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1.
PLoS One ; 15(9): e0238777, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32886719

RESUMO

BACKGROUND: Obstetric fistula significantly impacts women's mental health and well-being. Routine screening for mental health in fistula repair programs can be a gateway to link patients to services, and can produce routine data to inform programmatic investments. This study observed the integration of a mental health screening program into an obstetric fistula repair program in Mali, with two specific objectives: 1) to describe the social and mental health well-being of women presenting with obstetric fistulas in Mali, and 2) to document the impact of the mental health screening pilot on policy change in Mali. METHODS: Seven fistula repair campaigns were conducted between June 2016 and May 2017. All individuals presenting for fistula repair completed a mental health assessment at intake, including a depression screener (PHQ-9) and an assessment of psycho-social impacts of fistula. The depression screener was repeated three months following inpatient discharge. Findings were shared with stakeholders in Mali and impacts on policy were documented. RESULTS: Of 207 women who presented for fistula repair, 167 patients completed the mental health assessment at surgical intake, and 130 patients repeated the screener at 3-month follow-up. At intake, 36.5% of women had moderate or severe depression, decreasing to 16.9% at follow-up. The mean depression score differed significantly by timepoint (9.14 vs. 6.72, p <0.001). Results were shared in a report with stakeholders, and consultations with the Mali Ministry of Health. As a result of advocacy, mental health was a key component of Mali's National Fistula Prevention and Treatment Strategy (2018-2022). CONCLUSION: The high prevalence of depression in Malian fistula patients underscores a need for more robust mental health support for patients after surgery. Data on mental health from routine screening informs community reintegration strategies for individual patients, elevates the overall quality of care of fistula repair programs by addressing patients' holistic health needs, and contributes to evidence-informed decision-making and data-driven policy change within the larger health system.


Assuntos
Transtorno Depressivo/epidemiologia , Complicações do Trabalho de Parto/psicologia , Fístula Vesicovaginal/psicologia , Adulto , Feminino , Humanos , Mali/epidemiologia , Saúde Mental/estatística & dados numéricos , Pessoa de Meia-Idade , Gravidez , Adulto Jovem
2.
Int J Gynaecol Obstet ; 148(3): 331-337, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31778211

RESUMO

OBJECTIVES: To identify factors influencing the long-term prognosis after surgical repair of obstetric fistula, establish a prognosis-based classification system, and examine changes in quality of life after surgery. METHODS: A retrospective study of 308 women who underwent obstetric fistula repair at Saint Jean de Dieu Hospital, Tanguiéta, Benin, between 2008 and 2016, and were supported by a multidisciplinary management model. All participants were from rural areas of Burkina Faso. The women completed interviews before, immediately after, and 2, 4-6, and 12 months after surgery to assess their clinical state and socioeconomic and psychologic status. RESULTS: Overall, the fistulae of 230/274 (83.9%) women were considered to be repaired after 12 months. Factors associated with poor repair outcome included the presence of sclerotic tissue (odds ratio [OR], 0.25; 95% confidence interval [CI], 0.11-0.53) and intraoperative complications (OR, 0.16; 95% CI, 0.07-0.39). Women with successful surgery had a better quality of life as compared with women with an unrepaired fistula (Ditrovie score, 1.1 vs 3.9; P<0.001). CONCLUSION: The multidisciplinary Tanguiéta model for management of obstetric fistula allowed successful fistula closure, thereby facilitating the women's long-term social reintegration, and improved quality of life.


Assuntos
Qualidade de Vida , Fístula Vesicovaginal/cirurgia , Adulto , Burkina Faso , Feminino , Humanos , Pessoa de Meia-Idade , Gravidez , Estudos Retrospectivos , Resultado do Tratamento , Fístula Vesicovaginal/psicologia
3.
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
4.
Reprod Health ; 16(1): 183, 2019 Dec 21.
Artigo em Inglês | MEDLINE | ID: mdl-31864381

