Obstetric Fistula in Burundi: a comprehensive approach to managing women with this neglected disease
1 Médecins Sans Frontières, Medical department (Operational Research), Operational Center Brussels, MSF-Luxembourg, Luxembourg
2 Médecins Sans Frontières, Bujumbura, Burundi
3 Médecins Sans Frontières, Operational Centre Brussels, Brussels, Belgium
4 Ministry of Health, Gitega, Burundi
5 International Union against Tuberculosis and Lung Disease, Paris, France
6 London School of Hygiene and Tropical Medicine, London, United Kingdom
7 Medecins sans Frontieres (Operational center Brussels), Medical department (Operational research), Rue Dupré 94, 1090 Brussels, Belgium
BMC Pregnancy and Childbirth 2013, 13:164 doi:10.1186/1471-2393-13-164Published: 21 August 2013
In Burundi, the annual incidence of obstetric fistula is estimated to be 0.2-0.5% of all deliveries, with 1000–2000 new cases per year. Despite this relatively high incidence, national capacity for identifying and managing obstetric fistula is very limited. Thus, in July 2010, Medecins Sans Frontieres (MSF) set up a specialised Obstetric Fistula Centre in Gitega (Gitega Fistula Centre, GFC), the only permanent referral centre for obstetric fistula in Burundi. A comprehensive model of care is offered including psychosocial support, conservative and surgical management, post-operative care and follow-up. We describe this model of care, patient outcomes and the operational challenges.
Descriptive study using routine programme data.
Between July 2010 and December 2011, 470 women with obstetric fistula presented for the first time at GFC, of whom 458 (98%) received treatment. Early urinary catheterization (conservative management) was successful in four out of 35 (11%) women. Of 454 (99%) women requiring surgical management, 394 (87%) were discharged with a closed fistula, of whom 301 (76%) were continent of urine and/or faeces, while 93 (24%) remained incontinent of urine and/or faeces. In 59 (13%) cases, the fistula was complex and could not be closed. Outcome status was unknown for one woman. Median duration of stay at GFC was 39 days (Interquartile range IQR, 31–51 days).
The main operational challenges included: i) early case finding and recruitment for conservative management, ii) national capacity building in obstetric fistula surgical repair, and iii) assessing the psychosocial impact of this model.
In a rural African setting, it is feasible to implement a comprehensive package of fistula care using a dedicated fistula facility, and satisfactory surgical repair outcomes can be achieved. Several operational challenges are discussed.