bluuebunny/crossref_metadata_2025 huggingface dataset:
TERORIS PAK JENGGOT DITINJAU DARI TEORI TINDAKAN MANUSIA THOMAS AQUINAS
Authors: Nugraini Akuntansi Aprillia Intan
Published: June 2019

Terorisme sejatinya sudah tidak dapat dipisahkan lagi dari kehidupan manusia. Mulai dari dikenalnya kelompok radikal ISIS yang mendunia sampai kelompok JAD yang ada di negeri kita sendiri. Bahkan masyarakat sepertinya sudah hafal betul bahwa jika terjadi serangan teror dua kelompok itu pasti pelakunya. Entah itu serangan rudal, ajaran sesat dan yang sering terjadi adalah bom bunuh diri. Ajaran sesat yang dimaksud disini adalah ajaran paham terorisme dan radikalisme. Jika serangan rudal sering terjadi di suriah lain halnya di Indonesia, bom bunuh dirilah yang paling sering terjadi diantara sekian banyak kasus terorisme.
Manajemen Mutu Terpadu Sebuah Inovasi Pendidikan
Authors: putri septria melpi , Rusdinal  , Afriansyah Hade
Published: June 2019

The difficulty of applying TQM in the field of education is the difficulty in determining the quality of its products (graduates) which are more qualitative in nature.
Manajemen Mutu Terpadu
Authors: Yuli Desi Ratna , Rusdinal  , Afriansyah Hade
Published: June 2019

Abstrak- Quality is very important ineducation. We all admit, right now there areindeed problems in the education system.Middle school or college graduates are notready to meet community needs. Thisproblem affects the community.Anticipating changes that are so fast andthe challenges that are getting bigger andmore complex, there is no other way for thegovernment to function as an organizer ofdevelopment in the field of education andeducational institutions to seek every meansto increase the competitiveness of graduatesand other academic products among others,achieved through improving the quality ofeducation.
Manajemen mutu terpadu
Authors: Windryani Fadilla , Rusdinal  , Afriansyah Hade
Published: June 2019

Implementation of the Total Quality Management in the Learning Quality Management System in Educational Institutions. This study aimed to analyse the implementation of the Total Quality Management (TQM) in the learning quality management system in educational institutions. This study used a descriptive design. The population consisted of people in the organizational structure of the quality management system and the sample was pusposively selected. The data were collected through interviews and documents and were analysed using the descriptive technique. The findings show that: (1) the TQM has been implemented but it still needs optimizing, (2) it needs support from the heads of relevant units, (3) there are constraints because of work teams that are not optimal and limited time and funds, (4) the strategies to deal with the constraints depend on the condition and situation, and (5) the implementation of the TQM refers to an evaluation and monitoring study and the draft of academic quality assurance documents.
Implementasi Kurikulum
Authors: NOVITA DILA , Afriansyah Hade
Published: June 2019

This research is aimed to know the implementation of 2013 Curriculum in learning Mathematics and the obstacles that face at the X grade student of SMAN 1 South Solok. The type of this research is qualitative descriptive. The data collection is done using interview, questionnaire, observation and documentation.
Beyond Scientific Mechanisms: Subjective Perceptions with Viniyoga
Authors: Heeter Carrie , Allbritton Marcel , Bossart Chase
Published: June 2019

Healthcare professionals and research scientists generally recognize the potential value of mind–body practices grounded in ancient wisdom, but often have limited direct experience with such practices. Meditation participant self reports provide a window into subjective experiences of three Viniyoga meditations and how and why those meditations could contribute to health and well-being outcomes. Each of the meditations in this analysis had a unique structure and used a different aspect of the ocean as a meditation object. Yoga philosophy and yoga anatomy models of the human system are used to help explain participants’ experiences and associated personal benefits and insights. Four aspects of the individual that can influence what happens for them in meditation are illustrated with tangible examples: (1) What is happening in generally in someone’s life; (2) the state of their system (mind, body, breath) around the time of the meditation; (3) reactions to the meditation steps and instructions; and (4) their prior experiences with the object of meditation. Summaries of the practices, and why and for whom each meditation might be beneficial are discussed. The authors’ perspectives are grounded in Viniyoga and yoga therapy.
Intervention or Involvement: A Video Observational Analysis of Bouncers in Aggressive Encounters
Authors: Liebst Lasse Suonperä , Ejbye-Ernst Peter , Philpot Richard , Heinskou Marie Bruvik , Demant Jakob , Dausel Kasper Lykke , Lindegaard Marie Rosenkrantz
Published: June 2019

Little is known about how bouncer-patron interactions may influence a bouncer’s use of physical aggression. To address this gap, we offer a micro-interactional analysis examining real-life aggressive bouncer behavior captured by venue surveillance cameras. Quantitative results show that bouncer physical aggression is associated with interactions where bouncers are directly involved as a conflict party, compared to situations where they solely intervene as a third-party. Further, a qualitative analysis of emotional cues identifies anger as a plausible mechanism underpinning bouncer aggression. We consider the implications of these findings for night-time economy violence prevention strategies and discuss the relevance of video data for barroom research.
How to use replication assignments for teaching integrity in empirical archaeology
Authors: Marwick Ben , Wang Li-Ying , Robinson Ryan Patrick , Loiselle Hope
Published: June 2019

