Obstetric Fistula

Picking up from where John F. Benton left off in his 1985 study announcing the discovery of the *Practica* of Trota of Salerno, the present investigation brings together all known evidence for the writings and precepts of this early 12th-century Salernitan healer, for whom we have no other contemporary evidence beyond these writings themselves.  Using the evidence of the *Practica secundum Trotam* (“Practical Medicine According to Trota”) as well as the compendium *De egritudinum curatione* (a collection of excerpts from the works of seven Salernitan “masters,” including Trota) and the *De curis mulierum* (“On Treatments for Women”) and even an Anglo-Norman text which purports to record the teachings of Trota, I argue that collation of this evidence shows that Trota's oeuvre was probably much larger than previously suspected. Trota’s historicity was already established by Benton, and she can now be clearly distinguished from the textual fiction “Trotula,” which is in reality just the title of an ensemble of the *De curis mulierum* and two other, unrelated texts of likely male authorship. The present study offers further circumstantial evidence about the historic Trota, suggesting that it is possible to place her in the early 12th century. She was to some extent aware of and in dialogue with fellow male practitioners in Salerno, but she remained peripheral to the general trends toward theory and sophisticated pharmacopeia that characterized the work of her male contemporaries. The study includes editions and translations of excerpts of Trota’s authentic works and other *testimonia*.

Introduction and hypothesis The objective was to determine the contribution of female genital cutting to genital fistula formation in Niger from the case records of a specialist fistula hospital. Methods A retrospective review was undertaken of the records of 360 patients seen at the Danja Fistula Center, Danja, Niger, between March 2014 and September 2016. Pertinent clinical and socio-demographic data were abstracted from the cases identified. Results A total of 10 fistulas resulting from gurya cutting was obtained: 9 cases of urethral loss and 1 rectovaginal fistula. In none of the cases was genital cutting performed for obstructed labor or as part of ritual coming-of-age ceremonies, but all cutting procedures were considered Btherapeutic^ within the local cultural context as treatment for dyspareunia, lack of interest in or unwillingness to engage in sexual intercourse, or female behavior that was deemed to be culturally inappropriate by the male spouse, parents, or in-laws. Clinical cure (fistula closed and the patient continent) was obtained in all 10 cases, although 3 women required more than one operation. Conclusions Gurya cutting is an uncommon, but preventable, cause of genital fistulas in Niger. The socio-cultural context which gives rise to gurya cutting is explored in some detail.

Background: The Human Immunodeficiency Virus epidemic continues to be a major public health problem worldwide. It has become one of the world's serious health and development challenges. In sub-Sahara Africa women accounted for 56% of new HIV infections among adults in 2016. HIV testing is the first step clients take towards taking responsibility for the protection of themselves and others. By taking the voluntary step, they accept their vulnerability to HIV infection. In Somaliland the prevalence of HIV test uptake among women of reproductive age was 2.7% in 2011.Where 39,543 women attending ANC services in facilities offering PMTCT services in Somaliland, only 9,101 (23%) were tested for HIV and 5,869(0.06%) of them were HIV positive. In Somaliland the prevalence of HIV test uptake among women of reproductive age was 2.7% in 2011. Method: institutional based unmatched case control study was conducted from February 5 to March, 26, 2017. 88 Cases were women during reproductive age who were tested for HIV. 176 Controls were women during reproductive age and never tested for HIV. Descriptive and frequency statistics was done. BivariateandmultivariateanalysiswasalsoperformedusinglogisticregressiononSPSSversion21.softwarein order to determine factors associated with HIV test. Results: HIV test uptake was associated with; having less than three number of children (AOR=4.67, 95% CI=2.12, 10.29), knew on available of antiretroviral therapy (AOR=5.6, 95%CI=1.19, 26.28), perception about test confidentiality (AOR=0.09, 95%CI=0.02, 0.51), and fearing of stigma (AOR=0.05, 95%CI=0.005, 0.24) after the effect of other significant variables were controlled. Conclusion and recommendation: This study has identified; Source of information about HIV /AIDS, number of children, knowing availability of antiretroviral therapy, perceived test confidentiality an d stigma as determinants of HI V test uptake. Health care providers should motivate client to be tested for HIV by giving them adequate information about HIV/AIDs. Stigma is deeper rooted problem in community so that Intensive campaign and efforts against stigma should be taken in the community level continuously in order to root out stigma barrier.

