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Fistula after attended delivery and the challenge of obstetric care capacity in the eastern Democratic Republic of Congo
Author(s) -
Benfield Nerys,
YoungLin Nichole,
Kimona Christophe,
Kalisya Luc M.,
Kisindja Rogatien M.
Publication year - 2015
Publication title -
international journal of gynecology and obstetrics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.895
H-Index - 97
eISSN - 1879-3479
pISSN - 0020-7292
DOI - 10.1016/j.ijgo.2015.02.032
Subject(s) - medicine , vesicovaginal fistula , fistula , health care , health facility , observational study , retrospective cohort study , childbirth , workforce , nursing , family medicine , surgery , population , pregnancy , environmental health , economic growth , health services , pathology , economics , biology , genetics
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.