Vesicovaginal fistula in Uganda

Area of Science:

• Obstetrics and Gynecology
• Public Health
• Surgical Outcomes

Background:

• Vesicovaginal fistula (VVF) is a devastating injury, largely eradicated in developed nations but highly prevalent in developing countries.
• Factors contributing to VVF incidence include young childbearing age and limited access to emergency obstetric care.
• The current rate of fistula repair suggests it would take centuries to address the existing backlog of cases.

Purpose of the Study:

• To investigate the regional incidence and causative factors of vesicovaginal fistula (VVF) in patients admitted to Kitovu Hospital, Uganda.
• To analyze the severity, causes, and surgical outcomes of VVF cases.
• To highlight the challenges and successes in VVF management in Uganda.

Main Methods:

• Retrospective case review of patients admitted with vesicovaginal fistula (VVF) at Kitovu Hospital.
• Data collection included fistula history, severity (ICIQ score), causes, and treatment outcomes.
• Analysis of patient demographics, travel distances, and mode of transport.

Main Results:

• Patients suffered from VVF symptoms for an average of 4.97 years, with a mean ICIQ severity score of 7.21.
• High rates of prolonged labor were observed, leading to 69% stillbirth and 12% early neonatal death.
• Surgical repair at Kitovu Hospital achieved a 94% success rate (patients dry on discharge).

Conclusions:

• The study confirms the significant burden of VVF in Uganda, characterized by prolonged suffering, fetal loss, and extensive journeys for treatment.
• Kitovu Hospital demonstrates successful VVF repair outcomes, but highlights the limited service provision across Uganda.
• Further epidemiological research and collaborative efforts addressing poverty and gender inequality are crucial for VVF prevention and eradication.