TY - JOUR
T1 - Fistula after attended delivery and the challenge of obstetric care capacity in the eastern Democratic Republic of Congo
AU - Benfield, Nerys
AU - Young-Lin, Nichole
AU - Kimona, Christophe
AU - Kalisya, Luc M.
AU - Kisindja, Rogatien M.
N1 - Publisher Copyright:
© 2015 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.
PY - 2015
Y1 - 2015
N2 - Objective: To analyze the history of women with fistula in the eastern Democratic Republic of Congo (DRC) to understand the determinants of fistula development. Methods: In a retrospective observational study, data were analyzed from a survey of all women who underwent surgical fistula repair at HEAL Africa Hospital, Goma, between April 1, 2009, and March 1, 2012. Characteristics and obstetric histories were obtained by self-report. Results: The mean age of the 202 participants at treatment was 30.7 years (range 5-69). The mean duration of fistula was 45.6 months (range 0-600). In total, 171 (91.4%) fistulas were caused by obstructed labor, and 147 (86.5%) were vesicovaginal. Most women (129/175 [73.8%]) reported having received care during early labor under the supervision of a nurse or doctor in a healthcare facility. Among 176 women for whom delivery data were available, 102 (57.9%) delivered at a hospital, 42 (23.8%) at a health center, and 32 (18.2%) at home. Only 46 (26.3%) of 175 women were transferred to a higher level of care during labor. Conclusions: In the eastern DRC, efforts to enable transport to a healthcare facility and to encourage attended births must be accompanied by improvements in the capacity of existing facilities and in the training of staff to enable the timely diagnosis of labor abnormalities and appropriate intervention.
AB - Objective: To analyze the history of women with fistula in the eastern Democratic Republic of Congo (DRC) to understand the determinants of fistula development. Methods: In a retrospective observational study, data were analyzed from a survey of all women who underwent surgical fistula repair at HEAL Africa Hospital, Goma, between April 1, 2009, and March 1, 2012. Characteristics and obstetric histories were obtained by self-report. Results: The mean age of the 202 participants at treatment was 30.7 years (range 5-69). The mean duration of fistula was 45.6 months (range 0-600). In total, 171 (91.4%) fistulas were caused by obstructed labor, and 147 (86.5%) were vesicovaginal. Most women (129/175 [73.8%]) reported having received care during early labor under the supervision of a nurse or doctor in a healthcare facility. Among 176 women for whom delivery data were available, 102 (57.9%) delivered at a hospital, 42 (23.8%) at a health center, and 32 (18.2%) at home. Only 46 (26.3%) of 175 women were transferred to a higher level of care during labor. Conclusions: In the eastern DRC, efforts to enable transport to a healthcare facility and to encourage attended births must be accompanied by improvements in the capacity of existing facilities and in the training of staff to enable the timely diagnosis of labor abnormalities and appropriate intervention.
KW - Healthcare capacity
KW - Maternal complications
KW - Obstetric fistula
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U2 - 10.1016/j.ijgo.2015.02.032
DO - 10.1016/j.ijgo.2015.02.032
M3 - Article
C2 - 26089287
AN - SCOPUS:84936985268
SN - 0020-7292
VL - 130
SP - 157
EP - 160
JO - International Journal of Gynecology and Obstetrics
JF - International Journal of Gynecology and Obstetrics
IS - 2
ER -