bluuebunny/crossref_metadata_2025 huggingface dataset:
The Mobile Surgical Outreach Model for women with genital fistula in the Democratic Republic of Congo
Authors: Maroti Raha , Notia Amisi , Keyser L , McKinney J , Berg M , Mukwege D
Published: June 2019

Aims: To describe the PH Mobile Surgical Outreach (MSO) model of care delivery for women with GF and to present data highlighting the program’s scope and clinical impact in 2011-2017.
Methods: PH created the MSO program to deliver health services to women with genital fistula (GF) living in remote areas in DRC. The MSO model facilitates reintegration through community education about GF, leveraging local staff in all aspects of care. Outreach trips are organized annually/bi-annually per site, depending on case volume and funding. Site selection is a two-step process: (1) identification of accessible, strategically located hospitals; (2) initial site visit and readiness assessment. This paper presents 2011-2017 MSO activities, including geographic scope, patient and provider outcomes.
Results: The MSO team has worked with 43 clinic sites across 12 provinces. Since 2011, they have conducted 77 site visits and provided surgical care for 2,017 women. Table1 summarizes surgeries conducted annually by province, 2011-2017.Table 2 provides a clinical snapshot of 2017 case mix.
Conclusions: The MSO model demonstrates feasibility and indicates program successes for capacity-building in skilled medico-surgical care and enhancing community awareness of GF. Training serves to improve local provider skills, strengthens health workforce and offers scalable, sustainable solutions to prevention and treatment.
Surgical success of patients presenting for repair of VVF - Data from fistula repair centre, Ayub Teaching Hospital, Abbottabad, Pakistan (2016-18)
Authors: Nisa Abbasi, Kosar Inayat Azizun , Abbasi Azizun Nisa , Inayat Kosar
Published: June 2019

Abstract: Obstetrical fistula is a devastating condition which socially impairs the life of patients in reproductive years. These females are usually socially isolated. Mostly patients don't have awareness regarding management of their problem due to poverty and ignorance.
Fistula centre was estabished in Gynae department of Ayub Teaching Hospital, Abbottabad three years ago in collaboration with Pakistan National Forum on Women's Health ( PNFWH). In this presentation details of patients treated in fistula centre will be discussed.
Management Of Vesicouterine Fistulae During "Fistulae Surgical Caravan" in Cote D'ivoire
Authors: Djanhan LE , Dia JM , Menin MM , Kouamé B , Bohoussou E , Samaké Y , Kouakou KP , Doumbia Y
Published: June 2019

Aims: Describe the epidemiological, clinical and therapeutic characteristics of patients treated for vesico-uterine fistula.
Methods: This was a case series of 34 patients prospectively collected for descriptive purposes. Theywere treated for Vesico-uterine fistulae during "fistulas surgical caravans" from 1stJanuary 2012 to 31st December 2016.
Results: Vesico-uterine fistulae represented 2.1% of all treated urogenital fistulae. At the time of fistula occurrence, the average age of the patients was 33.3 years, and the majority were illiterate (88.2%), lived in rural areas and were unemployed (73.5%). All the fistulae were associated to childbirth, the majority of which took place on a scarred uterus (67.6%). And this childbirth responsible for the fistula was a delivery done by caesarean section in 97.7% of cases. Average duration of the fistula before management was 6 years. Finally, all the patients were operated by the same surgical technique, made by abdominal extra peritoneal transvesical way. The successful first repair rate was 97.1% in 33 patients. The only case of failure was successfully cured using surgical another technique in a second attempt.
Conclusion: The vesicouterine fistulae were rare, were mostly associated to previous uterus surgical history and the successful rate is almost 100%.
Performance-based funding: A case study in Madagascar
Authors: Cochran Seth
Published: June 2019

Aims: To successfully introduce a digital performance-based funding system into Sambava Hospital in the SAVA region of Madagascar in order that surgeons and clinical care workers would be incentivized to provide high-quality care to a greater number of patients.
Methods: We used a combination of monetary and non-monetary incentives, the first is that we provide a cash transfer when Dr. Fidèle and his team perform in line with our minimum standards of care; the quality of surgery and the entire continuum of care is measured by the use of Operation Fistula’s Global Obstetric Fistula Electronic Registry (GOFER) application. The non-monetary incentives include visualisations of Dr. Fidele’s surgical progress so that he can more effectively monitor the practices of the team.
Results: This pilot in Sambava Hospital revealed that the data collection tool serves three purposes: It ensures that the surgeries performed and nursing care maintained meet a minimum standard of care; It acts as a verification mechanism that triggers payment; and The data collected enables Dr. Fidèle to track and measure his own surgical progress, with our surgical dashboards.
Conclusions: The initial outcome of this pilot program has yielded positive results. From March to September, the treatment of 40 patients has been accounted for and transfers have been made, on receipt of corresponding data.
Keywords: Funding, high quality care, patients
Vesico-vaginal fistula post Right radical nephroureterectomy with bladder cuff excision
Authors: Poudel R , Dangal G , Karki A , Pradhan H , Shrestha R , Bhattachan K , Bajracharya N , Tiwari K
Published: June 2019