RESUMO

BACKGROUND: Obstetric fistula is among the most devastating maternal morbidities that occur as a result of prolonged, obstructed labor. Usually, the child dies in a large number of the cases. Moreover, some of the women become infertile while the majority suffer physical, psychosocial and economic challenges. Approximately 5000 new cases of obstetric fistula occur in Sudan each year. However, their experiences are under documented. Therefore, this study aimed to shed light on their daily lives living with obstetric fistula and how they cope. METHODS: Using a qualitative study design, 19 women living with obstetric fistula were interviewed. The study took place in the fistula ward located in Khartoum hospital and the fistula re-integration center in Khartoum, Sudan. Thematic analysis approach was employed. Stigma and coping theories guided the data collection, analysis, and discussion of the findings. FINDINGS: Women in our study suffered a challenging physical life due to leakage of urine. In addition, they encountered all forms of stigmatization. Women used both emotion-focused and problem-focused coping techniques to mitigate the consequences of obstetric fistula. CONCLUSION: The study findings underscore the importance of obstetric fistula prevention programs and the urgency of repair surgeries to alleviate women's suffering. Community sensitization, rehabilitation and re-integration of women back to their communities are also important strategies on their journey to wholeness.


Assuntos
Emoções/fisiologia , Trabalho de Parto/psicologia , Qualidade de Vida , Fístula Retovaginal/psicologia , Estresse Psicológico , Fístula Vesicovaginal/psicologia , Adolescente , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Gravidez , Pesquisa Qualitativa , Fístula Retovaginal/epidemiologia , Sudão/epidemiologia , Fístula Vesicovaginal/epidemiologia , Adulto Jovem
5.
Int J Gynaecol Obstet ; 147(2): 206-211, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31420877

RESUMO

OBJECTIVE: To measure depression over time using the Patient Health Questionnaire 9 (PHQ-9) and identify characteristics associated with persistent depression. METHODS: A database of women undergoing obstetric fistula repair was used to examine associations between depression and variables such as demographics, type of fistula, and postoperative continence status. RESULTS: A total of 797 patients completed the PHQ-9 at the initial preoperative assessment; 365 (45.8%) had a PHQ-9 score of 5 or higher, indicating depression. Preoperatively, depression was associated with women aged 18-34 years, with no children, and with fistula for 5 years or less. Postoperatively, depression was associated with persistent incontinence. Over time, however, depression was rarely found among women returning for follow-up. CONCLUSION: Postoperative depression decreased over time in women who returned for follow-up, either due to selection bias or due to improved adjustment to one's circumstances. This study underscores the need for ongoing follow-up, especially for those not presenting for care or with persistent incontinence.


Assuntos
Transtorno Depressivo/etiologia , Complicações Pós-Operatórias/psicologia , Incontinência Urinária/psicologia , Fístula Vesicovaginal/cirurgia , Adolescente , Adulto , Estudos de Casos e Controles , Transtorno Depressivo/epidemiologia , Transtorno Depressivo/psicologia , Feminino , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Período Pós-Operatório , Gravidez , Qualidade de Vida , Estudos Retrospectivos , Incontinência Urinária/epidemiologia , Fístula Vesicovaginal/classificação , Fístula Vesicovaginal/epidemiologia , Fístula Vesicovaginal/psicologia , Adulto Jovem
6.
BMC Womens Health ; 19(1): 84, 2019 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-31262289

RESUMO

BACKGROUND: Obstetric fistula is a debilitating condition resulted from poorly (un) managed prolonged obstructed labor. It has significant psychosocial and economic consequences on those affected and their families. Data regarding experiences and coping mechanisms of Ethiopian women with fistula is scarce. METHODS: Qualitative design was employed with in depth interview technique by using open ended interview guide. Eleven fistula patients waiting for surgical repair at the fistula treatment center of Gondar Specialized Referral Hospital were selected with typical case selection. Thedata were audio-taped, transcribed and translated from Amharic to English. Open code version 4.03was used to organize data and identify themes for analysis. RESULTS: The age of participants of the study ranged between 19 to 43 years. Ten of them were from rural areas. Regarding their educational status eight cannot read and write. Similar number were either separated or divorced. Six of them lived with obstetric fistula without treatment from one to five years. Five women related their condition to their fate. The women faced challenges in role performance, marital and social relationships and economic capability. Frequent bathing, use of stripes of old clothes as a pad, self-isolation and hiding from being observed, wearing extra clothes as cover, increasing water intake and reducing hot drinks and fluids other than water were the ways they have devised to cope with the incontinence. CONCLUSION: The study participants reported that they experienced deep sense of loss, diminished self-worth and multiple social challenges. They coped with the incontinence in various ways among which some were non effective and might have continuing negative impact on woman's quality of life even after corrective surgery. Developing bridging intervention for early identification and referral could reduce period of women's suffering.


