Knowledge and Attitudes of Nursing Staff towards Obstetric Fistula at the Abeche University Hospital, Chad

Introduction: Prevention of obstetric fistula (OF) remains a challenge in Chad where its incidence is 464 cases/year. The present study aims to determine the knowledge and attitudes of nursing staff towards obstetric fistula. Patients and Method: This was a cross-sectional, descriptive and analytical study including nursing staff at the Abéché University Hospital. The survey took place from March to May 2023 and the sampling was exhaustive. Data collection was done using a form including a questionnaire on sociodemographic parameters, knowledge and attitudes. Participation in the study was voluntary and individual. Results: Participation in the study was 76.11%. Emergency department staff were the most represented, followed by gynecology-obstetrics staff with 34.4% and 20.91% of cases respectively. Nurses represented 53.17% of participants followed by doctors (23.52%). An exact definition of obstetric fistula was reported by 7.84% of participants and it was partial in 80.39%. The level of knowledge of risk factors was considered good in 12.41%. Exact knowledge of clinical signs was reported by 74.5% of cases. Among the participants, 1.96% reported that the treatment of obstetric fistula is traditional. Knowledge about means of prevention was considered good by 13.72% (n = 21), and attitudes by 26.79%? Obstetric fistula knowledge was influenced by profession (doctor, p = 0.011) and attitudes by service (p = 0.004) and profession (doctor, p = 0.001). Conclusion: Obstetric fistula is a curable disease whose prevention remains possible and requires good knowledge of the disease and the promotion of safe motherhood. This study should serve as a basis for the establishment of the obstetric fistula module in the curriculum of healthcare personnel and the promotion of continuing training for its eradication.

Obstetric Fistula: Epidemiological, Social and Therapeutic Aspects: Prospective Study of 196 Patients Admitted to the ZINDER Mother and Child Health Centre (CSME)

Introduction: Obstetric fistula (OF) is an abnormal communication between the genital and urinary tracts and/or associated with a recto-vaginal communication resulting from prolonged dystocic delivery. It is a frequent pathology in underdeveloped countries. In Zinder no study has been carried out on obstetric fistula. The aim of this study was to evaluate the epidemiological, social impact and therapeutic aspects of obstetric fistula at the CSME of Zinder. Patient and Method: This was a descriptive cross-sectional study of obstetric fistula care at CSME during the period of (January 2018 to June 2020). Results: A total of 196 cases were collected over 30 months. This represents an annual incidence of 78.4 fistulas. The median age of the patients was 18.63 years, and more than 65% were over 20 years old. One hundred and ninety-one patients (97.45%) did not attend school, and 56.12% (n = 110) lived in polygamous households. One hundred and fifty-one women (n = 151), 77.04% had full assistance from their husband during the first four (4) months of the pathology. Twenty-four (12.24%) had been notified of repudiation. Obstetrical risk of dystocia was found in 39.79% (n = 78) of the patients, of whom 24.49% (n = 48) had a focused antenatal consultation (CPNR). The labour lasted more than 24 hours in 100%. The majority of women are multiparous and 60% had at least 2 pregnancies. vesicovaginal fistula is the main pathological type with 86.23%. Fistulas were closed in 83.16% and 68.87% exited without urine loss. Conclusion: Obstetric fistula is a devastating disease affecting girls and young women in Niger, as in other countries in Africa and Asia. It is a major concern worldwide and is a social tragedy because it is disabling and depressing.

