and 7 (5.6%) fistulas in the classic bladder exstrophy cohort (P = .019). Using either HAD or native tissue flaps resulted in a lower fistulization rate than using no interposed layers (5.8% vs 20.8%; P = .039). Of those with HAD, the use of a fibrin sealant did not decrease fistulization rates when compared to HAD alone (6.5% vs 8.8%, P = .695). There was no statistical difference in surgical complications between the use of HAD and native flaps (8.6% vs 5%, P = .716). CONCLUSION: Use of soft tissue flaps and HAD is associated with decreased fistulization rates after BNT. HAD is a simple option and an effective adjunct that does not require harvesting of tissues in patients where a native flap is not feasible.


Assuntos
Derme Acelular , Extrofia Vesical/cirurgia , Epispadia/cirurgia , Períneo , Doenças Uretrais/prevenção & controle , Fístula da Bexiga Urinária/prevenção & controle , Fístula Vesicovaginal/prevenção & controle , Adolescente , Adulto , Extrofia Vesical/complicações , Criança , Pré-Escolar , Epispadia/complicações , Feminino , Adesivo Tecidual de Fibrina/uso terapêutico , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos , Retalhos Cirúrgicos , Adesivos Teciduais/uso terapêutico , Bexiga Urinária/cirurgia , Fístula da Bexiga Urinária/etiologia , Adulto Jovem
5.
Obstet Gynecol ; 131(5): 863-870, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29630017

RESUMO

Although obstetric fistula has likely plagued women since the beginning of time, very little research proportionally exists. This article summarizes the most substantial research on the topic and delineates research gaps and future needs. Existing research demonstrates that access to care is the underlying cause of obstetric fistula and that the first attempt at closure holds the highest chance at success, ranging between 84% and 94%. For simple cases, 10 days of a catheter is sufficient, although what constitutes as simple is unclear. Circumferential fistulas are at high risk for ongoing urethral continence. Psychosocial programs are helpful for all women, but those who are "dry" tend to reintegrate into society, whereas those still leaking need additional support. Prenatal care and scheduled cesarean delivery are recommended to avoid another fistula. Gaps in research include accurate prevalence and incidence, interventions to improve access to care, surgical technique, especially for complex cases, and ways to prevent ongoing incontinence, among many others. In all areas, more rigorous research is needed.


Assuntos
Complicações do Trabalho de Parto , Saúde Reprodutiva , Feminino , Humanos , Complicações do Trabalho de Parto/prevenção & controle , Complicações do Trabalho de Parto/psicologia , Gravidez , Cuidado Pré-Natal/ética , Cuidado Pré-Natal/métodos , Cuidado Pré-Natal/normas , Sistemas de Apoio Psicossocial , Melhoria de Qualidade , Fístula Retovaginal/etiologia , Fístula Retovaginal/prevenção & controle , Fístula Retovaginal/psicologia , Saúde Reprodutiva/ética , Saúde Reprodutiva/normas , Fístula Vesicovaginal/etiologia , Fístula Vesicovaginal/prevenção & controle , Fístula Vesicovaginal/psicologia
7.
Women Birth ; 30(5): e258-e263, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28283307

RESUMO

BACKGROUND: Obstetric Fistula is a childbirth injury that disproportionately affects women in sub-Saharan Africa. Although poverty plays an important role in perpetuating obstetric fistula, sociocultural practices has a significant influence on susceptibility to the condition. AIM: This paper aims to explore narratives in the literature on obstetric fistula in the context of Hausa ethno-lingual community of Northern Nigeria and the potential role of nurses and midwives in addressing obstetric fistula. DISCUSSION: Three major cultural practices predispose Hausa women to obstetric fistula: early marriages and early child bearing; unskilled birth attendance and female circumcision and sociocultural constraints to healthcare access for women during childbirth. There is a failure to implement the International rights of the girl child in Nigeria which makes early child marriage persist. The Hausa tradition constrains the decision making power of women for seeking health care during childbirth. In addition, there is a shortage of nurses and midwives to provide healthcare service to women during childbirth. CONCLUSION: To improve health access for women, there is a need to increase political commitment and budget for health human resource distribution to underserved areas in the Hausa community. There is also a need to advance power and voice of women to resist oppressive traditions and to provide them with empowerment opportunities to improve their social status. The practice of traditional birth attendants can be regulated and the primary health care services strengthened.