The value of new archaeological knowledge is strongly determined by how credible it is, and a key measure of scientific credibility is how replicable new results are. However, few archaeologists learn the skills necessary to conduct replication as part of their training. This means there is a gap between the ideals of archaeological science, and the skills we teach future researchers. Here we argue for replications as a core type of class assignment in archaeology courses to close this gap and establish a culture of replication and reproducibility. We review replication assignments in other fields, and describe how to implement a replication assignment suitable for many types of archaeology programs. We describe our experience with replication in an upper level undergraduate class on stone artefact analysis. Replication assignments can help archaeology programs give students skills that enable transparent and reproducible research. Published version is online at DOI:10.1017/aap.2019.38P
Use of different bivariate statistical landslide susceptibility methods: A case study of Khulekhani watershed, Nepal
Authors: Singh Pradhan Ananta Man , Dawadi Anurag , Kim Yun Tae
Published: June 2019

Available with full text.
Comparison of clinical course of Acute Biliary and Non-Biliary Pancreatitis
Authors: Bhattarai Abhishek , Devkota Pragya , Kandel Bishu Prasad , Ghimire Bikal , Kansakar Prasan Bir Singh , Bhandari Ramesh Singh , Tamrakar Kishor Kumar , Lakhey Palaswan Joshi , Mishra Parshuram , Singh Yogendra Prasad , Vaidya Pradeep , Singh Keshaw Prasad
Published: June 2019

Introduction: Incidence of acute pancreatitis (AP) varies in different parts of the world. The published data are mainly based on retrospective analysis of hospital admissions, which show that there are considerable geographical differences in the incidence rate. There are also regional divergences with regard to the etiology, and its impact on morbidity and mortality. Therefore, we compare the clinical course of acute biliary and non-biliary pancreatitis at the Tribhuvan University Teaching Hospital (TUTH) as well as we compare the morbidity and mortality and duration of hospital stay in these groups.

Methods: This prospective study included the patients with a diagnosis of AP over a period of one year. Eighty-five patients with the diagnosis of AP were included in the study. Revised Atlanta classification system (2012) was used to diagnose and define the severity of disease. The occurrence of local and systemic complications, median duration of hospital stay and mortality in AP was studied.

Results: Among 85 patients, 34 patients were females and 51 were males. Among them, 46 patients belonged to the biliary group and 39 belonged to the non-biliary group. Alcohol intake was the major etiology in the non-biliary group (n = 26) and all of them were male. The majority of the gallstone induced AP patients were female (n = 29). Twenty-nine patients developed severe acute pancreatitis (SAP: 16 in biliary and 13 patients in non-biliary group). Complications were mostly seen in SAP. The acute fluid collection was the most common local complication (15 patients in biliary and 15 patients in non-biliary group, p > 0.05) and respiratory failure was the most common systemic complication (18 patients in biliary and 16 patients in non-biliary group, p > 0.05) in both groups. Three patients in biliary group and four patients in non-biliary group died due to multi-organ failure (p > 0.05). There was no statistical significant difference in the median duration of hospital stay in these groups.

Conclusion: Though pathogenesis vary for different etiologies, once the disease process has started, local complications, systemic complications, duration of hospital stay and mortality in AP depends on the severity of the disease irrespective of the etiology.
Rectovaginal Fistula Due to Missing Intra Uterine Contraceptive Device
Authors: Kawimbe Alexander Bambala
Published: June 2019

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.Keywords: fecal incontinence, missing IUD, rectovaginal fistula
Establishing Depression Levels among Women Seeking Obstetric Fistula Treatment at Fistula CarePlus Supported Sites in Uganda
Authors: Kaduyu Paul , Makisa Rose , Ibanda Veronica
Published: June 2019

Aims:This paper reports on the magnitude of depression among women with Obstetric Fistula.
Methods: Between June 2016 and December 2017, 10 nurses and midwives at four hospitals in Uganda (Hoima, Kamuli, Kitovu, and Jinja) were trained to evaluate depression among obstetric fistula clients using the PHQ-9 tool. The tool was scored at admission and at two weeks after surgery. Psychotherapy was provided after surgery. Depression severity was categorized from mild to severe and frequencies were tabulated. Scores from before and after treatment were compared in a subset of clients from Kamuli.
Results:Obstetric Fistula clients (180) were assessed preoperatively for depression at Hoima (55), Kamuli (59), Kitovu (22), and Jinja (44). All clients at Hoima (15.2% mild, 24.5% moderate, 28.3% moderate to severe and 32% severe) and Kamuli (23.7% mild, 13.6% moderate, 27.1% moderate to severe and 35.6% severe) had depression before treatment and pyschotherapy. At Kitovu and Jinja depression levels were 81% (13.6% Minimal, 4.5% moderate, 36.4% moderately severe, 45.5% severe) and 84% (Mild 36.5%, Moderate -36.5%, Moderate to Severe-9.7%, severe depression-17.3%) respectively. Post treatment screening was conducted at Kamuli and all clients still had depression but of less severity (Mild -94.9%, Moderate -3.4%%, Moderate to Severe 1.7%, severe depression - 0).
Conclusions:Clients with obstetric fistula have high levels of depression. Psychotherapy and surgery can mitigate depression symptoms.
Keywords: depression, fistula, psychotherapy, surgery
The association between female genital fistula symptoms and gender-based violence
Authors: Tripathi Vandana , Mallick Lindsay
Published: June 2019

