Research

Ongoing Research:

To read an interview about current research initiatives to improve fistula treatment and care, click here.

Determinants of Post-Operative Outcomes in Fistula Repair Surgery:
A Prospective Facility-Based Study

There is a lack of detailed information on the social causes of fistula and a severe gap in the evidence around the patient and fistula characteristics, as well as peri-operative techniques, that influence the success of fistula repair. To answer some of the most pressing clinical research questions and to inform future interventions and further research, in consultation with USAID, Fistula Care developed the study: "Determinants Of Post-Operative Outcomes in Fistula Repair Surgery." This study was conducted at 11 facilities in 5 countries: Bangladesh, Guinea, Niger, Nigeria, and Uganda. A total of 1,450 women were enrolled between 2007 and 2010. The primary objective of the study is to determine predictors of complications and success of fistula repair surgery. To this end, the study examines circumstances surrounding development of the fistula (including obstetric history), anatomical and clinical characteristics of the fistula, and pre-, intra- and post-operative techniques used. A secondary objective is to examine socio-structural factors associated with fistula; accordingly, we collected data on patient socio-demographic characteristics, details of the circumstances surrounding development of the fistula and availability of and access to obstetric services. Data collection has been completed and analysis is underway.

Multi Center Retrospective Record Review of Data Collection Procedures and Data Quality of Indications for Cesarean Deliveries

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 of the study 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.

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.

Data collection was completed in December 2010 at 11 facilities which receive support from Fistula Care in 5 countries (Bangladesh, Guinea, Niger, Nigeria, Uganda). A random sample of 350 cesarean deliveries in 2008 were selected from each facilities theater registers for review. Additionally, in-depth interviews with key informants working in the maternity ward and records room were conducted to assess strengths and weaknesses of the record keeping systems and reporting. A summary report of the findings will be available in 2011.

Planned Research:

Assessing the Costs of Fistula Treatment Services

Fistula Care is collaborating  with selected sites to undertake 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 at two sites in Nigeria. Other sites are yet to be determined.

Randomized Clinical Trial on Short Term Catheterization

In collaboration with WHO, Fistula Care is developing a randomized clinical trial to assess the efficacy and safety of using short-term catheterization after fistula repair rather than longer-term catheterization. Short-term catheterization has the potential to reduce hospital stays for women, free up bed space at facilities, and reduce costs, potentially allowing more women to receive clinical care. The protocol is under development and site selection as yet to be determined. The study is expected to begin in mid 2011.

Completed Research:

Current Practices in Treatment of Female Genital Fistula: A Cross Sectional Study

In 2009, self-administered questionnaires were completed by 40 surgeons who  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, published in 2010 in the BioMed Central Journal of Pregnancy and Childbirth,  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.