Obstetric Fistula “Disease” and Ensuing Care: Patients’ Views in West-Africa

Nathalie Maulet, Abdramane Berthé, Salamatou Traoré, Jean Macq


We explored obstetric fistula patients’ real-life experience of care in modern Health System. Our aim was to analyze how these women’s views impacted their care uptake and coping. We conducted 67 in-depth interviews with 35 fistula patients or former patients in 5 fistula repair centers within referral hospitals in Mali and Niger. Perceptions of obstetric fistula influenced the care experience and vice versa. Obstetric fistula was viewed as a severe chronic disease due to length of care process, limitation of surgery and persisting physical and moral suffering. We highlight the opportunity to build on patients’ views on obstetric fistula trauma and care in order to implement an effective holistic care process. (Afr J Reprod Health 2015; 19[1]: 112-123).

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Arrowsmith S, Hamlin EC, Wall LL. Obstructed labor injury complex: obstetric fistula formation and the multifaceted morbidity of maternal birth trauma in the developing world. Obstet Gynecol Surv 1996; 51(9):568-574. 2. Wall L.L., Arrowsmith S.D., Briggs N.D., Browning A., Lassey A. The obstetric vesicovaginal fistula in the developing world. Obstet Gynecol Surv 2005; 60(7 S1):S3-S51. 3. Velez A, Ramsey K, Tell K. The Campaign to End Fistula: What have we learned? Findings of facility and community needs assessments. International Journal of Gynecology & Obstetrics 2007; 99(Supplement 1):S143-S150. 4. Zheng AX, Anderson FW. Obstetric fistula in low-income countries. Int J Gynaecol Obstet 2009; 104(2):85-89. 5. Goh JT, Browning A, Berhan B, Chang A. Predicting the risk of failure of closure of obstetric fistula and residual urinary incontinence using a classification system. Int Urogynecol J Pelvic Floor Dysfunct 2008; 19(12):1659-1662. 6. Browning A. Risk factors for developing residual urinary incontinence after obstetric fistula repair. BJOG 2006; 113(4):482-485. 7. Nielsen HS, Lindberg L, Nygaard U, Aytenfisu H, Johnston OL, Sorensen B et al. A community-based long-term follow up of women undergoing obstetric fistula repair in rural Ethiopia. BJOG 2009; 116(9):1258-1264. 8. Browning A, Menber B. Women with obstetric fistula in Ethiopia: a 6-month follow up after surgical treatment. BJOG 2008; 115(12):1564-1569. 9. Alio AP, Merrell L, Roxburgh K, Clayton HB, Marty PJ, Bomboka L et al. The psychosocial impact of vesicovaginal fistula in Niger. Arch Gynecol Obstet 2011; 284(2):371-378. 10. Umoiyoho AJ, Inyang-Etoh EC, Abah GM, Abasiattai

AM, Akaiso OE. Quality of life following successful repair of vesicovaginal fistula in Nigeria. Rural Remote Health 2011; 11(3):1734. 11. Browning A, Fentahun W, Goh JTW. The impact of surgical treatment on the mental health of women with obstetric fistula. BJOG 2007; 114(11):1439-1441. 12. Goh JT, Sloane KM, Krause HG, Browning A, Akhter S. Mental health screening in women with genital tract fistulae. BJOG 2005; 112(9):1328-1330. 13. Aimakhu VE. Reproductive functions after the repair of obstetric vesicovaginal fistulae. Fertil Steril 1974; 25(7):586-591. 14. Bangser M, Mehta M, Singer J, Daly C, Kamugumya C, Mwangomale A. Childbirth experiences of women with obstetric fistula in Tanzania and Uganda and their implications for fistula program development. Int Urogynecol J 2011; 22(1):91-98. 15. Wilson AL, Chipeta E, Kalilani-Phiri L, Taulo F, Tsui AO. Fertility and pregnancy outcomes among women with obstetric fistula in rural Malawi. Int J Gynaecol Obstet 2011; 113(3):196-198. 16. Coombes R. Supporting surgery for obstetric fistula. BMJ 2004; 329(7475):1125. 17. Maulet N, Keita M, Macq J. Medico-social pathways of obstetric fistula patients in Mali and Niger: an 18month cohort follow-up. Trop Med Int Health 2013; 18(5):524-533. 18. Nafiou I, Idrissa A, Ghaichatou AK, Roenneburg ML, Wheeless CR, Genadry RR. Obstetric vesico-vaginal fistulas at the National Hospital of Niamey, Niger. International Journal of Gynecology & Obstetrics 2007; 99(Supplement 1):S71-S74. 19. Ndiaye P, Amoul KG, Abdoulaye I, Diagne CM, Tal-Dia A. [Itinerary of women suffering from obstetric fistula in Niger]. Med Trop (Mars ) 2009; 69(1):61-65. 20. Constantine G. Practical obstetric fistula surgery. The Obstetrician & Gynaecologist 2013; 12 (1)(66). 21. World Health Organization. Obstetric Fistula: Guiding principles for clinical management and programme development. Geneva: WHO; 2006. 22. Ng'ang'a N. Women of the courtyard. A nurse's journey to treat obstetric fistulae in Niger. AWHONN Lifelines 2006; 10(5):410-417. 23. Kent A. Working in a fistula hospital. Practising Midwife 2010; 13(4):15-16. 24. Khisa AM, Nyamongo IK. Still living with fistula: an exploratory study of the experience of women with obstetric fistula following corrective surgery in West Pokot, Kenya. Reprod Health Matters 2012; 20(40):59-66. 25. Mselle LT, Moland KM, Evjen-Olsen B, Mvungi A, Kohi TW. "I am nothing": experiences of loss among women suffering from severe birth injuries in Tanzania. BMC Womens Health 2011; 11:49. 26. Mselle LT, Evjen-Olsen B, Moland KM, Mvungi A, Kohi TW. "Hoping for a normal life again": reintegration after fistula repair in rural Tanzania. J Obstet Gynaecol Can 2012; 34(10):927-938. 27. Mwini-Nyaledzigbor PP, Agana AA, Pilkington FB.

