Risk factors that contribute to fistula formation among women attending at Borama National Fistula Hospital Somaliland from 2011 To 2014.

Abstract

Background: An obstetric fistula is preventable and in most cases, treatable childbirth injury that causes incontinence, stigmatization and psychosocial effects and often results in isolation from society. The constant and prolonged weight of the presenting part of the fetus against the delicate tissues around the vagina, bladder and or rectum during protracted delivery causes ischemic necrosis, leading to sloughing off of the necrotic area after 3-5 days leading to leakage of urine. Objective: To determine the factors associated with fistula formation in patients managed for obstetric fistula at Borama National Fistula Hospital (BNFH). Methods: A cross sectional study was carried out using medical records of all women who were treated for obstetric fistula at BNFH in the period between 2011 and 2014. Questionnaires were used to collect the information on OF. Data were entered into Microsoft Excel (version, 10) and then transferred to SPSS version 21 (IBM statistics, Chicago Inc.) for analysis. Descriptive analysis was performed to determine the frequencies and proportions of the various outcomes of fistula. Cross tabulation was used to check associations. Chi-square tests were used and cut off P-values below 0.05 deemed statistically important. Results: 234 records of women were used for this study, the mean age of the women with OF at BNFH was 29.6 years (SD ± 10.1). There were 224 (97.4%) unemployed women, 100 (43.5%) were married, 220 (95.7%) mothers reported that they had no formal education and 142 (62%) resided in rural areas. There were 154 women with VVF 66.1% (95% CI 60 – 72.2%); 54 with RVF 23.2% (95% CI 17.7 – 28.6%) and the remaining 25 women had combined VVF and RVF 10.7% (95 % CI 6.7 – 14.7%). There was no significant association between demographic xii characteristics: age (p = 0.328), parity (p = 0.424), occupation (p = 0.197), marital status (p = 0.052) or formal education (p = 0.908) and the type of fistula. There was a major connection between mode of delivery and the type of fistula following delivery (p < 0.001). Most 227 (97.8%) mothers underwent repair of fistula and 215 (92.3%) of fistulas were successfully repaired (95% 90% and 82% for SVD, CS and assisted deliveries, respectively). There were 192 (82.4%) repairs succeeding on first attempt. Conclusion: VVF is the predominant fistula type in BNFH and type of fistula that occurs shows significant association with mode of delivery. Repair of fistulas is frequently successful but successful attempts at repair are lower in combined VVF and RVF type. The findings from this study will assist the Ministry of Health and Borama National Fistula Hospital to develop strategy for obstetric fistula prevention, management in the country.