Assuntos
Complicações do Trabalho de Parto/psicologia , Qualidade de Vida/psicologia , Fístula Retovaginal/psicologia , Isolamento Social , Incontinência Urinária/psicologia , Fístula Vesicovaginal/psicologia , Adaptação Psicológica , Adulto , Etiópia , Incontinência Fecal/etiologia , Feminino , Humanos , Gravidez , Pesquisa Qualitativa , Autoimagem , Adulto Jovem
7.
Reprod Health ; 16(1): 29, 2019 Mar 08.
Artigo em Inglês | MEDLINE | ID: mdl-30849992

RESUMO

BACKGROUND: Obstetric fistula is a reproductive health problem causing immense suffering to 1% of women in Kenya that is formed as sequelae of prolonged obstructed labour. It is a chronic illness that disrupts women lives, causing stigma and isolation. Fistula illness often introduces a crisis in women's life begetting feelings of shame and serious disruption to their social, psychological, physical and economic lives, in addition to dealing with moral and hygiene challenges. Currently, women undergo free of charge surgery at vesicovaginal fistula (VVF) camps held in national referral hospitals and dedicated fistula centres generating a significant pool of women who have undergone surgery and are ready to regain normal lives. OBJECTIVE: The purpose of this study was to explore experiences of women immersing back into communities and their return to normalcy after surgery in three VVF repair centres in Kenya. We set out to answer the question: what strategies improve obstetric fistula patients' reintegration process? METHODS: We used grounded theory methodology to capture the reintegration and regaining normalcy experiences of women after surgery. Narrative interviews were held with 60 women during community follow-up visits in their homes after 6-19 months postoperatively. Grounded theory processes of theoretical sampling, repeated measurement; constant comparative coding in three stage open, axial and selective coding; memoing, reflexivity and positionality were applied. Emergent themes helped generate a grounded theory of reintegration and regaining normalcy for fistula patients. RESULTS: To regain normal healthy lives, women respond to fistula illness by seeking surgery.. After surgery, four possible outcomes of the reintegration process present; reintegration fully or partially back into their previous communities, not reintegrated or newly integrating away from previous social and family settings. The reintegration statuses point to the diversity outcomes of care for fistula patients and the necessity of tailoring treatment programs to cater for individual patient needs. CONCLUSION: The emerging substantive theory on the process of reintegration and regaining normalcy for fistula patients is presented. The study findings have implications for fistula care, training and policy regarding women's health, suggesting a model of care that encompasses physical, social, economic and psychological aspects of care after surgery and discharge.


Assuntos
Qualidade de Vida/psicologia , Estigma Social , Fístula Vesicovaginal/psicologia , Adolescente , Adulto , Feminino , Teoria Fundamentada , Procedimentos Cirúrgicos em Ginecologia , Humanos , Quênia , Pessoa de Meia-Idade , Gravidez , Pesquisa Qualitativa , Fístula Vesicovaginal/cirurgia , Adulto Jovem
8.
Int Urogynecol J ; 30(7): 1101-1110, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30810784