Case: 61 years, female presented at KMH OPD with involuntary urinary leakage per vaginum for seven months following Right radical nephreureterectomy with bladder cuff excision for urinary bladder carcinoma at other centre. Dye test was positive. Cystoscopy revealed VVF defect around 2 cm (Goh’s stage 3biii) at right posterior wall of urinary bladder. Ureteric catheter was placed in left ureter and VVF repair was done. Dye test following 14 days of Foley’s catheterization was negative and patient went home dry. We present here a case of successful repair of VVF following Right radical nephreureterectomy with bladder cuff excision. 
Key words: dye test, Goh’s stage, pelvic surgeries, urinary tract injuries, vesico-vaginal fistula
Media Leaders Workshop on Fistula Communication:An Innovation for capacity building of Bangladesh Press
Authors: Rahman Ashifur , Huda Sk Nazmul , Biswas Nitta
Published: June 2019

Aims: To share our experience of capacity building in the electronic and print media sector of Bangladesh for fistula related awareness.
Methods: We identified key media institutions and professional press forums in Bangladesh. We provided fourhours orientation training to 96 professionals from electronic and print media and other media related institutions in six workshops. We also provided an information pack for fistula communication. From the workshops we identified focal persons within the organizations for fistula and maternal health communication.
Results: Over 120 reports, editorials, features, news were published in papers and 67 television and radio program were broadcasted after the workshops. A range of topics were covered in the press including early marriage prevention, fistula related event coverage and promoting care-seeking behaviors for fistula suffers.
Conclusion: The Media Leaders workshop was very well accepted by the professional press and other media personnel. The training led to an increased capacity in mass communication on fistula. It is anticipated that the increased awareness of media personnel will result in continued contributions in the future.
Fistula Communication by Print and Electronic Media in Bangladesh as facilitated by Bangladesh Health Reporters Forum
Authors: Debnath Sebika , Biswas Nitta , Huda Sk Nazmul , Kagoj Dainik Bhorer
Published: June 2019

Aims: To describe the role of the Bangladesh Health Reporters Forum in fistula communication through print and electronic media in Bangladesh, to share the lesson learnt.
Methods: Sixty reporters and editors from different daily newspapers, satellite TV channels and media institutions were provided a basic workshop on fistula communication by the USAID-supported Fistula Care Plus Project at EngenderHealth Bangladesh from June 2015 to June 2018. They were also supported with information packs including definition, types, diagnosis and referral linkage of fistula by the workshop organizers.
Results: Among documented outputs of workshop attendees were 127 documented reports, essays, editorials in the newspapers; eight talk shows in television; and one documentary on fistula. At least 1.2 million people were reached with fistula messages.
Conclusions: Media practitioners’ workshops on fistula communication effectively prepared a group of media professionals for contributing in fistula communication. They need information packs help media professionals to develop and publish media products. Technical editorial support is important for upholding the quality of media reports and publications.
Primary menouria due to a congenital Urethrovaginal fistulawith vaginal agenesis
Authors: Razzak Lubna , Rizvi Raheela Mohsin
Published: June 2019

Case: A female aged 22 years, suffering from cyclical menouria since age of 12 years presented to our clinic with concerns for future sexuality and fertility. Clinical examination revealed the absence of a vagina, although labia minora and majora were adequately developed. Secondary sexual growth such as axillary and pubic hair, breast development was normal. Micturating cystogram shows abnormal fistulous communication between the posterior urethra and upper vagina with contrast outlining the uterine cavity. Magnetic resonance imaging revealed functioning left kidney along with vaginal agenesis and an abnormal communication between uterus and urethra. The surgical treatment included urethrovaginal fistula repair   and pull through vaginoplasty.  The patient was asymptomatic till her last visit
Conclusions: In this case, the diagnosis of congenital urethrovaginal fistula was delayed until adulthood despite menouria. This is a rare case report and to our best of literature search .we could not find any such case report.
Radiation induced vesicovaginal fistula
Authors: Tiwari Kenusha Devi
Published: June 2019

Case: A 63 years old female visited our outpatient department for involuntary loss of urine per vagina since 1.5 year. She had undergone radical hysterectomy and radiotherapy 16 years ago for cervical carcinoma. With positive dye test, on examination she had vesicovaginal fistula with Goh classification of 2biii. She underwent fistula repair via vaginal approach. After 3 weeks of catheterization, successful closure was achieved. Radiation therapy is an effective treatment for cervical cancer. However, of various complications, irradiation sometimes cause the formation of fistula between vagina and bladder and or rectum compromising the quality of life. Pelvic radiation is the primary cause of delayed vesicovaginal fistula with incidence of 13%. Majority of them become apparent 1.5-2 year after termination of radiotherapy and can occur even up-to 20-30 years after the original insult.
Keywords: cervical cancer, fistula, radiation induced
Predictors of Successful Urogenital Fistula Repair and Incidence of Urinary Problems Post Successful Fistula Repair
Authors: Tasnim Nasira , Bangash Kauser , Amin Oreekha , Batool Afshan , Javed Nosheela
Published: June 2019