Aims: This study examined the association between self-reported female genital fistula symptoms and experience of gender-based violence (GBV) among women interviewed in Demographic and Health Surveys (DHS) surveys.
Methods: This study pooled data from 13 recent DHS surveys with both fistula and domestic violence modules. Multivariable logistic regressions controlled for maternal and demographic factors.
Results: In this sample of 95,625 women, the prevalence of self-reported fistula symptoms ranges from 0.3% to 1.8% across countries. Among women reporting fistula symptoms,56% report past experience physical violence, more than among women with no symptoms (38%). Twice as many women with fistula symptoms report either lifetime (27%) or recent (16%) experience sexual violence than women not reporting symptoms (13% and 8%, respectively). Women whose first experience of sexual violence was from a non-partner have almost four times the odds of reporting fistula symptoms compared with those who never experienced sexual violence.
Conclusions: These findings must be interpreted with caution given the inability to identify temporal and causal relationships through DHS data. However, the increased risk of violence among women with fistula symptoms suggests that fistula treatment programs should incorporate GBV screening, referral, and services into their pre-discharge care.
Factors associated with obstetric fistula repair failure among women admitted at Gynocare Women’s and Fistula Hospital in Kenya, 2012-2016: a case control study
Authors: Mwangi Henry Ruiru , Wang'ombe Ann , Mabeya Hillary , Kipruto Hillary , Wanjala Anthony
Published: June 2019

Aims: Determine factors associated with obstetric fistula repair failure at Gynocare Women’s & Fistula Hospital in Kenya.
Methods: This was a case-control study whosestudy population was patients who underwent repair at Gynocare between January, 2012 to December, 2016; 119 cases and 238 controls were selected by simple random sampling out of 357 cases.
Results: Study participants were mostly (62.2%) married with low or no formal education (90.1%). Delivery that led to fistula development occurred in the hospital for 85.2% of the study participants and 66.7% resulted into C/S. Only 1/3 (n = 120) had previous repair(s).Patients classified to have VVF IIA were 20.5%, class IIB were 35.0% and class III were 9.2%, the rest (35.3%) were classified as class I. The odds of repair failure were 2.9 times more among those with previous repair attempts compared to those with no previous repair attempts. Women with VVF IIB were 4 times more likely to develop failure. While women who attained at least secondary educations were 77% less likely to have fistula repair failure.
Conclusions: After controlling the effects of age, marital status, comorbidities, parity, time to repair, and post-operative complications: having not attained at least secondary education level, having previous repair attempts, and VVF IIB were found to be independent predictors of repair failure.
Depression after Obstetric Fistula Repair
Authors: Stokes Mary , Wilkinson Jeffrey , Ganesh Prakash , Nundwe William , Pope Rachel
Published: June 2019

Aims: To measure depression using the PHQ-9 over time and to identify characteristics associated with persistent depression.
Methods: A database of women undergoing obstetric fistula repair was used to examine association of depression with variables such as general demographics, type of obstetric fistula, surgical outcome, and continence status at the time of discharge.
Results: 797 patients completed the PHQ-9 upon initial pre-operative assessment. 365 (45.8%) had a PHQ-9 score of 5 or higher, indicating symptoms of depression. Pre-operatively, depression was associated with the 18-34 year old age group and women with no children. Post-operatively, worse incontinence was associated with depression, however, over time depression was rarely found among women returning for follow-up.
Conclusions: The decrease of depression seen over time is either due to selection bias or due to improved adjustment to one’s circumstances. Either way, this study underscores the need for ongoing follow-up, perhaps especially for those not presenting. Further studies are needed to assess the mental health of women who do not present for follow-up visits.
Preliminary analysis of quality of life (QOL) before and after surgery for female genital fistula. A prospective cohort study
Authors: Saha Stacy , Ambauen-Berger Bea , Munira Shirajum
Published: June 2019

Aims: To describe the characteristics of women who come for repair of FGF, assess their QOL before & after surgery and estimate factors associated with improved quality of life.
Methods: All women who came to LAMB for FGF repairin 2016 and 2017 were interviewed on admission and called for a follow-up visit 6 months after successful surgery. Sociodemographic, obstetric, and fistula-related information was collected on admission. Health related QOLwasmeasured using the 36-item short form (SF-36), and perception of stigma and discrimination were assessed on admission and at follow-up.
Results: A total of 72 women were included.Mean age was 40.1 years, 49% had no education, and 42% were in the poorest wealth quintile.The mean stigma score (out of 7)went from 3.79 to 1.40 post surgery (p<0.001) and the mean discrimination score (out of 5)went from 2.2 to 0.4 (p<0.001). The mean score for all eight of the general health categories increased significantly after surgery (p<0.01 to 0.001). Poor women started lower but showed evidence of greater improvement in health related QOL compared to richer women (p<0.05)) and some evidence of greater improvement in discrimination (p<0.1). Women with no education had a larger decreasein perceived stigma (p= 0.03) compared to the educated.
Conclusions:  Surgery for FGF improves quality of life, with poor women showing greater increase in health related QOL and uneducated women reporting a greater decrease in stigma.  Further multivariable analysis is needed to determine which factors remain associated with improved QOL.
Rehabilitation and reintegration of Fistula Clients through Micro credit linked services
Authors: Mohiddin Sheikh , Haque Fazlul , Huda Sk Nazmul
Published: June 2019