RESUMO

INTRODUCTION AND HYPOTHESIS: Genitourinary fistulas (usually arising following prolonged obstructed labor) are particularly devastating for women in low-income counties. Surgical repair is often difficult and delayed. While much attention has been devoted to technical surgical issues, the challenges of returning to normal personal, family, and community life after surgical treatment have received less scrutiny from researchers. We surveyed young Ugandan women recovering from genitourinary fistula surgery to assess their social reintegration needs following surgery. METHODS: A cross-sectional survey of 61 young women aged 14-24 years was carried out 6 months postoperatively. Interviews were carried out in local languages using a standardized, interviewer-administered, semistructured questionnaire. Data were entered using EpiData and analyzed using SPSS. RESULTS: Ongoing reintegration needs fell into interrelated medical, economic, and psychosocial domains. Although >90% of fistulas were closed successfully, more than half of women had medical comorbidities requiring ongoing treatment. Physical limitations, such as foot drop and pelvic muscle dysfunction impacted their ability to work and resume their marital relationships. Anxieties about living arrangements, income, physical strength, future fertility, spouse/partner fidelity and support, and possible economic exploitation were common. Sexual dysfunction after surgery-including dyspareunia, loss of libido, fear of intercourse, and anxieties about the outcome of future pregnancies-negatively impacted women's relationships and self-esteem. CONCLUSIONS: Young women recovering from genitourinary fistula surgery require individualized assessment of their social reintegration needs. Postoperative social reintegration services must be strengthened to do this effectively.


Assuntos
Qualidade de Vida , Fístula Vesicovaginal/psicologia , Adolescente , Adulto , Cesárea/efeitos adversos , Cesárea/estatística & dados numéricos , Estudos Transversais , Feminino , Humanos , Gravidez , Estigma Social , Inquéritos e Questionários , Uganda , Fístula Vesicovaginal/cirurgia , Adulto Jovem
9.
BMC Womens Health ; 19(1): 37, 2019 02 26.
Artigo em Inglês | MEDLINE | ID: mdl-30808352

RESUMO

BACKGROUND: Obstetric fistula is a hole between the vagina and bladder, and/or between the vagina and rectum, triggered by prolonged obstructed labor. The World Health Organization has estimated that at least 50,000 to 100,000 cases of obstetric fistula occur every year, and that over two million women with obstetric fistula in developing countries remain untreated. Research on women's lived experiences of obstetric fistula is limited. This study aimed to explore the lived experience of women with obstetric fistula at Bahir Dar Hamlin Fistula Center, Amhara Regional State, Ethiopia. METHODS: A qualitative study design, drawing from a phenomenological approach, was employed to explore the lived experience of purposively-selected sample of ten women with obstetric fistula. In-depth interviews were conducted in the local language (Amharic) using an interview guide. Interviews were transcribed and translated into English, and transcripts were entered as primary documents into Atlas.ti 7 software. Thematic categories were identified, and transcripts were coded accordingly. RESULTS: Participants perceived that the contributing factors to obstetric fistula were: instrument-assisted delivery; inappropriate physical examination and care; early marriage; and long duration of labour. As a result of obstetric fistula, the patients suffered from uncontrolled dripping of urine and/or faeces (and associated offensive odours), ostracization by their family and community members, and feeling hopeless and isolation from the community. Patients used different coping mechanisms, including frequent washing of clothes and changing of underwear; they also expressed that they preferred to be alone. CONCLUSION: Women with obstetric fistula experienced urine incontinence and associated bad odour; social and psychological problems like isolation, divorce and fears were commonly reported. Our findings from perspectives of Ethiopian setting suggest that integrated services for women with obstetric fistula are warranted, including physical therapy, psychological support and social reintegration.


Assuntos
Países em Desenvolvimento , Complicações do Trabalho de Parto/psicologia , Fístula Retovaginal/psicologia , Fístula Vesicovaginal/psicologia , Adulto , Divórcio , Etiópia , Incontinência Fecal/etiologia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Entrevistas como Assunto , Complicações do Trabalho de Parto/etiologia , Gravidez , Pesquisa Qualitativa , Fístula Retovaginal/etiologia , Autoimagem , Isolamento Social , Marginalização Social , Incontinência Urinária/etiologia , Fístula Vesicovaginal/etiologia
10.
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
11.
J Obstet Gynaecol ; 39(3): 313-318, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30428739

