Abstract:

Background: World health organization (WHO) estimates that approximately two to four million women live with obstetric fistula (OF) worldwide with occurrence of around 1,200 to 3000 new cases of OF in Tanzania yearly, resulting into significant morbidity and loss of quality of life. Two previous studies conducted at Bugando Medical Centre (BMC) compared the fistula management techniques and identification of the high risk fistula population; but the short term complications after repair and factors associated with these complications remain to be explored in this setting.

Methodology: This was a follow up study conducted at BMC from September, 2014 to April, 2015 in Gynaecology ward and 132 selected eligible fistula patients were followed up for 21 days regarding their post-operative outcomes. Patients were informed about the study and voluntarily requested to consent and participate in the study. Social demographic and clinical information were collected using prestested questionnaire. Urine sample for culture and sensitivity were collected intra-operatively and processed according to standard operative procedures. Data were analyzed using STATA version 11.

Results: The median age of the women with OF (interquartile range) was 23 (20-23) years with a range of 16 to 58 years. The incidence of short term complications was 31.8% (42/132); with the predominant complications being failed repair 18 (42.9%), stress incontinence 10(23.8%) and multiple short term complications in about 9 (21.4%) patients. Asymptomatic bacteriuria was found in 33 (50.8%) of patients whose urine samples were collected intra-operatively with predominance of Gram negative bacteria, 93% (40/43). This factor had no association with occurrence of short term complications (p value =0.351). Majority of these women came from rural areas (p-value 0.042) and had obstetrics outcomes (p-value<0.001). HIV seropositivity was found in 4.1% (5/132) and significantly associated with short term complications (p-value=0.002). Fistula characteristics such as fistula type (p-value =0.005) and size (p-value=0.006), reduced bladder capacity (p-value<0.001) and urethral length (p-value=0.001) and presence of fibrosis (p-value =0.004) were significantly associated with short term complications among women repaired for OF

Conclusion: The proportion of women developing short term complications at BMC is high (31.8%); with the common complications being failed repair, stress incontinence and hemorrhage. Moreover, the short term complications were associated with residing in rural areas, poor birth outcomes, HIV seropositivity and fistula characteristics such as fistula type, site and size, reduced bladder capacity and reduced urethral length.