Objectives: To describe the process and performance of reintegration and rehabilitation of women with Fistula through microcredit linked services in north-western region in Bangladesh.
Introduction: Ad-din Social Financing for Community Health Development is a non profit microcredit system established in 1996. The program provides small capital and technical assistance for entrepreneurship development for its members, particularly women from underprivileged communities.
Methods: 56 paramedics linked with Ad-din microcredit system were provided training on fistula case identification, referral, reintegration and rehabilitation. The paramedics identified fistula clients and conducted customized need assessments for their reintegration and rehabilitation services. This included liveihood skills training, financial assistance for fistula clients or their family members and mobilization of local institutions.
Results: Out of 86 fistula clients identified by paramedics, 76 were in need of rehabilitation services and 12 were in need of reintegration support. Only three (4%) were covered by government safety net services. The program provided customized skill training to 43 fistula clients or family members. Three fistula clients were selected for food box drop at their place of residence.  
Conclusions: Customized need assessment of reintegration and rehabilitation of fistula clients is effective for sustainable result. The field resources of a micro credit system, which is present in many settings with a fistula burden, can efficiently provide rehabilitation services to fistula clients.
Baseline knowledge of female genital fistula symptoms, causes and treatment among a rural population in Northern Bangladesh
Authors: Saha Stacy , Ambauen-Berger Bea , Munira Shirajum
Published: June 2019

Aims: To provide baseline information among the general population on knowledge regarding female genital fistula (FGF) prior to media campaigns and diagnostic camps in 30 unions of 8 districts in Northern Bangladesh.
Introduction: The aim of the Bangladesh national strategy is to end fistula by 2030.  According to the Maternal Morbidity Validation Study approximately 19,755 women lived with obstetric fistula in 2016.  Poor understanding of FGF and how it is treated hinders case finding of those needing treatment.
Methods: The survey was conducted in Kurigram District.  Out of a total sample of 500, 380 (76%) were chosen from every 5th household of a randomly selected village on high land and 120 (24%) were all households of two river islands.
Results: The respondents were 83.4% female and 16.6% male.  The mean age was 36.2 years of age, ranging from 17 to 85; 58.6% had no formal education and 61% reported a family income of less than Tk 6000/ month.    Overall 12% of participants had heard of FGF (‘a condition with leaking of urine and/or feces’), 13% of those living on high land and 7.5% of those living on river islands (p<0.1).  98.2% of respondents could not name any cause of FGF; 90.6% could not name any symptom and only 7 (1.4%) knew that surgery is the only cure.
Conclusions: Knowledge of FGF is low among the public in rural Bangladesh, especially remote areas.  Campaigns to disseminate messages on FGF could contribute to case finding of affected women.
Fistula Prevention Awareness
Authors: Siddiqui Sajjad Ahmed
Published: June 2019

Aim: Genital tract fistula is a known tragedy in Pakistan. We know the causes of this tragedy and we also know the methods to eradicate this curse from the community. Despite the initiative from UNFPA, Islamic Development Bank and other concerned stake holders the government of Pakistan has failed to address the issue and an organized system is not developed to reduced maternal death rate and maternal morbidity in Pakistan. It’s a common practice to exploit the sad situation of victims of fistula and run ghost campaigns to eradicate genital tract fistula from the community.
Methods:In depth analysis on intersections of social inequities in health, polices in Pakistan. The review carried out on the available literature / reports around the theme of women health & rights responsiveness in health systems.  This analysis also includes the role and support of the donor agencies working on maternal health in Pakistan. 
Results: An overall unfairness prevailing in the healthcare system which is affecting women health resulting a very high maternal mortality ratio (MMR) maternal morbidity like fistula.  The health policy is a highly complex phenomenon needs a multi-disciplinary approach to develop public policy that aims to explain the interaction between institutions, interests and ideas in the policy process. Health policies must reflect the specific steps to address the issue of gender based discrimination.
Conclusion: The politics of fistula is serving people to become rich in vested interest group, its providing platform to governments to make their image in front of donor countries. It’s also providing opportunity to people working in donor agencies to get involve in corruption at the cost of poor patients of fistula. Prevention of fistula is ultimate goal to get rid of this morbidity need department of health for provision of basic health facilities specially availability of SBA BUT there is no such policy intervention to produce competent midwives local community level. The existing fistula cases are not treated at district level due to lack of skill of local gynecologists to repair the fistula at district level.
Randomized Controlled Trial: Prophylactic Autologous Fascia Sling for Women at Risk of Urethral Incontinence after Obstetric Fistula Repair
Authors: Pope Rachel , Browning Andrew , Chipungu Ennet , George Jeredine , Mariatu Tammimu , Wilkinson Jeffrey
Published: June 2019

