title: Fistula after attended delivery and the challenge of obstetric care capacity in the eastern Democratic Republic of Congo.
abstract: OBJECTIVE
  To analyze the history of women with fistula in the eastern Democratic Republic of Congo (DRC) to understand the determinants of fistula development.
  
  
  METHODS
  In a retrospective observational study, data were analyzed from a survey of all women who underwent surgical fistula repair at HEAL Africa Hospital, Goma, between April 1, 2009, and March 1, 2012. Characteristics and obstetric histories were obtained by self-report.
  
  
  RESULTS
  The mean age of the 202 participants at treatment was 30.7 years (range 5-69). The mean duration of fistula was 45.6 months (range 0-600). In total, 171 (91.4%) fistulas were caused by obstructed labor, and 147 (86.5%) were vesicovaginal. Most women (129/175 [73.8%]) reported having received care during early labor under the supervision of a nurse or doctor in a healthcare facility. Among 176 women for whom delivery data were available, 102 (57.9%) delivered at a hospital, 42 (23.8%) at a health center, and 32 (18.2%) at home. Only 46 (26.3%) of 175 women were transferred to a higher level of care during labor.
  
  
  CONCLUSIONS
  In the eastern DRC, efforts to enable transport to a healthcare facility and to encourage attended births must be accompanied by improvements in the capacity of existing facilities and in the training of staff to enable the timely diagnosis of labor abnormalities and appropriate intervention.
authors.affiliation: Department of Obstetrics and Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, NY, USA. Electronic address: nbenfiel@montefiore.org.
authors.forename: Nerys
authors.initials: N
authors.lastname: Benfield
authors.affiliation: University of California, San Francisco, San Francisco, CA, USA.
authors.forename: Nichole
authors.initials: N
authors.lastname: Young-Lin
authors.affiliation: Department of Surgery, HEAL Africa Hospital, Goma, Democratic Republic of Congo.
authors.forename: Christophe
authors.initials: C
authors.lastname: Kimona
authors.affiliation: Department of Surgery, HEAL Africa Hospital, Goma, Democratic Republic of Congo.
authors.forename: Luc M
authors.initials: LM
authors.lastname: Kalisya
authors.affiliation: Department of Obstetrics and Gynecology, HEAL Africa Hospital, Goma, Democratic Republic of Congo.
authors.forename: Rogatien M
authors.initials: RM
authors.lastname: Kisindja
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D015023:Democratic Republic of the Congo / Q000453:epidemiology; D005260:Female; D006801:Humans; D008875:Middle Aged; D007744:Obstetric Labor Complications / Q000453:epidemiology*; D010360:Patient Transfer / Q000706:statistics & numerical data; D011247:Pregnancy; D012189:Retrospective Studies; D014187:Transportation of Patients; D014624:Vaginal Fistula / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery; D014719:Vesicovaginal Fistula / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery; D055815:Young Adult
keywords: Healthcare capacity; Maternal complications; Obstetric fistula