Post-operative complications of obstetric fistula repair outcomes among patients treated at Gynocare fistula centre, Eldoret-Kenya

Abstract

Background: Obstetric fistula is an abnormal communication between the vagina and the urinary bladder and/or the rectum that commonly occurs as a result of prolonged obstructed labour. Other social factors contribute to fistula development such as poverty which leads to lack of emergency obstetric care, malnutrition, lack of basic education. The World Health Organization (WHO) estimates that about 50,000–100,000 women develop obstetric fistula annually with at least 33,000 of these located in sub- Saharan Africa. Objective: To assess the post-operative complications of obstetric fistula repair among patients treated at Gynocare fistula centre, Eldoret-Kenya. Methods: This was a prospective observational study carried out at Gynocare Fistula Center in Eldoret- Kenya. All women with obstetric fistula who met the inclusion criteria were recruited into the study. Participants were followed up at two weeks after repair of fistula for early postoperative complications, then at three and six month for late postoperative complications and fistula repair outcomes. Interviewer administered structured questionnaire was used to collect data. Data was analyzed using statistical software R core Team 2016. Association between categorical variables was conducted using Pearson’s Chi Square test. Logistic regression model was used to study the predictors of fistula repair success. The respective P values and odds ratios (OR) calculated at 95% confidence interval. Results: Eighty participants were recruited in the study. Seventy six (95%) of them had vesicovaginal fistula whereas four (5%) had rectovaginal fistula. The median age of the participant was 35.0 (IQR: 26.0, 42.2) years. Two thirds of the participants were married 54(67.5%) and 12.5% were divorced after developing fistula. One fifth had no formal education 17 (21.2%), and one third, 23 (28.7%) had at least a secondary level of education. Median age of fistula development was 24.0 (IQR: 19.0, 32.0). Majority were parity one 34(42.5%) at time of fistula development. Married participants had four times increased odds of fistula repair success, OR: 4.61 (95% CI: 1.25-19.31). Fifty nine (73.8%) of the participants had delivered in the hospital and 14 (17.9%) had assisted vaginal delivery which was associated with 81% reduced odds of fistula repair success OR: 0.19 (95% CI: 0.05, 0.76). Twelve (15.0%) of the participants had prior failed fistula repair attempt with half (50.0%) of whom had undergone more than one repair attempts. Prior repair was significantly associated with 98% reduced odds of successful fistula repair, OR: 0.02 (95% CI: 0.00, 0.11). Moderate vaginal stenosis was observed in 16 (21.1%) and this was associated with 83% reduced odds of fistula repair success, OR: 0.17 (95% CI: 0.01, 0.98). older age participants had 9 % reduced odds of fistula repair success OR 0.91 (95% CI: 0.84, 0.99). Prior fistula repair attempt and older age participants were the only variables independently associated with unsuccessful repair. Conclusion: The postoperative complications were vaginal stenosis, dyspareunia and urethral stricture. The success rate of fistula repair was 86.3%, which falls within the WHO recommendations. Determinants of successful fistula repair outcomes were prior failed fistula repair attempt and older age participants. Recommendations: Caution should be made for women who have prior attempts. Active surveillance to identify community based women suffering obstetric fistula with provision of fistula care services.