Aims: To compare sling types as anti-incontinence procedure for women with obstetric fistulas at high-risk for residual incontinence.
Methods: This is a multiple-site randomized controlled trial comparing autologous fascia slings to pubococcygeal (PC) slings at time of fistula repair. Participants with a Goh type 3 or 4 vesico-vaginal fistula (urethral length <2.5 cm) with no prior repair were randomized to receive either a rectus fascia sling or a PC sling while undergoing fistula repair. Interviews were performed before surgery and at follow up including the Michigan incontinence symptom index (M-ISI) and the Incontinence quality of life tool (I-QOL). Safety analysis was performed after ten participants have been enrolled in each arm.
Results: Eleven participants randomized to a PC sling and ten to a rectus sling. There was one repair breakdown in the PC group and three in the rectus group. Pad weights trended lower in the rectus group. QOL and MISI scores improved significantly for both groups. The study was terminated at safety analysis due to the number of breakdowns and difficulty of follow-up at one site.
Conclusions: There was no superiority between slings. Randomization proved problematic given the vast heterogeneity between fistula injuries. When compared to slings placed after an initial VVF repair in the literature, continence rate with the prophylactic rectus fascia sling was improved. There is a need for an innovative prophylactic anti-incontinence technique that does not result in repair failure.
Doctor! Will I be dry? Factors determining recurrence after vesicovaginal fistula repair
Authors: Abdullah Aziz , Syed Sher Shah , Farooqui Nuzhat , Siddiqui Sajjad
Published: June 2019

Aims: To evaluate various prognostic factors which determine outcome after surgical repair of VVF.
Methods: A retrospective analysis of the record of 640 patients which underwent surgical repair of VVF during a period from Jan 2006 to June 2011. Multivariate analysis of the record was done using SPSS-19 software determining odds ratio with 95% confidence interval.
Results: 640 patients underwent surgical repair of VVF. Overall success rate was 87.2%. Multivariate analysis determined that recurrence of VVF was significantly related to multiplicity (5 fold recurrence risk), pre-operative size of VVF (3 fold risk), secondary repair (3 fold risk) and etiology of the fistula (2 fold risk). Interposition of flap and delayed reconstruction was related to successful surgical outcome. Age, parity, route of repair and location of fistula were not significant prognostic factors for recurrence.
Conclusions: Successful surgical repair of VVF require careful evaluation of various factors including number, size, previous attempts to surgical repair and etiology of VVF. One should opt for transabdominal route with delayed reconstruction and interposition of flap if above mentioned factors are present.
Enhancing primary health care providers’ capacity in screening and referral of women with fistula
Authors: Ndwiga Charity , Sripad Pooja , Odwe George , Warren Charlotte
Published: June 2019

Aims: To describe PHC providers’ perspectives on the intervention and differences between intervention and comparison districts in PHC providers’ fistula-related capacity.
Methods: At intervention endline, structured interviews were conducted across 50 PHCs in intervention (n=22) and comparison (n=28) districts with 100 providers on their knowledge of fistula screening, counseling and referral, perceived access barriers and experience implementing the intervention.
Results: More than a third of trained providers used the job aid to screen for OF, while 25% used the hotline at least once. Half thought the transportation voucher was the most important intervention component, while 70% selected community agents. Awareness of emergency obstetric care as a prevention strategy was significantly higher in intervention than comparison district (56% v. 16%; p <0.001).  A higher proportion of providers in intervention sites recognize and refer women with fistula symptoms (38% v. 26%).
Conclusions: Strengthening PHC provider capacity can improve screening and referral of fistula patients in marginalized areas, reducing barriers to repair.
Reasons for delay in seeking medical care among women with Obstetric anal sphincter injuries
Authors: Banya Francis , Lukabwe Henry
Published: June 2019

Aims: To determine the reasons for delay in seeking medical care for OASIS among attendees of the Fistula Camp.
Methods: A cross sectional study done at Kisiizi hospital during the EngenderHealth Fistula Care Plus camp in July 2018 involving a total of 10women who had OASIS were enrolled into the study. Information was obtained using a questionnaire and analysis was done using Microsoft excel.
Results: The average period of time a woman stays with OASIS before seeking medical care was 10 years. On average, women deliver two babies following OASIS before they seek medical care. OASIS was sustained mainly during 1st and 2nddeliveries (80%), and delivering in absence of a skilled birth attendant (70%). The lack of: support from the husband (60%); funds to seek medical care (60%);and knowledge about the condition (70%); painless tear after healing (50%) are reasons for the delays.
Conclusions: Reasons for the delay in seeking medical care after OASIS were lack of funds, knowledge and the awareness required to seek medical care. Recommendation is to strengthen the OASIS awareness programs in Southwestern Uganda.
Keywords: care, delay, OASIS
Using GOFER to Digitize Patient Records in Kathmandu Model Hospital
Authors: Pradhan Hema Kumari , Dangal Ganesh , Karki Aruna , Shrestha Ranjana , Bhattachan Kabin , Poudel Rekha , Bajracharya Nishma , Tiwari Kenusha , Cochran Seth , Michaelson Bryony
Published: June 2019

