Obstetric fistula in Niger: 6-month postoperative follow-up of 384 patients from the Danja Fistula Center

Itengre Ouedraogo, Christopher Payne, Rahel Nardos, Avril J. Adelman, L. Lewis Wall

Research output: Contribution to journalArticle

5 Scopus citations

Abstract

Introduction and hypothesis: The impoverished West African country of Niger has high rates of obstetric fistula. We report a 6-month postoperative follow-up of 384 patients from the Danja Fistula Center and assess factors associated with operative success or failure. Methods: The medical records of 384 women who had completed a 6-month follow-up after fistula surgery were reviewed. Cases were categorized as “easy,” “of intermediate complexity,” or “difficult” based on a preoperative points system. Data were analyzed using simple chi-squared statistics and logistic regression. Results: The patients were predominantly of Hausa ethnicity (73%), married young (average 15.9 years), had teenage first pregnancies (average first delivery 16.9 years), and experienced prolonged labor (average 2.3 days) with poor outcomes (89% stillbirth rate). The average parity was four. Patients commonly developed their fistula during their first delivery (43.5%), but over half sustained a fistula during a subsequent delivery (56.5%). Prior fistula surgery elsewhere (average 1.75 operations) was common. The overall surgical success (“closed and dry”) was 54%. When the 134 primary operations were analyzed separately, the overall success rate was 80%. Increasing success was seen with decreasing surgical difficulty: 92% success for “easy” cases, 68% for “intermediate” cases, and 57% success for “difficult” cases. Success decreased with increasing numbers of previous attempts at surgical repair. Conclusions: These data provide further evidence that clinical outcomes are better when primary fistula repair is performed by expert surgeons in specialist centers with the support of trained fistula nurses.

Original languageEnglish (US)
Pages (from-to)345-351
Number of pages7
JournalInternational Urogynecology Journal
Volume29
Issue number3
DOIs
Publication statusPublished - Mar 1 2018

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Keywords

  • Niger
  • Obstetric fistula
  • Obstructed labor
  • Surgery
  • Vesicovaginal fistula

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Urology

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