Afghanistan Regional Needs Assessment for Female Pelvic Medicine conducted in Kabul Jalalabad, Mazar & Herat provinces for UNFPA. The proposal assimilates current fistula care in a full service program launch for Female Pelvic Medicine & Reconstructive Surgery. Capitalizing on economic and clinical economies of scale and scope, women suffering fistula, pelvic organ prolapse, incontinence, urogenital anomalies and pelvic pain syndromes receive integrated care from multidisciplinary regional teams.

Background: The Human Immunodeficiency Virus epidemic continues to be a major public health problem worldwide. It has become one of the world's serious health and development challenges. In sub-Sahara Africa women accounted for 56% of new HIV infections among adults in 2016. HIV testing is the first step clients take towards taking responsibility for the protection of themselves and others. By taking the voluntary step, they accept their vulnerability to HIV infection. In Somaliland the prevalence of HIV test uptake among women of reproductive age was 2.7% in 2011.Where 39,543 women attending ANC services in facilities offering PMTCT services in Somaliland, only 9,101 (23%) were tested for HIV and 5,869(0.06%) of them were HIV positive. In Somaliland the prevalence of HIV test uptake among women of reproductive age was 2.7% in 2011. Method: institutional based unmatched case control study was conducted from February 5 to March, 26, 2017. 88 Cases were women during reproductive age who were tested for HIV. 176 Controls were women during reproductive age and never tested for HIV. Descriptive and frequency statistics was done. BivariateandmultivariateanalysiswasalsoperformedusinglogisticregressiononSPSSversion21.softwarein order to determine factors associated with HIV test. Results: HIV test uptake was associated with; having less than three number of children (AOR=4.67, 95% CI=2.12, 10.29), knew on available of antiretroviral therapy (AOR=5.6, 95%CI=1.19, 26.28), perception about test confidentiality (AOR=0.09, 95%CI=0.02, 0.51), and fearing of stigma (AOR=0.05, 95%CI=0.005, 0.24) after the effect of other significant variables were controlled. Conclusion and recommendation: This study has identified; Source of information about HIV /AIDS, number of children, knowing availability of antiretroviral therapy, perceived test confidentiality an d stigma as determinants of HI V test uptake. Health care providers should motivate client to be tested for HIV by giving them adequate information about HIV/AIDs. Stigma is deeper rooted problem in community so that Intensive campaign and efforts against stigma should be taken in the community level continuously in order to root out stigma barrier.

Obstetric fistula is a condition that affects women and can lead to identity changes because of uncontrolled urinary and/or fecal incontinence symptom experiences. These symptoms along with different emerging identities lead to family and community displacement. Using narrative inquiry methodology that concentrates on the stories individuals tell about themselves; interviews were conducted for 15 fistula survivors to explore their perception of identities of living with obstetric fistula. Within a sociocultural context, these identities consist of the ‘Leaking’ identity, ‘Masu yoyon fitsari’ (leakers of urine) identity, and the ‘Spoiled’ identity, cause stigmatization and psychological trauma.  The ‘Masu yoyon fitsari’ identity however built hope and resilience for a sustained search for a cure. Identity is a socially constructed phenomenon and the findings reveal positive community involvement which reduces obstetric fistula stigmatization and improves women’s identity. Sexual and reproductive health issues remain of grave concern within a contextualized societal identity of women’s role.

Introduction: Complete cervico-urethral transection is a vesicovaginal fistula characterized by total disinsertion of the urethra from the bladder. It is a fis-tula of the cervico-urethral intersection threatening the mechanism of conti-nence. The aim of this study was to describe the epidemiological and therapeutic aspects of this type of fistula. Patients and Methods: This was a descriptive retrospective study on patients who have had surgery for cervi-co-urethral transection from June 01, 2012 to June 01, 2015. Results: Cervi-co-urethral transections (n = 76) accounted for 33.77% of all urogenital fistu-las admitted to our department of surgery during the study period. The average age was 25.02 ± 8, 6 years. Married patients accounted for 85.58%, 72.36% had not received any classical education. Fistulas less than one year old made up 56.58% of cases, associated lesions were perineal tears 25.0%, vaginal sclerosis , 21.05%, vaginal straps, 13.15%, rectovaginal fistula, 2.63% and the shortness of the urethra less than 2.5 cm in 42.10% of cases. All surgeries were performed vaginally with a 98.68% fistula closure rate and an average of 1.68 surgeries per patient. After closure of the fistula, 10.67% of patients presented a residual urinary incontinence. Conclusion: Complete cervico-urethral tran-section is a frequent vesicovaginal fistula. She sometimes exposes to urinary incontinence after closing the fistula. The results of his surgery are often good at the cost of multiple intervention.

