Trajectories of women's physical and psychosocial health following obstetric fistula repair in Uganda: a longitudinal study

Alison M El Ayadi, Justus Barageine, Abner Korn, Othman Kakaire, Janet Turan, Susan Obore, Josaphat Byamugisha, Felicia Lester, Hadija Nalubwama, Haruna Mwanje, Vandana Tripathi, Suellen Miller, Alison M El Ayadi, Justus Barageine, Abner Korn, Othman Kakaire, Janet Turan, Susan Obore, Josaphat Byamugisha, Felicia Lester, Hadija Nalubwama, Haruna Mwanje, Vandana Tripathi, Suellen Miller

Abstract

Objectives: To explore trajectories of physical and psychosocial health, and their interrelationship, among women completing fistula repair in Uganda for 1 year post-surgery.

Methods: We recruited a 60-woman longitudinal cohort at surgical hospitalisation from Mulago Hospital in Kampala Uganda (Dec 2014-June 2015) and followed them for 1 year. We collected survey data on physical and psychosocial health at surgery and at 3, 6, 9 and 12 months via mobile phone. Fistula characteristics were abstracted from medical records. All participants provided written informed consent. We present univariate analysis and linear regression results.

Results: Across post-surgical follow-up, most women reported improvements in physical and psychosocial health, largely within the first 6 months. By 12 months, urinary incontinence had declined from 98% to 33% and general weakness from 33% to 17%, while excellent to good general health rose from 0% to 60%. Reintegration, self-esteem and quality of life all increased through 6 months and remained stable thereafter. Reported stigma reduced, yet some negative self-perception remained at 12 months (mean 17.8). Psychosocial health was significantly impacted by the report of physical symptoms; at 12 months, physical symptoms were associated with a 21.9 lower mean reintegration score (95% CI -30.1, -12.4).

Conclusions: Our longitudinal cohort experienced dramatic improvements in physical and psychosocial health after surgery. Continuing fistula-related symptoms and the substantial differences in psychosocial health by physical symptoms support additional intervention to support women's recovery or more targeted psychosocial support and reintegration services to ensure that those coping with physical or psychosocial challenges are appropriately supported.

Keywords: complications obstétricales du travail; fistule recto-vaginale; fistule vésico-vaginale; incontinence urinaire; obstetric labour complications; quality of life; qualité de vie; rectovaginal fistula; social stigma; stigmatisation sociale; urinary incontinence; vesicovaginal fistula.

© 2018 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.

Figures

Figure 1
Figure 1
Trajectories of fistula‐related physical symptoms and psychosocial health indicators across 12‐month study follow‐up.

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