bluuebunny/crossref_metadata_2025 huggingface dataset:
Midwifery tutors training program
Authors: Syed Shershah
Published: June 2019

PAKISTAN has more than one forty eight (148) school of midwifery in different parts of country. Pakistan National Forum on Women's Health (PNFWH) realized that majority of these school of midwifery has no trained faculty to teach and train future midwives. It is also observed and shown in a study by UNICEF Pakistan that ninety percent midwives get their diploma in midwifery without doing a single delivery in labor room.
To face this challenge PNFWH started a six month midwifery tutors training program at Koohi Goth Women Hospital (KGWH) in Karachi. Twenty five midwifery tutors from midwifery schools in different parts of country came to stay at KGWH for this program.
They were taught to teach in class room with or without modern teaching aids. They were encouraged to use computer and should be able to do power presentation at the end of Theiler training. All tutors were posted in labor ward and train to do clinical teaching at the bed side and laboring women.
The program was a great success. Up till now eleven batches were trained with the help of donors who are working in their midwifery schools.
This paper discusses the issues related to tutors training and problems faced by midwifery schools in recruiting competent tutors.
Iatrogenic fistula in Luapula province. Inequitable distribution of good surgical skills
Authors: Shanzi Aubrev
Published: June 2019

Aims: To highlight the burden of iatrogenic fistula in Luapula province and associated factors.Methods: Data were collected from February 2017 to February 2018 using a structured questionnaire. At least two surgeons determined whether the fistula was iatrogenic or not from history, examination and finding during fistula surgery.Results: Hundred and sixty six (166) fistula surgeries were done in the period under study; 18% of these fistula were classified as iatrogenic; 61.5% of the iatrogenic fistula were a result of caesarean section and 38.5% from hysterectomies. The type of surgical injuries included vault fistula (19.2%), ureteric fistula (26.9%), Juxta-cervical fistula (50%) and utero-vesico fistula (3.8%).Conclusions: Iatrogenic fistula is a common among fistula patients in Luapula province. It is unacceptable that the most disabling obstetric morbidity should so frequently result from poor surgical skills. Training surgeons and other health care staff in emergency obstetric care is essential to preventing new cases of iatrogenic fistula.Keywords: fistula, iatrogenic, emergency obstetric care
Profile of Obstetric and Iatrogenic Fistula Surgeries At Kathmandu Model Hospital
Authors: Shrestha R , Karki A , Dangal G , Pradhan H , Bhattachan K , Poudel R , Bajracharya N , Tirwari K
Published: June 2019

Aims: To find out the pattern of urogenital fistula.
Methods: This was a retrospective study of 222 patients who underwent fistula surgery during the period of January 2012 to March 2018 in Kathmandu Model Hospital. The data were collected from the hospital records. The fistulae were classified according Goh system.  Patients’ demography, obstetric characteristics and surgical outcome were reviewed. The primary outcome was in terms of urinary continence.
Results: Among 222 cases, majority of the patients had fistula due to obstetrical cause, contributing 58% (n=127) and 42% (n=95) had fistula after gyanaecological surgery. The age ranged from 15 to 65 years. Most of the patients had fistula of type 1a, contributing 38% (n=84) and only 0.01% (n=3) of type 3c and 4b according to Goh’s classification. Hundred (78.7%) cases of obstetric fistula patients were dry and continent after surgery, whereas 95(89.4%) cases of fistula after gynecological surgery were successfully repaired. Eighteen patients with obstetric fistula and 6 patients with fistula after gynecological surgery had failed repair.
Conclusions: Our study showed obstructed and prolonged labor was the major cause of obstetric fistula, but   fistula resulting after gynecological surgery should not be overlooked.
Keywords: fistula, iatrogenic, labour
Incidence and characteristics of surgical fistula patients at LAMB hospital from 2011 to 2017
Authors: Ambauen-Berger Beatrice , Saha Stacy , Seadon Alison
Published: June 2019

Aims: To document the increasing trend of surgical fistulas seen at LAMB hospital and analyze the characteristics of these patients.
Methods: Retrospective analysis of data entered into our database of 766 fistula patients seen at LAMB hospital from 2011-2017. The number and variables of surgical fistulas were focused upon. Fistulas occurring after LSCS only were considered surgical, if the Cesarean Section was elective or performed in early labour and the fistula did not have the characteristics of an obstetric fistula.
Results: The total number of new fistula patients seen per year has remained stable at around 80. The proportion of surgical fistula has increased from 7% in 2011 to 45% in 2017. The percentage of patients who came with a fresh fistula (presenting within < 1 year) increased from 15% in 2011 to 47% in 2017 of which 33% and 80% respectively were surgical fistulas. 80% of surgical fistula occurred after abdominal hysterectomy, of which 78% are vault and 22% ureteric fistula. At least 50% of fistula occurred after an operation done without medical indication. 91% were performed in a private clinic. The majorities of patients with surgical fistula were of low socioeconomic status and had never attended school.
Conclusions: While the number of obstetric fistulas is decreasing in Bangladesh, LAMB has seen an increase of surgical fistulas over the last 6 years, mainly caused by TAH. The majority of these operations are done in private clinics and there seems to be a lack of proper indication and surgical skills.
Translation of Data into Action: Exploring Data Documentation process and further Scope for Improvement in Bangladesh
Authors: Biswas Animesh , Purno Nabila Hossain , Doraiswamy Sathyanarayanan
Published: June 2019

