title: Factors associated with loss to follow-up in women undergoing repair for obstetric fistula in Guinea.
abstract: OBJECTIVE
  To analyse the trend of loss to follow-up over time and identify factors associated with women being lost to follow-up after discharge in three fistula repair hospitals in Guinea.
  
  
  METHODS
  This retrospective cohort study used data extracted from medical records of fistula repairs conducted from 1 January 2007 to 30 September 2013. A woman was considered lost to follow-up if she did not return within 4 months post-discharge. Factors associated with loss to follow-up were identified using a subsample of the data covering the period 2010-2013.
  
  
  RESULTS
  Over the study period, the proportion of loss to follow-up was 21.5% (448/2080) and varied across repair hospitals and over time with an increase from 2% in 2009 to 52% in 2013. After adjusting for other variables in a multivariate logistic regression model, women who underwent surgery at Labe hospital and at Kissidougou hospital were more likely to be lost to follow-up than women operated at Jean Paul II hospital (OR: 50.6; 95% CI: 24.9-102.8) and (OR: 11.5; 95% CI: 6.1-22.0), respectively. Women with their fistula closed at hospital discharge (OR: 3.2; 95% CI: 2.1-4.8) and women admitted for repair in years 2011-2013 showed higher loss to follow-up as compared to 2010. Finally, loss to follow-up increased by 2‰ for each additional kilometre of distance a client lived from the repair hospital (OR: 1.002; 95% CI: 1.001-1.003).
  
  
  CONCLUSIONS
  Reimbursement of transport was the likely reason for change over time of LTFU. Reducing geographical barriers to care for women with fistula could sustain fistula care positive outcomes.
authors.affiliation: Ecole de Santé Publique, Université Libre de Bruxelles (ULB), Bruxelles, Belgium.|Centre national de formation et de recherche en santé rurale de Maferinyah, Maferinyah, Guinea.|Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Delamou
authors.affiliation: Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Thérèse
authors.initials: T
authors.lastname: Delvaux
authors.affiliation: Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Bettina
authors.initials: B
authors.lastname: Utz
authors.affiliation: Centre national de formation et de recherche en santé rurale de Maferinyah, Maferinyah, Guinea.
authors.forename: Bienvenu Salim
authors.initials: BS
authors.lastname: Camara
authors.affiliation: Centre national de formation et de recherche en santé rurale de Maferinyah, Maferinyah, Guinea.
authors.forename: Abdoul Habib
authors.initials: AH
authors.lastname: Beavogui
authors.affiliation: EngenderHealth, New York, NY, USA.
authors.forename: Bethany
authors.initials: B
authors.lastname: Cole
authors.affiliation: EngenderHealth, New York, NY, USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Levin
authors.affiliation: EngenderHealth, Conakry, Guinea.
authors.forename: Moustapha
authors.initials: M
authors.lastname: Diallo
authors.affiliation: EngenderHealth, Conakry, Guinea.
authors.forename: Sita
authors.initials: S
authors.lastname: Millimono
authors.affiliation: Hopital Prefectoral de Kissidougou, Kissidougou, Guinea.
authors.forename: Thierno Hamido
authors.initials: TH
authors.lastname: Barry
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA.
authors.forename: Alison Marie
authors.initials: AM
authors.lastname: El Ayadi
authors.affiliation: Ecole de Santé Publique, Université Libre de Bruxelles (ULB), Bruxelles, Belgium.
authors.forename: Wei-Hong
authors.initials: WH
authors.lastname: Zhang
authors.affiliation: Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Vincent
authors.initials: V
authors.lastname: De Brouwere
keywords: Conakry; Fistula care; Guinea; Guinée Conakry; Obstetric fistula; fistula obstétrica; fistule obstétricale; loss to follow-up; perte au suivi; pérdida durante el seguimiento; reparación de fístula; soins de la fistule