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Fistula Findings: A Q&A with Dr. Mark Barone

With funding from the U.S. Agency for International Development, the EngenderHealth-led Fistula Care project recently completed a study to help improve treatment and care for women living with obstetric fistula, which is primarily a childbirth-related injury that results in a hole, or abnormal opening, in the birth canal. The condition, which affects some 2 million women around the world, causes chronic leakage of urine and/or feces and can lead to stigma and other devastating social and economic consequences.

Dr. Mark Barone, EngenderHealth Senior Clinical Advisor and principal investigator of the study, took a moment to discuss the research.

Q: What inspired you to pursue this research and what did it entail?

A: Until recently, the published evidence base for addressing obstetric fistula has been very limited. We designed and conducted this study, in collaboration with our colleagues at USAID and our local partners in Africa and Asia, to help improve our understanding about factors that impact the outcome of fistula repair surgery. We hoped to increase our success in treating women with fistula and reintegrating them into their communities after repair surgery.

To collect the data for this study, we observed women who underwent fistula repair surgery and followed each one for 3 months after her repair surgery. This approach, which is known as a prospective cohort study, is significant, considering most of the past studies about fistula have only entailed retrospective reviews of client records.

The study included data from 11 health facilities supported by Fistula Care in five countries: Bangladesh, Guinea, Niger, Nigeria, and Uganda.

Q: What were you hoping to learn from the research?

A: We had two key objectives in conducting the research. The first was to identify factors that affect the outcome of fistula repair surgeries, so that we can make better prognoses for women undergoing repair surgeries. The second objective was to examine the socio-structural factors associated with fistula and to document the experiences of women seeking fistula repair services.

Q: Ultimately, what did we learn that is new? Why do the findings matter?

A: While we’re still in the process of analyzing data and formulating our conclusions, we’ve already learned a number of things. We have identified key fistula characteristics that affect the prognosis for successful fistula repairs, including the size of a woman’s bladder before the operation, her history of prior repair attempts, and the degree of vaginal scarring or urethral involvement. We also found that patient characteristics, such as age or parity, and other conditions, such as malnutrition or genital cutting, have no significant impact on the outcome of fistula surgery.

These results give us greater clarity about which characteristics to include in our medical prognostic systems. They may also help surgeons make decisions about the level of skill needed to repair certain fistula and help them better communicate to women about the possibility of a failed repair or residual incontinence, that is, incontinence that remains even though the fistula itself has been repaired.

Q: What makes this study unique from others that have examined fistula?

A: As I mentioned earlier, this was a prospective study, which allowed us to gather the same information from multiple sites in different countries. The study represents one of the largest data collection initiatives to date that assesses fistula repair outcomes and documents the experiences of women with fistula across multiple countries. It’s also one of few studies that followed women after they were discharged from the hospital to better understand somewhat longer-term outcomes and to get some sense of how well they become reintegrated socially and economically after their repair surgery.

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