title: Clinical procedures and practices used in the perioperative treatment of female genital fistula during a prospective cohort study.
abstract: BACKGROUND
  Treatment and care for female genital fistula have become increasingly available over the last decade in countries across Africa and South Asia. Before the International Federation of Gynaecology and Obstetrics (FIGO) and partners published a global fistula training manual in 2011 there was no internationally recognized, standardized training curriculum, including perioperative care. The community of fistula care practitioners and advocates lacks data about the prevalence of various perioperative clinical procedures and practices and their potential programmatic implications are lacking.
  
  
  METHODS
  Data presented here are from a prospective cohort study conducted between September 2007 and September 2010 at 11 fistula repair facilities supported by Fistula Care in five countries. Clinical procedures and practices used in the routine perioperative management of over 1300 women are described.
  
  
  RESULTS
  More than two dozen clinical procedures and practices were tabulated. Some of them were commonly used at all sites (e.g., vaginal route of repair, 95.3% of cases); others were rare (e.g., flaps/grafts, 3.4%) or varied widely depending on site (e.g. for women with urinary fistula, the inter-quartile range for median duration of post-repair bladder catheterization was 14 to 29 days).
  
  
  CONCLUSIONS
  These findings show a wide range of clinical procedures and practices with different program implications for safety, efficacy, and cost-effectiveness. The variability indicates the need for further research so as to strengthen the evidence base for fistula treatment in developing countries.
authors.affiliation: EngenderHealth, 440 9th Avenue, FL 13, New York, NY 10001, USA. jruminjo@engenderhealth.org.
authors.forename: Joseph K
authors.initials: JK
authors.lastname: Ruminjo
authors.forename: Veronica
authors.initials: V
authors.lastname: Frajzyngier
authors.forename: Muhammad
authors.initials: M
authors.lastname: Bashir Abdullahi
authors.forename: Frank
authors.initials: F
authors.lastname: Asiimwe
authors.forename: Thierno Hamidou
authors.initials: TH
authors.lastname: Barry
authors.forename: Abubakar
authors.initials: A
authors.lastname: Bello
authors.forename: Dantani
authors.initials: D
authors.lastname: Danladi
authors.forename: Sanda Oumarou
authors.initials: SO
authors.lastname: Ganda
authors.forename: Sa'ad
authors.initials: S
authors.lastname: Idris
authors.forename: Maman
authors.initials: M
authors.lastname: Inoussa
authors.forename: Maura
authors.initials: M
authors.lastname: Lynch
authors.forename: Felicity
authors.initials: F
authors.lastname: Mussell
authors.forename: Dulal Chandra
authors.initials: DC
authors.lastname: Podder
authors.forename: Abba
authors.initials: A
authors.lastname: Wali
authors.forename: Mark A
authors.initials: MA
authors.lastname: Barone
mesh_terms: D000328:Adult; D000775:Anesthesia, Spinal; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001510:Bed Rest; D004326:Drinking; D004733:Enema; D005193:Family Planning Services; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D061646:Operative Time; D019990:Perioperative Care / Q000379:methods*; D010808:Physical Examination / Q000379:methods; D011446:Prospective Studies; D020127:Recovery of Function; D012006:Rectovaginal Fistula / Q000601:surgery*; D016896:Treatment Outcome; D014522:Urethral Diseases / Q000601:surgery*; D001743:Urinary Bladder / Q000502:physiology; D014546:Urinary Catheterization; D013520:Urologic Surgical Procedures / Q000379:methods*; D014719:Vesicovaginal Fistula / Q000601:surgery*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents