title: Impact of surgery on quality of life of women with obstetrical fistula: a qualitative study in Burkina Faso.
abstract: OBJECTIVE
  Obstetric fistula, caused by traumatic delivery and patient lack of access to obstetric care, is an important public health concern in developing countries, particularly in Sub-Saharan Africa. This research focuses on the experience of women living with obstetric fistula in Burkina Faso as well as their reintegration into community after surgery.
  
  
  METHODS
  This project was funded by the Mères du Monde en Santé (MMS) Foundation and conducted in collaboration with the Boromo Hospital. A qualitative approach based on grounded theory and using the principles of participative action research (PAR) was used with semidirected interviews prior to surgery and follow-up interviews 1-2 years after surgery directly in the women's village of origin. Thirty-nine participants were recruited between 2012 and 2015.
  
  
  RESULTS
  The results point to circumstances leading to obstetric fistula development: poverty, gender inequality in terms of decision making, healthcare-system deficiencies, and lack of services for referral and treatment of this condition. Our results reinforce the knowledge about the social and psychological repercussions of fistula by exploring the concepts of gossips, shame and self-exclusion as powerful mechanisms of exclusion, but they also show that social support was conserved for several women through their journey with this disease. There was complete social rehabilitation within the community after surgery; however, persistent barriers in term of anxiety regarding obstetric future and economic insecurity were present.
  
  
  CONCLUSIONS
  Early recruitment for surgery and prevention are the main objectives when attempting to reduce the impact of obstetric fistula and facilitate patient reintegration. Improvements in local and governmental public health policies are required.
authors.affiliation: Department of Obstetrics, La Salle Hospital, McGill University, LaSalle, Québec, Canada. juliedesalliers@gmail.com.|Clinique Espace Santé, 8 Place du Commerce, Verdun, QC, Canada, H3E1N3. juliedesalliers@gmail.com.
authors.forename: Julie
authors.initials: J
authors.lastname: Désalliers
authors.affiliation: Department of Anthropology, Université de Montréal, Montréal, Québec, Canada.
authors.forename: Marie-Eve
authors.initials: ME
authors.lastname: Paré
authors.affiliation: Department of Sociology, Université de Ouagadougou, Ouagadougou, Burkina Faso.
authors.forename: Salam
authors.initials: S
authors.lastname: Kouraogo
authors.affiliation: Department of Urology, Jewish General Hospital, McGill University, Montréal, Québec, Canada.
authors.forename: Jacques
authors.initials: J
authors.lastname: Corcos
mesh_terms: D000328:Adult; D000368:Aged; D002050:Burkina Faso; D036861:Delivery, Obstetric / Q000009:adverse effects; D005260:Female; D006801:Humans; D008875:Middle Aged; D011247:Pregnancy; D012919:Social Behavior; D014624:Vaginal Fistula / Q000208:ethnology* / Q000209:etiology / Q000523:psychology* / Q000601:surgery; D055815:Young Adult
keywords: Fistula surgery; Grounded theory; Obstetric fistula; Qualitative approach; Social reintegration; West Africa; Women’s health