Aim: To collect and digitalize data of patients who underwent fistula repair at Kathmandu Model Hospital.
Methods: Operation Fistula built a digital version of Model Hospital’s Surgery Log, using a mobile data collection tool (Commcare). Researchers were trained on the data collection tool and provided with a tablet which hosted the application. Once data is collected, tableau dashboard will be built to visualize the collected data and to share key insights. Model Hospital then proceeded to input patient records, and provided Operation Fistula with key feedback to continue improving this process.
Results: The results of this process have been threefold: Facilitation of data collection, Creation of an accurate database, and Provision of clear insights with access to data visualization dashboards.
Conclusions: This study has shown the benefits of digitizing historical patient records using GOFER. By creating an online database, this has the potential to be used in future for academic research.
Female Genital Fistula Repair Performance of Ad-din Hospitals 2013-2018
Authors: Yesmin Nahid , Yesmin Farzana , Podder Sheela , Ghose Lucky
Published: June 2019

Aims: The aim of this paper is to document the female genital fistula repair services at Ad-din hospitals and to describe the etiology of fistula cases and care outcomes.
Methods: Data from fistula services provided by Ad-din Hospitals in Dhaka, Khulna and Jashore were regularly captured using an aggregated DHIS2 established by the Fistula Care Plus project since December 2013. In January 2017, the FC+ project introduced a Safe Surgery Tool Kit (SST) to capture and analyze individual client data.
Results: During the period of data collection, the Ad-din Hospitals have provided repair surgery to 259 clients including 134 female genital fistula cases, and 95 cases of complete perineal tear. Out of the fistula cases, 25% were iatrogenic. There is a trend of increasing iatrogenic fistula over this period. Over the data collection period, the closed and dry rate among fistula cases was 80%.
Conclusions: Ad-din hospitals are a major provider of fistula surgery to women suffering from fistula in Bangladesh. Ad-din institutions are linked with social financing and community health system. Ad-din community networks made significant contribution in case identification at field level, case referral and community based rehabilitation of fistula cases.
Human Resource Development for Prevention and Care of Fistula:Experience of University Fistula Center, BSMMU
Authors: Chowdhury Saleha Begum , Huda SkNazmul , Mahmud Sharmeen
Published: June 2019

Aims: The purpose of this presentation is to share the experience of doctors and nurses training on prevention and care of fistula at University Fistula Center (UFC), BSMMU.
Methods: From June 2016 to June 2018, UFC implemented training for doctors using a FIGO curriculum and for nurses using an EngenderHealth curriculum. The training and performance data have been captured using an aggregated DHIS2 database developed by the Fistula Care Plus (FC+) Project at EngenderHealth, FC+ Safe Surgery Toolkit, and regular narrative reports.
Results:  In this period, 11 surgeons were provided with basic and refresher training through four structured courses. Additionally, 16 nurses were provided training and refresher training on fistula nursing.
Conclusions: The multicenter approach for fistula training was found to be helpful in creating more opportunities for hands-on experience and developing partnerships for inter-institutional capacity sharing for fistula services.
Experience of Managing Ureterovaginal Fistulas following Obstetric and Gynecological Surgeries
Authors: Upadhyay Amit Mani , Kunwar Ashok , Shrestha Sanjesh , Pradhan Hema Kumari , Karki Aruna , Dangal Ganesh
Published: June 2019

Aims: Iatrogenic ureteric injuries leading to fistula are rare but devastating complications of obstetric and gynecological surgeries.The aim of the study is to review the demography of ureterovaginal fistula (UVF) and its surgical outcome in the starting phase of fistula surgery.
Methods: This is a retrospective review of 15 patients of ureterovaginal fistula who were referred to department of Obstetrics and Gynaecology of Kathmandu Model Hospital from Feb 2014 to Sept 2017. The study reviewed the demography, causes and surgical outcome of ureterovaginal fistula (UVF). Ten patients who had complete blind end at the distal ureter undergone Lich-Gregoir extravesicalur enteroneocystostomy.  In other 5 patients, guide wire was successfully negotiated beyond the fistula site, however retrograde double J stenting  could be done in only 4 patients.
Results: All the patients had distal ureteric injury close to vesicoureteric junction leading to ureterovaginal fistula. Among them, majority were due to post hysterectomy 60% (n=9) followed by obstetrics procedures (caesarean section) 40% (n=6). Fourteen patients (93%) had successful closure of the fistula with complete preservation of renal function till date. Retrograde double J stenting was possible in patients who were referred earlier within two weeks of the onset of injury.
Conclusions: In our short review, iatrogenic injury to the distal ureter during Obstetrics/Gynaecologic surgery was found to be the leading cause for the formation of ureterovaginal fistula. Endoscopic management with ureteric stents is still possible if the patients are referred earlier following primary surgery.
Doctors beyond the wall of the hospital: Reflections of Community Based Actions of University Fistula Center, BSMMU
Authors: Chowdhury Shuily , Chowdhury Saleha Begum , Alam Farhana
Published: June 2019

Aims: To describe the community-based interventions of University Fistula Center (UFC), Bangabandhu Sheikh Mujib Medical University (BSMMU) for prevention and care of female genital fistula.
Methods: Since January 2017, UFC implemented a range of field-based activities with local partners. This has been systematically documented using an aggregated DHIS2 database introduced by the Fistula Care Plus Project (FC+) as well as process narratives.
Results: During this period, UFC implemented 04 community based fistula diagnosis events. Through CFDES, we provided services to 180 women, confirmed diagnosis of fistula in 25 cases, and provided treatment, referral for repairing, counseling and rehabilitation services for them as appropriate. We provided orientation to 238 community level providers on fistula. Through the “School Girls for Fistula Free Bangladesh” we have reached 900 girls with fistula sessions and a roadmap for fistula-free communities led by adolescent girls.
Conclusions: Beyond the wall of the hospital, doctors and nurses mobilized by the UFC made a significant contribution at community level to end fistula in Bangladesh by 2030.
Keywords: community, doctors beyond the wall, university fistula center
An experience of abdominal repair of high genitourinary fistulae
Authors: Shafqat Tanveer
Published: June 2019