RESUMO

Utilisation of modern family planning (FP) is important for women with obstetric fistula (OF). Preventing pregnancy ensures a proper healing and the success of fistula repair. In Northern Nigeria, prevalence of OF is high while the prevalence of FP utilisation is low. This study assessed the willingness to use family planning among 420 women receiving care at obstetric fistula centres in three northern Nigerian States using a semi-structured questionnaire. Concerning family planning methods, 56.7% were aware, only three (1.3%) had ever utilised any method and 63.8% were willing to use a family planning method in the near future. Age, type of marriage and the presence of surviving children were the significant predictors of willingness to use family planning among women with fistula. There is a moderate awareness of family planning with very low utilisation rates. However, a high proportion of these women are willing to use FP. Therefore, there is a need for integration of FP services with OF services. Impact statement What is already known on this subject? Obstetric fistula remains a problem of public health significance in developing countries and emphasis is being laid on surgical repair which is successful in 80-95% of cases. What do the results of this study add? The willingness of women with OF to use FP to improve repair success rate and prevent recurrence by delaying pregnancy. What are the implications of these findings for clinical practice and/or further research? It provides a proxy for post-repair practice. It also assesses the integrated fistula repair services which include counselling and providing the use of family planning services.


Assuntos
Comportamento Contraceptivo/psicologia , Serviços de Planejamento Familiar/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Fístula Vesicovaginal/psicologia , Adolescente , Adulto , Comportamento Contraceptivo/estatística & dados numéricos , Estudos Transversais , Feminino , Humanos , Nigéria , Gravidez , Fatores Socioeconômicos , Inquéritos e Questionários , Fatores de Tempo , Fístula Vesicovaginal/cirurgia , Adulto Jovem
12.
BJOG ; 126(7): 926-934, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30461170

RESUMO

OBJECTIVE: We evaluated residual incontinence, depression, and quality of life among Malawian women who had undergone vesicovaginal fistula (VVF) repair 12 or more months previously. DESIGN: Prospective cohort study. SETTING: Fistula Care Centre in Lilongwe, Malawi. POPULATION: Women who had undergone VVF repair in Lilongwe, Malawi at least 12 months prior to enrolment. METHODS: Self-report of urinary leakage was used to evaluate for residual urinary incontinence; depression was evaluated with the Patient Health Questionnaire-9; quality of life was evaluated with the King's Health Questionnaire. MAIN OUTCOME MEASURES: Prevalence and predictors of residual incontinence, quality of life scores, and prevalence of depression and suicidal ideation. RESULTS: Fifty-six women (19.3%) reported residual urinary incontinence. In multivariable analyses, predictors of residual urinary incontinence included: pre-operative Goh type 3 [adjusted risk ratio (aRR) 2.82; 95% confidence interval (CI) 1.61-5.27) or Goh type 4 1.08-2.78), positive postoperative cough stress test (aRR = 2.42; 95% CI 1.24-4.71) and the positive 1-hour postoperative pad test (aRR = 2.20; 95% CI 1.08-4.48). Women with Goh types 3 and 4 VVF reported lower quality of life scores. Depressive symptoms were reported in 3.5% of women; all reported residual urinary incontinence. CONCLUSIONS: While the majority of women reported improved outcomes in the years following surgical VVF repair, those with residual urinary incontinence had a poorer quality of life. Services are needed to identify and treat this at-risk group. TWEETABLE ABSTRACT: Nearly one in five women reported residual urinary incontinence at follow up, 12 or months after vesicovaginal fistula repair.


Assuntos
Transtorno Depressivo/etiologia , Complicações na Gravidez/psicologia , Qualidade de Vida , Incontinência Urinária/psicologia , Fístula Vesicovaginal/cirurgia , Adolescente , Adulto , Transtorno Depressivo/epidemiologia , Feminino , Humanos , Malaui/epidemiologia , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Gravidez , Complicações na Gravidez/epidemiologia , Prevalência , Estudos Prospectivos , Incontinência Urinária/epidemiologia , Fístula Vesicovaginal/epidemiologia , Fístula Vesicovaginal/psicologia , Adulto Jovem
13.
BMC Womens Health ; 18(1): 106, 2018 06 20.
Artigo em Inglês | MEDLINE | ID: mdl-29925358

