Thesis (M.A.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / Obstetric Fistula (OF) is a devastating condition, normally caused by obstructed labor, which results in uncontrollable urinary and fecal incontinence and affects thousands of women every year. Most of the women affected by OF reside in small isolated, rural villages, creating challenges to diagnosis and treatment. Due to lack of standardization of therapy approaches, many women undergoing OF-repair often redevelop incontinence or other complications. This paper analyzes both vaginal and abdominal approaches to OF, evaluating their outcomes and the challenges they present. The therapies analyzed are: the Latzko approach, the layered-closure, and the Martius flap procedure. The goal of this paper is to determine which procedure is most appropriate to use for specific types of OF in order to establish therapeutic standardization. This study reviewed a significant amount of literature evaluating all three therapy approaches. It was determined that the Latzko approach should be utilized as the first approach to vesicovaginal fistula (WF) and vesicouterine fistula (VUF) due to its simplicity, avoidance of major operative complications, and successful postoperative repair results. Layered-closure approaches should be refrained from use, unless the Latzko approach is impossible or in specific cases of urethrovaginal fistula. Due to its more extensive operation and post-operative follow-up, the Martius flap procedures should be used only for significantly complex fistulas, such as those that involve multiple organs, are exceptionally large or recurrent. Surgical approaches, however, cannot repair the OF problem on its own, due to a number of challenges and ethical considerations. Therefore, challenges to OF treatment and repair were also considered and analyzed. A final evaluation determined that the creation of permanent infrastructure, such as women's reproductive health and delivery clinics will provide the greatest improvements to the current OF status. By solving problems such as surgeon shortages, cost issues, and the lack of follow-up and mental health services, it was determined that permanent delivery clinics with established transportation methods will produce the most significant reduction of obstructed labor, and therefore OF occurrence, and the most promising OF prevention method as well. / 2999-01-01

Obstetric Fistulas have a high prevalence rate in developing countries where there is a lack of immediate access to maternal health care for women. Although Obstetric Fistulas are physical injuries, they affect women’s psychosocial health. This analysis aims to display the inefficiency of focusing on surgical repairs as the only treatment option and to demonstrate the need to integrate mental health treatment at different Obstetric Fistulas treatment stages. A total of 8 research articles from both Pub Med and Web of Science met the inclusion criteria, and the analysis was done by country. The results showed the presence of depressive symptoms, although there is an immediate improvement in quality of life after surgical repair. In some cases, there was worsening of psychological symptoms due to residual incontinence with or without successful fistula closure. These results suggested that whereas surgical repairs positively impact Obstetric Fistula patients, it does not solve the depressive symptoms, which cause women to self-isolate and have suicidal ideations. The mental sequelae caused by Obstetrical Fistulas can only be resolved using structured mental health care that should be started before surgical repair and continued after repair.

The purpose of this study was to identify factors that contribute to women delaying seeking treatment for obstetric fistula. A stratified random sampling technique was used to select 384 study participants. A cross sectional analytical research design was used; data was collected by structured, closed ended questionnaires. Bivariate and multivariate logistic regression models were applied. Results show a significant correlation between traditional treatment and delay in seeking treatment (P-Value = 0.012). The presence of parents has a significant correlation in reaching treatment centres (p-value = 0.013), those women who are speaking about their fistula have less chance of delay in seeking treatment (p-value = 0.008), having no income significantly associated with delay in seeking treatment (AOR = 0.28) and women living closer to the treatment centres have less chance of delay (p-value = 0.008). Therefore, there are a number of factors that significantly influence women from early seeking of treatment for their fistulae. / Health Studies / M.A. (Public Health)

