Title : Proportion and determinants of successful surgical repair of obstetric fistula in low-and middle-income countries: A systematic review and meta-analysis
Abstract:
Introduction: Obstetric fistula is a serious and debilitating problem resulting from tissue necrosis on the reproductive and urinary and/or lower gastrointestinal tract organs due to prolonged labor. Primary studies aimed at the treatment success of obstetric fistula reported significantly variable results on the treatment outcomes following surgical repair. However, no systematic review and meta-analysis estimated pooled proportion and identified determinants of successful obstetric fistula repair outcomes.
Objective: To estimate the proportion and identify determinants of successful surgical repair outcomes of obstetric fistula in Low- and Middle-Income countries.
Methods: The protocol was developed and registered at the International Prospective Register of Systematic Reviews (ID CRD42022323630). Studies were searched from PubMed, Embase, CINAHL, Scopus databases, and Gray literature sources. All the accessed studies were selected with Covidence, and the quality of the studies was examined using quality assessment tools. The risk of bias assessment was also conducted in aggregate across the studies using publications bias and sensitivity analysis. Finally, the data were extracted using Excel sheet and analyzed with R software.
Result: This study included seventy-nine studies out of 9337 following the screening process. The study revealed that the proportion of successful surgical repair in low and middle-income countries was 77.85% (95%CI: 75.14%; 80.56%). The study identified that women who attained primary and above education, married, and had alive neonatal outcomes were more likely to have successful repair outcomes. In contrast, women with female genital mutilation, primiparity, large fistula size, fistula classification II and above, urethral damage, vaginal scarring, circumferential defect, multiple fistula, prior repair and postoperative complications were less likely to have successful repair outcomes.
Conclusion: This finding showed that the proportion of successful surgical repair outcome of obstetric fistula in low and middle-income countries remains suboptimal.
Recommendations: Stakeholders and policymakers must design and implement policies promoting advanced women's education. In addition, fistula care providers need to reach and manage obstetric fistula cases early before getting complicated, like vaginal fibrosis.
Audience Take Away:
- Understand the burden of obstetric fistula in low and middle-income countries.
- Know the proportion of obstetric fistula successful repair outcome.
- Identify the determinants of obstetric fistula successful repair outcome.
- Identify the research gaps regarding obstetric fistula.
