TY - JOUR
T1 - Rare causes of genital fistula in nine African countries
T2 - a retrospective review
AU - Ngongo, Carrie J.
AU - Raassen, Thomas J.I.P.
AU - Mahendeka, Marietta
AU - Lombard, Ladeisha
AU - van Roosmalen, Jos
AU - Temmerman, Marleen
N1 - Funding Information:
Fistula repairs for the women included in this series were made possible from the generous support of Amref Health Africa, EngenderHealth, the Fistula Foundation, the Freedom from Fistula Foundation, Gesellschaft für Technische Zusammenarbeit (GTZ; now GIZ), Johnson & Johnson, the Royal Netherlands Embassy of Tanzania, SOS East Africa, United Nations Population Fund (UNFPA), and Women and Health Alliance International (WAHA). The United States Agency for International Development (USAID), through EngenderHealth’s Fistula Care project, funded part of the data entry. We thank Millicent Oundo for data entry support. RTI International supported Carrie Ngongo to finalize this work through a professional development award. The Fistula Foundation and the International Federation of Gynecology and Obstetrics paid the journal's article processing charge for open-access publication. We appreciate the specialists and staff in the hospitals, who operated on the women and managed them during their hospital stays. Last but not least, we thank the women. This analysis would not have been possible without their willingness to share their unforgettable stories.
Funding Information:
Fistula repairs for the women included in this series were made possible from the generous support of Amref Health Africa, EngenderHealth, the Fistula Foundation, the Freedom from Fistula Foundation, Gesellschaft für Technische Zusammenarbeit (GTZ; now GIZ), Johnson & Johnson, the Royal Netherlands Embassy of Tanzania, SOS East Africa, United Nations Population Fund (UNFPA), and Women and Health Alliance International (WAHA). The United States Agency for International Development (USAID), through EngenderHealth’s Fistula Care project, funded part of the data entry. We thank Millicent Oundo for data entry support. RTI International supported Carrie Ngongo to finalize this work through a professional development award. The Fistula Foundation and the International Federation of Gynecology and Obstetrics paid the journal's article processing charge for open-access publication. We appreciate the specialists and staff in the hospitals, who operated on the women and managed them during their hospital stays. Last but not least, we thank the women. This analysis would not have been possible without their willingness to share their unforgettable stories.
Publisher Copyright:
© 2022, The Author(s).
PY - 2022/12
Y1 - 2022/12
N2 - Background: Most genital fistulas result from prolonged, obstructed labor or surgical complications. Other causes include trauma (from accidents, traditional healers, or sexual violence), radiation, carcinoma, infection, unsafe abortion, and congenital malformation. Methods: This retrospective records review focuses on rare fistula causes among 6,787 women who developed fistula after 1980 and sought treatment between 1994 and 2017 in Tanzania, Uganda, Kenya, Malawi, Zambia, Rwanda, Ethiopia, Somalia, and South Sudan. We compare fistula etiologies across countries and assess associations between rare causes and type of incontinence (urine, feces, or both). Results: Rare fistula accounted for 1.12% (76/6,787) of all fistulas, including traumatic accidents (19/6,787, 0.28%), traumatic sexual violence (15/6,787, 0.22%), traumatic injuries caused by traditional healers (13/6,787, 0.19%), unsafe abortion (10/6,791, 0.15%), radiation (8/6,787, 0.12%), complications of HIV infection (6/6,787, 0.09%), and congenital abnormality (5/6,787, 0.07%). Trauma caused by traditional healers was a particular problem among Somali women. Conclusion: Fistulas attributable to rare causes illuminate a variety of risks confronting women. Fistula repair training materials should distinguish trauma caused by traditional healers as a distinct fistula etiology. Diverse causes of fistula call for multi-pronged strategies to reduce fistula incidence.
AB - Background: Most genital fistulas result from prolonged, obstructed labor or surgical complications. Other causes include trauma (from accidents, traditional healers, or sexual violence), radiation, carcinoma, infection, unsafe abortion, and congenital malformation. Methods: This retrospective records review focuses on rare fistula causes among 6,787 women who developed fistula after 1980 and sought treatment between 1994 and 2017 in Tanzania, Uganda, Kenya, Malawi, Zambia, Rwanda, Ethiopia, Somalia, and South Sudan. We compare fistula etiologies across countries and assess associations between rare causes and type of incontinence (urine, feces, or both). Results: Rare fistula accounted for 1.12% (76/6,787) of all fistulas, including traumatic accidents (19/6,787, 0.28%), traumatic sexual violence (15/6,787, 0.22%), traumatic injuries caused by traditional healers (13/6,787, 0.19%), unsafe abortion (10/6,791, 0.15%), radiation (8/6,787, 0.12%), complications of HIV infection (6/6,787, 0.09%), and congenital abnormality (5/6,787, 0.07%). Trauma caused by traditional healers was a particular problem among Somali women. Conclusion: Fistulas attributable to rare causes illuminate a variety of risks confronting women. Fistula repair training materials should distinguish trauma caused by traditional healers as a distinct fistula etiology. Diverse causes of fistula call for multi-pronged strategies to reduce fistula incidence.
KW - Fistula
KW - Injury
KW - Traditional healer
KW - Trauma
UR - http://www.scopus.com/inward/record.url?scp=85143442992&partnerID=8YFLogxK
U2 - 10.1186/s12905-022-02050-z
DO - 10.1186/s12905-022-02050-z
M3 - Article
C2 - 36474228
AN - SCOPUS:85143442992
SN - 1472-6874
VL - 22
JO - BMC Women's Health
JF - BMC Women's Health
IS - 1
M1 - 497
ER -