Aims: This study done to explore the data documentation process of fistula in the facilities and scope to improve.
Methods: In-depth reviews of patents data recoding forms of six selected facilities were performed.  Of them, three were government and remaining were private facilities. The study also explored the process of data documentation, reporting in the DHIS-2.
Results: All centers are keeping records of fistula patients; five of them use structured forms. One government facility uses hospital register book to record the data. There was inconsistency in all six different forms. Therefore, uniform data is not captured. Rehabilitation data is missing in the data records. Government facilities report information on number of cases operated in the DHIS-2.  While, private facilities are not under this reporting system. Thus, there are gaps identified in the documentation process and reporting system.
Conclusions: Better data helps for better planning and intervene. Bangladesh is documenting gential fistula patient’s data. However, its demands for improvement. A comphesive and uniform database can help to eliminate fistula in Bangladesh as set target in the 2nd national strategy.
Management of Obstetric Fistula: Experience of the Schiphra Hospital
Authors: Ouedraogo D , Yaméogo P , Kiemtoré S
Published: June 2019

Aims: To study the management of obstetric fistula
Methods: Prospective and analytical cohort studycarried out at Schiphra Hospital in the period from 11 January to 31 August 2017.
Results: The average age of women with obstetric fistula was 35.92 ± 9.80 years. 85.45% were housewives, 92.73% were out of school and 85.45% lived in rural areas. In about 43.64% of cases, obstetric fistula occurred in the first two pregnancies. The average age of fistula was 7.6 years with extremes of 2 months to 32 years. The average duration of labor was 53.29, resulting in caesarean delivery in 58% of cases and death of the newborn in 80% of cases. The complex fistula with 58.18% was the most common. The treatment constituted to a fistulorraphy in 63.64% of the cases. Therapeutic outcomes judged with a mean follow-up of 6 months were complete healing in 61.82%, stress urinary incontinence in 3.64% and failure in 34.54% of cases.
Conclusions: Obstetric fistula is a reality in Burkina Faso today. The driving factor is the lack of adequate obstetric care. The Schiphra Hospital is engaged in its daily activities to eradicate it.
Fistula Champions leading local actions for Ending Fistula in Bangladesh
Authors: Karmakar Aysarjo , Karmakar Anirudha , Huda Sk Nazmul
Published: June 2019

Aims: To document how fistula champions are contributing to improving maternal health, prevention of female genital fistula in remote villages in Bangladesh and their achievements to date. 
Methods: Eight girls grade IX and X from three remote villages of Satkhira district were enrolled in School Girls for Fistula Free Bangladesh. They had four hours orientation workshop on obstetric fistula. They were provided a checklist for community actions for fistula awareness and prevention. The school girls prepared social maps of the villages, identified local resources and institutions for prevention of early marriage and promotion of safe motherhood. Activities included listing all pregnant women in their communities and educating them for pregnancy and labor care.
Results: The school girls identified 54 pregnant women in the villages; these women received 127 ANC visits, 23 deliveries took place in hospitals. There were no incidents of early marriage in the villages. The school girls met the benchmarks to be a fistula champion and were awarded certificates for achievements.   
Conclusions: Fistula champions have set up a model for local actions for ending fistula in remote communities.
Surgical Safety Toolkit based Quality Monitoring of Fistula Surgery in Bangladesh
Authors: Jahan Israt , Huda Sk Nazmul , Romanzi Lauri
Published: June 2019

Aims: To share our experience using a new tool to monitor quality in a surgical care delivery system and document fistula surgery-related mortality and morbidity.
Methods: Surgeons, nurses and other clinical care providers were trained to use SST for every client they served at seven facilities. From April 2017 to June 2018, data were captured for 283 clients across these facilities. Anonymous SST data were centrally collected, entered in a spreadsheet and summarized.
Results: Among 283 fistula patients, who had repair surgery, 27 morbidities were recorded and there was no mortality. 44% of morbidities were related to intra/post-operative hemorrhage requiring blood transfusion, 30% were repair wound breakdown. The SST documented that all women who had fistula surgery received counseling on follow-up care, the importance of abstinence during the recovery period and on family planning.
Conclusions: The SST is derived from global standards for safe surgical care with a focus on fistula-specific metrics. This toolkit can be used for routine documentation of surgical care processes for fistula cases and be adapted for monitoring other types of surgical care.
Keywords: fistula surgery, monitoring, surgical safety kit.
Prevalence findings from a community-based female genital fistula screening program in Bangladesh
Authors: Ghose Lucky , Huda Sk Nazmul , Tripathi Vandana
Published: June 2019

