Factors associated with the healing time from obstetric fistula at Kitovu Mission Hospital, Uganda

Abstract

In Uganda, about 2% of women who have ever given birth have experienced obstetric fistula. Patients with obstetric fistula can heal within 10-14 days but can take longer depending on several factors which increases the burden on the patient and the healthcare system. In Kitovu hospital, the time to obstetric fistula healing and the associated factors were not known. The study determined the mean and median time to obstetric fistula healing and its associated factors among patients managed at Kitovu mission hospital in Uganda. The study used a retrospective design. Relevant data were collected on 3793 study participants from the Kitovu hospital obstetric fistula database. The study used measures of central tendencies to summarize the characteristics of the study participants. The Kaplan-meier analysis was used to determine the average time to obstetric healing. The log-rank test and the discrete time logit model were used to determine the factors that are significantly associated with time to obstetric fistula healing. The study revealed that the mean and median time to obstetric fistula healing were 56 and 17 days respectively. Economically independent women were more likely to heal faster than economically dependent women (OR=1.352; 95% CI=1.240-1.473; p=0.000). Women with a fistula located > 3cm away from the vagina were more likely to heal faster than women with a fistula located < 3 cm away from the vagina (OR=1.390; 95% CI= 1.240-1.559; p=0.008). Women with one fistula are more likely to heal faster than those with multiple fistulae (OR=2.174; 95% CI 1.797-2.629; p=0.000). Overweight women were less likely to heal faster that those with normal weight and underweight (OR=0.864; 95% CI=0.800-0.934; p=0.000). Women with a fistula ≥ 3cm in diameter were less likely to heal faster than women with a fistula <3cm in diameter (OR=0,614; 95% CI= 0.540-0.699; p=0.000). Women with a large amount of fistula output were less likely to heal faster than women with moderate output or no output (OR=0.217; 95% CI=0.195-0.241; p=0.000). The study made the following recommendations. Kitovu Mission Hospital should strengthen targeted support programs for economically vulnerable obstetric fistula patients which should include financial assistance. The Ministry of Health, should review and strengthen existing obstetric fistula policies and clinical guidelines to provide for early initiation of treatment and standards for management of complex fistula types. Research institutions should conduct more research to triangulate the study findings and generate more context specific evidence on obstetric fistula in Uganda.