Introduction and hypothesis There is a need for expanded access to safe surgical care in low-and middle-income countries (LMICs) as illustrated by the report of the 2015 Lancet Commission on Global Surgery. 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. Although POP affects many more women in LMICs than fistula, donor support for fistula treatment in LMICs has been underway for decades, whereas treatment for POP is usually limited to hysterectomy-based surgical treatment, occurring with little to no donor support. This capacity-building discrepancy has resulted in POP care that is often non-adherent to international standards and in non-integration of POP and fistula services, despite clear areas of similarity and overlap. The objective of this study was to assess the feasibility and potential value of integrating POP services at fistula centers. Methods Fistula repair sites supported by the Fistula Care Plus project were surveyed on current demand for and capacity to provide POP, in addition to perceptions about integrating POP and fistula repair services. Results Respondents from 26 hospitals in sub-Saharan Africa and South Asia completed the survey. Most fistula centers (92%) reported demand for POP services, but many cannot meet this demand. Responses indicated a wide variation in assessment and grading practices for POP; approaches to lower urinary tract symptom evaluation; and surgical skills with regard to compartment-based POP, and urinary and rectal incontinence. Fistula surgeons identified integration synergies but also potential conflicts. Conclusions Integration of genital fistula and POP services may enhance the quality of POP care while increasing the sustainability of fistula care.

Abstract: Research on obstetric fistula has paid limited attention to the lived experiences of survivors. This qualitative study explored the evolution of survivors' perceptions of their social relationships and health since developing this obstetric complication.

Read this original research and sign up to receive International Journal of Women's Health here: http://www.dovepress.com/articles.php?article_id=19461

Background: The Human Immunodeficiency Virus epidemic continues to be a major public health problem worldwide. It has become one of the world’s serious health and development challenges. In sub-Sahara Africa women accounted for 56% of new HIV infections among adults in 2016. HIV testing is the first step clients take towards taking responsibility for the protection of themselves and others. By taking the voluntary step, they accept their vulnerability to HIV infection. In Somaliland the prevalence of HIV test uptake among women of reproductive age was 2.7% in 2011.Where 39,543 women attending ANC services in facilities offering PMTCT services in Somaliland, only 9,101 (23%) were tested for HIV and 5,869(0.06%) of them were HIV positive. In Somaliland the prevalence of HIV test uptake among women of reproductive age was 2.7% in 2011. Method: institutional based unmatched case control study was conducted from February 5 to March, 26, 2017. 88 Cases were women during reproductive age w...

The objective was to determine the contribution of female genital cutting to genital fistula formation in Niger from the case records of a specialist fistula hospital. A retrospective review was undertaken of the records of 360 patients seen at the Danja Fistula Center, Danja, Niger, between March 2014 and September 2016. Pertinent clinical and socio-demographic data were abstracted from the cases identified. A total of 10 fistulas resulting from gurya cutting was obtained: 9 cases of urethral loss and 1 rectovaginal fistula. In none of the cases was genital cutting performed for obstructed labor or as part of ritual coming-of-age ceremonies, but all cutting procedures were considered "therapeutic" within the local cultural context as treatment for dyspareunia, lack of interest in or unwillingness to engage in sexual intercourse, or female behavior that was deemed to be culturally inappropriate by the male spouse, parents, or in-laws. Clinical cure (fistula closed and the ...

This is a program strategy that was partially implemented before I departed HRH Rwanda program. It is an integrated implementation framework designed to build Rwandan capacity to evaluate and manage pelvic floor fistula through multidisciplinary teams operating in a coordinated central/decentralized system between the Central academic teaching hospitals and the regional hospitals. I am posting it here to make it accessible to colleagues who have requested it for use as a template of sustainable, integrated service delivery.