Aims: This paper presents the findings of a community-based program to conduct house-to-house fistula screening in a district in Bangladesh.
Methods: The USAID-supported Fistula Care Plus (FC+) project in Bangladesh purposively selected a district (Faridpur) for fistula programming. Fistula screening was integrated into the house-to-house activities of a NGO, active in community health. From July to December 2016, all households were reached by field staff for identification of any possible fistula cases using a four questions checklist. Suspected fistula cases were referred to community based fistula diagnosis events at regular intervals.
Results: Among 0.5 million women, using the 4Q checklist, field workers identified 604 women as suspected fistula or perineal tear with fecal incontinence cases. Of these, 149 cases were clinically confirmed. The prevalence of fistula was 0.3/1000 ever-married women in the district.
Conclusion: The fistula prevalence documented in Faridpur through this screening partnership is much lower than that reported in a 2003 UNFPA/EngenderHealth survey in Bangladesh (1.69/1000 ever-married women). This difference in district-level prevalence also suggests the value of local data in the development and implementation of fistula programs.
Management of Genital Fistula in Women with Meyer-Rokitansky-Kuster-Hauser Syndrome
Authors: Jenner Lengmang Sunday
Published: June 2019

Aims:  The study sought to document our experience with management of genital fistula and related symptoms in women with MRKH syndrome.
Methods: This is a retrospective review of women with MRKH syndrome who were treated for genital fistula and related conditions from January 2012 to July 2018. Our Microsoft Access database and operation register were used to locate the folders from which data was extracted. Follow up information was obtained by telephone interview. Data was analysed with SPSS version 17.
Results: The mean age at presentation of the six patients was 21.2 years (SD 4.5). Mean follow-up period was 27.3 months (SD 24.1). One patient presented with infertility; the remaining five presented with genital fistula (two iatrogenic, two gishiri cuts and one sexual trauma).  Three fistulae were vesicovaginal and two rectovaginal. All fistulae were successfully repaired.  All patients were offered sigmoid neo-vagina as one-stage or two-stage procedure for concerns about penetrative vaginal intercourse.  To date, two patients are sexually active during follow-up, and have a pleasing and satisfactory penetrative neo-vaginal sexual experience.
Conclusion: Women and girls with MRKH syndrome present with genital fistula from iatrogenic, harmful cultural practice and sexual trauma. Regardless of presenting complaints of women with MRKH syndrome, they also had concerns regarding penetrative vaginal intercourse. Depending on the mode of presentation, one- stage or two-stage surgical repair was possible and sigmoid neo-vaginal surgery provided a satisfactory penetrative neo-vaginal sexual outcome.
Causes and prevention of Iatrogenic fistula during Gynaecologic Surgery
Authors: Sharma Ashudeep
Published: June 2019

Pelvic surgery is most common cause of iatrogenic ureteral injury. The incidence of ureteric range from 0.2 to 1% during various gynaecological procedure including laparoscopic surgery. The majority of ureteral injury has no identifiable predisposing factor and occurs more frequently for procedure forbenign lesion. Two third of injury are diagnosed postoperative period. When the injury is recognized intra-operatively, the lesion can be repaired immediately with minimal risk of long term sequelae.  Urological injuries to urinary bladder & ureter- uncommon but important. Surgical complications during various obstetric & gynecological open and laparoscopic procedures. One of the important factors is anatomic proximity of ureters & bladder to genital tract. Bladder injuries- most frequent urologic injury. Bladder injuries usually recognized and repaired immediately, and potential complications are typically minor. But ureteral injuries(70%) typically are not recognized immediately & can lead to long term complications. Risk factors are Enlarged uterus, Previous pelvic surgery or radiation, Advanced malignancy Endometriosis, PID ,Pelvic adhesions, distorted pelvic anatomy.
Iatrogenic urologic injuries can be prevented by adequate pre-operative assessment, good surgical technique, and visualization of the bladder & ureters. Anticipation and high index of suspicion, early urological referral, and appropriate investigation of suspected urologic injury is of paramount importance.
Post-operatively they may present with fever, flank pain and tenderness, oligouria, anuria, uremia, ileus, peritonitis, urinary leakage and hematuria depending upon severity of injury. To prevent ureteral injury surgeon must have thorough knowledge of anatomy and location of ureter during various gynaecological procedure and the specific sites where it is most susceptible to injury.
Outcome and predictors of surgical repair of obstetric vesicovaginal fistula in a teaching hospital in ethiopia: retrospective cohort study
Authors: Amenu Demisew , Workineh Ahadu , Hika Desta
Published: June 2019

