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

• Published in: Tropical medicine & international health 2019-01, Vol.24 (1), p.53-64
• Main Authors: El Ayadi, Alison M., Barageine, Justus, Korn, Abner, Kakaire, Othman, Turan, Janet, Obore, Susan, Byamugisha, Josaphat, Lester, Felicia, Nalubwama, Hadija, Mwanje, Haruna, Tripathi, Vandana, Miller, Suellen
• Format: Article
• Language: English
• Subjects: Adaptation, Psychological; complications obstétricales du travail; Correlation analysis; Female; Fistula; Fistulae; fistule recto‐vaginale; fistule vésico–vaginale; Health; Humans; incontinence urinaire; Informed consent; Intervention; Longitudinal Studies; Medical records; obstetric labour complications; Original; Original Research Papers; Perception; Quality of life; Quality of Life - psychology; qualité de vie; rectovaginal fistula; Rectovaginal Fistula - psychology; Regression analysis; Repair; Self Concept; Social Stigma; stigmatisation sociale; Surgery; Surveying; Symptoms; Trajectories; Uganda; Urinary incontinence; Vaginal Fistula - psychology; Vaginal Fistula - surgery; vesicovaginal fistula; Vesicovaginal Fistula - psychology; Women; Women's Health
• ISSN: 1360-2276; 1365-3156
• DOI: 10.1111/tmi.13178

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 ed 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. Objectifs Explorer les trajectoires de la santé physique et psychosociale et leurs relations réciproques chez les femmes ayant subi une réparation de fistule en Ouganda, un an après la chirurgie. Méthodes Nous avons recruté une cohorte longitudinale de 60 femmes en hospitalisation de chirurgie à l'hôpital de Mulago, à Kampala en Ouganda (décembre 2014 à juin 2015) et les avons suivies pendant un an. Nous avons collecté des données d'enquête sur la santé physique et psychosociale lors de la chirurgie et à 3, 6, 9 et 12 mois via le téléphone mobile. Les caractéristiques de la fistule ont été extraites des dossiers médicaux. Toutes les participantes ont fourni un consentement éclairé écrit. Nous pré