Good clinical outcomes from a 7‐year holistic programme of fistula repair in Guinea

Objectives Female genital fistularemains a public health concern in developing countries. From January 2007 to September 2013 the FistulaCare project managed by EngenderHealth in partnership with the Ministry of Health and supported by USAID integrated fistularepair services in the maternity wards of general hospitals in Guinea. The objective of this article is to present and discuss the clinical outcomes of 7 years of work involving 2116 women repaired in three hospitals across the country. Methods This was a retrospective cohort study using data abstracted from medical records for fistularepairs conducted from 2007 to 2013. The study data was reviewed during the period April to August 2014. Results The majority of the 2116 women who underwent surgical repair had vesico vaginal fistula(n=2045 97%) and 3% had recto vaginal fistulaor a combination of both. Overall 1748 (83%) had a closed fistulaand were continent of urine immediately after surgery. At discharge 1795 women (85%) had a closed fistulaand 1680 (79%) were dry meaning they no longer leaked urine and/or faeces. 115 (5%) remained with residual incontinence despite fistulaclosure. Follow-up at three months was completed by 1663 (79%) women of whom 1405 (84.5%) had their fistulaclosed and 80% were continent. 21% were lostto follow-up. Conclusion Routine programmatic repair for obstetric fistulain low resources settings can yield good outcomes. However more efforts are needed to address loss to follow-up sustain the results and prevent the occurrence and/or recurrence of fistula.