Aims: To determine outcomes of obstetric fistula repair and predictors of outcomes among patients with obstetric vesicovaginal fistula.
Methods: A Hospital based Retrospective Cohort study design was conducted on all patients with Obstetric vesicovaginal Fistula, who were admitted to Gynecology ward, and had surgical repair from January 2011 to December 2014. Data was collected from patients’ chart, operation logbook and discharge logbook which were filled up from the entry of the patient to the hospital till her discharge. At discharge, a dye test was done to determine the outcome of repair.
Results: 168 patients with obstetric vesicovaginal fistula were repaired during the study period. The age of the women ranged from 12 to 45 years with mean of 25 (± 6) years. Eighty percent of patients were laboring for two or more days, 46.4% delivered abdominally, and 85.7% ended up in stillbirth. Out of 93.4% patients who had successful closure of their fistula, 84.5% of patients had their fistula healed and continent, 8.9 % of them developed urinary incontinence while 6.5% of fistula repair had failed at the time of discharge.
Unsuccessful fistula repair was significantly associated with being divorced/widowed (AOR 2.65 95%CI 1.06,6.67), Moderate/severe vaginal scaring (AOR5.25 95% CI 2.19, 12.60).
Conclusions: In this study most fistula patients are older than 18 years, referred from health centers either for cephalopelvic disproportion or obstructed labor after prolonged labor at home, high success rates were achieved with surgical repair, and being divorced /widowed and marked vaginal scarring are predictors for unsuccessful fistula repair. Therefore, increasing access to comprehensive emergency obstetric and new born care is essential to minimize the delay contributing to perinatal mortality and obstetric fistula.
Risk factors and management of obstetric fistula associated with bladder calculus at Saint Joseph Hospital, Kinshasa - DR Congo
Authors: Nembunzu Dolores , Mpunga Michel , Banze Félicien , Tena Brian Tena , Tripathi Vandana
Published: June 2019

Aims: Obstetric fistula can be complicated by bladder calculus. The mechanism of lithogenesis is caused by some predisposing factors. The article aims to describe risk factors predisposing to bladder calculus formation and repair outcome.
Methods: This was a comprehensive retrospective review from medical records of fistula obstetric repairs associated with bladder calculus at Saint Joseph Hospital in Kinshasa, DR Congo, from January 2007 to December 2017.
Results: Among 1416 women who had had obstetric fistula, 30 (2.12%) had bladder calculus. The average age of women was 38 years old and ranged between 22 and 82 years old. The average duration of fistula was 8 years and ranged from 5 months to 31 years. All fistulas were iatrogenic and 86.67% (n = 26) occurred after caesarean section. Size of calculus varied between 1 cm and 15 cm. Risk factors identified were: urinary tract infection 80% (n = 24), foreign bodies 13.33% (n = 4), malnutrition and dehydration in 33.33%. In majority of cases (90%), the removal of the calculus and repair of fistula were performed at the same time by transvesical way. 70.37% of the patients had successful repairs.
Conclusions: Iatrogenic fistula after caesarean section, urinary tract infection and foreign bodies are related to the formation of bladder calculi. Fistula repair and extraction of bladder calculus performed at the same time gives good results. Access to Obstetric Emergency Care, qualified personnel and available infrastructure and equipment are important for the prevention of the occurrence of bladder calculus.
Frequency and management of non-obstetric fistula in the Democratic Republic of Congo: experience from Fistula Care Plus project
Authors: Delamou Alexandre , Mpunga Michel , Banze Félicien , Nembunzu Dolores , Raha Kenny , Paluku Justin , Kinja Rachel , Kitambala Esther , Aussak Brian Tena-Tena , Bobina Ruth Bulu , Notia A , Mukuliboy Anne , Diop Altine , Tripathi Vandana , Romanzi Lauri
Published: June 2019

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.
Control of Iatrogenic urogenital fistula in developing country
Authors: Sharma Suman
Published: June 2019

Urogenital fistula is one major health problem of developing countries. It is an abnormal communication between genital tract (Vagina, Cervix and Uterus) and urinary tract (Bladder, Urethra and Ureter) secondary to obstetrical trauma or iatrogenic insult, causing continuous urinary leakage.
The previous studies shows obstructed labor as main cause of urogenital fistula but recently received an increase number of patients after gynaecological and obstetrical surgeries mainly hysterectomies and C -section. Iatrogenic urogenital fistula is not yet recorded as frequently as in some region such as southern Asia, but is becoming an issue with significant concern for treatment and prevention.Iatrogenic urogenital fistula is an indicator of the health system failing to provide good and quality health care system.
Iatrogenic fistula which is induced inadvertently by a surgeons or diagnostic procedure. There are several regions for iatrogenic urogenital fistula like unsafe surgeries, rising in C-section  and hysterectomy surgeries.  Iatrogenic urogenital fistula commonly occurs in emergency procedures conducted by the resident/junior registrars or lack of proper surgical training of surgeons performing these surgeries . Sometime it may be due to abnormal surgical anatomy .
Few things we can do to reduce or minimize Iatrogenic urogenital fistula . Firstly safe surgical practices for C-section, hysterectomy and ruptured uterus repair. We must improve training, establish  standardized surgical ,anesthesia and obstetric criteria. At least few months rotational training in urology should be mandatory for resident in obstetrics and gynaecology to deal with common complication of bladder, urethra and ureter encounter during gynaecological and obstetrical surgeries. Secondly we must reduce unnecessary surgeries such as C-section and hysterectomy. Finally we must expand access to basic maternal health care. All women have the rights to family planning to space desired birth and quality midwifery services to reduce unnecessary C-section and promote optimal birth outcome.
Prevalence of urinary incontinence and its determinants among pregnant women in Addis Ababa, Ethiopia
Authors: Weldetensaye Eskinder Kebede
Published: June 2019

