A Bishinga1, R Zachariah2, S Hinderaker3, K Tayler-Smith2, M Khogali2, J van Griensven4, W van den Boogaard5, M Tamura5, B Christiaens5, G Sinabajije6. 1. Médecins Sans Frontières (MSF), Operational Center Brussels, Burundi-Gitega, Burundi. 2. Medical Department (Operational Research), Operational Center Brussels, MSF-Luxembourg. 3. University of Bergen, Bergen, Norway. 4. Institute of Tropical Medicine, Antwerp, Belgium. 5. MSF, Bujumbura, Burundi. 6. Ministry of Health, Bujumbura, Burundi.
Abstract
SETTING: Gitega Fistula Centre (GFC), a dedicated obstetric fistula repair centre providing comprehensive care at the Gitega District Hospital, rural Burundi. OBJECTIVES: To describe 1) the proportion who returned for scheduled 3- and 6-month follow-up visits and 2) outcomes (fistula closure rates and continence status) at discharge from hospital and after 3 and 6 months among patients who underwent fistula repair surgery. DESIGN: Retrospective cohort analysis using programme data from April 2010 to December 2011. RESULTS: A total of 475 women with obstetric fistula underwent surgical repair. At discharge from hospital, 415 (87%) had a closed fistula, of whom 318 (77%) were continent of urine and/or faeces, while 97 (23%) remained incontinent despite closure. Of the 415 patients with closed fistula, only 244 (59%) were followed up at 3 months and 73 (18%) at 6 months (χ(2) for linear trend 576, P < 0.0001). This indicates progressive loss to follow-up, reaching 82% by 6 months. CONCLUSION: Women undergoing obstetric fistula repair surgery at GFC achieve good hospital exit outcomes. Thereafter, substantial and progressive loss to follow-up hinder the ability to judge programme success over time. Steps to address this operational problem are discussed.
SETTING:Gitega Fistula Centre (GFC), a dedicated obstetric fistula repair centre providing comprehensive care at the Gitega District Hospital, rural Burundi. OBJECTIVES: To describe 1) the proportion who returned for scheduled 3- and 6-month follow-up visits and 2) outcomes (fistula closure rates and continence status) at discharge from hospital and after 3 and 6 months among patients who underwent fistula repair surgery. DESIGN: Retrospective cohort analysis using programme data from April 2010 to December 2011. RESULTS: A total of 475 women with obstetric fistula underwent surgical repair. At discharge from hospital, 415 (87%) had a closed fistula, of whom 318 (77%) were continent of urine and/or faeces, while 97 (23%) remained incontinent despite closure. Of the 415 patients with closed fistula, only 244 (59%) were followed up at 3 months and 73 (18%) at 6 months (χ(2) for linear trend 576, P < 0.0001). This indicates progressive loss to follow-up, reaching 82% by 6 months. CONCLUSION:Women undergoing obstetric fistula repair surgery at GFC achieve good hospital exit outcomes. Thereafter, substantial and progressive loss to follow-up hinder the ability to judge programme success over time. Steps to address this operational problem are discussed.
Entities:
Keywords:
Burundi; loss to follow-up; obstetric fistula; operational research
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