12 research outputs found
Assessing the quality of record keeping for cesarean deliveries: results from a multicenter retrospective record review in five low-income countries
BACKGROUND: Reliable, timely information is the foundation of decision making for functioning health systems; the quality of decision making rests on quality data. Routine monitoring, reporting, and review of cesarean section (CS) indications, decision-to-delivery intervals, and partograph use are important elements of quality improvement for maternity services. METHODS: In 2009 and 2010, a sample of CS records from calendar year 2008 was reviewed at nine facilities in Bangladesh, Guinea, Mali, Niger, and Uganda. Data from patient records and hospital registers were collected on key aspects of care such as timing of key events, indications, partograph use, maternal and fetal outcomes. Qualitative interviews were conducted with key informants at all study sites to provide contextual background about CS services and record keeping practices. RESULTS: A total of 2,941 records were reviewed and 57 key informant interviews were conducted. Patient record-keeping systems were of varying quality across study sites: at five sites, more than 20% of records could not be located. Across all sites, patient files were missing key aspects of CS care: timing of key events (e.g., examination, decision to perform CS), administration of prophylactic antibiotics, maternal complications, and maternal and fetal outcomes. Rates of partograph use were low at six sites: 0 to 23.9% of patient files at these sites had a completed partograph on file, and among those found, 2.1% to 65.1% were completed correctly. Information on fetal outcomes was missing in up to 40% of patient files. CONCLUSIONS: Deficits in the quality of CS patient records across a broad range of health facilities in low-resource settings in four sub-Saharan Africa countries and Bangladesh indicate an urgent need to improve record keeping
Current practices in treatment of female genital fistula: a cross sectional study
Abstract Background Maternal outcomes in most countries of the developed world are good. However, in many developing/resource-poor countries, maternal outcomes are bleaker: Every year, more than 500,000 women die in childbirth, mostly in resource-poor countries. Those who survive often suffer from severe and long-term morbidities. One of the most devastating injuries is obstetric fistula, occurring most often in south Asia and sub-Saharan Africa. Fistula treatment and care are available in many countries across Africa and Asia, but there is a lack of reliable data around clinical factors associated with the success of fistula repair surgery. Most published research has been retrospective. While these studies have provided useful information about the care and treatment of fistula, they are limited by the design. This study was designed to identify practices in care that could lead to the design of prospective and randomized controlled trials. Methods Self-administered questionnaires were completed by 40 surgeons known to provide fistula treatment services in Africa and Asia at private and government hospitals. The questionnaire was divided into three parts to address the following issues: prophylactic use of antibiotics before, during, and after fistula surgery; urethral catheter management; and management practices for patients with urinary incontinence following fistula repair. Results The results provide a glimpse into current practices in fistula treatment and care across a wide swath of geographic, economic, and organizational considerations. There is consensus in treatment in some areas (routine use of prophylactic antibiotics, limited bed rest until the catheter is removed, nonsurgical treatment for postsurgical incontinence), while there are wide variations in practice in other areas (duration of catheter use, surgical treatments for postsurgical incontinence). These findings are based on a small sample and do not allow for recommending changes in clinical care, but they point to issues for possible clinical trial research that would contribute to more efficient and effective fistula care. Conclusions The findings from the survey allowed us to consider clinical practices most influential in the cost, efficacy, and safety of fistula treatment. These considerations led us to formulate recommendations for eight randomized controlled trials on the following subjects: 1) Efficacy/safety of short-term catheterization; 2) efficacy of surgical and nonsurgical therapies for urinary incontinence; 3) technical measures during fistula repair to reduce the incidence of post-surgery incontinence; 4) identification of predictive factors for "incurable fistula"; 5) usefulness of urodynamic studies in the management of urinary incontinence; 6) incidence and significance of multi-drug resistant bacteria in the fistula population; 7) primary management of small, new fistulas by catheter drainage; and 8) antibiotic prophylaxis in fistula repair.</p
