Risk factors for vesicovaginal and rectovaginal fistulae in women treated at Juba Teaching Hospital in 2020-2021: A retrospective study

Abstract

Introduction: Vesicovaginal fistulae (VVF) and rectovaginal fistulae (RVF) are major public health concerns especially in sub-Saharan Africa. Our hypothesis was that prolonged obstructed labour, teenage marriages, inadequate emergency obstetric care and poverty are responsible for a high prevalence of VVF and RVF in South Sudan.
Objective: The objective of the study is to determine the risk factors for vesicovaginal and rectovaginal fistulae in women treated at Juba Teaching Hospital in South Sudan.
Method: Data were obtained from the files of all the 40 women who were operated on for VVF and RVF in Juba Teaching Hospital (JTH) during the 2020 and 2021 fistula campaigns; three women were interviewed.
Results: Thirty-six women had VVF, two had RVF and two had both. The main cause was obstructed labour. Spontaneous vaginal delivery accounted for 22 cases, Caesarean Section for 13 while five had a forceps delivery. Four women were aged under 18 years; the age of marriage was below 18 years for 22 women and between 18-25 years for 18 women. Of these 40 women 21 were para 1 & 2,14 were para 3 to 5 and five were para 6 and above; 17 had delivered at home and 23 in hospital; 18 had been attended by midwives / doctor and 22 by Traditional Birth Attendants (TBAs) in the villages; 22 were in labour for more than three days. Thirty-two deliveries had resulted in stillbirths. Most women had not been to school, and all were classified as ‘poor’. Almost all (38) had not attended an ante-natal clinic (ANC) during
the pregnancy in which they developed fistula. Ten women were operated on more than three times, 10 twice and 20 once. Nine women were divorced after developing fistula and 13 were abandoned. The psychosocial consequences included childlessness, stigmatization, depression, divorce, and abandonment.
Conclusion: The main risk factor for developing obstetric fistula was prolonged obstructed labour. Secondary risk factors were delivering at home, lack of obstetric care facilities, deliveries attended by unskilled health workers and TBAs, poor ANC attendance during pregnancy, cultural factors that encourage early marriage, low socioeconomic status, and lack of education.