Assuntos
Acesso aos Serviços de Saúde/estatística & dados numéricos , Complicações do Trabalho de Parto/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Fístula Retovaginal/epidemiologia , Fístula Vesicovaginal/epidemiologia , Circuncisão Feminina/estatística & dados numéricos , Parto Obstétrico/estatística & dados numéricos , Feminino , Humanos , Tocologia , Nigéria , Complicações do Trabalho de Parto/terapia , Gravidez , Fístula Retovaginal/prevenção & controle , Fístula Vesicovaginal/prevenção & controle
10.
BMC Pregnancy Childbirth ; 13: 229, 2013 Dec 10.
Artigo em Inglês | MEDLINE | ID: mdl-24321441

RESUMO

BACKGROUND: Obstetric fistula is a worldwide problem that is devastating for women in developing countries. The cardinal cause of obstetric fistula is prolonged obstructed labour and delay in seeking emergency obstetric care. Awareness about obstetric fistula is still low in developing countries. The objective was to assess the awareness about risk factors of obstetric fistulae in rural communities of Nabitovu village, Iganga district, Eastern Uganda. METHODS: A qualitative study using focus group discussion for males and females aged 18-49 years, to explore and gain deeper understanding of their awareness of existence, causes, clinical presentation and preventive measures for obstetric fistula. Data was analyzed by thematic analysis. RESULTS: The majority of the women and a few men were aware about obstetric fistula, though many had misconceptions regarding its causes, clinical presentation and prevention. Some wrongly attributed fistula to misuse of family planning, having sex during the menstruation period, curses by relatives, sexually transmitted infections, rape and gender-based violence. However, others attributed the fistula to delays to access medical care, induced abortions, conception at an early age, utilization of traditional birth attendants at delivery, and some complications that could occur during surgical operations for difficult deliveries. CONCLUSION: Most of the community members interviewed were aware of the risk factors of obstetric fistula. Some respondents, predominantly men, had misconceptions/myths about risk factors of obstetric fistula as being caused by having sex during menstrual periods, poor usage of family planning, being a curse.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Complicações do Trabalho de Parto/prevenção & controle , Fístula Retovaginal/etiologia , Fístula Retovaginal/prevenção & controle , Fístula Vesicovaginal/etiologia , Fístula Vesicovaginal/prevenção & controle , Adolescente , Adulto , Feminino , Grupos Focais , Humanos , Masculino , Pessoa de Meia-Idade , Gravidez , Pesquisa Qualitativa , Fístula Retovaginal/psicologia , Fatores de Risco , População Rural , Uganda , Fístula Vesicovaginal/psicologia , Adulto Jovem
13.
BMC Pregnancy Childbirth ; 12: 68, 2012 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-22809234

RESUMO

BACKGROUND: An obstetric fistula is a traumatic childbirth injury that occurs when labor is obstructed and delivery is delayed. Prolonged obstructed labor leads to the destruction of the tissues that normally separate the bladder from the vagina and creates a passageway (fistula) through which urine leaks continuously. Women with a fistula become social outcasts. Universal high-quality maternity care has eliminated the obstetric fistula in wealthy countries, but millions of women in resource-poor nations still experience prolonged labor and tens of thousands of new fistula sufferers are added to the millions of pre-existing cases each year. This article discusses fistula prevention in developing countries, focusing on the factors which delay treatment of prolonged labor. DISCUSSION: Obstetric fistulas can be prevented through contraception, avoiding obstructed labor, or improving outcomes for women who develop obstructed labor. Contraception is of little use to women who are already pregnant and there is no reliable screening test to predict obstruction in advance of labor. Improving the outcome of obstructed labor depends on prompt diagnosis and timely intervention (usually by cesarean section). Because obstetric fistulas are caused by tissue compression, the time interval from obstruction to delivery is critical. This time interval is often extended by delays in deciding to seek care, delays in arriving at a hospital, and delays in accessing treatment after arrival. Communities can reasonably demand that governments and healthcare institutions improve the second (transportation) and third (treatment) phases of delay. Initial delays in seeking hospital care are caused by failure to recognize that labor is prolonged, confusion concerning what should be done (often the result of competing therapeutic pathways), lack of women's agency, unfamiliarity with and fear of hospitals and the treatments they offer (especially surgery), and economic constraints on access to care. SUMMARY: Women in resource-poor countries will use institutional obstetric care when the services provided are valued more than the competing choices offered by a pluralistic medical system. The key to obstetric fistula prevention is competent obstetrical care delivered respectfully, promptly, and at affordable cost. The utilization of these services is driven largely by trust.


