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Research
Determinants of Post-Operative Outcomes in Fistula Repair Surgery:
A Prospective Facility-Based Study
Obstructed labor is a major cause of maternal and neonatal mortality and morbidities, including obstetric fistula. Only an operative procedure can ease the obstruction, and the provision of quality and timely cesarean delivery services is therefore an essential component of emergency obstetric care. Although data is available about cesarean rates, little data is available about the indications for cesareans or what data is routinely collected, analyzed and reviewed at hospitals and reported to health authorities. The overall goal is to determine the leading indications for cesarean delivery. Specific objectives are to identify key details about the cesarean delivery, e.g., use of the partograph, cadre of personnel conducting the surgery, as well as quality and use of record keeping systems for cesarean deliveries.The study is being undertaken as part of Fistula Care’s prevention strategy for addressing obstetric fistula. Fistula Care is focusing on four key prevention measures: family planning, consistent and correct use of the partograph, immediate catheterization for women who experience obstructed labor, and strengthening cesarean delivery services. Results from this study will assist in the identification of appropriate reporting indicators on the indications for cesarean, identification of the strengths and weaknesses in the use of the partograph, and quality of record keeping.
This study is a retrospective review of patient records and maternity registers at Fistula Care supported sites in 5 countries (Bangladesh, Guinea, Niger, Nigeria, Uganda). A random sample of 350 cesarean deliveries in 2008 will be selected from the theater register for review. Information from patient records, the theater register and maternity register will be the primary sources of information for the review. Additionally, in-depth interviews with six key informants working in the maternity ward and records room will be conducted to assess strengths and weaknesses of the record keeping systems and reporting. Data collection will be completed at all sites by December 2010 and a summary report on findings will be available in 2011.
Identification of Current Practices in Fistula Treatment:
A Qualitative Review
This study will catalogue information about the current clinical practices in:
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the use of antibiotics before, during, and after fistula surgery.
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the role of catheterization in fistula management.
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management of patients with stress incontinence after fistula repair.
In 2009, self-administered questionnaires were completed by 40 surgeons known to provide fistula treatment services in Africa and Asia at private and government hospitals. The questionnaire was divided into three parts to address three issues: prophylactic use of antibiotics before, during, and after fistula surgery; urethral catheter management; and management practices for patients with urinary incontinence following fistula repair.
The results provide a snapshot of current practices in fistula treatment and care. There is consensus in treatment in some areas while there are wide variations in practice in other areas (duration of catheter use, surgical treatments for postsurgical incontinence). These findings are based on a small sample and do not allow for recommending changes in clinical care, but they point to issues for possible clinical trial research that would contribute to more efficient and effective fistula care. The results from this study will help guide the development of protocols for one or more randomized clinical trials. For more information contact Fistula Care.
Planned Studies
Cost Study
In FY 10/11 Fistula Care will undertake, in collaboration with selected supported sites, a cost study to determine the cost of provision of fistula repair services. The study is intended to assist fistula repair sties to identify, allocate and manage resources for the provision of quality fistula care services. Findings and implications will be discussed with the site, local and national authorities, including the National Fistula Working Groups or Ministries of Health. We anticipate the results will facilitate improved coordination with other donors and provide standardization in the approach to calculating the costs of fistula surgery. Data collection will begin in 2011. Sites have not yet been determined.