Good clinical outcomes from a 7-year holistic programme of fistula repair in Guinea
Objectives. Female genital fistula remains a public health concern in developing countries. From January 2007 to September 2013, the Fistula Care project, managed by EngenderHealth in partnership with the Ministry of Health and supported by USAID, integrated fistula repair services in the maternity wards of general hospitals in Guinea. The objective of this article was to present and discuss the clinical outcomes of 7 years of work involving 2116 women repaired in three hospitals across the country. Methods. This was a retrospective cohort study using data abstracted from medical records for fistula repairs conducted from 2007 to 2013. The study data were reviewed during the period April to August 2014. Results. The majority of the 2116 women who underwent surgical repair had vesicovaginal fistula (n = 2045, 97%) and 3% had rectovaginal fistula or a combination of both. Overall 1748 (83%) had a closed fistula and were continent of urine immediately after surgery. At discharge, 1795 women (85%) had a closed fistula and 1680 (79%) were dry, meaning they no longer leaked urine and/or faeces. One hundred and fifteen (5%) remained with residual incontinence despite fistula closure. Follow-up at 3 months was completed by 1663 (79%) women of whom 1405 (84.5%) had their fistula closed and 80% were continent. Twenty-one per cent were lost to follow-up. Conclusion. Routine programmatic repair for obstetric fistula in low resources settings can yield good outcomes. However, more efforts are needed to address loss to follow-up, sustain the results and prevent the occurrence and/or recurrence of fistula. Objectifs. La fistule gĂ©nitale fĂ©minine reste un problème de santĂ© publique dans les pays en dĂ©veloppement. De janvier 2007 Ă septembre 2013, le projet Fistula Care, gĂ©rĂ© par Engender Health en partenariat avec le Ministère de la SantĂ© et soutenu par l’USAID, a intĂ©grĂ© les services de rĂ©paration de fistules dans les maternitĂ©s des hĂ´pitaux gĂ©nĂ©raux en GuinĂ©e. L'objectif de cet article est de prĂ©senter et de discuter les rĂ©sultats cliniques de sept annĂ©es de travail impliquant 2116 femmes traitĂ©es dans trois hĂ´pitaux Ă travers le pays. MĂ©thodes. Il s'agit d'une Ă©tude de cohorte rĂ©trospective utilisant des donnĂ©es extraites des dossiers mĂ©dicaux de rĂ©parations de fistules menĂ©es de 2007 Ă 2013. Les donnĂ©es de l’étude ont Ă©tĂ© analysĂ©es au cours de la pĂ©riode allant d'avril Ă aoĂ»t 2014. RĂ©sultats. La majoritĂ© des 2116 femmes qui ont subi une rĂ©paration chirurgicale avaient une fistule vĂ©sico vaginale (n = 2 045, 97%) et 3% avaient une fistule recto vaginale ou une combinaison des deux. Au total, 1748 (83%) femmes ont eu leur fistule refermĂ©e et sont devenues continentes d'urine immĂ©diatement après la chirurgie. Ă€ la sortie, 1795 femmes (85%) avaient une fistule fermĂ©e et 1680 (79%) Ă©taient sèches, c'est Ă dire qu'elles n'avaient plus de fuite d'urine et/ou de matières fĂ©cales. 115 (5%) femmes avaient toujours une incontinence rĂ©siduelle malgrĂ© la fermeture de la fistule. Le suivi Ă trois mois a Ă©tĂ© complĂ©tĂ© par 1663 (79%) femmes dont 1405 (84,5%) ont eu leur fistule fermĂ©e et 80% Ă©taient continentes. 