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4th ICI Lecture Series: Vesico-vaginal fistula in the developing world (Committee 18)

Presented by Dirk DeRidder, MD, et al., at the Fourth International Consultation on Incontinence (ICI) - July 5 - 8, 2008. Palais des Congres, Paris, France.



Vesico-Vaginal Fistula in the Developing World - View Multimedia Presentation




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This presentation reflects a work-in-progress, and the science contained herein
will be published in textbook format at a future date.



D. De Ridder Belgium G. Badlani USA A.Browning Ethiopia P. Singh India I. Sombie Burkina Faso L. Wall USA  The evidence  Epidemiology  Etiology  Diagnosis  Classification  Treatment  Prevention  Organisation of fistula care  Recommandations  Pubmed and Sumsearch ◦515 articles  149 published over the last 5 years  8 trials  Mostly observational studies  Mostly by a small group of authors  All evidence levels 3 or 4  This is not a criticism but a challenge and even obligation for the scientific communities!!  The evidence  Epidemiology  Etiology  Diagnosis  Classification  Treatment  Prevention  Organisation of fistula care  Recommandations  Literature based estimates ◦Prevalence: 2 million women ◦Incidence: 10000-50000/y  Estimates by surgical centres ◦Prevelant cases ( Northern Nigeria) ◦Incidence ( Ethiopia, Tanzania) ◦Proportion of pregnant women with fistula ( Pakistan) ◦Proportion of married women with fistula (Bangladesh)  Population based surveys ◦Western Africa , Bangladesh & Malawi  Incidence ◦Empirical estimate Vangeenderhuysen 2001  124/100 000 in Sub-Saharan Africa ◦Model-based estimate Abou Zahr 1998  18.8/100 000 in Sub-Saharan Africa  Global 654000 of which 262000 in Sub-Saharan Africa  Prevalence ◦Life time prevalence in Malawi 1/20 Johnson 2007 ◦1,5 / 1000 in 26819 interviewed women Muleta 2007 The World Health Report 2005: Make every mother and child count, WHO Geneva, 2005 Maternal mortality as surrogate risk indicator for obstetric fistula  WHO Monitoring of the struggle against fistula ◦Epidemiologic  Incidence & prevalence  Estimated rate / 1000 deliveries ◦Delivery of care  Persons with midwifery & cesarean skills/ 1000 births  Number of fistula centres  Number of fistula ( simple & complex) surgeons ◦Training  Training facilities & number of surgeons trained ◦Quality of care  Proportion of successfull closures,continence  Proportion of failed fistula repairs  Social reintegration L. Wall & De Bernis, 2006 Prevention -incidence/prevalence -rate/1000 births -persons with skills …. Treatment -training facilities -surgeons trained ….. Reintegration - Social reintegration Maulet 2007 Number of patients treated Nigeria Mohammad 2007 0 5 10 15 20 25 30 1999/00 2000/01 2001/02 2002/03 2003/04 2004/05 2005/06 Years N um b e r o f f is tu la c l ie n ts External funding stopped  The evidence  Epidemiology  Etiology  Diagnosis  Classification  Treatment  Prevention  Organisation of fistula care  Recommandations  The obstructed labor complex ◦Delay in deciding to seek help ◦Delay in arriving at the health care facility ◦Delay in receiving adequate care  Injuries sustained during operative interventions ◦Forceps, cesarean section in difficult conditions with subsequent complications  Sexual abuse, rape, accidents  Traditional practices ◦Gishiri cutting, infibulation Low socio-economic status of women Malnutrition Limited social roles Illiteracy and lack of formal education Early marriage Childbearing before pelvic growth is complete Relatively large fetus or malpresentation Cephalopelvic disproportion Lack of access to emergency obstetric service s Obstructed labor Harmful traditional practices

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