Abstract:

Background: Genitourinary fistulas pose a public health challenge in areas where women have inadequate access utilization of quality emergency obstetric and gynecological care. This distressing and socially debilitating health condition for women occurs most commonly as a result of obstetrics and gynecological injuries. Despite various ongoing improvements, the problem persists, with about 1 to 3.5 million women who suffer from genitourinary fistula worldwide. In Tanzania, it is estimated that there are approximately 2,500-3,000 new cases of fistula each year of labor-related and iatrogenic etiology. This necessitates the need to assess determining factors associated with genitourinary fistulas.

Objective: To determine the clinical patterns of genitourinary fistula and its associated factors among patients treated at BMC and CCBRT hospitals in Tanzania.

Methodology: Cross-sectional study was conducted from March 2021 to June 2021 at BMC and CCBRT hospitals in Tanzania. It included all patients treated in the gynecological ward at BMC and fistula ward at CCBRT hospitals respectively. Non-probability purposive sampling technique was used; data were collected in a structured interviewer-administered questionnaire after a thorough history and physical examinations, later analyzed by STATA software version 15.

Results: During the study period, 332 patients were enrolled from BMC and CCBRT hospitals, the prevalence of genitourinary fistula at BMC was found to be 28.5% of the total gynecological admission. Juxta cervical location of the fistula was found to be common (37.9%), followed by ureteric injuries (17.9%), it was found commonly among patients who developed fistula post-surgery section accounted for the accounted surgery. Cesarean section accounted for the majority of the procedures done followed by hysterectomy.
The occurrence of the genitourinary fistula was associated with labor duration for more than 24 hours AOR 3.2 [95% CI 1.7-6.0], p-value<0.00, illiteracy AOR 3.8 [95%CI 1.1-12.6], p-value 0.029 and living in rural areas AOR 3.7[95% CI 1.8-7.8], p-value<0.001.

Conclusion: The prevalence of genitourinary fistula from a single facility was 28.5%. The majority of the patients was having juxta cervical locations that were commonly found among those patients who developed fistula post-surgical interventions due to obstetrics or gynecological complications. Fistula occurrences was associated with prolonged labor duration, illiteracy, and residing in rural areas. Therefore continuous education and proper labor monitoring are to be conducted regularly. Early recognition, timely interventions, and referral for abnormal labor are recommended. And to have properly trained staff from the training institutions that can detect and intervene accordingly.