Aims: We aim to present our experience of repair of genitourinary fistulae by abdominal approach with special emphases on repairs of high fistula.
Methods: This study includes all the patients from January 2016 to December 2017 who underwent abdominal repair of VVF. The patient who had vaginal repair of VVF were excluded.
Results: Forty cases were included in the study. Mean age was ( 20-50) 34.8 years with parity ranging from 2-8, Out of 40 cases 13( 32.5 %) were vesico cervical, 5(12.5%) were vesico uterine and 22 (55.00%) were vault fistula. So these all were high fistula involving uterus, cervix and vault, resulting after caesarean section, caesarean hysterectomy and Gynecological hysterectomy. All had abdominal repair which was successful in 39 cases giving success rate of (97.5%).
Conclusions: An abdominal approach seems to give superior results especially for high fistulae.
Iatrogenic Genitourinary Fistula: Changing Trends
Authors: Pradhan T , Agrawal A , Regmi MC
Published: June 2019

Aims: To study the frequency of iatrogenic cause amongst the surgery done for genitourinary fistula and to study the type and cause of iatrogenic genitourinary fistula.
Methods: This is a 5 year retrospective study analyses 73 iatrogenic fistulas from 217 women undergoing surgery for genitourinary fistula repair from year 2013 to 2018 on going. The analysis considers frequency and characteristics of type of fistula.
Results: Out of 217 genitourinary fistula 73(33.6%) were iatrogenic. Vaginal vault fistulas were 54.7% followed by ureteric fistula 32.8%, vesicovaginal fistula 10.9% and there were 2 iatrogenic RVF. The frequency of surgeries for iatrogenic fistula were found to be in increasing trend towards current years and 83.5% of the iatrogenic fistula were found with history of hysterectomy followed by emergency caesarean section 16.4%. 
Conclusions: Women undergoing hysterectomy were under risk for iatrogenic fistula. Optimum work environment is important to reduce surgical error during procedures. Operating training should be emphasized on optimal surgical skills, decision making.
Role of a community clinic for Prevention of Female Genital Fistula
Authors: Karmakar Anirudha , Huda Sk Nazmul
Published: June 2019

Aims: To describe how a community clinic in Bangladesh playing role in prevention of female genital fistula in remote villages in Bangladesh.
Methods: Fistula service related program data and records of a community clinic during January 2018 to September 2018 have been used to prepare this report.
Results: Mobilizing the Community Clinic Group and Community Clinic Support Groups, a community clinic centered plan of action for prevention and care of fistula was prepared. Universal coverage of obstructed labor was achieved during this period through mobilizing the community clinic support groups. There was no case of early marriage in the coverage area during this time. Debipur community clinic facilitated the “School Girls for Fistula Free Bangladesh program” in the villages.
Conclusions: Community Clinics in Bangladesh may play a major role in prevention of early marriage, promotion of safe motherhood and prevention of female genital fistula in villages. Community clinic centered social mobilization engaging school girls would help in ending fistula in remote communities.
Assessment of the aetiology and outcome of fistulae cases (VVF RVF) operated at Shaikh Zaid woman hospital Larkana
Authors: Baloch Rafia , Shaik Shazia , Chandio Fouzia , Qazi Marvi Nisar
Published: June 2019

Aims: To study etiology of fistula in patient at Shaikh Zaid Women hospital Larkana.
Methods: A cross-sectional Survey was conducted at Gynecology and obstetrics wards of Shaikh Zaid Women hospital Larkana. All patients were admitted in outpatient departments along with emergency department were the part of the study. Sample was collected by universal sample technique. Total sample size was of 49 patients. Detailed history regarding fistula formation and its etiology and duration, examination and related investigation carried out in each and every patient. Young and elderly patients both were included.
Results: 49 patients were selected, who were admitted and registered at the gynecological and obstetrics wards of Shaikh Zaid Women hospital, out of which 38 patients were found having urinary fistula from which 28 patients were having fistula due to obstetric causes while 10 pts were having fistula due to iatrogenic causes. Moreover, 11 patients were having fecal fistula from them 7 were again due to obstetric causes, 1 patient was having congenital fistula and remaining 3 patients were found having fistulas due to malignancy.
Conclusions: Obstetrics fistula is still most common cause of fistula followed by iatrogenic cause.  Urinary fistula is more common than fecal fistula.
The medical and psychological morbidity of patients with urogenital fistulae
Authors: Srichand Pushpa
Published: June 2019

