Factors associated with obstetric fistula repair failures at St. Francis and Monze mission hospitals, Zambia, 2010—2016; a retrospective facility based cohort.
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Date
2019
Authors
Kapaya, Fred
Journal Title
Journal ISSN
Volume Title
Publisher
The University of Zambia
Abstract
Obstetric fistula causes significant maternal morbidity especially in sub-Saharan African. In Zambia the prevalence is about 0.53%. Despite a number of women receiving corrective surgery for fistula at a number of hospitals in Zambia, there is paucity of data on the quality of care. This study was conducted to determine the overall proportion of fistula repair failures and identify factors associated with failure in Eastern and Southern Provinces, Zambia. This was a retrospective cohort study using data extracted from hospital records of obstetric fistula repairs between January 2010 to December 2016 at St. Francis and Monze Mission Hospitals which are among the four major fistula repair hospitals in Zambia. All women who
underwent repair for obstetric fistula between 2010 and 2016 were included while non obstetric fistulas and lack of dye test results at discharge were excluded from the study. The outcome of interest was failure of fistula repair at hospital discharge confirmed by a dye test. Descriptive
statistics were calculated and STATA version 13 used to conduct multivariable logistic regression to determine factors associated with failure of fistula repair. A total of 453 obstetric fistula repairs were included in the analysis. Of these, 56 (12.4%) had failure of fistula repair at hospital discharge. The median age at fistula development was 23 years; at fistula repair was 27 years; and years with fistula was 1 (IQR: 0–5). In multivariable logistic regression, factors associated with increased odds of failure included having a fistula with urethral involvement (55.4 % versus 14.1%; AOR=6.0, 95% CI: 2.83—12.97; vaginal scarring (46.4% versus 18.6%; AOR=2.5, 95% CI: 1.17—5.35 ;) and experiencing post-
operative complications (48.2% versus 2.3%; AOR=22.9, 95%CI: 9.33—55.97). Women with vaginal scarring, urethral involvement and post-operative complications, had greater odds of repair failure. It is therefore recommended that quality of post-operative care be improved and caution be paid to the repair of women who present with urethral damage, vaginal scarring and post-operative complications. The evidence generated would help the Ministry of Health to restructure and improve fistula care programs in Zambia.
Description
Thesis of Master of Science in Epidemiology
Keywords
Research Subject Categories::MEDICINE::Surgery::Obstetrics and women's diseases , Research Subject Categories::MEDICINE::Surgery::Obstetrics and women's diseases::Obstetrics and gynaecology