title: Medico-social pathways of obstetric fistula patients in Mali and Niger: an 18-month cohort follow-up.
abstract: OBJECTIVE
  To gain understanding of care pathways and induced mobility patterns of obstetric fistula patients in French-speaking West African fistula repair centres.
  
  
  METHODS
  We followed prospectively during 18 months a cohort of obstetric fistula patients in Mali and Niger (2008-2009). 120 patients were recruited at different stages of their care process in 5 reference fistula repair centres. Follow-up was carried out in repair centres and communities. Quantitative data were collected through close-ended questionnaires at three time points. Medico-social pathways were explored through a longitudinal analysis focusing on six indicators: fistula duration, care process duration, patients' mobility, marital status, number of surgeries and continence status.
  
  
  RESULTS
  Patients' pathways were characterised by their length: fistula duration (median 4 years), care process duration (median 2.7 years), aggregated time spent in repair centres during study (median 7 months). Patients developed four mobility patterns (homebound, itinerant, institutionalised and urbanised). Adverse marital status change continued over time. Sample stratification according to number of previous surgeries revealed differences in care process duration and outcome: 23/31 new cases (≤1 surgery) gained continence with a mean of 1.5 surgeries in a median of 0.6 year while only 17/78 old cases (≥2 surgeries) became continent with a mean of 4 surgeries in a median time of 4.9 years.
  
  
  CONCLUSIONS
  The quest for continence does not end with admission to a fistula repair centre. Analysing fistula care experience across time within the varying settings highlights the twofold population and mixed medico-social outcomes that should prompt new development in obstetric fistula care management and research.
authors.affiliation: Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium. nathalie.maulet@uclouvain.be
authors.forename: Nathalie
authors.initials: N
authors.lastname: Maulet
authors.forename: Mahamoudou
authors.initials: M
authors.lastname: Keita
authors.forename: Jean
authors.initials: J
authors.lastname: Macq
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008137:Longitudinal Studies; D008302:Mali; D017533:Marital Status; D008875:Middle Aged; D051346:Mobility Limitation; D009548:Niger; D007744:Obstetric Labor Complications; D011183:Postoperative Complications; D011247:Pregnancy; D011446:Prospective Studies; D012006:Rectovaginal Fistula / Q000601:surgery / Q000628:therapy*; D012086:Reoperation / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D013997:Time Factors; D014549:Urinary Incontinence / Q000209:etiology / Q000601:surgery; D014719:Vesicovaginal Fistula / Q000601:surgery / Q000628:therapy*; D055815:Young Adult