Economic burden of obstetric fistula among patients in the National Obstetric Fistula Centre, Nigeria

Background: Obstetric fistula (OF) continues to be a major health problem in developing countries such as Nigeria. It is a communication between the vagina and bladder/rectum following prolonged obstructed labor that leads to urine/and fecal leakage per vaginam. There is a paucity of information on cost of accessing care by women with OF. Objective: The study was to evaluate the cost implications of accessing care and treatment among women with OF in the National Obstetric Fistula Centre, Ningi Bauchi, state. Materials and Methods: A prevalence-based cost-of-illness approach was employed in this study to estimate the cost of fistula treatment from the patients' perspective. Data on costs of health-care utilization of services rendered to the patients in the facility and indirect costs were estimated. The data were analyzed with the Statistical Package for the Social Sciences (SPSS V21). Results: A total of 75 women participated in the study. The total costs incurred by all the 75 patients amounted to Nigerian Naira (NGN) 8211640.00 (USD 26923.41). The average cost of accessing care for fistula per patient was NGN109488.50 (USD 358.98). Direct cost accounted for 5751740.00 (USD 18858.16), whereas the indirect cost was 2785600.00 (USD9133.11). There was a significant difference in cost of care between patients that were teenagers compared to those who were not (P = 0.04) and the type of treatment (P < 0.001). Conclusions: The cost of illness of OF is high in the studied area, and the patients are from the low socioeconomic background. Both the direct and indirect costs were high relative to the national minimum wage in Nigeria. The age of the patients and the type of treatment received by the patient accounted for the differences in cost of illness between the patients.

Les fistules labyrinthiques secondaires aux otites moyennes cholestéatomateuses: diagnostic et prise en charge

BUT : Analyser les particularités cliniques et paracliniques des fistules labyrinthiques secondaires aux cholestéatomes de l'oreille moyenne, et discuter les différentes modalités de prise en charge de cette affection PATIENTS ET MÉTHODES : Il s'agit d'une étude rétrospective ayant inclus, parmi 273 dossiers médicaux de patients opérés pour otite moyenne chronique cholestéatomateuse, ceux des patients présentant une fistule labyrinthique confirmées chirurgicalement. RESULTATS : Vingt-cinq cas de fistule labyrinthique ont été inclus dans l'étude, soit une incidence de 9,1 %.Le tableau clinique était marqué par une surdité dans tout les cas et un vertige roratoire dans 60% des cas. Le signe de la fistule a été objectivé dans 12 cas (48%). La sensibilité de la TDM dans la détection des fistules labyrinthiques était de 72 %. L'éradication complète de la matrice du cholestéatome a été réalisée chez tous les malades. Le comblement de la fistule a été réalisé dans tous les cas par du matériel autologue. Les matériaux étaient l'aponévrose temporale superficielle, le périchondre et la poudre d'os. Après chirurgie, nous avons noté une amélioration du seuil de la conduction osseuse dans 9 cas (36 %), une aggravation dans 3 cas (12 %) et dans 13 cas (52%), le seuil est resté stable.CONCLUSION : La fistule labyrinthique est une complication sévère de l'otite moyenne chronique cholestéatomateuse. Sa présen-tation clinique n'est pas spécifique d'où l'intérêt de l'imagerie. Sa prise en charge a fait l'objet de plusieurs débats, elle est actuelle¬ment mieux codifiée

Disintegrating Perineal Disease in Patients with Urethral Stricture and HIV Infection: A Review of 12 Cases