RESUMO

BACKGROUND: Women with fistula live in a state of distress and in fear of their future life. An obstetric fistula has a devastating impact on affected women and their families. The objective of this systematic review was to synthesize the evidence from published articles on the consequences of obstetric fistula on women who endure the condition. METHODS: The consequences were systematically reviewed from purely qualitative and mixed method primary studies. The literatures were searched through the search engines Google, Google scholar, Hinari using Pub Med data bases, and citation tracking. Relevant source of publications were searched for primary qualitative studies by formulating search protocol using related search terms. Time (articles published between January first of 2007 and 30th September 2016), participants (women who experienced obstetric fistula due to obstructed labor complications), types of study (purely qualitative and mixed method primary articles), findings (reporting consequences/impacts of obstetric fistula) were used as inclusion criteria. The quality appraisal tool for qualitative studies and the critical appraisal skills program were used to appraise the quality of the studies. The findings of sixteen studies were included in the review. The data were collected and then a thematic framework approach was applied for analysis. RESULTS: The thematic categories shared across most studies were related to the physical challenges of losing body control, women's social and family relationships, and the challenges of losing income. Obstetric fistula has far reaching consequences on women's physical well being, social and marital relationships, mental health and economic capacity. Fistula also challenged women coping abilities. CONCLUSION: The consequences of obstetric fistula are far more than the visible medical condition. Little evidence is available on mental health, child and fertility issues, and coping mechanisms. Therefore, further researches shall be aimed at addressing the understudied area and suitable interventions shall be offered to improve women's overall quality of life.


Assuntos
Qualidade de Vida , Fístula Retovaginal/psicologia , Fístula Vesicovaginal/psicologia , África ao Sul do Saara , Divórcio , Distocia , Feminino , Humanos , Renda , Relações Interpessoais , Saúde Mental , Gravidez , Pesquisa Qualitativa , Fístula Retovaginal/etiologia , Fístula Vesicovaginal/etiologia
14.
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
15.
Int J Urol ; 25(1): 25-29, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-28762575

RESUMO

Vesicovaginal fistula has remained a scourge and of public health importance, causing significant morbidity, and psychological and social problems to the patient. Continuous wetness, odor and discomfort cause serious social issues. The diagnosis has been traditionally based on clinical evaluation, dye testing, cystoscopic examination and contrast studies. A successful repair of such fistulas requires an accurate diagnosis and timely surgical intervention using techniques that are based on basic surgical principles with or without the use of interpositional flaps. The method of repair depends on the type and location of the fistula, and the surgeon's training and expertise. The main complications are recurrence and stress/urge incontinence. Prevention must include universal education, improvement in the social and nutritional status of women, discouraging early marriages, and the provision of improved accessible healthcare services.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Qualidade de Vida , Incontinência Urinária de Urgência/prevenção & controle , Procedimentos Cirúrgicos Urológicos/tendências , Fístula Vesicovaginal/cirurgia , Feminino , Acesso aos Serviços de Saúde/tendências , Humanos , Estado Nutricional , Educação de Pacientes como Assunto , Recidiva , Fatores de Tempo , Resultado do Tratamento , Incontinência Urinária de Urgência/etiologia , Procedimentos Cirúrgicos Urológicos/métodos , Fístula Vesicovaginal/diagnóstico , Fístula Vesicovaginal/etiologia , Fístula Vesicovaginal/psicologia
16.
Int Urogynecol J ; 29(3): 397-405, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-28836060

RESUMO

INTRODUCTION AND HYPOTHESIS: Delays in receiving obstetric care during labor contribute to high rates of maternal morbidity in sub-Saharan Africa. This exploratory study was conducted to identify important delays experienced during the development and subsequent repair of obstetric fistula in northern Tanzania. METHODS: Sixty women presenting to a tertiary hospital with obstetric fistula completed structured surveys about the birth experience that led to fistula development and their experiences seeking surgical repair. A subset of 30 provided qualitative accounts. Clinical data were collected postsurgery. Data were analyzed according to a four-delay model, with iterative analysis allowing for triangulation of all sources. RESULTS: During the index pregnancy, women labored for a median of 48 h. Most women (53/60; 88.3%) delivered in a facility but labored for a median of 12.4 h before deciding to seek care (Delay 1). Women spent a median of 1.25 h traveling to a facility (Delay 2). After presenting to care, 15/51 (29.4%) waited at least an hour to see a medical provider, and 35/53 (66.0%) required transfer to another facility (Delay 3). Women lived with fistula for a median of 10 years (Delay 4). Qualitative data provided context and a deeper understanding of the factors contributing to each delay. CONCLUSIONS: Critical delays exist both outside and within the healthcare system that contribute to the development and timely repair of obstetric fistula. Healthcare system strengthening, particularly with regard to emergency obstetric care, is critical to reduce the burden of obstetric fistula in women in Tanzania.