Objective: Despite the successful fistula repair many patients may continue to complaint of persistence of symptoms in terms of frequency, urgency, urge incontinence and stress incontinence. To evaluate the association of various predictive factors with the outcome of surgical repair of urogenital fistula and todetermine the incidence and association of urinary problems post successful fistula repair.
Methods: The retrospective analysis was conducted at Maternal Child Health, PIMS, Islamabad. It comprised data related to vesicovaginal fistula repair of patients from January 2008-June 2018. Various modalities were used to determine the underlying cause of these symptoms including patient’s history, examination, ultrasound, urine examination and urodynamic studies.
Results: A total of 364 patients of urogenital fistula repair were reviewed, with an overall success in 318 (87.4%) cases.Primary surgical repair of vesicovaginal (90.0%), vesicouterine (86%), ureteric (100%) & ureterovaginal (98%) were more successful. Success rate was further decreased with the history of >1repair attempt of vesicovaginal (71.4%) & vesicouterine (66.5%) fistula.
Among 318 successful fistulas repair patients, 78 (24.5%) had urinary problems post operatively. Out of these 78, 56.4% had stress incontinence, 41% infection and 2.6% urge incontinence.
Conclusions: Urinary incontinence after fistula repair requires careful evaluation as the successful repair of a urogenital fistula can correct the fistula defect, but it might not make the patient dry.
Implementing physiotherapy services into fistula care at Panzi Hospital, Bukavu, DRC
Authors: Keyser LE , McKinney JL , Mukwege CH , Mukwege D , Kinja Rachel
Published: June 2019

Aims: To describe implementation of physiotherapy services in the context of fistula care and report early program observations.
Methods: Process evaluation of treatment pathway/protocol implementation and presentation of provider observations of treatment results since January 2016.
Results: Dedicated physician, nursing, social work and physiotherapy staff provide various aspects of rehabilitative care to women with fistula, pre- and post-operatively. Following variations in hospital census, 5-50 women participate in group exercise sessions 2-3x/week.  Targeted individual physiotherapy is selectively provided to 1-15 women 1-5x/week.  Staffing priorities reflect perceived importance and impact of physiotherapy services. Providers offer clinical observations of program successes, including improved post-surgical functional outcomes, and express interest in further training to cultivate advanced clinical skills.
Conclusions: Early results indicate value of physiotherapy-informed care in a comprehensive approach to fistula care services. Improving and expanding upon these skills may prove equally useful in addressing the physical impairments associated with other reproductive morbidities, such as POP. In the future, systematic use of standardized tools, such as WHODAS 2.0 is recommended, both to quantify the burden of disability in this population, as well as to measure change with therapeutic interventions, including surgery and rehabilitation.
Building the confidence of teachers to facilitate sexual and reproductive health information to in-school youth clubs in Uganda
Authors: Tunusiime Molly , Kaduyu Paul , Kanakulya Hassan , Mukisa Rose
Published: June 2019

Aims: To build the confidence of schoolteachers to provide sexual and reproductive health (SRH) information and empower in-school youth to make healthy and informed decisions.
Methods: Using a 4-pointscale,school teachers reported their confidence discussing eleven SRH topics (e.g. adolescent development, characteristics of sexually healthy adolescents, adolescent pregnancy and prevention, and HIV/AIDS).Confidence was assessed before and after a 5-day training, and a year after implementing in-school SRH sessions.
Results: Self-reported confidence rose for all items after training. For example, only35% of teachers were confident or very confident to discuss characteristics of sexually healthy adolescents or male sexual anatomy before training; this rose to 96% and 87%, respectively. Similarly, the percentage of teachers who felt confident/very confident to conduct sessions on adolescent pregnancy and HIV/ prevention rose from 39% to 96%.
Conclusions: With appropriate training, secondary school teachers with limited SRH information can gain the confidence to disseminate accurate SRH information and help adolescents make informed SRH choices. This is crucial to promote SRH among Ugandan adolescents and support a fistula-free generation.
Fistula Program Management using DHIS2: Experience of Fistula Care Plus Project in Bangladesh
Authors: Uddin Masum Salah , Huda Sk Nazmul
Published: June 2019

Aims: To share the experience of using DHIS2 in managing the Fistula Care Plus Project in Bangladesh.
Methods: Since the beginning of the Fistula Care Plus Project in Bangladesh, we used DHIS2 for capturing cluster data from organizational units. Program data was entered in a customized DHIS2 platform on a quarterly basis. Program data was analyzed and shared with / disseminated to project partners and stakeholders on a regular basis. Directorate General of Health Services (DGHS) also included seven fistula related indicators for collecting fistula data from all the facilities across the country.
Results: We were able to capture and manage 100% of project data using DHIS2 throughout the project period. Fistula data reported at governmental platforms was negligible. Through a structured process called “clinical data for decision making (CDDM)”, project partners were given critical insights for quality monitoring and upholding performance. DHIS2 based performance analysis was also found very helpful for project monitoring. 
Conclusion: DHIS2 was found to be very effective for fistula program management. Effective use of DHIS2 for fistula data management by the facilities throughout the country under the DGHS would require training and capacity building inputs.
Surgical proficiency grading and outcome of fistula repair; does it really matter?
Authors: Lawal OO , Morhason-Bello IO , Bello OO , Abduls-Salam RA , Efem I , Amodu A , Ojengbede AO
Published: June 2019