Aims: To establish the prevalence of urinary incontinence and its determinants among pregnant women in Addis Ababa, Ethiopia.
Methods: This was a facility based cross-sectional study. Data was collected in July 2016 by trained data collectors using the International Consultation on Incontinence criteria qualified questionnaire interviewing333 consenting pregnant women aged 15 to 42 years who were attending antenatal care (ANC) through an exit interview. Data was entered and cleaned using Epi Info, and analyzed using SPSS version 20.0 statistical software. The univariate analysis such as proportions, percentages, ratios, frequency distributions and appropriate graphic presentations were used for describing data. Bivariate analysis of socio-demographic, co-morbidities, mode of deliveries, and parity were included. Then multivariate logistic regression model was employed to control confounding factors.
Results: A big number of the pregnant women, 82(24.6%), reported Urinary Incontinence. Thirty-eight (11.4%) reported stress urinary incontinence (SUI) only and 15 (4.5%) reported urge incontinence (UUI) only while 29 (8.7%) reported mixed stress and urge incontinence during the preceding month. Seven women (8%) had moderate or severe symptoms. Out of the 82 cases, only 18 (21.9%) had consulted a health-care professional. A total of 9 (23.7%) of women with SUI, 3 (20%) of those with UUI and 6 (20.7%) with MUI had sought help for urinary symptoms. Treatment seeking was related to severity (measured as frequency of leakage), with 17% of treatment seekers leaking monthly or less often, 39% leaking weekly and 44% leaking daily, whereas 25% of non-treatment seekers leaked monthly or less, 53.1% leaked weekly and 21.9% leaked daily. The commonest reason not to seek help was that it was considered as normal and common during pregnancy. The determining factor for prevalence of UI was the mode of delivery. Those pregnant women who delivered by C/S had only lower odds to be urinary incontinent (AOR: 0.46:95%CI (0.22, 0.98) than those women who delivered vaginally. Storage phase symptoms (nocturia, urgency and daytime frequency) were common among respondents. Of these, nocturia was the commonest with 85% of reporting respondents.
Conclusions: This study showed that many pregnant women in Ethiopia suffer in silence from a variety of lower urinary tract symptoms, at levels comparable to their counterparts in other parts of the world. There is a need to create awareness among health care providers on the lower urinary tract related morbidities in pregnancy and build their capacity to recognize, investigate and manage these symptoms.
Socio-economic reintegration after medico-surgical management of obstetric fistula
Authors: Ouedraogo D , Yaméogo P , Kiemtoré S
Published: June 2019

Aims: To study the socio-economic reintegration of victims of obstetric fistula after their recovery.
Methods: Prospective and analytical cohort study
Results: The average age of women with obstetric fistula was 35.92 ± 9.80 years. 85.45% were housewives, 92.73% were out of school and 85.45% lived in rural areas. In about 43.64% of cases, obstetric fistula occurred in the first two pregnancies. The average age of fistula was 7.6 years with extremes of 2 months to 32 years. The average duration of labor was 53.29, resulting in caesarean delivery in 58% of cases and death of the newborn in 80% of cases. Marital status changed in 14% of cases after healing. Before surgery, 87% had stopped all economic activity, 76.36% did not participate in social events and 52.73% of cases had no regular sexual activity. After surgery, patients participated in all community celebrations in 91.18% of cases; there was sexual intercourse in 52.94% of cases and 14.71% of cases had returned to work
Conclusions: In order to ensure the restoration of a woman with dignity, medico-surgical management must be combined with social and economic support.
Rehabilitation and Reintegration Programming Following Female Genital Fistula Surgery: A Scoping Review
Authors: El Ayadi Alison M
Published: June 2019

Aims: To examine the range of rehabilitation and reintegration services provided as adjunct to genital fistula surgery, map the existing programming and outcomes, and identify areas where additional research is necessary.
Methods: Our scoping review is informed by existing methodological frameworks and conducted in accordance with PRISMA guidelines.The search strategy was designed in collaboration with a medical librarian and is applied to nine biomedical, public health, and social science databases. Grey literature is identified through targeted searches and relevant organizational websites. Two primary reviewers independently screened titles and abstracts of all articles, followed by full-text screening and standardized data extraction. Eligible articles will discuss research or programmatic efforts around service provision in adjunct to surgery.
Results: The literature review is currently underway and preliminary results including summary tables and narrative will be available to share at the ISOFS conference.
Conclusions: The results of this scoping review will help in understanding and describing what is known and unknown about rehabilitation and social reintegration of women following genital fistula surgery in sub-Saharan Africa and may be useful in developing and evaluating social reintegration projects.
Contribution of Ad-din Micro-credit program in Fistula Prevention, Case identification and Referral
Authors: Haque Fazlul , Mohiuddin Sheikh , Huda Sk Nazmul
Published: June 2019