BACKGROUND: Obstetric fistula (OF) is described as a health and human rights tragedy due to its devastating consequences and debilitating sequelae. In sub-Saharan Africa, the lifetime prevalence of OF symptoms is estimated at 3.0 cases (95% CI 1.3-5.5) per 1000 women of reproductive age. In Guinea, this prevalence is 6·0 (95% CI 3·9–7·4) per 1000 women of reproductive age, a double that of sub-Saharan Africa. As maternal mortality reduction is accelerating in many countries due to better access to cesarean section and more women are benefiting treatment for OF worldwide, women who have a successful fistula repair need more attention to prevent fistula recurrence and adverse maternal and neonatal outcomes.AIM: To analyze the long-term reproductive health outcomes in women who undergo fistula surgery in Guinea and contribute to closing the knowledge gap on the reproductive health of women after fistula surgery.METHODS: The situational analysis of fistula management programs in Guinea included three retrospective cohort studies. Study I analyzed the clinical outcomes of fistula care programs in Guinea. Study II analyzed the trends and factors associated with loss to follow-up after surgical repair of obstetric fistula in Guinea. Study III estimated the overall proportions of surgical failure of fistula closure and incontinence among women undergoing repair for obstetric fistula in Guinea and identified factors associated with these outcomes. To analyze the health and reproductive outcomes in women after female genital fistula surgery in Guinea, two studies (IV and V) were conducted. Study IV critically reviewed the existing literature on pregnancy and childbirth post repair of obstetric fistula and Study V analyzed the incidence of fistula recurrence and pregnancy post repair along with the associated maternal and neonatal outcomes. RESULTS: Routine programmatic repair of OF was found to achieve satisfactory short-term clinical outcomes with 85% of women having their fistula closed and 79% becoming continent after surgery (Study I). However, additional 18% recurrence and 10% residual urinary incontinence were recorded within 28 months median follow-up post-surgery (Study V). Reimbursement of transportation costs and the reduction of geographical barriers to care for women with OF were highly related to reduced loss to follow-up after hospital discharge (Study II). Women who present for surgery with a damaged urethra and those who delivered vaginally during the delivery leading to the fistula were more likely to experience surgical repair failure and residual urinary incontinence (Study III). Women who become pregnant and deliver after fistula repair in sub-Saharan Africa were identified as carrying high risk of adverse maternal and neonatal health outcomes (Study IV). In Guinea, only few women achieved pregnancy (28%) after surgery. Stillbirths (24%) and recurrence of fistula after delivery (14%) were common among women who delivered after fistula repair (Study V). CONCLUSIONS: Improving the performance of fistula management programs in the context of decentralization of services in Guinea needs therefore to integrate long-term perspectives. This should include establishing a “level of care framework” into fistula surgery along with training for health providers, tracing of women after repair, and increased community awareness-raising that include men and target gender inequalities (Studies I to III). Increasing funding and support for fistula care from both local governments and international donors is needed in the current context of decentralization of fistula care to address service gaps for women suffering from fistula (Studies III to V). Achieving a fistula free generation should include interventions to address women’s vulnerability before fistula formation and after fistula repair (Studies IV and V). / Doctorat en Sciences de la santé Publique / info:eu-repo/semantics/nonPublished

The purpose of this study was to identify factors that contribute to women delaying seeking treatment for obstetric fistula. A stratified random sampling technique was used to select 384 study participants. A cross sectional analytical research design was used; data was collected by structured, closed ended questionnaires. Bivariate and multivariate logistic regression models were applied. Results show a significant correlation between traditional treatment and delay in seeking treatment (P-Value = 0.012). The presence of parents has a significant correlation in reaching treatment centres (p-value = 0.013), those women who are speaking about their fistula have less chance of delay in seeking treatment (p-value = 0.008), having no income significantly associated with delay in seeking treatment (AOR = 0.28) and women living closer to the treatment centres have less chance of delay (p-value = 0.008). Therefore, there are a number of factors that significantly influence women from early seeking of treatment for their fistulae. / Health Studies / M.A. (Public Health)

Masters of Science - Msc (Physiotherapy) / Post-operative physiotherapy plays a vital role in the management of patients with incontinence in order to optimise the outcome of obstetric fistula surgery. Women who suffer residual urinary incontinence continue to experience shame, social isolation and institutional rejection. Incontinence continues to impair them leading to lower levels of role participation and restriction in most activities. Gynocare Fistula Center, Eldoret, receives a number of referrals for women with obstetric fistula requiring surgical and physiotherapy care. Many studies have focused on the determinants of surgical outcomes and social reintegration but none have focused on woman's perceptions and experiences with postoperative physiotherapy. While continence is not always achieved immediately after surgery, this study was designed to explore women's perceptions and experience of postoperative physiotherapy management at an obstetric fistula center in Eldoret,Kenya. Participants were then asked about their experiences and related perceptions and perceived challenges regarding the physiotherapy service following discharge from the Center. An explorative qualitative method was used to explore the women's perceptions and experiences of the post-operative physiotherapy management, as well as their perceived challenges regarding access to physiotherapy post discharge.

