Journal Articles

Demand and capacity to integrate pelvic organ prolapse and genital fistula services in low-resource settings. Vandana Tripathi, Sohier Elneil, Lauri Romanzi. International Urogynecology Journal. 6 February 2018doi: 10.1007/s00192-018-3561-2. [Epub ahead of print].  Packages of closely-related surgical procedures may create platforms of capacity that maximize impact in LMIC. Pelvic organ prolapse (POP) and genital fistula care provide an example. This study found that integration of genital fistula and POP services may enhance the quality of POP care while increasing the sustainability of fistula care.

The association between female genital fistula symptoms and gender-based violence: A multicountry secondary analysis of household survey data. Lindsay Mallick, Vandana Tripathi. Tropical Medicine & International Health. 15 December 2017. doi:10.1111/tmi.13008  Lindsay Mallick and Vandana Tripathi examined associations between self-reported fistula symptoms and experience of gender-based violence (GBV) among women interviewed in DHS surveys. Findings indicate increased risk of physical and sexual violence among women with fistula symptoms; the authors suggest that fistula programmes should incorporate GBV into provider training and services.

Development and preliminary validation of a post-fistula repair reintegration instrument among Ugandan women. Reproductive Health. 2017 Sep 2;14(1):109.                                                                                                                                    FC+ supported research teams from UCSF’s Bixby Center for Global Reproductive Health and Makerere University to conduct an exploratory sequential mixed-methods study with women who underwent fistula surgery within two previous years to inform measure development and validate a measurement instrument.

Fistula recurrence, pregnancy, and childbirth following successful closure of female genital fistula in Guinea: a longitudinal study. Lancet Global Health. 2017; 11:e1152-e1160.                                                                                    Alexandre Delamou, Therese Delvaux, Alison M El Ayadi, Vandana Tripathi, Bienvenu S Camara, Abdoul H Beavogui, Lauri Romanzi, Bethany Cole, Patrice Bouedouno, Moustapha Diallo, and co-authors report results of a longitudinal study in women discharged with a closed fistula from three repair hospitals supported by EngenderHealth in Guinea.

Ending fistula within a generation: making the dream a reality. Lancet Global Health. 2017 Aug; 5(8):e747-e748.         Erin Anastasi, Lauri Romanzi, Saifuddin Ahmed, Anneka T Knuttson, Oladosu Ojengbede, Kate Grant, on behalf of Campaign to End Fistula, assert that a global strategy linked to national strategies and action plans is mandatory for ending fistula within a generation.

A realist review of the partograph: when and how does it work for labour monitoring? BMC Pregnancy and Childbirth. 2017, Volume 17, number 1.                                                                                                                                                            Carol Bedwell, Karen Levin, Celia Pett, and Dame Tina Lavender highlight concerns about limitations in the way the partograph is used in the clinical context, and the potential impact on its effectiveness in a systematic review.

Factors associated with loss to follow-up in women undergoing repair for obstetric fistula in Guinea. Tropical Medicine & International Health. 2015 Nov;20(11):1454-1461.
Alex Delamou and co-authors analyse the trend of loss to follow-up over time and identify factors associated with women being lost to follow-up after discharge in three fistula repair hospitals in Guinea.

Development and validation of an index to measure facility-based labor and delivery care processes in sub-Saharan Africa. PLOS ONE. 2015. 10(6): e0129491.
Vandana Tripathi, Cynthia Stanton, Donna Strobino, and Linda Bartlett identified key dimensions of the quality of the process of intrapartum and immediate postpartum care (QoPIIPC) in facility deliveries and developed a quality assessment measure representing these dimensions.

Breakdown of simple female genital fistula repair after 7 day versus 14 day postoperative bladder catheterisation: a randomised, controlled, open-label, non-inferiority trial. The Lancet. July 2015. 386 (9988):56–62.
Mark Barone and co-authors aimed to establish whether 7 day bladder catheterisation was non-inferior to 14 days in terms of incidence of fistula repair breakdown in women with simple fistula. Findings of this Randomized Controlled Trail showed that 7 day bladder catheterisation after repair of simple fistula is non-inferior to 14 day catheterisation and could be used for management of women after repair of simple fistula with no evidence of a significantly increased risk of repair breakdown, urinary retention, or residual incontinence up to 3 months after surgery.