Aims: To analyze the frequency of medical and psychological morbidity of patients with urogenital fistulae. There are many complications related to childbirth and gynaecological surgeries. Urogenital fistula is one of the worst complications. The women suffer from significant medical and psychological morbidity. These issues need to be addressed at every forum.
Methods:  A descriptive study was carried out at Liaquat University Hospital and Isra University Hospital Hyderabad Pakistan from 01/06/2007 to 30/06/2018.  520 patients with urogenital fistulae were managed. A pre-designed performa was used to record the details about medical and psycho-social consequences. Data was analyzed, results were described as frequency and percentage.
Results:  During the study period 520 confirmed cases of urinary fistulae were managed. Regarding psychological health all (100%) patients had major degree depression. 511 (98%) patients were found socially isolated. 458 (88%) patients were malnourished. 338 (65%) had severe excoriation of vulva, bladder and vaginal calculi were present 25 (4.8%) patients. Majority of the patients were suffered  social, verbal and physical abuse.
Conclusions: Patients with urogenital fistulae are not only having the surgical morbidity but they do suffer significant medical and social morbidity. There is a definite need to address these under looked miseries by a devoted fistulae team work in collaboration with social workers, religious leaders and healthcare providers to bring life back to these patients.
Childbirth injuries encountered on outreach in remote RDCongo
Authors: Lussy Justin Paluku , Kitambala Esther Kahambu , Mukekulu Eugénie Kamabu
Published: June 2019

Aims: This paper describes childbirth injuries encountered in remote DR Congo. Causes of identified injuries and their surgical repair outcomes are outlined.
Methods: Through community awareness activities, patients with urinary or fecal incontinence were mobilized to report for care. Records from patients examined during outreach surgical camps in the Nord-Ubangi province from January to June 2018 were reviewed.
Results: A total of 151 patients, ages 16-72 years, were attended for urinary and/or fecal incontinence after childbirth. Among 105patients who reported with urinary incontinence, 103 had vesico-vaginal fistulae that were classified as type I or type II (77 (77/103, 74.8%) patients) and type III of Waaldjik (26 (25.2%) patients). Two patients had urinary incontinence secondary to a small bladder.Among 46 patients who came complaining of fecal incontinence, 15 (15/46, 32.6%) patients had recto-vaginal fistulae while 31 (31/46, 67.4%) patients had third or fourth degree perineal tears.
Vaginal delivery (79.2%), caesarean section (16.1%) and hysterectomy (4.7%) caused observed injuries.84.2% of the urinary incontinence group and 86.7% of the fecal incontinence group were dry and continent after repair.
Conclusions: Genito-urinary fistulae were predominant among childbirth injuries encountered in remote DRCongo. Vaginal delivery was the leading cause of childbirth injuries. Surgical repair success rates were high.
Genito urinary fistula: a series of 1704 cases
Authors: Nawaz Haq
Published: June 2019

Aims: To review our experience in causes, diagnosis and basic principles of surgical treatment of urogenital fistulas.
Methods: A retrospective study of 1704 patients with different types of urogenital fistulas were reviewed between October 1995 to October 2018. They were analyzed with regard to age, parity, casual factor, mode of treatment and outcome. Patients were also evaluated at two or three weeks initially, three monthly and later depending upon symptoms.
Results: We reviewed our series of female urogenital fistulas that have been treated over a 22 years period. Out of these 1704 cases 864 (62.44%) were Vesico vaginal fistulas, 432 (25.35%) were Urethro vaginal fistulas and 188 (12.2%) were Uretero vaginal. Majority of the patients were young in child bearing age between 16 and 30 years of age, although age range was wide i.e., 11 to 50 years. The most common cause of urogenital fistulas were Obstetrical trauma due to obstructed labor in 400(37.59%) & Gynecological (hysterectomy 180(18.79%) & caesarian section in 72 (6.77%). Patients of Uretero vaginal fistulas were mainly due to unrecognized ureteral injuries during Gynecological procedures (hysterectomy in 136 cases & caesarian section in 10 cases. For repair of vesico vaginal fistulas Transvaginal route for repair was used in 424(39.84%) patients, while Thans abdominal route for repair was used in 560 (52.63%) patients. There were 32 (12.03%) failures in Vesico vaginal fistulas with a success rate of 88%. Mean Hospital stay was 15+ 3.5 days (range 4-30 days) and a mean follow-up of 8+ 3.2 months (range 4 months to 2 years).
Conclusions: Management of Urogenital fistulas are among the most distressing complications of obstetric and gynecologic procedures. The patients suffer physically, emotionally and socially. The lack of skilled supervision and adequate obstetric emergency facilities are to blame.
What is happening with Obstetric Fistula in the West of Nepal?
Authors: Heywood Shirley
Published: June 2019

Aims: Analyzing the changes in the characteristics of patients presenting with fistula in Surkhet. The impact of births after the development of fistula on the grade of fistula and outcome is examined.
Methods: This study examines the records of 282 fistula patients identified in Surkhet between 2009 and 2018.
Results: There has been reduction in number of women presenting with the most complex vesico-vaginal fistulae and reduction in average number of years women have lived with obstetric fistula before treatment. More women present within one year of injury and better outcome is seen in those with more recent injury. A moderate increase in patients presenting with iatrogenic fistula is seen, (2011 obstetric fistula 77%, iatrogenic 6%, 2018 obstetric fistula 68.5%, iatrogenic 17%).
Conclusions: The findings suggest that easier access to maternity care and better fistula awareness is reducing the occurrence of the most severe injuries and improving outcomes.