Aims: To measure and validate the outcome of fistula repair with FIGO surgical proficiency grading.
Methods: Review of obstetric fistula managed at University College Hospital/Adeoyo fistula center was done. The lead expert fistula surgeon trainer at FIGO certified fistula training center graded all trainee surgeons and fistula complexity. Data was collected using a structured proforma. The fistula characteristics,level of surgeon and surgical outcomes were assessed. Analysis was done using SPSS version 25. Level of significance was set at P<0.05.
Results: Out of the 216 fistulas reviewed, 86 (47.5%) were classified as complex fistula, 43 (23.8%) as simple, moderate 38(21%) and irreparable 14 (7.7%). Majority 146 (67.3%) were performed by advanced level surgeons and only 9 (4.1%) by standard level surgeons. Successful outcome for all levels was above 80% (Standard = 88.9%, Advanced = 81.4% and Expert=83.9%). Expectedly, surgeons at the expert level had a higher closure for complex fistula 86% vs 64.3% compared to advanced level.
Conclusions: This preliminary study shows some sort of validation of the FIGO grading system with a high successful outcome of repair across all proficiency levels.
Genital tract fistula: Changing trends in presentation and outcome
Authors: Ojen AO , Abduls-Salam RA , Morhason-Bello IO , Bello OO , Lawal OO
Published: June 2019

Aims: To find out the clinical profile of obstetric fistula.
Methods: A retrospective review of women presenting for OF repair in Ibadan, Oyo State from 2017-2018. All repairs were performed by the Oyo State fistula team at Adeoyo Maternity Hospital or University College Hospital, Ibadan. Two hundred and eighteen women were repaired during the period; information on socio-demographic and presentation characteristics was extracted. Data analysis was done using IBM SPSS version 25.0.
Results: The commonest cause of genital tract fistula in this review was obstructed labour (68.5%), 44.9% of the women had caesarean delivery either to relieve obstruction or as elective procedure. Only 8.3% had elective caesarean section and 5.6% had gynaecologic surgery. Majority were urinary fistula (92.5%) and in the mid-vaginal (21.6%) location followed by juxta-cervical and ureterovaginal fistula (9.2%). Urethral involvement and severe vaginal fibrosis were seen in 12.4% and 61.3% of cases respectively.
Conclusions: There is a need for continuing medical education on critical emergency obstetric care skills in order to improve maternal health care service delivery.
Addressing the Shortage of Fistula Surgeons; up date from FIGO’s Training Initiative
Authors: Slinger Gillian , Trautvetter Lilli
Published: June 2019

The FIGO Fistula Surgery Training Initiative has been developed to build the capacities of fistula surgeons in identified training centres using the Global Competency-Based Fistula Surgery Training Manual. 
Since the launch of the Training Manual in 2011, the project has evolved, and in the last 4 years, has expanded substantially. Coming from 19 fistula affected countries around the world, there are presently 57 trainee fistula surgeons (‘Fellows’) on the Programme, undergoing training placements in established training centres, as well as receiving coaching visits in their home facilities to progressively build their fistula skills and activities over time.
While good progress has been made, FIGO recognises and is ready to address the challenges still facing the Programme, and the next exciting phase will include further expansion, with continued admission of Fellows and fistula care teams from selected, high-need countries, while moving towards programmatic consolidation, by further strengthening the skills and activities of Fellows already on the Programme, so that significantly more affected women have access to high quality, life changing fistula treatment.
It takes a village: The vital role of community organizations in enhancing fistula patient identification, referral, and reintegration in Kenya
Authors: Mohamed Habiba C. , Pollaczek Lindsey
Published: June 2019

Action on Fistula, Kenya, is a multi-year initiative (2014-present) focused on expanding access to fistula care and building the national capacity for fistula treatment, training, and community mobilization. Led by Fistula Foundation in partnership with the Ministry of Health, public and private hospitals, and community-based outreach organizations, over 4,000 fistula repair surgeries have been performed at six hospitals throughout the country. One of key factors in driving the success of the program is the use of extensive community outreach networks to increase patient referrals, improve community awareness and knowledge of fistula, and facilitate reintegration for women following fistula repair surgery. Through this community initiative, women from all of Kenya’s 47 counties have been treated and over 85% of patients have come through the AOF partner outreach efforts. 
Varied mobilization strategies have been utilized to maximize results, including training and engagement of community outreach workers, media engagement through radio spots and live talk shows, partnerships with health facilities and training of health center staff, community outreaches and rallies, and the use of “Kick Fistula out of Africa” soccer team to raise awareness and help destigmatize the condition. In the second phase of the initiative, reintegration programs were also initiated by the same community organizations and enhanced follow-up measures were put in place to assess longer-term outcomes for continence status, social and psychological wellbeing, and economic health.
Fistula as a Public Health challenge in Pakistan
Authors: Noushad Shamoon , Syed Shershah , Ahmed Sadaf
Published: June 2019

