title: Good clinical outcomes from a 7-year holistic programme of fistula repair in Guinea.
abstract: OBJECTIVE
  Female genital fistula remains a public health concern in developing countries. From January 2007 to September 2013, the Fistula Care project, managed by EngenderHealth in partnership with the Ministry of Health and supported by USAID, integrated fistula repair services in the maternity wards of general hospitals in Guinea. The objective of this article was to present and discuss the clinical outcomes of 7 years of work involving 2116 women repaired in three hospitals across the country.
  
  
  METHODS
  This was a retrospective cohort study using data abstracted from medical records for fistula repairs conducted from 2007 to 2013. The study data were reviewed during the period April to August 2014.
  
  
  RESULTS
  The majority of the 2116 women who underwent surgical repair had vesicovaginal fistula (n = 2045, 97%) and 3% had rectovaginal fistula or a combination of both. Overall 1748 (83%) had a closed fistula and were continent of urine immediately after surgery. At discharge, 1795 women (85%) had a closed fistula and 1680 (79%) were dry, meaning they no longer leaked urine and/or faeces. One hundred and fifteen (5%) remained with residual incontinence despite fistula closure. Follow-up at 3 months was completed by 1663 (79%) women of whom 1405 (84.5%) had their fistula closed and 80% were continent. Twenty-one per cent were lost to follow-up.
  
  
  CONCLUSIONS
  Routine programmatic repair for obstetric fistula in low resources settings can yield good outcomes. However, more efforts are needed to address loss to follow-up, sustain the results and prevent the occurrence and/or recurrence of fistula.
authors.affiliation: Ecole de Santé Publique, Université libre de Bruxelles, Bruxelles, Belgium; Centre national de formation et de recherche en santé rurale de Maferinyah, Forecariah, Guinea; Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Delamou
authors.forename: Moustapha
authors.initials: M
authors.lastname: Diallo
authors.forename: Abdoul Habib
authors.initials: AH
authors.lastname: Beavogui
authors.forename: Thérèse
authors.initials: T
authors.lastname: Delvaux
authors.forename: Sita
authors.initials: S
authors.lastname: Millimono
authors.forename: Mamady
authors.initials: M
authors.lastname: Kourouma
authors.forename: Karen
authors.initials: K
authors.lastname: Beattie
authors.forename: Mark
authors.initials: M
authors.lastname: Barone
authors.forename: Thierno Hamidou
authors.initials: TH
authors.lastname: Barry
authors.forename: Mohamed
authors.initials: M
authors.lastname: Khogali
authors.forename: Mary
authors.initials: M
authors.lastname: Edginton
authors.forename: Sven Gudmund
authors.initials: SG
authors.lastname: Hinderaker
authors.forename: Joseph
authors.initials: J
authors.lastname: Ruminjo
authors.forename: Wei-Hong
authors.initials: WH
authors.lastname: Zhang
authors.forename: Vincent
authors.initials: V
authors.lastname: De Brouwere
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D016701:Guinea / Q000453:epidemiology; D006694:Holistic Health; D006801:Humans; D059012:Lost to Follow-Up; D008875:Middle Aged; D012006:Rectovaginal Fistula / Q000453:epidemiology / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014719:Vesicovaginal Fistula / Q000453:epidemiology / Q000601:surgery*
keywords: Guinea; Guinée; SORT-IT; cuidados de fístula; fistula care; fistula obstétrica; fistule obstétrique; investigación de operaciones; obstetric fistula; operational research; recherche opérationnelle; soins pour la fistule