Assuntos
Complicações do Trabalho de Parto/prevenção & controle , Fístula Vaginal/prevenção & controle , Fístula Vesicovaginal/prevenção & controle , Adulto , Cesárea , Competência Clínica , Países em Desenvolvimento , Serviços Médicos de Emergência , Feminino , Humanos , Mortalidade Materna , Complicações do Trabalho de Parto/diagnóstico , Complicações do Trabalho de Parto/fisiopatologia , Obstetrícia , Gravidez , Resultado da Gravidez , Cuidado Pré-Natal , Fatores de Tempo , Fístula Vaginal/fisiopatologia
14.
Obstet Gynecol Surv ; 67(2): 111-21, 2012 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-22325301

RESUMO

UNLABELLED: An obstetric fistula is classically regarded as an "accident of childbirth" in which prolonged obstructed labor leads to destruction of the vesicovaginal/rectovaginal septum with consequent loss of urinary and/or fecal control. Obstetric fistula is highly stigmatizing and afflicted women often become social outcasts. Although obstetric fistula has been eliminated from advanced industrialized nations, it remains a major public health problem in the world's poorest countries. Several million cases of obstetric fistula are currently thought to exist in sub-Saharan Africa and south Asia. Although techniques for the surgical repair of such injuries are well known, it is less clear which strategies effectively prevent fistulas, largely because of the complex interactions among medical, social, economic, and environmental factors present in those countries where fistulas are prevalent. This article uses the Haddon matrix, a standard tool for injury analysis, to examine the factors influencing obstetric fistula formation in low-resource countries. Construction of a Haddon matrix provides a "wide angle" overview of this tragic clinical problem. The resulting analysis suggests that the most effective short-term strategies for obstetric fistula prevention will involve enhanced surveillance of labor, improved access to emergency obstetric services (particularly cesarean delivery), competent medical care for women both during and after obstructed labor, and the development of specialist fistula centers to treat injured women where fistula prevalence is high. The long-term strategies to eradicate obstetric fistula must include universal access to emergency obstetric care, improved access to family planning services, increased education for girls and women, community economic development, and enhanced gender equity. Successful eradication of the obstetric fistula will require the mobilization of sufficient political will at both the international and individual country levels to ensure that adequate resources are devoted to this problem and that maternal health becomes a high priority on national political agendas. TARGET AUDIENCE: Obstetricians & Gynecologists and Family Physicians. LEARNING OBJECTIVES: After participating in this CME activity, physicians should be better able to apply the Haddon matrix, a tool commonly used for injury analysis, to the field of obstetrics and gynecology; analyze the problem of obstructed labor and obstetric fistula formation in low-resource countries using the Haddon matrix, and implement possible strategies for the prevention of obstetric fistulas and the mitigation of harm in cases of obstructed labor that arise from the use of the Haddon matrix.


Assuntos
Países em Desenvolvimento , Distocia , Serviços de Saúde Materna/organização & administração , Complicações do Trabalho de Parto , Fístula Retovaginal , Fístula Vesicovaginal , África ao Sul do Saara/epidemiologia , Interpretação Estatística de Dados , Distocia/epidemiologia , Distocia/etiologia , Distocia/prevenção & controle , Meio Ambiente , Incontinência Fecal/etiologia , Feminino , Acesso aos Serviços de Saúde/normas , Necessidades e Demandas de Serviços de Saúde , Humanos , Serviços de Saúde Materna/métodos , Bem-Estar Materno/estatística & dados numéricos , Complicações do Trabalho de Parto/epidemiologia , Complicações do Trabalho de Parto/prevenção & controle , Gravidez , Saúde Pública/estatística & dados numéricos , Fístula Retovaginal/epidemiologia , Fístula Retovaginal/etiologia , Fístula Retovaginal/prevenção & controle , Fatores de Risco , Fatores Socioeconômicos , Incontinência Urinária/etiologia , Fístula Vesicovaginal/epidemiologia , Fístula Vesicovaginal/etiologia , Fístula Vesicovaginal/prevenção & controle
16.
Mt Sinai J Med ; 78(3): 352-61, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21598262

RESUMO

Vesicovaginal fistula secondary to obstructed labor continues to be an all-too-common occurrence in underdeveloped nations throughout Africa and Asia. Vesicovaginal fistula remains largely an overlooked problem in developing nations as it affects the most marginalized members of society: young, poor, illiterate women who live in remote areas. The formation of obstetric fistula is a result of complex interactions of social, biologic, and economic influences. The key underlying causes of fistula are the combination of a lack of functional emergency obstetric care, poverty, illiteracy, and low status of women. In order to prevent fistula, some strategies include creation of governmental policy aimed toward reducing maternal mortality/morbidity and increasing availability of skilled obstetric care, as well as attempts to increase awareness about its prevention and treatment among policymakers, service providers, and communities. Whereas prevention will require the widespread development of infrastructure within these developing countries, treatment of fistula is an act which can be done "in the now." Treatment and subsequent reintegration of fistula patients requires a team of specialists including surgeons, nurses, midwives, and social workers, which is largely unavailable in developing countries. However, there is increasing support for training of fistula surgeons through standardized programs as well as establishment of rehabilitation centers in many nations. The eradication of fistula is dependent upon building programs that target both prevention and treatment.