Aims: To explore the impact of obstetric fistula in the county and to propose effective public health interventions that can help to prevent the condition with a long-term goal of eradicating the condition.
Methods: The survey and analysis included secondary data addressing women's experiences of fistula; dynamics and limitationsdetermining women's access to in healthcare facilities for fistula management; and restraintsof health professional as well as health inequities.
Results: It was assessed that recently, many hospitals and organizations in the country go on board on intercessions to address the impact of the illness, however, much importance is on pinpointing and discussing the existing cases rather than focusing on public health interventions that can help to prevent and eventually eradicate the condition in Pakistan.
Situation of obstetric fistula in a marginalized teagarden community of Bangladesh: A Qualitative Study.
Authors: Abdullah Abu Sayeed Md.
Published: June 2019

Aims: To explore the situation of obstetric fistula among the teagarden women in Bangladesh.
Methods: A qualitative study was conducted. During the screening, a total number of five obstetric fistula cases identified from the 10 teagardens covering around 50 thousand populations. The study performed in depth face to face interview with the all women with a guideline.
Results: The mean age was 41 years.  All were married before 15 years of age and delivered the following year. Obstructed labour was the reason for fistula in all cases. Mean duration of suffering was 19 years. One woman is found divorced, two woman’s husband leaves her and two is continuing her conjugal life. In all cases, husband separated and women were living alone. Only one woman receiving treatment from a tertiary facility left treatment due to economic crisis. The other causes of not receiving treatment include lack of knowledge and its treatment, misperception of self recovery, negligence, lack of time due to job at teagarden, ignorance, transportation and economic crisis. All women faced serious negligence and were culturally restricted to attend the family or religious programme. All women wanted to be cured.
Conclusions: Focused intervention is required to eliminate obstetric fistula, very small number of cases flag many stories. It is likely teagarden catchment areas in Bangladesh is vulnerable with obstetric fistula cases which are still unexplored. It’s important to know actual epidemiology of obstetric fistula in the teagarden community, on the other hands it also demands for establishment of timely referral pathway, proper management system including rehabilitation and reintegration in order to reduce or eliminate obstetric fistula in Bangladesh by 2030.
Evidence based classification/staging system for Obstetric Fistula: Planning and preliminary intervention in Nigeria
Authors: Adeoye S , OJengbede OA , Efem I , Amodu A , Nasir S , Wara A , Amir Y , Morhason-Bello IO , Abdus-Salam A , Bello OO , Lawal OO , Akinlusi F , Lawal K , Njagu P , Ibrahim H , Ogunmayin O , Afolabi KA
Published: June 2019

Aims: To review the classification systems of obstetric fistula (OF). 
Methods: A two-day stakeholders’ meeting in Nigeria involving fistula surgeons, nurses, anesthetists, trainee, fistula desk officers at the federal and state government levels and other stakeholders was facilitated by Engender health. The meeting involved presentation of common classifications of obstetric fistula, critical analysis of each classification, group and plenary discussions. Presentation involved a critical analysis of classification parameters, strength and weakness. Three working groups designed classification criteria, prognostic scoring and suggested level of surgical skills needed to manage the patient. Outcome of each group work was presented and discussed in plenary. Each of the classification scenarios were modified by consensus and ratified at subsequent follow up meeting.
Results: Three new classification systems of the OF were developed, and from these, a consensus classification was also developed in plenary. The initial three classifications developed from group work were similar to each other. Each classification considered size, location, previous repair, scaring, associated morbidity involvement of closing mechanism of the bladder neck, degree of urethral involvement and presence of transection of bladder neck (circumferential defect). The consensus classification, that was adopted, considered classification and prognostic scoring system. The four classification systems will be field tested to generate evidence for reliability and reproducibility.
Conclusions: We believe a new classification system of obstetric fistula that will provide robust information to the managing team and patient is long overdue. This modest idea is a wake-up call for practitioners to design appropriate tool that is back up with reproducible evidence.
Assessment of the impact of non-state actors in the support for obstetric fistula care: Matters arising
Authors: Abduls-Salam RA , Lawal OO , Morhason-Bello IO , Bello OO , Babawarun TO , Ojengbede AO
Published: June 2019

Aims: To review the impact of support of non-state actors on communal OF repair effort in fistula repair Centre.
Methods: We reviewed the support given for OF repairs at Adeoyo Maternity Hospital, Ibadan from 2013 to 2018. The type of support was either Partial or Full support; involved support from various organizations such as Extended Hands, GWIN, Faith Hookes Foundation, Engenderhealth/USAID. Partial support was provided by above-listed organizations between 2013- 2016. However, sustained Full support was provided by Fistula carePlus/Engenderhealth/USAID between 2017 and 2018.
Results: Partial support involved supply of equipment, health education, radio jingles, fistula repairs; while Full support included supply of medical consumable, mobilization of fistula clients/client mobilization using social workers, feeding of clients for minimum of 2 weeks, provision of power backup, mobilization and remuneration of OF surgeons and manpower, in addition to those listed above. One hundred, eighty-seven women benefitted from support. Fistula types ranging from obstetric, iatrogenic and traumatic fistula were repaired using both pooled effort and routine repair models. During partial support, 70(37.4%) women were repaired compared to 117 (62.6%) when sustained full support was provided. All women freely accepted participation in the supported repair program.
Conclusions: There is a compelling improvement in patronage, access to care and opportunity to develop the skills of enthusiast among the health-workers; and thus a need for more commitment in our quest to eliminate obstetric fistula.
Enhancing Holistic Care of Patients with Obstetric Fistula and Other Childbirth Injuries -TERREWODE’s Experience of Developing a Dedicated Fistula Hospital in Uganda
Authors: Emasu Alice , Andrews Martin , Ruder Bonnie , Barageine Justus K
Published: June 2019

