SHORT-TERM COMPLICATIONS AND ASSOCIATED FACTORS AMONG WOMEN UNDERGOING OBSTETRIC FISTULA REPAIR AT BUGANDO MEDICAL CENTRE, MWANZA, TANZANIA
Introduction: Obstetric fistula is the most distressing condition in developing countries due to morbidity and loss of quality of life attributable to it. This study was conducted to determine short term complications and factors associated with these complications after repair the fistula.
Methods: This was descriptive follow up study conducted at Bugando Medical Centre from September 2014 to April 2015 involving 132 women with obstetric fistula and operated at the Centre. Social, demographic and clinical information were collected using questionnaires. Urine samples for culture and sensitivity were collected intra-operatively and data was analyzed using STATA version 11 software.
Results: The median (interquartile range) age of the participants was 23 (20-32) years. The proportion of women who developed short term complications was 42 (31.8%); with predominant complications being failed repair 18 (42.9%) and stress incontinence 10 (23.8%). Asymptomatic bacteriuria was found in 50.8% (33/65) of patients with preponderance of Gram negative bacteria. HIV seropositivity was documented in 4.1% of 123 tested patients and it was significantly associated with short term complications (p=0.002). Moreover, residing in rural areas (p=0.042); median duration of labor for more than 24 hours (p=0.002) with OR (95%CI) 4.38 (1.59 – 13.89), fistula type (p =0.005) and size (p =0.006), reduced bladder capacity (p <0.001) and urethral length (p =0.001) as well as presence of fibrosis (p =0.004) were significantly associated with short term complications among women repaired for obstetric fistulas.
Conclusion: The proportion of women developing short term complications at Bugando Medical Centre is high; with the common complications being failed repair and stress incontinence. The complications were associated with residing in rural areas, HIV seropositivity and fistula characteristics.
Keywords: Obstetric fistula repair, Short term complications, Tanzania
Thompson F. Fixing fistula. Bulletin of the World Health Organization. 2012;90(2):84-5.
de Bernis L. Obstetric fistula: guiding principles for clinical management and programme development, a new WHO guideline. Int J Gynaecol Obstet. 2007 Nov;99 Suppl 1:S117-21.
Hilton P, Cromwell DA. The risk of vesicovaginal and urethrovaginal fistula after hysterectomy performed in the English National Health Service--a retrospective cohort study examining patterns of care between 2000 and 2008. BJOG. 2012;119(12):1447-54.
Creanga AA, Genadry RR. Obstetric fistulas: a clinical review. Int J Gynaecol Obstet. 2007;99 Suppl 1:S40-6.
Dangal G, Thapa K, Yangzom K, Karki A. Obstetric Fistula in the Developing World: An Agonising Tragedy. Nepal Journal of Obstetrics and Gynaecology. 2014;8(2):5-15.
Raassen TJ, Verdaasdonk EG, Vierhout ME. Prospective results after first-time surgery for obstetric fistulas in East African women. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(1):73-9.
Muleta M, Rasmussen S, Kiserud T. Obstetric fistula in 14,928 Ethiopian women. Acta Obstet Gynecol Scand. 2010;89(7):945-51.
Semere L, Nour NM. Obstetric fistula: living with incontinence and shame. Rev Obstet Gynecol. 2008;1(4):193-7.
Siddle K, Vieren L, Fiander A. Characterising women with obstetric fistula and urogenital tract injuries in Tanzania. Int Urogynecol J. 2014;25(2):249-55.
Gutman RE, Dodson JL, Mostwin JL. Complications of treatment of obstetric fistula in the developing world: gynatresia, urinary incontinence, and urinary diversion. Int J Gynaecol Obstet. 2007;99 Suppl 1:S57-64.
Ayed M, El Atat R, Hassine LB, Sfaxi M, Chebil M, Zmerli S. Prognostic factors of recurrence after vesicovaginal fistula repair. Int J Urol. 2006;13(4):345-9.