A Case-Control Study of Obstetric Fistula Risk Factors in the Democratic Republic of the Congo

Background: Pregnant women in the Democratic Republic of Congo (DRC) are at increased risk for developing obstetric fistulas (OFs) as a result of obstructed labor, in conditions similar to many other African countries. No case-control study of biological and social risk factors for OF has been reported from the DRC. This study aimed to identify factors that would aid in prevention and early identification of women who are at risk of developing OF. Methods: Participants were enrolled in a case-control study at four obstetric clinics in the central DRC. Cases of OF were evaluated as they presented, then a control participant was enrolled among women presenting subsequently to the same clinic, seeking to match parity at the time of the fistula and tribe of the case. A questionnaire was administered to elicit physical, obstetric, demographic, socioeconomic, religion, geographic, and delivery attributes of the participants. Case-control comparisons sought to identify independent risk factors for OF in the total case-control pairs and in subgroups of the participants. Logistic regression was utilized to identify independent risk factors for OF in the total case-control study group and in selected subgroups of the participants, and linear regression was utilized to estimate the variation explained between case and control outcomes from the variables independently significant in the logistic regression models. Results: A total of 177 case-control pairs were enrolled. Among all pairs, shorter height of the case (odds ratio = 1.06, 95% Confidence Limits 1.02 - 1.12);more kilometers travelled to the delivery site (1.02, 1.01 - 1.02);her village, not town, residence (OR = 5.52, 2.72 - 11.2), and her lower professional status (2.95, 1.53 - 5.72) were statistically independent factors associated with OF development. When applied in linear regression comparison of the pairs, these variables yielded an r2 = 0.48, imputing 48% of the difference in delivery outcome between the pairs was explained by these variables. Among the 38 pairs who were primigravida, the independent variables were more kilometers travelled to the delivery site (1.02, 1.00 - 1.05), village, not town, residence (50.0, 10.2 - 248.7), and facility intended for lower patient acuity (3.7 s, 1.01 - 13.6, r2 = 0.66) patients who were matched on parity and tribe, the significant risk factors were professional status (OR = 0.29), greater distance travelled to the clinic (OR = 1.02, 1.01 - 1.02), village, not town, residence (5.52, 2.72 - 11.2), and mother’s lower professional status (2.95, 1.53 - 5.72) when the OF occurred. Conclusions: Our study showed biological and social factors associated with the development of OF. Shorter height was the only biological risk factor found to be statistically significant in the study population. Other factors were related to limited resources and limited access to medical care.

Epidemiological and Therapeutic Aspects of Obstetric Fistula in 2021: A Review of 97 Cases at the Departmental University Hospital Centre of Borgou and Alibori in Benin

Background: Obstetric Fistula (OF) is a breach of the birth canal due to obstructed labor. It is a major public health problem in developing countries. Objective: Study the epidemiology and treatment of obstetric fistulas at the Departmental University Hospital Centre of Borgou and Alibori (CHUD-B/A) in Parakou, Benin. Study Method: This was a descriptive and analytical cross-sectional study with prospective data collection on women treated during OF care missions from February 2020 to April 2021 in CHUD-B/A in Parakou, Benin. The data concerned their socio-demographic characteristics, obstetric history, the clinic and therapeutic characteristics of their obstetric fistulas. Results: In total 97 patients with OF were treated during the 14-month period. The average age of the patients was 36.42 ± 11.75 years old. The patients were married (51.54%), without professional occupation (54.64%) and had no formal education (73.20%). The vesico-vaginal variety was predominating (54.64%). The fistulas were of Type I (46.39%), Type II (20.62%) and Type III (32.99%) according to the classification of Waaldjik Kees. The patients were operated on under spinal anesthesia (94.79%), and vaginally (55.67%) according to the principle of Chassar Moir (68, 60%). The associated procedures were lengthening urethroplasty (17.53%), and interposition of the Martius flap (1.03%). The overall success rate without Stress Urinary Incontinence was 71.13%. The factors associated with the failure of the fistula repair were: the nutritional status of the patients (p = 0.004), the previous repair failure (p = 0.001), the high size of the fistula (p = 0.007), the fistula severity (p and a urethral reconstruction (p Conclusion: OF is a relatively frequent pathology in Benin. Vesico-vaginal fistula is the most common form. The success rate of the surgical treatment is satisfactory, but depends on some factors.

