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Treatment-seeking for vaginal fistula in sub-Saharan Africa


Autoři: Samson Gebremedhin aff001;  Anteneh Asefa aff002
Působiště autorů: School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia aff001;  School of Public Health, Hawassa University, Hawassa, Ethiopia aff002
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0216763

Souhrn

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.

Klíčová slova:

Fistulas – Health economics – Health education and awareness – Obstetric procedures – Obstetrics and gynecology – Pregnancy – Surgical and invasive medical procedures – Surgical repair


Zdroje

1. Debas HT, Donkor P, Gawande A, Jamison DT, Kruk ME, Mock CN (eds). Essential Surgery: Disease Control Priorities; Obstetric Fistula. Third edition. Washington (DC): The World Bank; 2015.

2. Maheu-Giroux M, Filippi V, Samadoulougou S, Castro MC, Maulet N, Meda N, et al. Prevalence of symptoms of vaginal fistula in 19 sub-Saharan Africa countries: a meta-analysis of national household survey data. Lancet Glob Health 2015; 3: e271–78. doi: 10.1016/S2214-109X(14)70348-1 25889469

3. Bashah DT, Worku AG, Mengistu MY. Consequences of obstetric fistula in sub-Sahara African countries, from patients’ perspective: a systematic review of qualitative studies. BMC Women's Health 2018; 18:106. doi: 10.1186/s12905-018-0605-1 29925358

4. Ahmed S, Holtz SA. Social and economic consequences of obstetric fistula: life changed forever? Int J Gynaecol Obstet 2007; 99 Suppl 1: S10–5.

5. Drew LB, Wilkinson JP, Nundwe W, Moyo M, Mataya R, Mwale M, et al. Long-term outcomes for women after obstetric fistula repair in Lilongwe, Malawi: a qualitative study. BMC Pregnancy Childbirth 2016; 16: 2. doi: 10.1186/s12884-015-0755-1 26732574

6. United Nations Population Fund. Campaign to end fistula. 2019. Accessed from: http://www.endfistula.org/what-fistula. Accessed on 12 April 2019.

7. World Health Organization. Sexual and reproductive health: End fistula. Restore Women's Dignity. 2019. Accessed from: https://www.who.int/reproductivehealth/topics/maternal_perinatal/fistula/en/. Accessed on: 11 April 2019.

8. Tunçalp Ö, Tripathi V, Landry E, Stanton CK, Saifuddin Ahmed S. Measuring the incidence and prevalence of obstetric fistula: approaches, needs and recommendations. Bull World Health Organ 2015; 93: 60–62. doi: 10.2471/BLT.14.141473 25558110

9. Lewis G, de Bernis L (eds). Obstetric fistula: Guiding principles for clinical management and programme development Geneva: World Health Organization; 2006.

10. Khisa AM, Omoni GM, Nyamongo IK, Spitzer RF. ‘I stayed with my illness’: a grounded theory study of health seeking behaviour and treatment pathways of patients with obstetric fistula in Kenya. BMC Womens Health 2017; 17: 92. doi: 10.1186/s12905-017-0451-6 28962566

11. Cichowitz C, Watt MH, Mchome B, Masenga GG. Delays contributing to the development and repair of obstetric fistula in northern Tanzania. Int Urogynecol J 2018; 29(3): 397–405. doi: 10.1007/s00192-017-3416-2 28836060

12. Baker Z, Bellows B, Bach R, Warren C. Barriers to obstetric fistula treatment in low‐income countries: a systematic review. Trop Med Int Health 2017; 22(8): 938–9. doi: 10.1111/tmi.12893 28510988

13. MEASURE DHS/ICF International. Demographic and Health Surveys methodology: Sampling and household listing manual. Calverton, MD: ICF International;2012.

14. Gele AA, Salad AM, Jimale LH, Kour P, Austveg B, Kumar B. Relying on visiting foreign doctors for fistula repair: The profile of women attending fistula repair surgery in Somalia. Obstet Gynecol Int 2017; 2017: 6069124. doi: 10.1155/2017/6069124 28761443

15. United Nations Population Fund and Engender Health. Obstetric fistula needs assessment report: Findings from nine African countries. New York: Engender Health; 2003.

16. Velez A, Ramsey K, Tell K. The campaign to end Fistula: What have we learned? Findings of facility and community needs assessments. Int J Gynaecol Obstet 2007; 99 Suppl 1: S143–50.

17. Maheu-Giroux M, Filippi V, Maulet N, Samadoulougou S, Castro MC, Meda N, et al. Risk factors for vaginal fistula symptoms in Sub-Saharan Africa: a pooled analysis of national household survey data. BMC Pregnancy Childbirth 2016; 16: 82. doi: 10.1186/s12884-016-0871-6 27098261

18. Atuyambe L, Mirembe F, Tumwesigye NM, Annika J, Kirumira EK, Faxelid E. Adolescent and adult first-time mothers' health seeking practices during pregnancy and early motherhood in Wakiso district, central Uganda. Reprod Health 2008; 5: 13. doi: 10.1186/1742-4755-5-13 19116011

19. Banke-Thomas OE, Banke-Thomas AO, Ameh CA. Factors influencing utilisation of maternal health services by adolescent mothers in Low-and middle-income countries: a systematic review. BMC Pregnancy Childbirth 2017;17(1): 65. doi: 10.1186/s12884-017-1246-3 28209120

20. Nardos R, Browning A, Chen CCG. Risk factors that predict failure after vaginal repair of obstetric vesicovaginal fistulae. Am J Obstet Gynecol 2009; 200: 578.e1-578.e4.

21. Egziabher TG, Eugene N, Ben K, Fredrick K. Obstetric fistula management and predictors of successful closure among women attending a public tertiary hospital in Rwanda: a retrospective review of records. BMC Res Notes 2015; 8:774. doi: 10.1186/s13104-015-1771-y 26654111

22. Ramsey K, Iliyasu Z, Idoko L. Fistula fortnight: innovative partnership brings mass treatment and public awareness towards ending obstetric fistula. Int J Gynaecol Obstet 2007;99 Suppl 1: S130–6.

23. Delamou A, Delvaux T, Beavogui AH, Toure A, Kolié D, Sidibé. Factors associated with the failure of obstetric fistula repair in Guinea: implications for practice. Reprod Health 2016; 13: 135. doi: 10.1186/s12978-016-0248-3 27821123

24. Tunçalp Ö, Isah A, Landry E, Stanton CK. Community-based screening for obstetric fistula in Nigeria: a novel approach. BMC Pregnancy Childbirth 2014; 14: 44. doi: 10.1186/1471-2393-14-44 24456506


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