title: Beyond repair - family and community reintegration after obstetric fistula surgery: study protocol.
abstract: BACKGROUND
  Obstetric fistula is a debilitating birth injury that affects an estimated 2-3 million women globally, most in sub-Saharan Africa and Asia. The urinary and/or fecal incontinence associated with fistula affects women physically, psychologically and socioeconomically. Surgical management of fistula is available with clinical success rates ranging from 65-95 %. Previous research on fistula repair outcomes has focused primarily on clinical outcomes without considering the broader goal of successful reintegration into family and community. The objectives for this study are to understand the process of family and community reintegration post fistula surgery and develop a measurement tool to assess long-term success of post-surgical family and community reintegration.
  
  
  METHODS
  This study is an exploratory sequential mixed-methods design including a preliminary qualitative component comprising in-depth interviews and focus group discussions to explore reintegration to family and community after fistula surgery. These results will be used to develop a reintegration tool, and the tool will be validated within a small longitudinal cohort (n = 60) that will follow women for 12 months after obstetric fistula surgery. Medical record abstraction will be conducted for patients managed within the fistula unit. Ethical approval for the study has been granted.
  
  
  CONCLUSIONS
  This study will provide information regarding the success of family and community reintegration among women returning home after obstetric fistula surgery. The clinical and research community can utilize the standardized measurement tool in future studies of this patient population.
authors.affiliation: Department of Obstetrics and Gynecology, Makerere University College of Health Sciences, Kampala, Uganda. jbyamugisha@gmail.com.|Mulago National Referral and Teaching Hospital, Kampala, Uganda. jbyamugisha@gmail.com.
authors.forename: Josaphat
authors.initials: J
authors.lastname: Byamugisha
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California San Francisco, California, USA.
authors.forename: Alison
authors.initials: A
authors.lastname: El Ayadi
authors.affiliation: Mulago National Referral and Teaching Hospital, Kampala, Uganda.
authors.forename: Susan
authors.initials: S
authors.lastname: Obore
authors.affiliation: Mulago National Referral and Teaching Hospital, Kampala, Uganda.
authors.forename: Haruna
authors.initials: H
authors.lastname: Mwanje
authors.affiliation: Department of Obstetrics and Gynecology, Makerere University College of Health Sciences, Kampala, Uganda.
authors.forename: Othman
authors.initials: O
authors.lastname: Kakaire
authors.affiliation: Mulago National Referral and Teaching Hospital, Kampala, Uganda.
authors.forename: Justus
authors.initials: J
authors.lastname: Barageine
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California San Francisco, California, USA.
authors.forename: Felicia
authors.initials: F
authors.lastname: Lester
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California San Francisco, California, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Butrick
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California San Francisco, California, USA.
authors.forename: Abner
authors.initials: A
authors.lastname: Korn
authors.affiliation: Department of Obstetrics and Gynecology, Makerere University College of Health Sciences, Kampala, Uganda.
authors.forename: Hadija
authors.initials: H
authors.lastname: Nalubwama
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California San Francisco, California, USA.
authors.forename: Sharon
authors.initials: S
authors.lastname: Knight
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California San Francisco, California, USA.
authors.forename: Suellen
authors.initials: S
authors.lastname: Miller
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D007744:Obstetric Labor Complications; D011247:Pregnancy; D011788:Quality of Life; D020127:Recovery of Function; D012006:Rectovaginal Fistula / Q000150:complications / Q000523:psychology / Q000601:surgery*; D012107:Research Design; D012944:Social Support; D013997:Time Factors; D016896:Treatment Outcome; D014454:Uganda; D014549:Urinary Incontinence / Q000209:etiology / Q000601:surgery; D014719:Vesicovaginal Fistula / Q000150:complications / Q000523:psychology / Q000601:surgery*