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Published in Ebby Elahi, World Compendium of Healthcare Facilities and Nonprofit Organizations, 2021
Helps women and girls who are injured and left incontinent following prolonged, obstructed childbirth by providing free surgical repairs for patients already suffering with obstetric fistula, as well as maternity care to prevent these fistulas from happening at all.
Gynaecological Considerations and Urogenital Fistulas
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Brooke Gurland, André D’Hoore, Paul Hilton
Comparing the outcomes of treatment between different reports and different methods is made difficult by the inconsistent outcome measures used. Most studies report anatomical closure (based on inspection or dye testing), anatomical closure with residual incontinence (based on patient-reported symptoms at the time of discharge from hospital) or failure of repair. Others have the more specific but less sensitive outcome of the need for a repeat repair procedure. Follow-up in obstetric fistula patients is inevitably difficult in many low-resourced countries, but even amongst surgical or radiotherapy cases in well-resourced countries, relatively few reports describe examination findings or symptoms at later post-operative review. Long-term outcomes and quality of life measures have only rarely been reported.42,43
Fistula repair
Published in J. Richard Smith, Giuseppe Del Priore, Robert L. Coleman, John M. Monaghan, An Atlas of Gynecologic Oncology, 2018
Surgical fistula patients are usually previously healthy individuals who entered the hospital for what was expected to be a routine procedure, and end up with symptoms infinitely worse than their initial complaint. Obstetric fistula patients in under-resourced countries are social outcasts (Muleta et al. 2008, Muleta et al. 2010, Murphy 1981, Zacharin 1988). Whatever the cause, these women are invariably devastated by their situation. It is vital that they understand the nature of the problem, why it has arisen, and the plan for management at all stages. Confident but realistic counseling by the surgeon is essential, and the involvement of nursing staff or counselors with experience of fistula patients is also highly desirable. The support given by previously treated sufferers can also be of immense value in maintaining patient morale, especially where a delay prior to definitive treatment is required (Hilton 1997, de Ridder et al. 2013).
Determinanet of the survival pattern of tuberculosis patients treated under directly observed treatment short course at Pawe Hospital, Ethiopia
Published in Cogent Medicine, 2021
Tsehay Haile, Kasim Mohammed, Endeshaw Assefa
The sample size was determined by using sample size determination formula for time to event data (Chow et al., 2008). The following assumptions are considered for the sample size determination: Zα/2 is the critical value of standard normal distributed variable at 5% significance level, Zβ is the critical value of standard normal distributed variable at 20% of β and β is the probability of type two error, b is log (hazard ratio), p1 is the proportion of number of patients in the first category, p2 is the proportion of number of patients in the second category, and d represents proportion of the event. The proportion of recovered patients from obstetric fistula (d = 0.817) was taken from a previous study conducted at Addis Ababa Abreham (2009). Finally, the required sample was 637 patients. In total, 1,007 TB were treated in the hospital, from 21 September 2009 to 10 January 2010, of which 637 patients were selected randomly.
Vesicovaginal fistula in Uganda
Published in Journal of Obstetrics and Gynaecology, 2018
Fiona Katherine McCurdie, Joanne Moffatt, Kevin Jones
Prolonged labour and delay in seeking emergency medical care have widely been documented as fundamental to the development of obstetric fistula (Wall et al. 2005; Ahmed and Holtz 2007; Cowgill et al. 2015). Recent statistics show that only 57.4% of women in Uganda give birth in the presence of a skilled healthcare worker (Newby and Say 2015). The remainder gave birth alone or with the help of a ‘traditional birth attendant’ who has often not received any formal training. Thus, in just under half of deliveries the decision as to whether emergency medical care should be sought is left to an individual without the necessary qualification or experience. In the absence of a trained professional, non-clinical factors such as socioeconomic and cultural barriers determine the treatment-seeking (Kyomuhendo 2003). In this sample, prolonged labour was described with an average length of 2.56 days and a range from 1 to 14 days. However, delays in seeking medical help were generally not described. 96% of women reported seeking help from a ‘medical professional’ during their labour, 54% of which within the first 24 hours. Only 6% of women in this sample delivered at home. In many respects this is encouraging as it demonstrates knowledge of, and access to, emergency obstetric care. It is unfortunate then that, despite this, VVFs developed in each of these women indicating a substandard level of care provided once at the medical facility.
Feasibility and acceptability of mobile phone data collection for longitudinal follow-up among patients treated for obstetric fistula in Uganda
Published in Health Care for Women International, 2022
Alison M. El Ayadi, Hadija Nalubwama, Justus K. Barageine, Suellen Miller, Susan Obore, Othman Kakaire, Abner Korn, Felicia Lester, Nadia G. Diamond-Smith, Haruna Mwanje, Josaphat Byamugisha
Obstetric fistula, a debilitating maternal birth trauma mainly due to prolonged obstructed labor, is an important maternal morbidity largely affecting women in sub-Saharan Africa and Asia. Prevalence and incidence data are poor, yet estimates suggest that two million women globally may be living with obstetric fistula, with annual incident cases ranging as high as 100,000 (Wall, 2006; WHO, 2006). Women living with obstetric fistula experience severe physical, psychological, and social sequelae (Ahmed & Holtz, 2007; Browning & Menber, 2008; Roush, 2009; Siddle et al., 2013; Turan et al., 2007) and are a paradigm of a marginalized population. Delays in treatment are common due to costs of surgery, sparse transport, and lodging; and poor geographic access to medical services (Bellows et al., 2014; Kabayambi et al., 2014; Phillips et al., 2016; UNFPA and Ministry of Health, Uganda, 2003; UNFPA & Family Care International, 2007; Woldeamanuel, 2012). Obstetric fistula occurs most frequently in remote geographies (Direct Relief, 2016), largely correlating to availability of emergency obstetric care; thus, affected women are often geographically dispersed. Furthermore, risk of fistula follows a social gradient consistent with socioeconomic patterns of health care inequity (Maheu-Giroux et al., 2015, 2016), further complicating patient access to care and follow-up due to marginalization of this population. Treatment facilities, on the contrary, are typically highly specialized referral centers located in major cities, which can be difficult to access for the surgery itself, placing a further significant travel burden on study participants for in-person longitudinal research participation.