Aims: To document experiences of establishing state of the art women’s hospital offering holistic care to women with obstetric fistula and other child birth injuries. The care includes comprehensive treatment and management of the affected women, reintegration services that support the restoration of women’s dignity and clinical for prevention
Methods: TERREWODE Women’s Community Hospital (TWCH) founded in 2016 is a subsidiary of The Association for Rehabilitation and Re-Orientation of Women for Development (TERREWODE), a Ugandan Non-Government Organization. We received, funding and support from International Fistula Alliance ,Ugandan Fistula Fund for TERREWODE, Catherine Hamlin Fistula Foundation, Hamlin Fistula USA and Hamlin Fistula Ethiopia.
Results: The first phase has a 30-bed fistula surgical block and 30-bed rehabilitation and reintegration center, in addition to administration, catering and support facilities. This community-focused hospital will provide holistic routine care to patients with obstetric fistula and other childbirth injuries. It will also conduct: health education, research, Continuous Professional Development, patient rehabilitation and reintegration. On completion other services will include: conducting deliveries, neonatal care, and Antenatal care and family planning services. Up to 600 surgeries annually will be conducted in the unit. This will decongest public health facilities and reduce current backlog. Our critical success factors include: ability to attract and retain highly qualified and self-motivated personnel; our relationship with key stakeholders including Ministry of Health, suppliers, development partners and our target beneficiaries.
Conclusions: It is possible with collaboration to establish specialized units offering quality care to women with birth trauma. Our experience can be replicated in other settings.
Making the dream a reality: how are we going to end fistula within a generation?
Authors: Anastasi Erin , Asiamah Bridget
Published: June 2019

Aims: To provide a global overview on progress, successes, challenges/lessons learned, and the way forward towards the UN global vision of ending fistula within a generation.
Methods: This interactive presentation will feature highlights of the 2018 United Nations Secretary-General's report on "Intensifying efforts to end obstetric fistula within a generation" and the subsequent United Nations General Assembly Resolution A/RES/71/169.   
Results: Key elements in the Report include linking the call to end fistula within a generation with the achievement of the Sustainable Development Goals (SDGs); integrating fistula with global efforts to achieve universal access to emergency/essential surgery; addressing root causes of fistula; and calling for UNFPA/Campaign to End Fistula to lead development of a new global road map to end fistula within a generation.
Conclusions: To succeed in ending fistula within a generation, we must galvanize momentum and mobilize the international community to invest and act upon key recommendations of the 2018 Secretary General’s Report on fistula. These include: strengthening health systems; implementing and monitoring cost national strategies for eliminating fistula; including fistula into national SDGs implementation plans; strengthening national task forces for fistula; securing significantly increased, predictable, sustained, and adequate financial support; strengthening awareness-raising and advocacy; and improving research, data collection, monitoring and evaluation to end fistula and make the “invisible”, visible.
Obstetric Fistula Orientation Program in Nepal
Authors: Shakya Tara
Published: June 2019

Aims: To find out the hidden cases by strengthening/upgrading the knowledge of the participants and also to refer the identified cases not only to the phect -NEPAL's fistula surgery center (Kathmandu Model Hospital/Kirtipur hospital) but also to the nearest fistula centers of the country.
Methods: In 2018, phect-NEPAL has conducted orientation program in seven districts. During the orientations, pretest/posttest was done with health service providers, female community health volunteers, NGOs /teachers and school students to see their knowledge on obstetric fistula. Public Health Concern Trust (phect-NEPAL) is working in this area not only in curative part but also in preventive/awareness part since 2014. Till now, phect-NEAPAL has conducted orientations in more than 17 districts (one Municipality and one village Municipality in each district). 
Results: Among the 370 health service providers who got orientation in 2018,  a total of 90% of health service providers know what is obstetric fistula, 55%  know about Pelvic organs involved in obstetric Fistula, 47 % HSP knows about the causes of obstetric fistula, 22% know about symptoms of obstetric fistula, only 37% know about diagnostic criteria for identifying obstetric fistula and  49% have confusing knowledge with other gynae problems like uterine prolapse.
Among 660 FCHVs, almost 80 % of female community health volunteers did not heard about obstetric fistula. Those FCHVs who said they heard about obstetric fistula,  more than 80% have confused knowledge of prolapse uterus /piles, leaking urine while coughing/sneezing, etc. Almost 90% of teachers and 60% of NGOs do not know about obstetric fistula.
Conclusion:  Awareness on obstetric fistula is a Key Component for successful implementation of Obstetric Fistula Program in Nepal.
Epidemiological profile of obstetric fistula women at the National Obstetric Fistula Reference Center in Niamey; from January 2016 to 31 December 2017
Authors: Idrissa Abdoulaya , Abdul Rashid Adamou Moumouni
Published: June 2019

