Socio-demographic and delivery characteristics of patients with obstetric fistula in Haut-Katanga Province, Democratic Republic of Congo

Document Type: Research/Original Article

Authors

1 Department of Gynecology and Obstetrics, Faculty of Medicine, University of Lubumbashi, Lubumbashi, Democratic Republic of Congo

2 Department of Maternal and Child Health, Institut Supérieur des Techniques Médicales, Lubumbashi, Democratic Republic of Congo,

3 Department of Gynecology and Obstetrics, Faculty of Medicine, University of Lubumbashi, Lubumbashi, Democratic Republic of Congo.

Abstract

Background: In developing countries, fistulae are generally caused by long obstructed labors. Obstetric fistula (OF) is a severe condition which can have devastating consequences for a woman’s life.
Objective: Describe the socio-demographic and delivery characteristics of patients with OF in Haut-Katanga province in the DRCongo.
Methods: This is a prospective descriptive study of 413 patients with OF in Haut-Katanga province during the period from September 2009 to December 2018.
Results: At fistula occurrence, 53.3% of patients were younger than 20 years (mean age: 21.3 ± 6.7 years) and 65.8% were primiparous. More than half had primary education and 39.7% were illiterate; 70.2% of the patients were separated or divorced. Fistula developed after delivery at home in 239 (57.9%) of 413 women. A total of 393 (95.2%) women developed fistula after vaginal delivery. A total of 387 (93.7%) of the 413 women reported that the fetus did not survive the labor during which fistula developed. 92.3% had a vesico-vaginal fistula and the mean age of fistula was 6.5 years. Surgical repair was successful in 82.9%.
Conclusion: Obstructed labor remains the most important cause of OF in Haut-Katanga. It is important to prevent OF arising from obstructive causes. The surgical treatment of OF will depend upon the type, size and location of fistula.

Keywords


  1. Langkilde NC, Pless TK, Lundbeck F, Nerstrøm B. Surgical repair of vesicovaginal fistulae—a ten-year retrospective study. Scand J Urol Nephrol 1999;33(2):100–3.
  2. Wall LL, Karshima JA, Kirschner C, Arrowsmith SD. The obstetric vesicovaginal fistula: characteristics of 899 patients from Jos, Nigeria. Am J Obstet Gynecol 2004; 190(4):1011–9.
  3. UNFPA. Campaign to end fistula. 2008. Accessible sur http://www.endfistula.org et consulté le 27 juillet 2017.
  4. Creanga AA, Ahmad S. Prevention and treatment of Obstetric fistula: Identifying research needs and public health priorities. International Journal of Gynaecology and Obstetrics 2007; 99(1): 151-4.
  5. Muleta M. Socio-demographic Profile and Obstetric experience of fistula Patients managed at Addis Ababa fistula hospital. Ethiopia Medical Journal 2004; 42(1):9-16.
  6. Wall LL. Obstetric Vesicovaginal fistula as an International Public Health problem. The Lancet 2006, 368(9542):1201-1209.
  7. Ministère du Plan et Macro International. 2008. Enquête Démographique et de Santé, République Démocratique du Congo 2007. Calverton, Maryland, U.S.A. : Ministère du Plan et Macro International.
  8. Holme A, Breen M, MacArthur C. Obstetric fistulae: a study of women managed at the Monze Mission Hospital, Zambia. BJOG 2007; 114(8): 1010-1017.
  9. Harouna YD, Seibou A, Maikano S, Djambeidou J, Sangare A, Bilane SS, Abdou HM. Enquêtes auprès de 52 femmes admises au village des fistuleuses. Niamey, Niger. Médecine d’Afrique Noire 2001; 48 (2) : 55-59.
  10. Falandry L. Vesicovaginal fistula in Africa. 230 cases. Presse Med 1992; 21(6):241-245.
  11. Ayuba II, Gani O. Outcome of teenage pregnancy in the Niger delta of Nigeria. Ethiop J Health Sci. 2012; 22 (1): 45-50. 
  12. Tebeu PM, Tantchou J, Obama Abena MT, Mevoula OD, Leke RJ. Delivery outcome of adolescents in Far North Cameroon. Rev Med Liege 2006; 61(2):124–127.
  13. Kakudji PL, Mukuku O, Tambwe AM, Kalenga PM. Etude du pronostic maternel et périnatal au cours de l’accouchement chez l’adolescente à Lubumbashi, République Démocratique du Congo. The Pan African Medical Journal 2017; 26: 182.
  14. Hancock B, Collie M. Vesicovaginal fistula surgery in Uganda. East and Central African Journal of surgery 2004; 2:95-99.
  15. Nsambi JB, Mukuku O, Kinenkinda X, Kakudji P, Kizonde J, Kakoma JB. Fistules obstétricales dans la province du Haut-Katanga, République Démocratique du Congo: à propos de 242 cas. Pan African Medical Journal 2018; 29: 34.
  16. Meyer L. Commonalities among women who experienced vesico-vaginal fistula as a result of obstetric trauma in Niger: results from a survey given at the National Hospital Fistula Centre, Niamey Niger. Am J Obstet Gynecol 2007; 197: 90.e1–4.
  17. Ijaiya MA, Aboyeji PA. Obstetric urogenital fistula: the Ilorin experience, Nigeria. West Afr J Med 2004; 23(1):7–9.
  18. Hilton P, Ward A. Epidemiological and surgical aspects of urogenital fistulae: a review of 25 years’ experience in southeast Nigeria. Int Urogynecol J Pelvic Floor Dysfunct 1998; 9:189-94.
  19. Nathan LM, Rochat HC, Bank E, Gringorescu B. Obstetric fistula in West Africa: patients’ perspectives. Am J Obstet Gynecol 2008; 200(5):40-42.
  20. Nafiou I, Idrissa A, Ghaïchatou AK, Roenneburg ML, Wheeless CR, Genadry RR. Obstetric vesico-vaginal fistulas at the National Hospital of Niamey, Niger. International Journal of Gynecology and Obstetrics 2007; 99: S71–S74.
  21. Rijken Y, Chilopora GC. Urogenital and recto-vaginal fistulas in southern Malawi: a report on 407 patients. Int J Gynaecol Obstet 2007; 99(Suppl 1):S85–S89.
  22. Nisar N, Yousfani S, Muntaz F: Profile of women who experienced vesicovaginal fistula due to obstetric trauma: results from a survey at a gynaecological surgical camp 2005. Pak J Med Sci 2010 ; 26(1):62-65.
  23. Muleta M. Obstetric fistula: a retrospective study of 1210 cases at the Addis Ababa Fistula Hospital. J Obstet Gynaecol 1997; 17:68-70.
  24. Kambou T, Zango B, Outtara TA, Dao B, Sano D. Point sur la prise en charge des fistules uro-génitales au CHU Souro Sanou de Bobo-Dioulasso : étude de 57 cas opérés en deux ans. Médecine d’Afrique Noire 2006; 53 (12): 665-673.
  25. Moudouni S, Nouri M, Koutani A, Ibn Attya A, Hachimi M, Lakrissa A. Les fistules vésico-vaginales obstétricales. A propos de 114 cas. Progrès en Urologie 2001 ; 11: 103-108.
  26. Kayondo M, et al. Predictors and outcome of surgical repair of obstetric fistula at a regional referral hospital, Mbarara, western Uganda. BMC Urology 2011; 11:23.