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Medico‐social pathways of obstetric fistula patients in Mali and Niger: an 18‐month cohort follow‐up
Author(s) -
Maulet Nathalie,
Keita Mahamoudou,
Macq Jean
Publication year - 2013
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/tmi.12086
Subject(s) - medicine , fistula , marital status , cohort , population , cohort study , surgery , prospective cohort study , general surgery , pediatrics , demography , environmental health , sociology
Objectives To gain understanding of care pathways and induced mobility patterns of obstetric fistula patients in French‐speaking West African fistula repair centres. Methods We followed prospectively during 18 months a cohort of obstetric fistula patients in Mali and Niger (2008–2009). 120 patients were recruited at different stages of their care process in 5 reference fistula repair centres. Follow‐up was carried out in repair centres and communities. Quantitative data were collected through close‐ended questionnaires at three time points. Medico‐social pathways were explored through a longitudinal analysis focusing on six indicators: fistula duration, care process duration, patients' mobility, marital status, number of surgeries and continence status. Results Patients' pathways were characterised by their length: fistula duration (median 4 years), care process duration (median 2.7 years), aggregated time spent in repair centres during study (median 7 months). Patients developed four mobility patterns (homebound, itinerant, institutionalised and urbanised). Adverse marital status change continued over time. Sample stratification according to number of previous surgeries revealed differences in care process duration and outcome: 23/31 new cases (≤1 surgery) gained continence with a mean of 1.5 surgeries in a median of 0.6 year while only 17/78 old cases (≥2 surgeries) became continent with a mean of 4 surgeries in a median time of 4.9 years. Conclusion The quest for continence does not end with admission to a fistula repair centre. Analysing fistula care experience across time within the varying settings highlights the twofold population and mixed medico‐social outcomes that should prompt new development in obstetric fistula care management and research.