<p>Up to two million women worldwide have obstetric fistula, a maternal morbidity prevalent in developing countries that causes uncontrollable leaking of urine and/or feces and a persistent bad odor. There is both theoretical and empirical evidence for psychopathology in patients presenting for fistula surgery, albeit with methodological limitations. The current studies sought to improve on past limitations of study design. Study A compared psychological symptoms and social support between fistula patients and a comparison group recruited from gynecology outpatient clinics. Measures included previously validated psychometric questionnaires, administered orally by data collectors. Results showed that compared to gynecology outpatients, fistula patients had significantly higher levels of depression, traumatic stress, somatic symptoms and avoidant coping, and had lower social support. Study B investigated changes in psychological symptoms, stigma and social support between the time of admission for fistula repair and 3 months after discharge from the hospital. At follow-up, fistula patients reported significant improvements in all study outcome variables. Exploratory analysis revealed that the extent of leaking was associated with depression and PTSD. These results indicate the potential benefit of mental health interventions for this population. Additionally, future research may clarify the relationship between residual leaking after fistula surgery, and its effect on post-surgery mental health outcomes.</p> / Dissertation

Women’s rights have been recognized by national, regional and international human rights instruments. In Africa particularly, both the African Charter and the African Women Protocol provide for the right to health. However, the continent offers the highest rate of women suffering from fistula. This paper aims to answer the question whether the current level of governments’ response to the plight of victims of obstetric fistula, complies with the requirements of international human rights law. It looks at whether the consideration of victims of fistula from a right-based approach will contribute to affordability and free access to treatment for women suffering from the disease / Thesis (LLM (Human Rights and Democratisation in Africa)) -- University of Pretoria, 2008. / A Dissertation submitted to the Faculty of Law University of Pretoria, in partial fulfilment of the requirements for the degree Masters of Law (LLM in Human Rights and Democratisation in Africa). Prepared under the supervision of Prof. Doutor Gilles Cistac, of the faculty of law, Universidade Eduardo Mondlane, Mozambique / http://www.chr.up.ac.za/ / Centre for Human Rights / LLM

Obstetric surgical repair is the common therapeutic intervention available to women with obstetrical fistula. While surgical repair can address the physical symptoms, it may not end the psychological challenges that women with fistula face. This longitudinal study investigated the effects of surgical obstetric fistula repairs on the severity of depression and anxiety associated with obstetric fistula among 219 women admitted at six fistula hospitals in Ethiopia. Data was collected through structured Likert-scale questionnaire both on admission (prior to surgical obstetric fistula repairs) and on discharge (post obstetric fistula repairs).. Statistical Package for Social Science plus Analysis of Moment Structures (SPSS-AMOS) version 20 was used for data analysis. Findings indicate that women with obstetric fistula have higher psychological distress such as depression (91%) and anxiety (78%) pre-surgical repair than post-surgical repair. These psychological distresses were exacerbated by poor social and psychological support of women with obstetric fistula by the family and health care professionals. The findings were used to develop integrated mental health treatment model for women with obstetric fistula in order to address psychological health needs of this population. / Health Studies / D. Litt. et Phil. (Health Studies)

In Uganda, there are an estimated 200,000 women suffering from obstetric fistula, with 1,900 new cases expected annually. These figures, combined with a persistently high maternal mortality rate, have led to an international discourse that claims the solution to improving maternal health outcomes is facility-based delivery with a skilled birth attendant. In accord with this discourse, the Ugandan government criminalized traditional birth attendants in 2010. In this study, I examine the lived experience of traditional birth attendants and women who have suffered from an obstetric fistula in eastern Uganda. Using data collected from open-ended, semi-structured interviews, focus groups, and participant-observation, I describe the biocultural determinants of obstetric fistula. Based on findings, I argue that although emergency obstetric care is critical to prevent obstetric fistula in cases of obstructed labor, the criminalization of the locally constructed system of care, TBAs, serves as yet another layer of structural violence in the lives of rural, poor women. Results demonstrate how political-economic and cultural determinants of obstetric fistula are minimized in favor of a Western prescribed, bio-medical solution, which is heavily resource dependent. This solution is promoted through a political economy of hope fueled by the obstetric imaginary, or the enthusiastic belief in Western-style biomedical obstetric care’s ability to deliver positive health outcomes for women and infants regardless of local context and constraints. Recommendations include increased obstetric fistula treatment facilities with improved communication from medical staff, decriminalization of traditional birth attendants and renewed training programs, and engaging local populations in maternal health discourse to ensure culturally competent programs. / Graduation date: 2013