The value of building health promotion capacities within communities: Evidence from a maternal health intervention in Guinea. Health Policy and Planning.  2015 Sep;30(7):885-94.
Ellen Brazier, Renee Fiorentino, Mamadou Saidou Barry, and Moustapha Diallo present results from a study that explored the association between community capacity for maternal health promotion and women’s use of preventive and curative maternal health services in Guinea. The intervention aimed to build the capacity of community-level committees to heighten awareness about maternal health risks and to promote use of professional maternal health services throughout pregnancy and childbirth

Good clinical outcomes from a 7-year holistic programme of fistula repair in Guinea. Tropical Medicine in International Health. 2015 Jun;20(6):813-9.
Alex Delamou, Moustapha Diallo, and co-authors present and discuss the clinical outcomes of 7 years of Fistula Care work in Guinea, involving 2116 women repaired in three hospitals across the country.

What to measure and why? Experience developing monitoring indicators for an emerging maternal health issue: the case of obstetric fistula. Journal of Health Informatics in Developing Countries. 2015 9(1): 14-22.
Carrie Ngongo, Evelyn Landry, Karen Levin, Simon Ndizeye, Iretioluwa Sutton, and Vandana Tripathi recounts the process of developing, refining, and using standardized monitoring indicators as part of a fistula prevention and repair project in fourteen countries—Bangladesh, Benin, Democratic Republic of the Congo, Ethiopia, Ghana, Guinea, Liberia, Mali, Niger, Nigeria, Rwanda, Sierra Leone, Togo, and Uganda.

Measuring the incidence and prevalence of obstetric fistula: approaches, needs, and recommendations. Bulletin of the World Health Organization. 2015 Jan; 93(1):60-62
Özge Tunçalp, Vandana Tripathi, Evelyn Landry, Cynthia K Stanton,  and Saifuddin Ahmed assert that knowing the absolute numbers of women requiring treatment is also essential for effective health-care planning.

Community-based screening for obstetric fistula in Nigeria: a novel approach. BMC Pregnancy and Childbirth. 2014, 14:44
Ozge Tuncalp, Adamu Isah, Evelyn Landry, Cynthia Stanton aim to quantify the backlog of obstetric fistula cases within two states in Nigeria via community-based screenings and to assess the questions in the Demographic Health Survey (DHS) fistula module.

Mortality risk associated with surgical treatment of female genital fistula. International Journal of Gynecology and Obstetrics. 2014 Apr 18. pii: S0020-7292(14)00194-5.
Joseph Ruminjo, Evelyn Landry, Karen Beattie, Adamu Isah, Abu Jamal Faisel, and Sita Millimono describe the mortality risk associate with surgical treatment of obstetric fistula and the contributory and contexual factors, drawn from inquiries and clinical audits at 14 fistula repair sites in 7 countries between 2005 and 2013.

Clinical procedures and practices used in the perioperative treatment of female genital fistula during a prospective cohort study. BMC Pregnancy and Childbirth. 2014,  14:220
Joseph Ruminjo, Veronica Frajzyngier, Muhammad Bashir Abdullahi, Frank Asiimwe, et al. present data from a prospective cohort study conducted between 2007-2010 at 11 Fistula Care-supported repair facilities in five countries. Clinical procedures and practices used in the routine perioperative management of over 1300 women are described.

Iatrogenic genitourinary fistula: an 18-year retrospective review of 805 injuries. International Journal of Urogynecology. 2014 Jul 26.
Thomas Raassen, Carrie Ngongo, and Marietta Mahendeka completed a retrospective study which analyzed 805 iatrogenic fistulas from a series of 5,959 women undergoing fistula repair in 11 countries between 1994 and 2012.

Assessing the quality of record keeping for cesarean deliveries: results from a multicenter retrospective record review in five low-income countries. BMC Pregnancy and Childbirth. 2014, 14:139
Evelyn Landry, Celia Pett, Renee Fiorentino, Joseph Ruminjo, and Cristina Mattison reviewed a sample of year 2008 cesarean section (CS) records from nine facilities in Bangladesh, Guinea, Mali, Niger, and Uganda.

Rethinking How to Promote Maternity Care-Seeking: Factors Associated With Institutional Delivery in Guinea. Health Care for Women International. 2014, 35(7-9).
Ellen Brazier, Renee Fiorentino, Mamadou Saidou Barry, Yaya Kasse, and Sita Millimono present findings from a study on women’s delivery care-seeking in two regions of Guinea. They explored exposure to interventions promoting birth preparedness and complication readiness among women with recent live births and stillbirths. The study findings highlight the importance of focusing on preparation for all births–and not simply obstetric emergencies–in interventions aimed at increasing women’s use of skilled maternity care.

