Fistula after attended delivery and the challenge of obstetric care capacity in the eastern Democratic Republic of Congo1. Issue 2 (30th April 2015)

• Record Type: Journal Article
• Authors: Benfield, Nerys; Young‐Lin, Nichole; Kimona, Christophe; Kalisya, Luc M.; Kisindja, Rogatien M.
• Is Part Of: International journal of gynaecology and obstetrics. Volume 130:Issue 2(2015:Aug.)
• Page Start: 157
• Page End: 160
• Publication Date: 2015-04-30
• Subjects: Healthcare capacity -- Maternal complications -- Obstetric fistula; Gynecology -- Periodicals; Obstetrics -- Periodicals; Electronic journals; 618
• DOI: 10.1016/j.ijgo.2015.02.032
• Languages: English
• ISSNs: 0020-7292

Abstract

Abstract: 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.