Assuntos
Complicações na Gravidez , Fístula Vesicovaginal/epidemiologia , Países em Desenvolvimento , Feminino , Política de Saúde , Acesso aos Serviços de Saúde , Necessidades e Demandas de Serviços de Saúde , Humanos , Pobreza , Gravidez , Cuidado Pré-Natal , Fatores de Risco , Fatores Socioeconômicos , Estados Unidos/epidemiologia , Fístula Vesicovaginal/etiologia , Fístula Vesicovaginal/prevenção & controle
17.
J Womens Health (Larchmt) ; 19(11): 2091-9, 2010 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-20973667

RESUMO

This article uses Scale of Change theory as a framework to guide global health researchers to synergistically target women's health outcomes in the context of improving their right to freedom, equity, and equality of opportunities. We hypothesize that health researchers can do so through six action strategies. These strategies include (1) becoming fully informed of women's human rights directives to integrate them into research, (2) mainstreaming gender in the research, (3) using the expertise of grass roots women's organizations in the setting, (4) showcasing women's equity and equality in the organizational infrastructure, (5) disseminating research findings to policymakers in the study locale to influence health priorities, and (6) publicizing the social conditions that are linked to women's diseases. We explore conceptual and logistical dilemmas in transforming a study using these principles and also provide a case study of obstetric fistula reduction in Nigeria to illustrate how these strategies can be operationalized. Our intent is to offer a feasible approach to health researchers who, conceptually, may link women's health to social and cultural conditions but are looking for practical implementation strategies to examine a women's health issue through the lens of their human rights.


Assuntos
Pesquisa sobre Serviços de Saúde/organização & administração , Saúde da Mulher , Direitos da Mulher , Feminino , Humanos , Cooperação Internacional , Nigéria , Fístula Retal/prevenção & controle , Fístula Vesicovaginal/prevenção & controle
20.
Ann Afr Med ; 8(2): 122-6, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19805944

RESUMO

BACKGROUND: So much has been written on vesicovaginal fistula (VVF) but there is little on the patients' perspective of the condition. The objectives of this study were to determine the knowledge of patients who have developed VVF on the causes of the fistula and their attitude toward measures that would prevent future occurrence. METHODS: The questionnaire-based survey was conducted on VVF patients on admission from June to August 2003 at Maryam Abacha Women and Children Welfare Hospital, Sokoto, Nigeria. The case notes of the patients were reviewed after the interview to match the responses from the patients with those documented in the folders. Focus group discussions were held with the maternity staff to ascertain the content and quality of existing counseling. RESULTS: One hundred and thirty patients were studied out of which 121 (93%) had no formal education. Teenagers constituted 37%, while 57% were primiparae. Thirty-five (27%) patients were divorced or separated because of the VVF. There were seven cases of recurrence after a previous successful repair. Prolonged obstructed labor was the cause of the VVF in 110 (85%) patients and 77 (70%) correctly attributed their problem to the prolonged labor. The 33 patients who could not identify the prolonged obstructed labor as the cause either attributed their condition to God/destiny or to the operation that was done to relief the obstruction and therefore would not have hospital delivery in their subsequent pregnancies. From the focus group discussions, it was confirmed that pre and post-operative counseling were inadequate. CONCLUSION: Even though majority (70%) of the patients knew the cause of their fistula from the health talks, some (32%) would still not change from risky obstetric behavior. Mandatory provision of accurate and appropriate information and education to all VVF patients and their relatives or spouses by trained counselors should be ensured. Such information and education should emphasize the etiology and management of obstetric fistula in order to prevent a recurrence.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Fístula Vesicovaginal/etiologia , Feminino , Grupos Focais , Educação em Saúde , Inquéritos Epidemiológicos , Humanos , Nigéria , Fatores de Risco , Percepção Social , Inquéritos e Questionários , Fístula Vesicovaginal/prevenção & controle
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