Aims: To describe the socio-demographic, clinical and therapeutic aspects of fistula.
Methods: It is a retrospective and descriptive study. The sampling method was exhaustive.
Results: 140 women with obstetric fistula have been identified. The average age was 27 years old; 87.14% were married; 41% were primiparous; 97.86% were housewives. Urogenital fistula was found in 94% of cases smaller than 2 cm in 56.43%; 51.43% were on their first course; 91% were operated with a cure rate of 32.03% and failure of 16.41%. In 51.56% of cases, the outcome of treatment was not notified.
Conclusions: Obstetric fistula remains a public health problem in Niger, given the number of new cases registered. Compared with previous studies, there has been an increase in the average age and an increase in the number of women married with fistula. The completeness of the filling of medical records would allow a better assessment of the quality of care.
How Operation Fistula uses data visualization to help women with obstetric fistula
Authors: Hollbrügge Naledi
Published: June 2019

Aims: To enable all parts of Operation Fistula to make data-driven decisions in their work and to use data visualisation to simplify complex processes. Moreover, to effectively use data visualisation to educate the public about Obstetric Fistula and other issues of gender inequality.
Methods: An experienced visual design analyst was hired full time to lead the analytics setup at the organisation and provide training for the team in the use of Tableau Desktop software.
Results: Using a visual representation of data has spread information about Obstetric Fistula in an entirely new way to new audiences. One of our analyses has received over 10,000 views at this time. The use of data visualisation has created powerful partnerships for the organisation that have allowed Operation Fistula to raise significant funds and improve visibility of the cause. Staff members are now empowered to use data in their everyday work to make data-driven decisions.  
Conclusions: In a world that is driven by data, it is important that evidence-driven actions are implemented not only in the treatment of obstetric fistula but that we make data central to the everyday operation of our workplaces. Data visualisation is a powerful technique to make unfamiliar topics accessible, gain clarity on complex processes, and garner interest from otherwise unengaged actors. With new developments in commercial tools, data visualisation has become more accessible to every level of the business and is no longer exclusively the realm of data analysts.
Facilitating data for decision making to improve Health Management Information Systems reporting at four supported sites in Uganda
Authors: Kanakulya Hassan , Kyozira Carol , Kaduyu Paul , Mukisa Rose
Published: June 2019

Aims: To share Data for Decision-Making (DDM) initiatives used across health service sites supported by USAID-funded Fistula Care Plus (FC+) Project at EngenderHealth.
Methods: FC+ and the HMIS Department at the Ministry of Health conducted a DQA at four supported sites in Jinja, Hoima, Masaka and Kamuli to verify whether reported data was consistent with facility registers. A qualitative assessment identified other data quality/capacity issues. The team worked with facility staff from October 2016 to March 2018 to address data and capacity gaps, including capacity building, feedback through DDM meetings, development of DDM committees, and support to action plans developed during the DQA exercise.
Results: 60%-80% of which were implemented. Three sites set programmatic targetsfor2017-2018 and shared them to facilitate better resource allocation. Three sites used data visualization. All sites made critical decisions based on data they generated, such as timely maternal death audits, forecasting and re-supply of HMIS tools. There was improved data accuracy, with scores on indicators of acceptable data quality increasing at Kamuli from 45% to 60%, Jinja from 9% to 33%, Kitovu from 60% to 83%, and Hoima 4 % to 23%.
Conclusions: These results demonstrate the value of and effective strategies for promoting pragmatic data use among those who collect clinical data, going beyond the traditional use of data for reporting purposes only.
Women’s experiences of fistula-related stigma in Uganda: application of a conceptual framework to inform stigma-reduction interventions
Authors: Elayadi Alison
Published: June 2019

Aims: To understand women’s fistula-related stigma experiences using a conceptual framework.
Methods: In-depth interviews and focus groups discussion including 33 women who underwent fistula surgery 6-24 months prior at Mulago Hospital in Kampala, Uganda in May-July 2014.Coded transcripts were analyzed thematically for experiences and consequences of enacted, anticipated, and internalized stigma.
Results: Narratives of enacted stigma experiences included verbal abuse, relationship dissolution, and exclusion from household, family and community activities. Women’s stigma anticipations reflected fears of enacted stigma. Internalized stigma reports revealed pervasive shame and low self-esteem: reduction in self-worth, disgrace, and envisioning no future. Consequences of fistula-related stigma described by women included self-imposed social isolation, changes to normal household activities, non-disclosure of fistula, and poor mental health.
Conclusions: Refining stigma theory to specific conditions has resulted in nuanced understanding of stigma dimensions, manifestations, mechanisms, and consequences, permitting comparison across contexts and populations, and development and evaluation of stigma-reduction interventions. These lessons should be applied to fistula, acknowledging its unique features: concealability, management needs, lack of community awareness, and links with infertility and stillbirth. Reducing fistula-related stigma requires timely access to surgical and supportive care, developing and evaluating evidence and theory-based interventions for social reintegration and stigma reduction, and addressing the complex societal structures perpetuating this condition.
A Health Systems Strengthening Approach to Female Genital Fistula in Kenya
Authors: Wala Elizabeth , Mwoka Meggie , Okoro Dan
Published: June 2019

