title: Obstetric fistula in Burundi: a comprehensive approach to managing women with this neglected disease.
abstract: BACKGROUND
  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.
  
  
  METHODS
  Descriptive study using routine programme data.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors: Katie
authors: K
authors: Tayler-Smith
authors: Rony
authors: R
authors: Zachariah
authors: Marcel
authors: M
authors: Manzi
authors: Wilma
authors: W
authors: van den Boogaard
authors: An
authors: A
authors: Vandeborne
authors: Aristide
authors: A
authors: Bishinga
authors: Eva
authors: E
authors: De Plecker
authors: Vincent
authors: V
authors: Lambert
authors: Bavo
authors: B
authors: Christiaens
authors: Gamaliel
authors: G
authors: Sinabajije
authors: Miguel
authors: M
authors: Trelles
authors: Stephan
authors: S
authors: Goetghebuer
authors: Tony
authors: T
authors: Reid
authors: Anthony
authors: A
authors: Harries
mesh_terms: D000328:Adult; D002063:Burundi; D036861:Delivery, Obstetric / Q000009:adverse effects*; D005260:Female; D006801:Humans; D012006:Rectovaginal Fistula / Q000209:etiology / Q000628:therapy*; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D001743:Urinary Bladder / Q000601:surgery*; D014546:Urinary Catheterization; D014621:Vagina / Q000601:surgery*; D014719:Vesicovaginal Fistula / Q000209:etiology / Q000628:therapy*; D055815:Young Adult
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