Risk factors for failed fistula closure in Addis Ababa at fistula centre, central Ethiopia.

IF 2.3 Q2 OBSTETRICS & GYNECOLOGY
Frontiers in global women's health Pub Date : 2024-11-21 eCollection Date: 2024-01-01 DOI:10.3389/fgwh.2024.1460227
Tadesse Mamo Dejene, Asrat Kassaw Belachew, Michael Amera Tizazu, Sadat Mohammed Yesuf
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引用次数: 0

Abstract

Background: Obstetric Fistula leads to fecal and urine incontinence in women and girls. Surgical repair is the cornerstone of care. Failure to repair an obstetric fistula exposes women not only to repeated surgery but also to ongoing incontinence and its sequela, depression, and social exclusion. Which impacts the nation's health intervention programs and socioeconomic burden.

Objective: To determine factors associated with failed fistula closure in women who underwent Fistula Closure at the Hamlin Fistula Center in Addis Ababa, central Ethiopia, between February 10, 2018, and December 28, 2020.

Methods: Women who underwent Fistula Closure between February 10, 2018, and December 28, 2020 were included in a case-control study that was conducted between May and June 2021. In total, 417 study participants (139 cases and 280 controls) were selected using a systematic random sampling technique. Two professional midwife data collectors and one BSC nurse for the supervisory assessment of women's medical cards utilized a structured questionnaire to collect data. SPSS version 25 was used to enter, clean, and analyze the data. During data analysis, bivariate and multivariate regression models were used. A p-value of less than 0.05 indicates a significant correlation.

Results: Forty-nine patients (35.3%) and 133 controls (47.8%) who were older than 26 years were at repair while they were (14-19 years old). The factors that contributed to failure of fistula closure included age at repair (14-19 years old) [AOR = 2.1, 95% CI (0.94-4.89)], prior fistula attempts (9.6, rural residence [AOR = 2.69, 95% CI (1.36-5.35)], height <150 cm [AOR = 1.80, 95% CI (0.99-3.59)], labor duration longer than 2 days [AOR = 1.89, 95% CI (0.99-3.59)], delivery by cesarean section [AOR = 1.88, 95% CI (1.04-3.89)], damaged urethra [AOR = 2.02, 95% CI (1.04-3.89)], diameter of fistula >3 cm, mild vaginal scar [AOR = 3.20, 95% CI (1.24-8.29)], moderate and severe vaginal scar [AOR = 5.49, 95% CI (1.92-15.75)], and completion of ANC [AOR = 0.20 (0.11, 0.38)].

Conclusion and recommendation: Age at the time of repair, Residence, Height, duration of labor, mode of delivery, completion of ANC, damaged urethra, fistula diameter >3 cm, previous fistula attempts, and vaginal scar are factors related to failure of fistula closure. By focusing on these areas, we can significantly improve the outcomes for patients undergoing fistula repair and lower the likelihood of failed closures in the future. Community-based health education regarding obstetric fistula and the importance of seeing a doctor as soon as possible during labor to lower the risk of obstructed delivery, boost antenatal care completion, and shorten the length of labor are all necessary to prevent failed fistula closure in comparable patients in the future.

埃塞俄比亚中部亚的斯亚贝巴瘘管中心瘘管闭合失败的危险因素。
背景:产科瘘导致妇女和女童大便和尿失禁。手术修复是护理的基石。产科瘘修复失败不仅会使妇女面临重复手术,还会导致持续的尿失禁及其后遗症、抑郁和社会排斥。这影响了国家的健康干预计划和社会经济负担。目的:确定2018年2月10日至2020年12月28日期间在埃塞俄比亚中部亚的斯亚贝巴Hamlin瘘管中心接受瘘管闭合的妇女瘘管闭合失败的相关因素。方法:在2018年2月10日至2020年12月28日期间接受瘘管闭合的妇女被纳入2021年5月至6月进行的病例对照研究。采用系统随机抽样技术,共选择417名研究参与者(139例病例和280例对照)。负责妇女医疗卡监督评估的两名专业助产士数据收集人员和一名平衡记分卡护士使用结构化问卷收集数据。使用SPSS version 25对数据进行录入、清理和分析。在数据分析中,采用双变量和多变量回归模型。p值小于0.05表示相关性显著。结果:年龄大于26岁的患者(14 ~ 19岁)有49例(35.3%)和133例(47.8%)处于修复期。导致瘘道闭合失败的因素包括修复年龄(14-19岁)[AOR = 2.1, 95% CI(0.94-4.89)]、既往瘘道尝试(9.6,农村户籍[AOR = 2.69, 95% CI(1.36-5.35)]、身高3 cm、轻度阴道瘢痕[AOR = 3.20, 95% CI(1.24-8.29)]、中重度阴道瘢痕[AOR = 5.49, 95% CI(1.92-15.75)]、完成ANC [AOR = 0.20(0.11, 0.38)]。结论与建议:修复时的年龄、居住地、身高、分娩时间、分娩方式、ANC完成情况、尿道损伤、瘘管直径bbb3cm、既往造瘘尝试、阴道瘢痕等均是导致瘘管闭合失败的因素。通过关注这些领域,我们可以显著改善患者进行瘘管修复的结果,并降低未来关闭失败的可能性。以社区为基础的产科瘘管病健康教育,以及在分娩过程中尽快就医的重要性,以降低难产的风险,提高产前护理的完成率,缩短分娩时间,都是预防未来类似患者瘘管闭合失败的必要条件。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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CiteScore
3.70
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