Aims: The objective of this presentation is to describe the practice of fistula case identification, referral and rehabilitation of  patients under the Ad-din microcredit program and to share performance data and program experience in this field.
Methods: Using a 4 question checklists developed through the Fistula Care Plus project, Ad-din field workers identify fistula clients from community. Ad-din does a customized rehabilitation need assessment of individual fistula cases then and supports them accordingly.
Results: During this period, 358 cases have been identified with probable fistula symptoms. Diagnosis was confirmed among 169 cases through community fistula diagnosis events. Ad-din facilitated treatment of 153 cases. The program has provided rehabilitation training to 46 cases and livelihood support to 59 cases.
Conclusion: Microcredit networks can be used for community-based fistula case identification, treatment facilitation, case referral and case rehabilitation. If the networks of microcredit systems in many settings are utilized in fistula prevention and care, they could be useful partners to address fistula in any community.
Community Radio Supporting Maternal and Child Health and Preventing obstetric Fistula in an area impacted by climate change
Authors: Shahriar Selim , Al Mahmood Abdullah , Biswas Nitta , Huda Sk Nazmul , Nalta Radio , Satkhira -
Published: June 2019

Aims: To describe how a community radio station and its allied resources have supported maternal and child health promotion and prevention of fistula in hard to reach and climate change-affected areas in Bangladesh.
Methods:  The volunteers and operators of Radio Nalta were provided training on maternal health and fistula communication by a development partner. Information packs were made available through different institutions.
Results: We produced and broadcast public service announcements on maternal health and fistula, integrated maternal health and fistula related messages radio plays and prioritized maternal health and fistula coverage in community radio news. We aired 11 talk shows on fistula, eight in observation to International day to end obstetric fistula. We reached 600,000 people with fistula information.
Conclusions: Community radio can help in reaching out populations in hard to reach areas with information and education for promoting maternal health and prevention of fistula. Coastal areas are impacted by climate change and the community radio can effectively communicate with communities there.
Rectovaginal fistula due to missing Intra Uterine Contraceptive Device
Authors: Kawimbe Alexander Bambala
Published: June 2019

Case: Rectovaginal fistula is an abnormal communication between the rectum and the vaginal. This leads to uncontrollable passage of feces and flatus through the vagina. It therefore causes distressing physical, social and psychological symptoms on the affected woman. The commonest cause of Rectovaginal Fistula is obstetric trauma commonly in developing countries with poor access to Obstetric care or substandard care provision. The case reported here highlights a rare situation in which a birth control measure of Intrauterine Contraceptive Device (IUD) in a 36 years old healthy female leads to a high Rectovaginal fistula.
Using a participatory curriculum and cascade-training model to empower Ugandan youth to make responsible social, beconomic, sexual and reproductive health decisions
Authors: Tumusiime Molly , Kaduyu Paul , Kanakulya Hassan , Mukisa Rose
Published: June 2019

Aims: To demonstrate an integrated, gender-transformative holistic approach to promote youth empowerment and community referral for healthcare in Uganda.
Methods: The USAID-funded Fistula Care Plus (FC+) project supported implementation of sexual and reproductive health (SRH) education for in- and out-of-school youth. FC+ used the adapted Aflateen PLUS curriculum, integrating SRH with concepts such as financial and leadership skills and planning for future, FC+ trained and provided continuous supervision support to 19 teachers and 29 peer-educators to facilitate the curriculum to 10 in-school youth clubs and 10 out-of-school youth groups across Jinja and Kamuli Districts.
Results: In- and out-of-school youth participating in the Aflateen clubs reached an additional 5,950 community members with SRH and financial savings information and referred 1,364 individuals to health care, including family planning, maternal care, STI testing, and evaluation of fistula symptoms.
Conclusion: The Aflateen Plus curriculum’s learner-centered and in-depth engagement approach engages youth to critically think about present and future decisions. The curriculum and club model empowered youth and promoted a culture of information sharing and community referral to reduce vulnerability. Stakeholder engagement (e.g., teachers, peer-educators, local government, and health care sector) increased ownership and sustainability of the intervention.
Bladder care and management of prolonged/obstructed labor for obstetric fistula: A global survey of intrapartum and postpartum clinical practices
Authors: Tripathi Vandana , Arnoff Ally
Published: June 2019

