Development and Pilot Test of a Multi-Component Intervention to Support Women's Recovery from Female Genital Fistula.

Journal: International urogynecology journal

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Affiliated Institutions:  Department of Obstetrics and Gynaecology, College of Health Sciences, Makerere University, Kampala, Uganda. Department of Urogynaecology, Mulago Specialized Women and Neonatal Hospital, Kampala, Uganda. Department of Social Work, Mulago Specialized Women and Neonatal Hospital, Kampala, Uganda. Department of Physiotherapy, Mulago Specialized Women and Neonatal Hospital, Kampala, Uganda. Department of Physiotherapy, Kawempe National Referral Hospital, Kampala, Uganda. Mama, LLC, Canton, MA, USA. Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA. School of Public Health, University of California Berkeley, Berkeley, CA, USA. Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA. alison.elayadi@ucsf.edu.

Abstract summary 

We evaluated a pilot multi-component reintegration intervention to improve women's physical and psychosocial quality of life after genital fistula surgery.Twelve women undergoing fistula repair at Mulago Specialized Women and Neonatal Hospital (Kampala, Uganda) anticipated in a 2-week multi-component intervention including health education, psychosocial therapy, physiotherapy, and economic investment. We assessed feasibility through recruitment, retention, and adherence, acceptability through intervention satisfaction, and preliminary effectiveness through reintegration, mental health, physical health, and economic status. We collected quantitative data at enrollment, 6 weeks, 3 months, and 6 months. We conducted in-depth interviews with six participants. Quantitative data are presented descriptively, and qualitative data analyzed thematically.Participants had a median age of 34.5 years (25.5-38.0), 50% were married/partnered, 42% were separated, 50$ had completed less than primary education, and 67% were unemployed. Mean number of sessions received was 12 for health education (range 5-15), 8 for counseling (range 8-9), and 6 for physiotherapy (range 4-8). Feasibility was demonstrated by study acceptance among all those eligible (100%); comfort with study measures, data collection frequency and approach; and procedural fidelity. Acceptability was high; all participants reported being very satisfied with the intervention and each of the components. Participant narratives echoed quantitative findings and contributed nuanced perspectives to understanding approach and content.Our results suggest that the intervention and associated research were both feasible and acceptable, and suggested certain modifications to the intervention protocol to reduce participant burden. Further research to determine the effectiveness of the intervention above and beyond surgery alone with regard to the health and well-being of women with fistulas is warranted.

Authors & Co-authors:  Barageine Justus K JK Nalubwama Hadija H Obore Susan S Mirembe Esther E Mubiru Dianah D Jean Angella A Akori Susan S Opio Samuel S Keyser Laura L McKinney Jessica J Korn Abner P AP Ali Shafeesha S Byamugisha Josaphat J El Ayadi Alison M AM

Study Outcome 

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Citations :  United Nations General Assembly. Intensifying efforts to end obstetric fistula within a decade. Report of the secretary-general. A/75/264. New York, NY: United Nations, 2020.
Authors :  14
Identifiers
Doi : 10.1007/s00192-024-05814-3
SSN : 1433-3023
Study Population
Women,Female
Mesh Terms
Other Terms
Female genital fistula;Holistic care approaches;Obstetric fistula;Rehabilitation;Reintegration;Uganda
Study Design
Study Approach
Quantitative,Qualitative
Country of Study
Uganda
Publication Country
England