Assuntos
Acesso aos Serviços de Saúde/estatística & dados numéricos , Comportamento de Busca de Ajuda , Complicações do Trabalho de Parto/etiologia , Tempo para o Tratamento , Fístula Vesicovaginal/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Pessoa de Meia-Idade , Complicações do Trabalho de Parto/psicologia , Complicações do Trabalho de Parto/cirurgia , Avaliação de Processos e Resultados em Cuidados de Saúde , Projetos Piloto , Pobreza , Gravidez , Inquéritos e Questionários , Tanzânia , Fístula Vesicovaginal/psicologia , Fístula Vesicovaginal/cirurgia , Populações Vulneráveis/psicologia , Populações Vulneráveis/estatística & dados numéricos , Adulto Jovem
17.
BMC Int Health Hum Rights ; 17(1): 17, 2017 06 19.
Artigo em Inglês | MEDLINE | ID: mdl-28629455

RESUMO

BACKGROUND: Obstetric fistula is a childbirth injury caused by prolonged obstructed labor that results in destruction of the tissue wall between the vagina and bladder. Although obstetric fistula is directly caused by prolonged obstructed labor, many other factors indirectly increase fistula risk. Some research suggests that many women in rural Malawi have limited autonomy and decision-making power in their households. We hypothesize that women's limited autonomy may play a role in reinforcing childbirth practices that increase the risk of obstetric fistula in this setting by hindering access to emergency care and further prolonging obstructed labor. METHODS: A medical student at Baylor College of Medicine partnered with a Malawian research assistant in July 2015 to conduct in-depth qualitative interviews in Chichewa with 25 women living within the McGuire Wellness Centre's catchment area (rural Central Lilongwe District) who had received obstetric fistula repair surgery. RESULTS: This study assessed whether women's limited autonomy in rural Malawi reinforces childbearing practices that increase risk of obstetric fistula. We considered four dimensions of autonomy: sexual and reproductive decision-making, decision-making related to healthcare utilization, freedom of movement, and discretion over earned income. We found that participants had limited autonomy in these domains. For example, many women felt pressured by their husbands, families, and communities to become pregnant within three months of marriage; women often needed to seek permission from their husbands before leaving their homes to visit the clinic; and women were frequently prevented from delivering at the hospital by older women in the community. CONCLUSIONS: Many of the obstetric fistula patients in our sample had limited autonomy in several or all of the aforementioned domains, and their limited autonomy often led both directly and indirectly to an increased risk of prolonged labor and fistula. Reducing the prevalence of fistula in Malawi requires a broad understanding of the causes of fistula, so we recommend that the relationship between women's autonomy and fistula risk undergo further investigation.


Assuntos
Complicações do Trabalho de Parto/diagnóstico , Parto/fisiologia , Autonomia Pessoal , Fístula Vesicovaginal/psicologia , Adulto , Parto Obstétrico/efeitos adversos , Serviços Médicos de Emergência , Feminino , Humanos , Malaui , Gravidez , Pesquisa Qualitativa , População Rural , Cônjuges/psicologia , Fístula Vesicovaginal/cirurgia
18.
Midwifery ; 50: 55-61, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28390255