Aims: To understand intrapartum and postpartum clinical practices among skilled birth attendants in low- and middle-income countries (LMICs).
Methods: This survey, based on clinical guidelines and curricula, was administered online in French and English, from May-Oct, 2017. Summaries of respondent characteristics, knowledge, and practices were generated. Chi-square tests investigated significant disparities by region, facility type, and geography. Data were analyzed using Stata v12.
Results: Respondents (222) were primarily midwives (61%) and OB-GYNs (15%); 56% in Africa and 39% in South-East Asia. A majority practice many recommended practices related to intrapartum/postpartum bladder care and P/OL management. Most reported using partograph to monitor labor (99%), monitoring voiding frequency for postpartum patients (95%), and utilizing UC after P/OL (94%). Findings revealed a lack ofprotocols on bladder care and P/OL management, variation in practice by region, and less access to in-service training and supplies in Africa and public facilities.
Conclusions: Findings reveal a strong foundation for standardization in intrapartum/postpartum bladder care and P/OL management. UC after P/OL appears feasible and acceptable, meaning its systematic practice can be scaled up to prevent obstetric fistula and other sequelae of P/OL in low-resource settings. However, SBAs need protocols, in-service training, and consistent supplies, especially in Africa and public facilities.
Assessment of health worker knowledge in fistula management in Uganda
Authors: Kanakulya H , Ndwiga C , Sripad P , Arnoff E , Mukisa R , Warren S , Barageine J
Published: June 2019

Aims: To assess knowledge, attitudes, and practices related to female genital fistula among Primary Health Care (PHC) providers in Uganda.
Methods: A structured questionnaire was administered to purposively sampled PHC providers, data were collected using the ODK mobile technology platform and analyzed using Stata 13.1 software.
Results: 114 PHC providers (62 Masaka, 52 Kalungu) in 50 health centers (28 level II, 18 level III and 4 level IV) were assessed. Findings showed that 57% could define prolonged labor correctly; almost none knew that leaking faeces and urine was a postnatal fistula sign/symptom. 28% reported having seen patients that leaked urine uncontrollably. 24% reported having seen clients fistula symptoms, 39% knew that fistula clients should be counseled and referred for treatment, and 25% had ever referred clients who leak urine.
Conclusions: PHC providers lacked adequate knowledge of fistula and related issues. If PHC providers are to be engaged in fistula screening and referral, this topic must be integrated into the training curriculum. Conversely, it may be important to provide women with direct access to information on referral and treatment of fistula.
Steps towards Elimination of Obstetric Fistula in Bangladesh: Reflection from 2nd National Strategy for Obstetric Fistula 2017-2022
Authors: Biswas Animesh , Purno Nabila Hossain , Doraiswamy Sathyanarayanan
Published: June 2019

Aims: To see impact of second National Strategy for Obstetric Fistula 2017-2022 in Bangladesh
Methods: Under the supervision of The National Task Force on Obstetric Fistula of the Ministry of Health and Family Welfare, UNFPA supported the government in the development of the 2nd national strategy. A technical group developed the strategy and submitted to the Ministry of Health and Family Welfare for final approval. The second national obstetric fistula strategy 2017 – 2022 is a major step towards a fistula-free Bangladesh within a generation and reduces the burden of disease.
Results: The strategy sets the vision for all girls born henceforth in Bangladesh will enjoy a life free from the risk of Obstetric Fistula and all cases of fistula will receive the highest quality of care enabling a high quality of life. Six directions set include prevention, improvement of services, quality treatment, psychosocial reintegration and rehabilitation, evidence generation and increase awareness. The set target aims to reach zero incidences of obstetric fistula by2022, reduce prevalence of repairable fistula cases by 90% and provide social safety nets and rehabilitation to 50% of all (repairable and incurable) cases of fistula between 2017 and 2022.
Conclusions: Multi sectoral efforts needed under an effective coordination to operationalize the second strategy in Bangladesh.
Results of urogenital fistulas repair using caravan approach in Côte d’Ivoire
Authors: Bohoussou E , Kouamé B , Djanhan L , Djanhan Y , Manzan K , Gnanazan G , Boni S
Published: June 2019

Aims: To report the experience of surgical caravans for urogenital fistulas care.
Methods: It was a retrospective study covering the period from January 1st 2014 to December 31st 2014 and which took place on 7 sites of fistula care. The epidemiological, anatomic, clinical, therapeutic and evolutionary aspects were studied. Recruitment was made by radio announcements and word of mouth approaches. Treatment was free of charge for patients.
Results: During 14 caravans 346 patients were operated. Their mean age was 33.11 years (12 - 70 years). Most of these patients were without remunerative activities (80%) and without education (63.3%). They had been living with fistula for 6.08 years on average (0 to 42). Obstetrical etiology was predominant (87.9%), the otherswere iatrogenic and traumatic. According to the Kees Waaldijk classification, fistulas were distributed as follows: type I (67.4%), type II Aa (12.7%), type II Ab (8.4%) and type III (11.5%). The most common surgical approach was the transvaginal route (82.1%). The vesicovaginal splitting with separated suture of the bladder and the vagina was the basic technique (94.7%). The therapeutic results were judged after a follow-up of 1 month and 3 months. Lost to follow-up within that period was 23% i.e. 80 patients in month one and 70% (245 patients) at month three. The success rates evaluated in patients reviewed at month one and at  month  3 were respectively 70% and 64%.
Conclusions: Caravan approach to recruit patients with fistula was feasible using local advertisements mans. Patients have been living with fistula for long time. Follow-up was difficult at Month 3.
Pelvic Floor Muscle Training Program in Pregnant Nepalese Women- A Feasibility Study
Authors: Achary Ranjeeta Shijagurumayum , Tveter Anne Therese , Grotle Margreth , Khadgi Bimika , Eberhard-Gran Malin , Braekken Ingeborg H. , Stuge Britt
Published: June 2019

