ABSTRACT
Introduction:
Given their importance and impact on the patient's quality of
life, Urogenital fistulas (UGF) deserve more interest in Rwanda.
In developing countries, obstetric fistulas are mainly caused
by obstructed labour, most of time delayed at home.
Poorly or uninstructed young women are likely to have low
income; they are abandoned once their partners are aware of severity and long
duration of fistula disability.
Surgical management of fistula can be performed but there is
no special centre for fistula in Rwanda.
This is a big challenge for the country as 400 up to 600 new
fistulas occur yearly but only 100 are treated.
Materials and Methods:
A transversal descriptive and analytic study was done on a
sample of 36 women with UGF. These women were chosen among 160 women presenting
themselves at the Maternity of Ruhengeri hospital in the north of Rwanda.
They had come for a radio announced workshop of surgical management of
obstetric fistula organized from 06 March 2006 up to March 10, 2006.
These thirty-six selected women with UGF were interviewed and
clinically followed. Data were collected during their hospitalization and at
the appointment fixed 6 weeks after the discharge. A questionnaire was filled,
coded with EpiData 3.1 and analyzed with SPSS 11.5.
The test chi square of Pearson was used to analyze the
proportions; the T-test of Student was used for the analysis of the
averages.
Results:
The occurrence mean age of uro genital fistula was 26 #177;7
years old .The extreme range was 15 in one hand and 42 years old in the other
hand.
More than half of the population (51.4%) has had an early
marriage and childbirth before 20 years of age and 50% developed UGF at the
first pregnancy delivery. Half of the population was with a height under150 cm.
Level of education is very poor (none in 22.2%), and primary none completed in
66.7%). All of them are peasants with a monthly poor income of 16660 Frw (20.8
US $) are late to attend health services. The mean duration of prolonged and
obstructed labor was 37.53 hours with 5 and 77 extreme hours. A delay at home
(26.56 hours) in deciding to seek care and a delay at health centre (15.08
hours) have been reported. 94.4% delivered stillbirths.
Negative impact of UGF on couple marital status was found (P:
0.000). Separation has been reported in 36.1% of cases after 14.38 months as
the mean duration and 0-60months as extremes.
100% of cases had become seriously poor .The UGF with urinary
incontinence mean duration was 49 months and the extremes of 1-171months.
100% have undergone with vulvae dermatitis, vaginal stenosis
(44.4%) and dyspareunia (40.7%). Vaginal route was used to repair fistulas in
22.9% of cases. Simple suture to close fistula was performed in 65.7% whereas
suture and additional anterior vaginal wall suspension were used in 22.9% of
cases. 80% of our patients were totally cured and 20% cured but still having
urethral stress incontinence.
Locally the mean cost of treatment was estimated to 47,300
Rwfs (84.46 US $ at a rate change of 1US $ =560 Rwfs) and to 179990 Rwfs
(321.260 US $) if we consider foreign expert and supplementary expenses.
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