Outcomes of Two Different Obstetric Social Reintegration Program Approaches After Obstetric-Related Fistula Repair.

INTRODUCTION AND HYPOTHESIS: The objective was to characterize psychosocial-economic outcomes after obstetric-related vesicovaginal fistula repair (OFR) and completing a comprehensive psychosocial-economic reintegration service at a dedicated fistula center (Association Renaissance, ARENA) compared with women receiving both services in a multispecialty country hospital (Larry Ebert Medical Center, LEMC).

MATERIALS AND

METHODS

This retrospective study included women who underwent OFR and re-integration training at ARENA fistula center, Ouagadougou, Burkina Faso, from January 2022 through July 2023, and at LEMC from July 2020 through March 2022. A standardized questionnaire assessing areas of household/income/employment/finance experiences, support resources, and patients' feelings was completed by in-person interview or phone. Analyses included Wilcoxon's rank sum tests, Chi-squared, or Fisher's exact test. Logistic regression models adjusting for age, time living with fistula, and time from surgery were performed to evaluate associations of selected outcomes.

RESULTS

Median age and time having a fistula between the ARENA center (N=134) and LEMC (N=146) participants were similar: (age, years, median, [IQR] 32.0 [25, 40] vs 34.0 [27, 41] respectively, p = 0.30; time with fistula, years 1.6 [0.2, 10.0] vs 2.5 [0.8, 11] respectively, p = 0.06). Women undergoing treatment at a dedicated fistula center had greater odds of self-satisfaction (aOR4.6, 95% CI 1.4,15.2), being a person of worth (aOR 12.6, 95% CI 3.7, 42.4), and having income-generating assets (aOR 5.1, 95% CI 1.7, 14.9).

CONCLUSIONS

Overall, psychosocial and economic outcomes for women after OFR reflected greater improvement when post-OFR reintegration services were at a dedicated fistula center.