Aims: Obstetric Fistula is one of the common pelvic floor dysfunctions that affects the women’s quality of life. PFMT is recommended as first line treatment for prevention and treatment of pelvic floor dysfunctions. There is lack of knowledge on the feasibility of performing a PFMT program in pregnant Nepalese women. The aim was to develop a Pelvic floor muscle training (PFMT) program and to assess the feasibility of the program by assessing attendance to antenatal follow-up visits and adherence to PFMT.
Methods: The PFMT program included development of education material (video, leaflet, and poster) and PFMT in different positions. Pregnant women (before 16 weeks of gestation) visiting Dhulikhel Hospital were recruited consecutively. Sociodemographic factors, pregnancy history, symptoms of urinary incontinence, pelvic organ prolapse and depression questionnaires were collected at first and last visit. Number of antenatal follow-up visits, exercise diary records and motivation questions for performing PFMT were also collected.Compliers were defined as women attending four or more PFMT antenatal follow-up visits. 
Results: Two hundred and fifty three pregnant women with mean age25 (Standard deviation, (SD) 4) years and mean gestation weeks of 10(SD 3) were included. In total, 164 (65%) participants complied with the PFMT program and 89 (35%) did not comply.Eight percent of the women reported not doing PFMT and approximately 20% women over-reported to have performed PFMT.
Conclusions: More than half of the women completed the PFMT program. Adherence to PFMT had inconsistent results.
Increasing opportunities for obstetric fistula case detection and treatment by using a multifaceted approach – the case of Kalungu district –Uganda
Authors: Tumusiime Molly , Kaduyu Paul , Kanakulya Hassan , Mukisa Rose , Arnoff Elly , Tripathi Vandana
Published: June 2019

Aims: To identify fistula treatment barriers and increase treatment access in Kalungu, Uganda.
Methods: Responding to treatment barriers identified through formative research, the USAID-funded Fistula Care Plus (FC+) Project is implementing a comprehensive intervention to address fistula treatment barriers. The intervention utilizes multiple communication channels (free fistula screening hotline, health workers, and community agents), a consistent screening algorithm for fistula screening, and a transportation voucher to enable positively-screened women to travel to and from the fistula treatment facility.
Results: FC+ trained and oriented 42 health workers and 275 community agents across Kalungu District to raise awareness and identify suspected fistula cases; trainees were provided with fistula hotline advertisements and data collection and referral tools. Thirty drivers were also trained and oriented on the transportation voucher system. From July 2017 to July 2018, the hotline received 120 callers from Kalungu; 88 screened positively. 37 women from Kalungu used the voucher system for free transport. In all, 51 women from Kalungu were referred to the fistula facility through the intervention’s referral channels. Facility records indicate that the number of women seeking fistula treatment from Kalungu District increased during the intervention period compared to the prior year. 
Conclusions: Applying client-centered communication, screening, referral, and transportation mechanisms enabled FC+ to address treatment barriers in Uganda. This approach may be replicated in other settings where the backlog of unidentified/untreated fistula cases persists.
Private initiative in addressing fistula problem in Bangladesh
Authors: Akhter Sayeba
Published: June 2019

Aims: Fistula is a disease of the poorest women of poor country and treating fistula is always a non-profit venture. That is why private sector lags behind in the movement of fistula eradication. About 19,500 women are living with OF in Bangladesh. There is a rising trend in post-surgical fistula. Private initiatives also need to be encouraged and patronized for prevention and treatment of fistula.
Methods: The purpose of this paper is to focus on the courageous attempt of running a fistula hospital in a private setup. MAMM’S Institute of Fistula & Women’s Health(MIFWOH) was established in 2012 in Dhaka, Bangladesh with an aim to serve the fistula victims of the country. Long term working experience in the field of genital tract fistula has facilitated the journey to a great extent. But challenges and obstacles are there. The purpose of this paper is to share the personal experiences of running a charitable hospital with private initiative.
Results: The paper focuses on the success and challenges faced in past 5 years of journey. Around 1200 patients including 278 fistulae patients were treated during this period of time with an overall success rate of 86.33% in fistula surgery. The institute also takes initiative in training doctors and nurses for prevention and treatment of fistula. Challenges are there in respect of funding, space constrain, bringing patients to facility & also in developing surgical skills for taking over in future.
Conclusions: Government and public participation is the dire necessity for future sustainability of the institute. At the same time focus must be put on encouraging young generation doctors in fistula surgery and train them up for future continuation of fistula eradication program.