Barone MA, Frajzyngier V, Ruminjo J, Asiimwe F, Barry TH, Bello A, et al. Determinants of postoperative outcomes of female genital fistula repair surgery. Obstet Gynecol. 2012;120(3):524-31.
Goh JT, Browning A, Berhan B, Chang A. Predicting the risk of failure of closure of obstetric fistula and residual urinary incontinence using a classification system. Int Urogynecol J Pelvic Floor Dysfunct. 2008 ;19(12):1659-62.
Gumodoka B, Mach E, Majinge CR. Genito-urinary fistula patients at Bugando Medical Centre. East Afr Med J. 2010;87(7):294-8.
Tebeu PM, Maninzou SD, Takam D, Nguefack-Tsague G, Fomulu JN, Rochat CH. Surgical outcome following treatment of obstetric vesicovaginal fistula among HIV-positive and HIV-negative patients in Cameroon. Int J Gynaecol Obstet. 2014;125(2):168-9.
Yabaya A, Auta B. Microorganisms associated with the urinogenital system of Vesico Vaginal Fistula (VVF) patients in north western Nigeria. Science World Journal. 2007;1(1).
Adeoye IS, Oladeinde O, Uneke J, Adeoye J. An assessment of asymptomatic bacteriuria among women with vesico-vaginal fistula in South-Eastern Nigeria. Nepal Journal of Epidemiology 2011;1(2):64-9.
BMC. Gynecology ward register book of 2011-2013 in Bugando Medical Cente, Mwanza. 2014.
Taro Y. Statistics: An introductory analysis. Harper and Row, New York. 1967.
NACP. National Guidelines for the Management of HIV and AIDS. Ministry of Health of and Social Welfare. The United Republic of Tanzania. Dar-Es-Salaam 2012.
Koneman EW, Allen SD, Janda WM, Schreckenberger PC. Color Atlas and Textbook of Diagnostic Microbiology. : Lippincott.; 1997.
CLSI. Perfomance Standars for Antimicrobial Susceptibility Testing; Twenty first information supplement: Wayne, PA: Clinical and Laboratory Standards Institute; 2011.
McFadden E, Taleski SJ, Bocking A, Spitzer RF, Mabeya H. Retrospective review of predisposing factors and surgical outcomes in obstetric fistula patients at a single teaching hospital in Western Kenya. J Obstet Gynaecol Can. 2011;33(1):30-5.
Munoz O, Bowling CB, Gerten KA, Taryor R, Norman AM, Szychowski JM, et al. Factors Influencing Post-Operative Short-Term Outcomes of Vesicovaginal Fistula Repairs in a Community Hospital in Liberia. Br J Med Surg Urol. 2011;4(6):259-65.
Kayondo M, Wasswa S, Kabakyenga J, Mukiibi N, Senkungu J, Stenson A, et al. Predictors and outcome of surgical repair of obstetric fistula at a regional referral hospital, Mbarara, western Uganda. BMC Urol. 2011;11:23.
Holme A, Breen M, C. M. Obstetric fistula: a study of women managed at the Monze Mission Hospital, Zambia. BJOG. 2007;114(10):10-7.
Browning A, B M. Women with obstetric fistula in Ethiopia: a 6-month follow-up after surgical treatment. BJOG. 2008;115:1564-9.
Ayed M, Rabii El A, Lotfi Ben Hassine, Mohamed Sfaxi, Chebil' M, Zmerli. S. Prognostic factors of recurrence after vesicovaginal fistula repair. International Journal of Urology. 2006;13(4):345-9.
Nardos R, Browning A. Risk factors that predict failure after vaginal repair of obstetric vesicovaginal fistulae. Am J Obstet Gynecol. 2009;200:578.e1-.e4.
Goh TWJ, Browning A, A C. Predicting the risk of failure of closure of obstetric fistula and residual urinary incontinence using a classification system. Int Urogynecol J 2008;19:1659-62.