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Obstetric fistulae in southern Mozambique: incidence, obstetric characteristics and treatment
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research. Univ Eduardo Mondlane UEM, Fac Med, Dept Obstet & Gynaecol, Av Agostinho Neto 679, Maputo 1100, Mozambique..
Karolinska Inst, Dept Publ Hlth Sci, Tomtebodavagen 18A,Plan 4, Stockholm, Sweden.;London Sch Hyg & Trop Med, Dept Dis Control, Keppel St, London WC1E 7HT, England..
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
CISM, Rua 12,Vila Manhica, Manhica 1121, Mozambique..
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2017 (English)In: Reproductive Health, ISSN 1742-4755, E-ISSN 1742-4755, Vol. 14, article id 147Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Obstetric fistula is one of the most devastating consequences of unmet needs in obstetric services. Systematic reviews suggest that the pooled incidence of fistulae in community-based studies is 0.09 per 1000 recently pregnant women; however, as facility delivery is increasing, for the most part, in Africa, incidence of fistula should decrease. Few population-based studies on fistulae have been undertaken in Sub-Saharan Africa, including Mozambique. This study aimed to estimate the incidence of obstetric fistulae in recently delivered mothers, and to describe the clinical characteristics and care, as well as the outcome, after surgical repair.

METHODS: We selected women who had delivered up to 12 months before the start of the study (June, 1st 2016). They were part of a cohort of women of reproductive age (12-49 years), recruited from selected clusters in rural areas of Maputo and Gaza provinces, Southern Mozambique, who were participating in an intervention trial (the Community Level Interventions for Pre-eclampsia trial or CLIP trial). Case identification was completed by self-reported constant urine leakage and was confirmed by clinical assessment. Women who had confirmed obstetric fistulae were referred for surgical repair. Data were entered into a REDCap database and analysed using R software.

RESULTS: Five women with obstetric fistulae were detected among 4358 interviewed, giving an incidence of 1.1 per 1000 recently pregnant women (95% CI 2.16-0.14). All but one had Caesarean section and all of the babies died. Four were stillborn, and one died very soon after birth. All of the patients identified and reached the primary health facility in reasonable time. Delays occurred in the care: in diagnosis of obstructed labour, and in the decision to refer to the secondary or third-level hospital. All but one of the women were referred to surgical repair and the fistulae successfully closed.

CONCLUSION: This population-based study reports a high incidence of obstetric fistulae in an area with high numbers of facility births. Few first and second delays in reaching care, but many third delays in receiving care, were identified. This raises concerns for quality of care.

Place, publisher, year, edition, pages
2017. Vol. 14, article id 147
Keywords [en]
Obstetric fistula, Caesarean, Incidence, Population-based, Sub-Saharan Africa
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:uu:diva-341929DOI: 10.1186/s12978-017-0408-0ISI: 000414870000001PubMedID: 29126412OAI: oai:DiVA.org:uu-341929DiVA, id: diva2:1185559
Available from: 2018-02-26 Created: 2018-02-26 Last updated: 2018-02-26Bibliographically approved

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