RESUMO

OBJECTIVE: to explore the cultural, social and economic needs and challenges of women in northern Ghana as they resume their day-to-day lives post obstetric fistula repair. DESIGN: a critical ethnographic approach. SETTING: a state run fistula treatment center in Tamale, northern Ghana, and 24 rural communities in northern Ghana. PARTICIPANTS: ninety-nine (N=99) participants were recruited using purposive, convenience and snowball sampling. The sample consisted of women (N=41) who had experienced an obstetric fistula repair and their family members (N=24). Health care providers (N=17) and stakeholders (N=17) who had specialised knowledge about reintegration programs at a community or national level were also included. FINDINGS: the needs and challenges of northern Ghanaian women post obstetric fistula repair were historically and culturally rooted. A woman's psychosocial acceptance back into her community post obstetric fistula was significant to her well-being but many women felt they had to 'prove' themselves worthy of acceptance and hid any signs of urinary incontinence post obstetric fistula repair. The cost of treatment compounded by a woman's inability to work while having the obstetric fistula exaggerated her economic needs. Skills training programs offered assistance but were often not suited to a woman's physical capability or geographic location. Many women who have experienced obstetric fistula along with women leaders have initiated obstetric fistula awareness campaigns in their communities with the aim of overcoming the challenges and improving the reintegration experiences of others who have had an obstetric fistula repair. CONCLUSION: developing understanding about the needs and challenges of women post obstetric fistula is an important step forward in creating social and political change in obstetric fistula care and reintegration. IMPLICATIONS FOR PRACTICE: Strategies to support women reintegrating to their communities post obstetric fistula repair include exploring alternative forms of skills training and income generation activities, creating innovative pre and post obstetric fistula health education and community awareness to reduce the perception of the condition as 'incurable', and promoting peer advocacy.


Assuntos
Fístula Retovaginal/psicologia , Fístula Vesicovaginal/psicologia , Adolescente , Adulto , Antropologia Cultural/métodos , Feminino , Gana , Acesso aos Serviços de Saúde/normas , Humanos , Pessoa de Meia-Idade , Complicações do Trabalho de Parto/psicologia , Gravidez , Pesquisa Qualitativa , Qualidade de Vida/psicologia , Fístula Retovaginal/complicações , Fístula Retovaginal/etiologia , População Rural , Estigma Social , Fístula Vesicovaginal/complicações , Fístula Vesicovaginal/etiologia
19.
Midwifery ; 42: 54-60, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27769010

RESUMO

AIM: this study aimed to gain understanding of the views of community members in relation to obstetric fistula. DESIGN AND METHOD: a qualitative, grounded theory approach was adopted. Data were collected using in-depth interviews with 45 community members. The constant comparison method enabled generation of codes and subsequent conceptualisations, from the data. SETTING: participants were from communities served by two hospitals in Kenya; Kisii and Kenyatta. Interviews took place either in the home, place of work, or hospital. FINDINGS: the core category (central concept) is 'secrecy hinders support'. This was supported by three themes: 'keeping fistula hidden', 'treatment being a lottery' and 'multiple barriers to support.' These themes represent the complexities around exposure of individual fistula sufferers and the impact that lack of information and women's status can have on treatment. Keeping fistula secret reinforces uncertainties around fistula, which in itself fuels myths and ignorance regarding causes and treatments. Lack of openness, at an individual level, prevents support being sought or offered. CONCLUSIONS: A multi-layered strategy is required to support women with fistula. At a societal level, the status of women in LMIC countries needs elevation to a level that provides equity in health services. At a national level, laws need to protect vulnerable women from mistreatment as a direct result of fistula. Furthermore, resources should be available to ensure provision of timely management, as part of routine services. At community level, awareness and education is required to actively engage members to support women locally. Peer support before and after fistula repair may be beneficial, but requires further research.


Assuntos
Acesso aos Serviços de Saúde , Complicações do Trabalho de Parto/psicologia , Qualidade de Vida/psicologia , Fístula Retovaginal/psicologia , Estigma Social , Fístula Vesicovaginal/psicologia , Adulto , Feminino , Teoria Fundamentada , Humanos , Entrevistas como Assunto , Quênia , Masculino , Pessoa de Meia-Idade , Gravidez , Pesquisa Qualitativa , Qualidade da Assistência à Saúde , Uretra/lesões , Incontinência Urinária/etiologia , Fístula Vesicovaginal/complicações , Adulto Jovem
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