Maulet et al. Experience of Obstetric Fistula Care

African Journal of Reproductive Health March 2015; 19 (1): 123

Lived experiences of ghanaian women with obstetric fistula. Health Care Women Int 2013; 34(6):440-460. 28. Yeakey MP, Chipeta E, Taulo F, Tsui AO. The lived experience of Malawian women with obstetric fistula. Cult Health Sex 2009; 11(5):499-513. 29. Aliyu F, Esegbona G. Living with obstetric fistula. BMJ 2011; 342:d2881. 30. Wall LL. Fitsari 'dan Duniya. An African (Hausa) praise song about vesicovaginal fistulas. Obstet Gynecol 2002; 100(6):1328-1332. 31. Jodelet D. Les représentations sociales. Paris: PUF; 1991. 32. Flament C. Structures, dynamiques et transformations des représentations sociales. In: Abric J-C, editor. Pratiques sociales et représentations. Paris: PUF; 2003. 12-37. 33. Olivier de Sardan J-P. La logique de la nomination. Représentations fluides et prosaiques de deux maladies au Niger. Sciences sociales et santé 12[3], 15-45. 1994. Anthropologie de la maladie: nouveaux lieux, nouvelles approches. 34. Olivier de Sardan J-P. La représentation sociale des maladies: des modules? In: Jaffré Y & Olivier de Sarda, editor. La construction sociales des maladies: les entités nosologiques populaires en Afrique de l'Ouest. Paris: PUF; 1999. 15-40. 35. Thaddeus S, Maine D. Too far to walk: maternal mortality in context. Soc Sci Med 1994; 38(8):1091-1110. 36. Olivier de Sardan J-P, Moumouni A, Souley A. L'accouchement c'est la guerre. Grossesse et accouchement en milieu rural nigérien. [1]. 2001. Niamey, LASDEL. Etudes et Travaux. 37. Herzlich C. Health and illness: a social-psychological analysis. 3d ed. London: Academic Press; 1992. 38. Nathan LM, Rochat CH, Grigorescu B, Banks E. Obstetric fistulae in West Africa: patient perspectives. Am J Obstet Gynecol 2009; 200(5):40-42. 39. Hassan MA, Ekele BA. Vesicovaginal fistula: do the patients know the cause? Ann Afr Med 2009; 8(2):122-126.

Tebeu PM, de Bernis L., Boisrond L, Le Duc A., Mbassi AA, Rochat CH. [Knowledge, attitude and perception about obstetric fistula by Cameroonian women]. Prog Urol 2008; 18(6):379-389. 41. Zheng AX, Harrington AH, Love SA, Thelemaque LD, Anderson FW. Fistula awareness among sisters of women with fistula. Int J Gynaecol Obstet 2013; 120(3):232-235. 42. Kazaura MR, Kamazima RS, Mangi EJ. Perceived causes of obstetric fistulae from rural southern Tanzania. African Health Sciences 2011; 11(3):377-382. 43. Johnson KA, Turan JM, Hailemariam L, Mengsteab E, Jena D, Polan ML. The role of counseling for obstetric fistula patients: Lessons learned from Eritrea. Patient Educ Couns 2009. 44. Castille YJ, Avocetien C, Zaongo D, Colas JM, Peabody JO, Rochat CH. Impact of a program of physiotherapy and health education on the outcome of obstetric fistula surgery. Int J Gynaecol Obstet 2013. 45. Yeakey MP, Chipeta E, Rijken Y, Taulo F, Tsui AO. Experiences with fistula repair surgery among women and families in Malawi. Glob Public Health 2011; 6(2):153-167. 46. Onolemhemhen DO. Combating Vesico Vaginal Fistula in Northern Nigeria: The Transformation of Women's Health in Africa. Social Development Issues 2000; 22(2-3):32-38. 47. Roush KM. Social implications of obstetric fistula: an integrative review. J Midwifery Womens Health 2009; 54(2):21-33. 48. Tayler-Smith K, Zachariah R, Manzi M, van den Boogaard W, Vandeborne A, Bishinga A et al. Obstetric Fistula in Burundi: a comprehensive approach to managing women with this neglected disease. BMC Pregnancy Childbirth 2013; 13(1):164. 49. Williams G. The Addis Ababa fistula hospital: an holistic approach to the management of patients with vesicovaginal fistulae. Surgeon 2007; 5(1):54-57.


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