title: High loss to follow-up following obstetric fistula repair surgery in rural Burundi: is there a way forward?
abstract: METHODS
  Gitega Fistula Centre (GFC), a dedicated obstetric fistula repair centre providing comprehensive care at the Gitega District Hospital, rural Burundi.
  
  
  OBJECTIVE
  To describe 1) the proportion who returned for scheduled 3- and 6-month follow-up visits and 2) outcomes (fistula closure rates and continence status) at discharge from hospital and after 3 and 6 months among patients who underwent fistula repair surgery.
  
  
  METHODS
  Retrospective cohort analysis using programme data from April 2010 to December 2011.
  
  
  RESULTS
  A total of 475 women with obstetric fistula underwent surgical repair. At discharge from hospital, 415 (87%) had a closed fistula, of whom 318 (77%) were continent of urine and/or faeces, while 97 (23%) remained incontinent despite closure. Of the 415 patients with closed fistula, only 244 (59%) were followed up at 3 months and 73 (18%) at 6 months (χ(2) for linear trend 576, P < 0.0001). This indicates progressive loss to follow-up, reaching 82% by 6 months.
  
  
  CONCLUSIONS
  Women undergoing obstetric fistula repair surgery at GFC achieve good hospital exit outcomes. Thereafter, substantial and progressive loss to follow-up hinder the ability to judge programme success over time. Steps to address this operational problem are discussed.
authors.affiliation: Médecins Sans Frontières (MSF), Operational Center Brussels, Burundi-Gitega, Burundi.
authors.forename: A
authors.initials: A
authors.lastname: Bishinga
authors.affiliation: Medical Department (Operational Research), Operational Center Brussels, MSF-Luxembourg.
authors.forename: R
authors.initials: R
authors.lastname: Zachariah
authors.affiliation: University of Bergen, Bergen, Norway.
authors.forename: S
authors.initials: S
authors.lastname: Hinderaker
authors.affiliation: Medical Department (Operational Research), Operational Center Brussels, MSF-Luxembourg.
authors.forename: K
authors.initials: K
authors.lastname: Tayler-Smith
authors.affiliation: Medical Department (Operational Research), Operational Center Brussels, MSF-Luxembourg.
authors.forename: M
authors.initials: M
authors.lastname: Khogali
authors.affiliation: Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: J
authors.initials: J
authors.lastname: van Griensven
authors.affiliation: MSF, Bujumbura, Burundi.
authors.forename: W
authors.initials: W
authors.lastname: van den Boogaard
authors.affiliation: MSF, Bujumbura, Burundi.
authors.forename: M
authors.initials: M
authors.lastname: Tamura
authors.affiliation: MSF, Bujumbura, Burundi.
authors.forename: B
authors.initials: B
authors.lastname: Christiaens
authors.affiliation: Ministry of Health, Bujumbura, Burundi.
authors.forename: G
authors.initials: G
authors.lastname: Sinabajije
keywords: Burundi; loss to follow-up; obstetric fistula; operational research