Factors associated with the failure of obstetric fistula repair in Guinea: implications for practice.
BACKGROUND
The prevention and treatment of obstetric fistula still remains a concern and a challenge in low income countries. The objective of this study was to estimate the overall proportions of failure of fistula closure and incontinence among women undergoing repair for obstetric fistula in Guinea and identify its associated factors.


METHODS
This was a retrospective cohort study using data extracted from medical records of fistula repairs between 1 January 2012 and 30 September 2013. The outcome was the failure of fistula closure and incontinence at hospital discharge evaluated by a dye test. A sub-sample of women with vesicovaginal fistula was used to identify the factors associated with these outcomes.


RESULTS
Overall, 109 women out of 754 (14.5 %; 95 % CI:11.9-17.0) unsuccessful repaired fistula at discharge and 132 (17.5 %; 95 % CI:14.8-20.2) were not continent. Failure of fistula closure was associated with vaginal delivery (AOR: 1.9; 95 % CI: 1.0-3.6), partially (AOR: 2.0; 95 % CI: 1.1-5.6) or totally damaged urethra (AOR: 5.9; 95 % CI: 2.9-12.3) and surgical repair at Jean Paul II Hospital (AOR: 2.5; 95 % CI: 1.2-4.9). Women who had a partially damaged urethra (AOR: 2.5; 95 % CI: 1.5-4.4) or a totally damaged urethra (AOR: 6.3; 95 % CI: 3.0-13.0) were more likely to experience post-repair urinary incontinence than women who had their urethra intact.


CONCLUSIONS
At programmatic level in Guinea, caution should be paid to the repair of women who present with a damaged urethra and those who delivered vaginally as they carry greater risks of experiencing a failure of fistula closure and incontinence.
Ecole de Santé Publique, Université libre de Bruxelles (ULB), Bruxelles, Belgium. alexdelamou@yahoo.fr.|Centre national de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea. alexdelamou@yahoo.fr.|Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium. alexdelamou@yahoo.fr.
Alexandre
http://orcid.org/0000-0002-9397-7106
A
Delamou
Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
Therese
T
Delvaux
Centre national de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea.
Abdoul Habib
AH
Beavogui
Department of Public Health, Faculty of Medicine, University of Conakry, Conakry, Guinea.
Abdoulaye
A
Toure
Centre national de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea.
Delphin
D
Kolié
Centre national de Formation et de Recherche en Santé Rurale de Maferinyah, Forécariah, Guinea.|Department of Public Health, Faculty of Medicine, University of Conakry, Conakry, Guinea.
Sidikiba
S
Sidibé
Centre Médicosocial Jean Paul II de Conakry, Conakry, Guinea.
Mandian
M
Camara
Hôpital Régional de Labé, Labé, Guinea.
Kindy
K
Diallo
Engenderhealth, Conakry, Guinea.
Thierno Hamidou
TH
Barry
Hôpital préfectoral de Kissidougou, Kissidougou, Guinea.
Moustapha
M
Diallo
Ecole de Santé Publique, Université libre de Bruxelles (ULB), Bruxelles, Belgium.
Alain
A
Leveque
Ecole de Santé Publique, Université libre de Bruxelles (ULB), Bruxelles, Belgium.
Wei-Hong
WH
Zhang
Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
Vincent
V
De Brouwere
D000293:Adolescent; D000328:Adult; D036861:Delivery, Obstetric / Q000009:adverse effects / Q000379:methods; D005260:Female; D016701:Guinea / Q000453:epidemiology; D006801:Humans; D008875:Middle Aged; D007744:Obstetric Labor Complications / Q000453:epidemiology / Q000601:surgery*; D011247:Pregnancy; D011364:Professional Practice; D012006:Rectovaginal Fistula / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors; D017211:Treatment Failure; D014521:Urethra / Q000293:injuries; D014549:Urinary Incontinence / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D014719:Vesicovaginal Fistula / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D055815:Young Adult
Factors associated; Failure; Guinea; Incontinence; Obstetric fistula; Repair