Open AccessFrequency and management of non-obstetric fistula in the Democratic Republic of Congo: experience from Fistula Care Plus project
Author(s) -
Alexandre Délamou,
Michel Mpunga,
Félicien Banze,
Dolorès Nembunzu,
Kenny Raha,
Justin Paluku,
Rachel Kinja,
Esther Kitambala,
Brian Tena-Tena Aussak,
Ruth Bulu Bobina,
A Notia,
Anne Mukuliboy,
Altine Diop,
Vandana Tripathi,
Lauri J. Romanzi
Publication year - 2018
Publication title -
nepal journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
eISSN - 1999-9623
pISSN - 1999-8546
DOI - 10.3126/njog.v13i2.21883
Subject(s) - medicine , fistula , hysterectomy , caesarean section , urethra , retrospective cohort study , etiology , surgery , vesicovaginal fistula , sex organ , general surgery , obstetrics , gynecology , pregnancy , genetics , biology
Aims: To describe the frequency and management of non-obstetric fistula (NOF) in Democratic Republic of Congo (DRC).
Methods: A retrospective cohort study reviewed patients’ medical records in three fistula repair sites supported by the USAID-funded Fistula Care Plus (FC+) Project, covering 1 January 2015 to 31 December 2017. Study variables included demographic characteristics, fistula etiology as reported by surgeon, fistula type (Waaldijk classification), and treatment outcomes.
Results: Of 1984 women treated for female genital fistula between 2015 and 2017 in the three sites, 384 (19%) were considered to be NOF cases. 91% of these women resided in rural areas. 49.3% were married/in relationship at time of treatment compared to 69% before the fistula (p<0.001). Most (n=316; 82.3%) had no previous repair attempts and 96.2% had an intact urethra. Type III (n=247; 64.3%) and type I (n=121; 31.5%) fistulas (Waaldijk classification) were most common. The main causes of NOF were medical procedure (n=305; 79.4%), congenital origin (41; 10.7%) or sexual assault (28; 7.3%). Caesarean section (n=234; 76.7%) and hysterectomy (n=54; 17.7%) were the most common causative procedures. 369 women with NOF received surgical repair (96%), mainly through routine services (n=317; 85.9%). At discharge, 353 women were closed and dry (95.7%) and 11 were closed with residual incontinence (3.0%).
Conclusions: NOF, particularly due to iatrogenic causes, was relatively common in DRC. Surgical repair at FC+-supported sites led to good clinical outcomes. However, to achieve a fistula-free generation in DRC, prevention of iatrogenic fistula is needed, requiring improved quality of maternal care.