title: Obstetric fistula management and predictors of successful closure among women attending a public tertiary hospital in Rwanda: a retrospective review of records.
abstract: BACKGROUND
  Globally, 50,000-100,000 women develop obstetric fistula annually. At least 33,000 of these women live in Sub-Saharan Africa where limitations in quality obstetric care and fistula corrective repairs are prevalent. Among women with fistula seeking care at public health facilities in resource-limited settings, there is paucity of data on quality of care received. The aim of this study was to characterize obstetric fistula among Rwandan women managed at a public tertiary hospital and evaluate for predictors of successful fistula closures.
  
  
  METHODS
  A retrospective review of records for all obstetric fistula women managed at a public referral health facility between 2007 and 2013 was performed. Patient socio-demographics, obstetric characteristics and fistula repair outcomes data were reviewed. A multivariate logistic regression model was used to analyse for predictors of successful fistula repair outcomes.
  
  
  RESULTS
  A total of 272 women aged between 16 to 78 years and with a mean age of 34.6 years were included. Of these, 93 (34.2 %), 48 (17.6 %), 65 (24 %) and 64 (23 %) women had vesico-vaginal fistula, recto-vaginal fistula, urethro-vaginal fistula and vesico-uteral fistula types, respectively. Successful fistula closure was achieved among 86.3 %. Women with fistula who reported being in labour for ≥3 days, having ≥1 previous fistula repair attempt, and having lived with the fistula for >1 year, had significantly lower odds of successful repair outcomes.
  
  
  CONCLUSIONS
  Among 272 women with obstetric fistula managed in this study, 69.5 and 26.5 % of their fistula were causally associated with obstructed labour complications and iatrogenic factors, respectively. Successful fistula closure rates of about 89 % among women of index repair attempt were achieved. Conversely, reported histories of ≥3 days in labour, ≥1 previous failed attempts at repair and a fistula duration of >1 year, were significant determinants of failed fistula closures. To effectively mitigate obstetric fistula burden in Rwanda, a comprehensive package of services including quality emergency obstetric care, increased availability of and access to quality fistula repair, active surveillance to identify community-based women with fistula and a strong political will towards effective fistula care, are recommended.
authors.affiliation: Rwanda Military Hospital, P.O. BOX 3377, Kigali, Rwanda. teklel@yahoo.com.
authors.forename: Tekle G
authors.initials: TG
authors.lastname: Egziabher
authors.affiliation: Rwanda Military Hospital, P.O. BOX 3377, Kigali, Rwanda. ngogaeu@gmail.com.
authors.forename: Ngoga
authors.initials: N
authors.lastname: Eugene
authors.affiliation: Rwanda Military Hospital, P.O. BOX 3377, Kigali, Rwanda. benkarenzi@gmail.com.
authors.forename: Karenzi
authors.initials: K
authors.lastname: Ben
authors.affiliation: Rwanda Military Hospital, P.O. BOX 3377, Kigali, Rwanda. fkkateera@yahoo.com.
authors.forename: Kateera
authors.initials: K
authors.lastname: Fredrick
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006779:Hospitals, Public / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008875:Middle Aged; D015999:Multivariate Analysis; D007744:Obstetric Labor Complications / Q000453:epidemiology / Q000601:surgery*; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data; D011247:Pregnancy; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D012432:Rwanda / Q000453:epidemiology; D012923:Social Class; D062606:Tertiary Care Centers / Q000706:statistics & numerical data*; D014624:Vaginal Fistula / Q000453:epidemiology / Q000601:surgery*; D055815:Young Adult