Assessing Strategies of Obstetric Fistula Management by Nurses/Midwives of Yaoundé Central Hospital and University Teaching Hospital

Every minute, a woman dies in pregnancy, and for every woman who dies 20 - 30 others will survive with morbidity, one of which is obstetrical fistula. Women who suffer from obstetric fistula experience continuous incontinence of urine and/or stool, stigma, social isolation and associated health problems. The World Health Organization estimates that there are currently more than 2 million women living with untreated obstetric fistula mostly in sub-Saharan Africa and South-East Asia, as well as in various other parts of the world. Caring for fistula patients and nursing them back to full physical and mental health can be one of the most challenging and also rewarding tasks undertaken by nurses. The surgery cannot succeed without proper pre-, peri- and post-operative care. The patients undoubtedly recover better with high-quality care—meaning the truly holistic, generous, and selfless care of a nurse who has the skills, understanding and determination to help these very vulnerable patients. Objective: This research seeks to assess the strategies of obstetric fistula management by nurses/midwives of Yaoundé central hospital and CHU by exploring the care they offer to clients pre-operatively, post-operatively, and when they are discharged from the hospital. Achieving Millennium Development Goal (MDG) 3 still remains a challenge to the developing countries although maternal mortality reduction is a priority agenda of each country. Methodology: This retrospective cross-sectional descriptive study design employed a sample of 100 nurses/midwives on active service, and who have at least managed a case of obstetric fistula. A quantitative questionnaire was used to collect data, which was analyzed using SPSS version 23. Results: The study proved a highly significant difference between management and qualification, with a p-value of 0.002. Also, it showed that there was a statistically significant difference between longevity of service and management with a p-value of 0.001. A majority of respondents were nurse assistants (52%), and up to 43% of respondents had 11 - 20 years of work experience. Up to 53% did not offer standard care with respect to their qualification, and up to 52% did not offer standard care with respect to their longevity in service. Conclusion: VVF is the most common type of obstetric fistula with a frequency of 6 to 10 cases, there is an overall poor management of obstetric fistula by nurses and midwives in YCH and CHU. There is an urgent need to train and retrain these health workers on the management strategies of obstetric fistula and to remind them of their personal commitment as care givers.

Exploring awareness of obstetric fistula in Eastern and Northern Nigeria:perceived causes,symptoms,and availability of treatment services

Background:Evidence suggests that there are approximately two female genital fistula cases per 1000 women of reproductive age in sub-Saharan Africa.It is estimated that more than 200,000 women are affected by fistula in Nigeria,primarily due to obstetric causes.Awareness has been indicated as a risk factor for the development of obstetric fistula.This study explored the awareness of obstetric fistula such as causes,symptoms,and availability of and access to treatment services in southeastern and northwestern Nigeria.Methods:An exploratory qualitative study design was used to conduct this research in Kano and Ebonyi states in northern and eastern Nigeria,respectively.A total of six(6)focus group discussions were conducted with three categories of participants:women who were successfully repaired and discharged(n=2),community-married men(n=2),and women(n=2).Forty-four(44)In-depth interviews were conducted three categories of participants:18 with women with fistula who were either awaiting repair or had been repaired;6 family member caregivers accompanying fistula patients,and 20 health service providers at fistula repair centers.We developed a data analysis plan based on the emerging themes.The transcripts and field notes were imported into QSR Nvivo version 11 and coded accordingly.Content and thematic analysis was run by inductively drawing themes based on the elicited information from participants.Results:There was lack of knowledge of obstetric fistula and its causes among married men and women in the community,caregivers,and some patients were unaware of what caused their fistula for years.In this study,none of the community men and women nor caregivers correctly identified the causes and symptoms of a fistula or knew where to seek treatment.Knowledge about fistula was more common among women who had undergone repairs.Some repaired women attributed the cause of fistula to the providers who attended to them during delivery.Conclusions:Findings reveal a widespread lack of awareness of obstetric fistula onset and awareness of the availability of repair services at the community level.There is an urgent need to explore multi-pronged strategies for increasing awareness of obstetric fistula and available treatment services among women and other community members.