29 research outputs found

    Perceived Causes of Obstetric Fistula and Predictors of Treatment Seeking among Ugandan Women: Insights from Qualitative Research

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    Many obstetric fistula patients remain untreated or present late to treatment despite increasing surgical availability in Uganda. We explored women‘s perceptions of the cause of their obstetric fistula and their treatment seeking behaviours, including barriers and facilitators to timely care access. In-depth interviews and focus group discussions were conducted from June–August 2014 among 33 women treated for obstetric fistula at Mulago Hospital, Kampala. Data were analysed to describe dimensions and commonalities of themes identified under perceived causes and treatment seeking experiences, and their intersection. Perceived obstetric fistula causes included delays in deciding on hospital delivery, lengthy labour, injury caused by the baby, health worker incompetence, and traditional beliefs. Treatment seeking timing varied. Early treatment seeking was facilitated by awareness of treatment availability through referral, the media, community members, and support by partners and children. Barriers to early treatment seeking included inadequate financial and social support, erroneous perceptions about fistula causes and curability, incorrect diagnoses, and delayed or lack of care at health facilities. Our study supports broad educational and awareness activities, facilitation of social and financial support for accessing care, and improving the quality of emergency obstetric care and fistula treatment surgical capacity to reduce women‘s suffering. Keywords: Obstetric fistula, perceived causes, treatment seeking, maternal morbidity, UgandaDe nombreux patients atteints de fistule obstĂ©tricale restent non traitĂ©s ou se prĂ©sentent tardivement au traitement malgrĂ© une disponibilitĂ© chirurgicale croissante en Ouganda. Nous avons explorĂ© la perception qu'ont les femmes de la cause de leur fistule obstĂ©tricale et de leurs comportements de recherche de traitement, y compris les obstacles et les facilitateurs pour un accĂšs rapide aux soins. Des entretiens approfondis et des discussions de groupe ont Ă©tĂ© menĂ©s de juin Ă  aoĂ»t 2014 auprĂšs de 33 femmes traitĂ©es pour fistule obstĂ©tricale Ă  l'hĂŽpital de Mulago, Kampala. Les donnĂ©es ont Ă©tĂ© analysĂ©es pour dĂ©crire les dimensions et les points communs des thĂšmes identifiĂ©s sous les causes perçues et les expĂ©riences de recherche de traitement, et leur intersection. Les causes perçues de la fistule obstĂ©tricale comprenaient des retards dans les dĂ©cisions d'accouchement Ă  l'hĂŽpital, un travail prolongĂ©, des blessures causĂ©es par le bĂ©bĂ©, l'incompĂ©tence des agents de santĂ© et les croyances traditionnelles. Le calendrier de recherche du traitement variait. La recherche prĂ©coce d'un traitement a Ă©tĂ© facilitĂ©e par la sensibilisation Ă  la disponibilitĂ© du traitement grĂące Ă  l'aiguillage, aux mĂ©dias, aux membres de la communautĂ© et au soutien des partenaires et des enfants. Les obstacles Ă  la recherche d'un traitement prĂ©coce comprenaient un soutien financier et social inadĂ©quat, des perceptions erronĂ©es sur les causes et la curabilitĂ© des fistules, des diagnostics incorrects et un retard ou un manque de soins dans les Ă©tablissements de santĂ©. Notre Ă©tude soutient de vastes activitĂ©s d'Ă©ducation et de sensibilisation, la facilitation du soutien social et financier pour l'accĂšs aux soins et l'amĂ©lioration de la qualitĂ© des soins obstĂ©tricaux d'urgence et du traitement chirurgical de la fistule pour rĂ©duire la souffrance des femmes.  Mots-clĂ©s: Fistule obstĂ©tricale, causes perçues, recherche de traitement, morbiditĂ© maternelle, Ougand

    “...Our support is not enough”: a qualitative analysis of recommendations from informal caregivers of women with female genital fistula in Uganda

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    Informal caregivers remain critical across the care continuum for complex and stigmatized conditions including female genital fistula, particularly in lower-resource settings burdened by underfunded health systems and workforce shortages. These caregivers often provide significant nonmedical support in both community and facility settings, without pay. Despite their unique insight into the lived experiences of their patients, few studies center the perspectives of informal caregivers. We asked informal caregivers of women seeking surgical treatment of fistula in Kampala Uganda for their ideas about what would improve the recovery and reintegration experiences of their patients. Economic empowerment and community capacity building emerged as primary themes among their responses, and they perceived opportunities for clinical medicine and global health to strengthen strategies for fistula prevention through reintegration. Informal caregivers urged simultaneous investment in women's economic status and community capacity to build fistula-related awareness, knowledge, and skills to improve inclusion of both fistula patients and their informal caregivers

    Identifying Opportunities for Prevention of Adverse Outcomes Following Female Genital Fistula Repair: Protocol for a Mixed-Methods Study in Uganda

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    BACKGROUND: Female genital fistula is a traumatic debilitating injury, frequently caused by prolonged obstructed labor, affecting between 500,000-2 million women in lower-resource settings. Vesicovaginal fistula causes urinary incontinence, and other morbidity may occur during fistula development. Women with fistula are stigmatized, limit social and economic engagement, and experience psychiatric morbidity. Improved surgical access has reduced fistula consequences yet post-repair risks impacting quality of life and well-being include fistula repair breakdown or recurrence and ongoing or changing urine leakage or incontinence. Limited evidence on risk factors contributing to adverse outcomes hinders interventions to mitigate adverse events. This study aims to quantify these adverse risks and inform clinical and counseling interventions to optimize women\u27s health and quality of life following fistula repair through: identifying predictors and characteristics of post-repair fistula breakdown and recurrence (Objective 1) and post-repair incontinence (Objective 2), and to identify feasible and acceptable intervention strategies (Objective 3). METHODS: This mixed-methods study incorporates a prospective cohort of women with successful vesicovaginal fistula repair at approximately 12 fistula repair centers in Uganda (Objectives 1-2) followed by qualitative inquiry among key stakeholders (Objective 3). Cohort participants will have a baseline visit at the time of surgery followed by data collection at 2 weeks, 6 weeks, 3 months and quarterly thereafter for 3 years. Primary predictors to be evaluated include patient-related factors, fistula-related factors, fistula repair-related factors, and post-repair behaviors and exposures, collected via structured questionnaire at all data collection points. Clinical exams will be conducted at baseline, 2 weeks post-surgery, and for outcome confirmation at symptom development. Primary outcomes are fistula repair breakdown or fistula recurrence and post-repair incontinence. In-depth interviews will be conducted with cohort participants (n ~ 40) and other key stakeholders (~ 40 including family, peers, community members and clinical/social service providers) to inform feasibility and acceptability of recommendations. DISCUSSION: Participant recruitment is underway. This study is expected to identify key predictors that can directly improve fistula repair and post-repair programs and women\u27s outcomes, optimizing health and quality of life. Furthermore, our study will create a comprehensive longitudinal dataset capable of supporting broad inquiry into post-fistula repair health. Trial Registration ClinicalTrials.gov Identifier: NCT05437939
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