Aims: To contribute to Universal Health Coverage by strengthening the capacity of the health system in Kenya to address female genital fistula using NHIF as an entry point.
Methods: This involves a revolving fund model using NHIF rebates from an initial donor funded payment of NHIF premiums for 3 years for as part of FGF management. USD 180 will be paid for NHIF subscription per patient. This will cover the woman and her dependents for 3 years. NHIF in return will pay a rebate of USD 600 per patient. The rebates will be used by County Governments for facility improvement especially on reproductive health services. This will be done with support from UNFPA who will provide technical guidance, capacity building, support of repair services and resource materials.
Results: The expected results of this innovative approach include: Contribution to Universal Health Coverage through increased uptake of NHIF; increased knowledge of health workers on RMNCH and FGF management; insurance cover for fistula champion and her dependents; and strengthening policies and legislation around facility improvement funds.
Conclusions: Addressing FGF will require a concentrated and coordinated effort at the national and local levels of different stakeholders under the leadership of the Ministry of Health (MOH) and county government to provide centralized coordination to ensure that quality services are available. Using NHIF as an entry point, the domino effect is health systems strengthening around FGF management and social health protection for household. This is a shift from the previous patient-focused management of fistula that had individual and not social impact.
Reliability, Validity, and Responsiveness of the Mini-Balance Evaluation Systems Test in Ambulatory Individuals with Multiple Sclerosis
Authors: Potter Kirsten , Bowling Rachel , Kavanagh Lindsey , Stone Ashley , Witt Brittany , Wooldridge Ashley
Published: June 2019

Purpose: The purpose of this study was to determine the reliability, validity, and responsiveness of the Mini-Balance Evaluation Systems Test (MBT) in persons with multiple sclerosis (pwMS). Method: A total of 32 pwMS completed a questionnaire on disease severity, the Activities-specific Balance Confidence Scale (ABC), and the MBT. The MBT was re-administered 1 week later. Results: The interrater and test–retest reliability of the total MBT and subscales were excellent. The standard error of measurement for the total MBT, calculated from test–retest and interrater reliability, respectively, was 1.32 and 1.07. The minimal detectable change (MDC) for the total MBT was 3.74; the MDC for the subscales ranged from 0.98 (sensory) to 2.38 (gait). The correlations between individual subscale scores and the total MBT, among subscales, and between the total MBT and disease severity and ABC were excellent. Correlations between the total MBT and age, MS type, and fall and imbalance histories were moderate. Disease severity and ABC scores were the strongest predictors of MBT score. No floor effects were found. Ceiling effects were found for two subscales, but not for the total MBT. Conclusions: The MBT is reliable and valid in pwMS. MDC values will facilitate assessing the effectiveness of treatment. Because ceiling effects were found for two subscales, but not the total MBT, it is recommended that clinicians administer the MBT in its entirety.
Cambio demográfico y proveeduría laboral de los hogares en las urbes de México, 2005-2017
Authors: Montoya García María Valeria Judith
Published: June 2019

El objetivo de este artículo es analizar las transformaciones en la proveeduría laboral de los hogares familiares suscitadas entre 2005 y 2017, es decir cuántos y cuáles miembros están colaborando, y sus relaciones con el cambio de la estructura por edad de la población. La fuente de datos es la Encuesta Nacional de Ocupación y Empleo, para el segundo trimestre de esos años. Los principales resultados muestran que ha aumentado el número de proveedores laborales por hogar, principalmente en las parejas sin hijos. Por otro lado, aunque la participación económica del jefe de hogar sigue siendo importante, se incrementó sustantivamente la presencia de hogares en los que las cónyuges colaboran con su sostenimiento económico. Para ambos años, la participación de hijos y otros miembros se encuentra en mayor medida en los hogares monoparentales con hijos y en los ampliados.
De Bangladesh ao Sul do Brasil: dimensões da imigração contemporânea no Brasil
Authors: Tedesco Joao Carlos
Published: June 2019

O artigo analisa a imigração de bengalis para o Sul do Brasil. É um fluxo imigratório recente, mas que chama muito a atenção da população autóctone em razão de sua especificidade, de serem confundidos como indianos, de terem se deslocado de tão distante e optado para migrar ao Brasil. A pesquisa busca dar ênfase a essa migração como sendo expressiva dos fenômenos da globalização, ou seja, sem vínculos histórico-culturais entre os dois países. Através de pesquisa de campo e entrevistas, conclui-se que são imigrantes que estão inteiramente inseridos no mercado formal de trabalho, para além do horizonte laboral não há vínculos ou processos de integração social, enfrentam inúmeros limites, principalmente no tocante ao domínio da língua, compreensão dos processos culturais e de sociabilidade.