The aim of this study was to define disintegrating perineal disease (DPD) and to determine whether the fulminating nature of the condition could be explained by urine and perineal swab microbiology or perineal histology. A retrospective study that included 12 male patients with urethral strictures and DPD was performed. DPD was defined as a chronic; destructive; purulent perineal inflammation with multiple fistulae or sinuses of the perineum; scrotum or penoscrotal area; which continued for more than six weeks despite a patent urethra after direct vision internal urethrotomy (DVIU) or urinary diversion by means of suprapubic cystostomy. The median patient age was 43.5 years (range of 22-68 years). The patients all tested positive for human immunodeficiency virus (HIV) infection. Their mean CD4 count was 340 cells/mm3 (range of 244-1 252 cells/mm3). Histology of the fistula tracts showed non-specific inflammation in 8 patients (66.7); tuberculosis in 2 (16.7); hydradenitis suppurativa in one (8.3); and squamous cell carcinoma in situ with condylomata acuminata in one patient (8.3). DVIU was performed in 10 patients. Patency of the urethra could be achieved in only three patients for more than six weeks. Perineal urethrostomy was completed in three patients after failed DVIU. Ileal conduit urinary diversion and simple cystectomy was carried out in three patients and curing the DPD was accomplished in two. DPD relates to urethral stricture disease in HIV-positive men with secondary infection as the initiating cause; but no predominant microorganism is responsible for the condition. Simple cystectomy with urinary diversion may be the only solution to treating this debilitating disease

Are some Women More at Risk of Obstetric Fistula in Uganda? Evidence from the Uganda Demographic and Health Survey

With only four years left for the Millennium Development Goal's 2015 deadline for reducing poor maternal health outcomes; developing countries are still bearing a huge burden of maternal morbidity worldwide. Estimates show that over 2 million women worldwide are suffering from obstetric fistula; the majority of which live in sub-Saharan Africa; Southeast Asia; and the Arab region. The purpose of this study is to shed a light on obstetric fistula by examining risk factors associated with this morbidity in Uganda. Descriptive and multivariate analyses were conducted using data from the 2006 Uganda Demographic and Health Survey. Older age at first sexual intercourse was significantly associated with a lower risk of obstetric fistula (OR=0.302) compared to younger age at first intercourse (7-14 years). Lack of autonomy was negatively associated with the risk of obstetric fistula; women who have problems securing permission from their husband to go seek care (OR=1.658) were more likely to suffer from this morbidity. Significant differentials in obstetric fistula have also been observed based on the region of residence: women living in Central (OR=4.923); East Central (OR=3.603); West Nile (OR=2.049); and Southwest (1.846) more likely to suffer from obstetric fistula than women living in North Central. Findings demonstrate the importance of improving geographical accessibility to maternal health care services; and emphasize the need to reinforce intervention programs; which seek to address gender inequalities

Management of Complex Urogenital Fistulae in the Female

Objective: To present our experience in the management of complex genitourinary fistulae in the female. Patients and Methods: Between 1995 and 2004; 12 female patients with a mean age of 30 (range 6 - 40) years were managed in our department for various types of complex genitourinary fistulae caused by difficult labor in 6 cases; abdominal hysterectomy in 5 cases and car accident in one case. All patients were subjected to clinical; radiological and endoscopic examination. The fistulae were managed by open surgery. The procedures were individualized according to the existing pathology and included bladder augmentation and construction of a bladder tube. Results: The fistulae were repaired successfully and socially acceptable continence was achieved in all patients. Conclusion: Through urological evaluation of complex urinary fistulae is recommen- ded. The treatment should be individualized based on the existing pathology and may include bladder augmentation and construction of a bladder tube

Spontaneous Appendicocutaneous Fistula: A Case Report

Ruptured appendicitis is not a common cause of spontaneous enterocutaneous fistula. A case of ruptured retrocaecal appendicitis presenting as an enterocutaneous fistula in a Nigerian woman is presented. The literature on this disorder is also reviewed

La fistule urogenitale au Niger : aspects epidemiologiques et consequences

Les auteurs rapportent les resultats d'une enquete nationale sur les fistules obstetricales. Divers aspects de cette pathologie invalidante sont passes en revue: le profil des patientes (age; parite; provenance; conditions de deroulement et complications de l'accouchement); le type de fistules et les consequences genitales et sociales de leur survenue. La fistule urogenitale se rencontre essentiellement chez des jeunes femmes habitant dans des zones rurales enclavees; eloignees de formations sanitaires. La meilleure strategie preventive reste l'amelioration de la couverture obstetricale et l'accessibilite des formations sanitaires de premier niveau et la prompte reference des parturientes a risque a l'echelon superieur