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. 2017 Nov 10;14(1):147.
doi: 10.1186/s12978-017-0408-0.

Obstetric fistulae in southern Mozambique: incidence, obstetric characteristics and treatment

Sibone Mocumbi  1   2 , Claudia Hanson  3   4 , Ulf Högberg  5 , Helena Boene  6 , Peter von Dadelszen  7 , Anna Bergström  5   8 , Khátia Munguambe  6   9 , Esperança Sevene  6   10 ; CLIP working group
Affiliations

Obstetric fistulae in southern Mozambique: incidence, obstetric characteristics and treatment

Sibone Mocumbi et al. Reprod Health. .

Abstract

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.

Keywords: Caesarean; Incidence; Obstetric fistula; Population-based; Sub-Saharan Africa.

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Conflict of interest statement

Ethics approval and consent to participate

Ethical approval was provided by the Bioethics Review Joint Committee of the UEM Faculty of Medicine and Maputo Central Hospital (CIBS FM&HCM/33/2015, dated 28 August 2015). Informed consent was obtained from each participant before interview. Those aged less than 18 years were asked about their willingness to participate. Thereafter, informed consent was obtained from their parents or legal guardians, and additional assent was then obtained from those participants. For illiterate participants, a literate witness was involved in the consent process, the participant’s fingerprint was taken, and the consent form signed by the witness and the data collector. Women affected by obstetric fistula who presented themselves because of their awareness of the study but who did not fulfil the study inclusion criteria, were offered treatment.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Diagram showing the flow through the study
See this image and copyright information in PMC

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References

    1. WHO . Obstetric fistula: Guiding principles for clinical management and program development. Geneva: World Health Organization; 2006.
    1. De Ridder D, Badlani GH, Browning A, et al. Fistulas in the developing world. In: Abrams P, Cardozo L, Khoury S, Wein A, editors. Incontinence, 4th ed. Paris: Health Publications Ltd.; 2009. p. 1419–58.
    1. Neilson JP. Obstructed labor. Br Med Bull. 2003;67(1) - PubMed
    1. Wall LL, et al. The obstetric vesicovaginal fistula in the developing world. Obstet Gynecol Surv. 2005;60(7 Suppl 1):S3–S51. https://www.ncbi.nlm.nih.gov/m/pubmed/16034313/?i=4&from=/16895244/related. - PubMed
    1. Hilton P. Trends in the aetiology of urogenital fistula: a case of 'retrogressive evolution'? Int Urogynecol J. 2016;27(6):831–837. doi: 10.1007/s00192-015-2919-y. - DOI - PMC - PubMed

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