title: Living with constant leaking of urine and odour: thematic analysis of socio-cultural experiences of women affected by obstetric fistula in rural Tanzania.
abstract: BACKGROUND
  Obstetric fistula is a worldwide problem that affects women and girls mostly in Sub Saharan Africa. It is a devastating medical condition consisting of an abnormal opening between the vagina and the bladder or rectum, resulting from unrelieved obstructed labour. Obstetric fistula has devastating social, economic and psychological effect on the health and wellbeing of the women living with it. This study aimed at exploring social-cultural experiences of women living with obstetric fistula in rural Tanzania.
  
  
  METHODS
  Women living with obstetric fistula were identified from the fistula ward at CCBRT hospital. Sixteen individual semi structured interviews and two (2) focus group discussions were conducted among consenting women. Interviews were transcribed verbatim and transcripts analysed independently by two researchers using a thematic analysis approach. Themes related to the experiences of living with obstetric fistula were identified.
  
  
  RESULTS
  Four themes illustrating the socio-cultural experiences of women living with obstetric fistula emerged from the analysis of women experiences of living with incontinence and odour. These were keeping clean and neat, earning an income, maintaining marriage, and keeping association. Women experiences of living with fistula were largely influenced by perceptions of people around them basing on their cultural understanding of a woman.
  
  
  CONCLUSIONS
  Living with fistula reveals women's day-to-day experiences of social discrimination and loss of control due to incontinence and odour. They cannot work and contribute to the family income, cannot satisfy their husband's sexual needs and or bear children, and cannot interact with members of the community in social activities. Women experience of living with fistula was influenced by perceptions of people around them. In the eyes of these people, women who leak urine were of less value since they were not capable of carrying out ascribed social roles.
authors.affiliation: Department of Clinical Nursing, Muhimbili University of Health and Allied Sciences, PO Box 65004, Dar es Salaam, Tanzania. nakutz@yahoo.com.
authors.forename: Lilian T
authors.initials: LT
authors.lastname: Mselle
authors.affiliation: Department of Nursing Management, Muhimbili University of Health and Allied Sciences, PO Box 65004, Dar es Salaam, Tanzania. thecla.kohi@gmail.com.
authors.forename: Thecla W
authors.initials: TW
authors.lastname: Kohi
mesh_terms: D000328:Adult; D005260:Female; D017144:Focus Groups; D006801:Humans; D008875:Middle Aged; D007744:Obstetric Labor Complications / Q000523:psychology; D009812:Odorants; D011247:Pregnancy; D036301:Qualitative Research; D012006:Rectovaginal Fistula / Q000150:complications / Q000523:psychology; D012424:Rural Population; D066252:Sociological Factors; D013636:Tanzania; D014549:Urinary Incontinence / Q000150:complications* / Q000523:psychology*; D014719:Vesicovaginal Fistula / Q000150:complications* / Q000523:psychology*