Striving for excellence: Nurturing midwives’ skills in Freetown, Sierra Leone. Midwifery, March 2013, Volume 29, Issue 6
Read the abstract in French
Carrie Ngongo, Kate Christie, Jude Holden, Carolyn Ford and Celia Pett describe the techniques used for ongoing staff development of midwives in the Aberdeen Women’s Centre in Sierra Leone. Their success in this endeavor was dependent on an environment of supportive supervision, continuing education, enabling policies, and access to equipment and referral facilities.

Development and Comparison of Prognostic Scoring Systems for Surgical Closure of Genitourinary Fistula. AJOG, February 2013, Volume 208, Issue 2
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Vera Frajzyngier, Joseph Ruminjo, and Mark Barone test the diagnostic performance of five existing classification systems and a prognostic scoring system that was derived empirically from prospective data to predict fistula closure three months after surgery. They find the prognostic values of existing urinary classifications systems and the empirically derived score were poor to fair suggesting that further evaluation of existing classification systems to predict fistula closure is warranted.

Factors Influencing Choice of Surgical Route of Repair of Genitourinary Fistula, and the Influence of Route of Repair on Surgical Outcomes: Findings from a Prospective Cohort Study BJOG, October 2012, Volume 119, Issue 11
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Vera Frajzyngier, Joseph Ruminjo, Mark Barone, et al. find that using a vaginal route for surgical fistula repair was associated with increased risks of failed fistula closure. While reasons for this remain unclear, the analyses suggest that the risk of failed fistula closure among women repaired vaginally was particularly elevated for those women who met indications for an abdominal repair.

Factors Influencing Urinary Fistula Repair Outcomes in Developing Country Settings: A Systematic Review of the Literature American Journal of Obstetrics and Gynecology, October 2012, Volume 207, Issue 4.
Read the abstract in French
Vera Frajzyngier, Joseph Ruminjo, and Mark Barone review the literature examining factors influencing urinary fistula repair outcomes in developing countries.

Determinants of Post-Operative Outcomes of Female Genital Fistula Repair Surgery Obstetrics and Gynecology, September 2012, Volume 120, Issue 3.
Read the abstract in French
Vera Frajzyngier, Joseph Ruminjo, Mark Barone discuss results indicating that prognosis for genital fistula closure is related to preoperative bladder size, history of fistula repairs, vaginal scarring, and urethral involvement from a multi-country prospective cohort study.

Non-Inferiority of Short-Term Urethral Catheterization Following Fistula Repair Surgery: Study Protocol for a Randomized Controlled Trial BMC Women’s Health 2012, 12:5.
Read the abstract in French
Mark Barone, Vera Frajzyngier, Steven Arrowsmith, Joseph Ruminjo, Armando Seuc, Evelyn Landry, Karen Beattie, Thierno Hamidou Barry, Alyona Lewis, Mulu Muleta, Dolorès Nembunzu, Robert Olupot, Ileogben Sunday-Adeoye, Weston Khisa Wakasiaka, Mariana Widmer, and Metin Gulumezoglu compare the new proposed short-term (7 day) urethral catheterization to longer-term (14 day) in terms of predicting fistula repair breakdown.

Current Practices in Treatment of Female Genital Fistula: A Cross Sectional Study BMC Pregnancy & Childbirth 2010, 10:73.
Steve D. Arrowsmith, Joseph Ruminjo, and Evelyn Landry provide a look into current practices in fistula treatment and care across geographic, economic, and organizational considerations and find common practices in some areas with diverging practices in others.

Fistula and Traumatic Genital Injury from Sexual Violence in a Conflict Setting in Eastern Congo: Case Studies Reproductive Health Matters, May 2008, Volume 16, Issue 31.
Ahuka Ona Longombe, Kasereka Masumbuko Claude, and Joseph Ruminjo document stories from sexual violence survivors in the Democratic Republic of the Congo.

Obstetric Fistula and the Challenge to Maternal Health Care Systems (PDF, 388KB) IPPF Medical Bulletin, Vol. 41, No. 4, December 2007.
Joseph Ruminjo summarizes the maternal health and systematic challenges faced in the fight against fistula.