21% ont Ă©tĂ© perdues au suivi. Conclusion. La rĂ©paration programmatique de routine de la fistule obstĂ©tricale dans les rĂ©gions Ă faibles ressources peut donner de bons rĂ©sultats. Toutefois, davantage d'efforts sont nĂ©cessaires pour remĂ©dier Ă la perte au suivi, maintenir les rĂ©sultats et prĂ©venir l'apparition et/ou la rĂ©apparition de fistules. Objetivos. La fĂstula genital femenina continĂşa siendo una preocupaciĂłn de salud pĂşblica en paĂses en vĂas de desarrollo. Entre Enero 2007 y Septiembre 2013, el proyecto Fistula Care, manejado por EngenderHealth junto con el Ministerio de Salud de Guinea, y financiado por USAID, integrĂł los servicios de reparaciĂłn de fistula en las maternidades de hospitales generales en Guinea. El objetivo de este artĂculo es presentar y discutir los resultados clĂnicos de 7 años de trabajo con 2116 mujeres intervenidas en tres hospitales del paĂs. MĂ©todos. Estudio retrospectivo de cohortes utilizando datos tomados de historias clĂnicas de reparaciones de fĂstula realizadas entre el 2007 y el 2013. Los datos del estudio se revisaron durante el periodo entre Abril y Agosto 2014. Resultados. La mayorĂa de las 2116 mujeres que se sometieron a la reparaciĂłn quirĂşrgica tenĂan una fistula vesico-vaginal (n = 2045, 97%) y 3% tenĂan una fĂstula recto-vaginal o una combinaciĂłn de ambas. En general, 1748 (83%) tenĂan la fĂstula cerrada y eran continentes inmediatamente despuĂ©s de la cirugĂa. En el momento del alta, 1795 mujeres (85%) tenĂan la fistula cerrada y 1680 (79%) estaban secas, es decir que ya no perdĂan orina y/o heces. 115 (5%) continuaron teniendo incontinencia residual a pesar de que la fistula estaba cerrada. El seguimiento a los tres meses se completĂł para 1663 (79%) mujeres, de las cuales 1405 (84.5%) tenĂan la fistula cerrada y 80% eran continentes. Un 21% fueron perdidas durante el seguimiento. ConclusiĂłn. La reparaciĂłn rutinaria programada de la fĂstula obstĂ©trica en lugares con pocos recursos puede dar buenos resultados. Sin embargo, se requieren más esfuerzos para resolver la pĂ©rdida durante el seguimiento, mantener los resultados y prevenir la apariciĂłn y/o reapariciĂłn de la fĂstula
Fistula and Traumatic Genital Injury from Sexual Violence in a Conflict Setting in Eastern Congo: Case Studies
Factors influencing urinary fistula repair outcomes in developing countries: a systematic review
Non-inferiority of short-term urethral catheterization following fistula repair surgery: study protocol for a randomized controlled trial
<p>Abstract</p> <p>Background</p> <p>A vaginal fistula is a devastating condition, affecting an estimated 2 million girls and women across Africa and Asia. There are numerous challenges associated with providing fistula repair services in developing countries, including limited availability of operating rooms, equipment, surgeons with specialized skills, and funding from local or international donors to support surgeries and subsequent post-operative care. Finding ways of providing services in a more efficient and cost-effective manner, without compromising surgical outcomes and the overall health of the patient, is paramount. Shortening the duration of urethral catheterization following fistula repair surgery would increase treatment capacity, lower costs of services, and potentially lower risk of healthcare-associated infections among fistula patients. There is a lack of empirical evidence supporting any particular length of time for urethral catheterization following fistula repair surgery. This study will examine whether short-term (7 day) urethral catheterization is not worse by more than a minimal relevant difference to longer-term (14 day) urethral catheterization in terms of incidence of fistula repair breakdown among women with simple fistula presenting at study sites for fistula repair service.</p> <p>Methods/Design</p> <p>This study is a facility-based, multicenter, non-inferiority randomized controlled trial (RCT) comparing the new proposed short-term (7 day) urethral catheterization to longer-term (14 day) urethral catheterization in terms of predicting fistula repair breakdown. The primary outcome is fistula repair breakdown up to three months following fistula repair surgery as assessed by a urinary dye test. Secondary outcomes will include repair breakdown one week following catheter removal, intermittent catheterization due to urinary retention and the occurrence of septic or febrile episodes, prolonged hospitalization for medical reasons, catheter blockage, and self-reported residual incontinence. This trial will be conducted among 512 women with simple fistula presenting at 8 study sites for fistula repair surgery over the course of 24 months at each site.</p> <p>Discussion</p> <p>If no major safety issues are identified, the data from this trial may facilitate adoption of short-term urethral catheterization following repair of simple fistula in sub-Saharan Africa and Asia.</p> <p>Trial registration</p> <p>ClinicalTrials.gov Identifier <a href="http://www.clinicaltrials.gov/ct2/show/NCT01428830">NCT01428830</a>.</p