Characteristics and Surgical Repair Outcomes of Obstetric Fistula Patients Managedata Teaching Hospital in Zambia: A Retrospective Cross-Sectional Study

BackgroundThe obstetric fistula is a chronic maternal morbidity of global public health concern. The condition is preventable and, in most cases, treatable. Surgicalrepairis themainstay of treatment with varying degrees of success. The aim of this study was to determine the characteristics, surgical outcomes and factors influencing surgical outcomes of women presenting with obstetric fistulas at a Teaching Hospital in Lusaka, Zambia. Methods: Aretrospective review of medical records for all women who underwent obstetric fistula repair surgeryat Women and Newborn Hospital from 2017 to 2019. Descriptive analysis was done. Fischer's exact test was used to measure association between surgical outcomes and variables in the model.: ResultsIn total,18 out of 29 records of patients who underwentfistularepairwereretrievedandanalyzed. Ages ranged from 15 to 47 years, mean age 29years.Overtwothirds(72.23%)weremultiparous, and over 3/4ths (77.8%) underwent caesarean section in the antecedent pregnancy. Success rate for fistula repair was 83%at 2 weeks post-operative.Study findings were inadequate to show a significant association between successful repair and factors in the model. Conclusion: Majority of women presenting with obstetric fistula were multiparous with a history of prolonged labour, delivery by caesarean section and poor birth outcomes. Success rate for obstetric fistula repair at Women and Newborn Hospital was 83% at 2weeks postoperative. Further studies are needed to assess long-term outcomes and factors influencing surgical outcomes.:

Maternal factors and short-term outcome associated with episiotomy during vaginal delivery at the Women and Newborn Hospital, Lusaka, Zambia

Objective:To explore the maternal factors and short-term outcomes associated with episiotomy during vaginal delivery at Women and Newborn Hospital, Lusaka, Zambia.Materials and Methods:An unmatched case control study was conducted in postnatal wards of Women and New-born hospital in Lusaka, Zambia between November 2019 and April 2020 with convenient sample for the cases and systematic sample for the controls.Asemi-structuredintervieweradministered questionnaire was used and 102 participants (cases) who had episiotomy performed were recruited while 204(controls) werewithoutepisiotomy.Results:Atotal of 306 (102 are cases and 204 are control) were included. Age was found to be a good predictor of episiotomy in that those younger than 18 years were more than seven times likely to have an episiotomy (AOR=7.65; 95%CI 1.36-18.21; p=0.035). It was also found out that primi gravidas were five times likely to have an episiotomy performed compared to parous women (OR=4.96; 95%CI 2.58-9.52; p<0.001). Out of those delivered by a midwife, 73(28.3%) participants had an episiotomy performed compared to 29(60.4%) deliveredbyamedicalofficer.Multivariateregression it was shown that being delivered by a midwife was protective against an episiotomy (OR=0.260; 95%CI 0.14-0.49; p=0.001). Out of the 102 participants who had an episiotomy, only two had third degree tear extension. It was also noted that 99 out of 102 (97%) participants who had an episiotomy experienced post-delivery perineal pain compared to 94 out of 204(46%) of those who had no episiotomies. In univariate analysis, it was found that post-delivery perineal pain was associated with episiotomy (p<0.001). It was further found that those who had an episiotomy performed were about 4 times likely to experience perineal pain post- delivery (OR=3.8; 95%CI 1.2-12.3) Conclusion:Maternal factors associated with episiotomy includedage,parity,method of induction,and the personnel conducting the elivery. Shorttermmaternaloutcomesofepisiotomy were perineal tear extension, and post-delivery perineal pain. It was found that 8.5% of women had undergone an episiotomy done on them. Health professional conducting deliveries should be educated on indications of episiotomy, patient selection during episiotomy and trained on surgical skills to repair episiotomy to reduce morbidity associated the procedure.

In-Vitro Susceptibility Pattern of Candida isolated from Women with Vaginal Candidiasis to four Anti-fungal Agents in Dar es Salaam; Tanzania

Objective: To determine anti-fungal susceptibility pattern of Candida species (n = 272) isolated from women with vaginal candidiasis (VC) in Dar es Salaam; Tanzania against varying concentrations (0.05 to 12.8 g/ml) of miconazole; clotrimazole; ketoconazole and nystatin using agar dilution and broth macro-dilution methods. Test isolates and reference strains: Clinical isolates and reference strains; Candida albicans (ATCC 32354); Candida krusei (ATCC6258); Candida parapsilosis (ATCC22019) and Candida glabrata (ATCC2001).Methods: Determination of minimum inhibitory concentration ranges; and MIC50 and MIC90 (required to inhibit 50and 90of the isolates); respectively. MIC for nystatin was least concentration that prevented visible growth while for the azoles MIC was the concentration that caused 80growth inhibition compared with drug free control. Results: The MIC for Candida albicans; Candida famata; Candida krusei; Candida lusitaniae; Candida parapsilosis and Candida norvegensis were between 0.05 to 0.2 g/ml against all four anti-fungal drugs tested. Some Candida tropicalis and Candida glabrata isolates had moderately high (MIC =6.4) and high MICs (12.8 g/ml); especially with the azole anti-fungal drugs. The overall agreement between the results of the two methods were 88; and for individual antifungals the agreement was 90.8; 91.3; 80and 88for clotrimazole; ketoconazole; miconazole and nystatin; respectively. C. glabrata and C. parapsilosis gave low agreement (68- 75) for the azole antifungals. Conclusions: i) most of the clinical isolates had low MIC values to all the four anti-fungal drugs tested; indicating susceptibility; ii) some strains of C. tropicalis and C. glabrata had high MIC values; and; iii) there was a good overall agreement ( 88) between agar dilution and broth macro-dilution methods. There is a need for a follow-up in-vivo study to determine clinical response following treatment with the investigated anti-fungals

Aplasie vaginale congenitale: a propos de 2 observations. [Lettre a l'editeur]

Les auteurs rapportent 2 cas d'aplasie vaginale; 1 cas d'absence isolee du vagin et 1 syndrome de RAKITANSKY-KUSTER-HAUSER; traites par le clivage inter-vesico-rectal par une double voie abdominale et perineale. La physiopathologie; la clinique et le traitement de cette malformation sont discutes

Vaginal Flora of women in Zimbabwe

High vaginal and cervical swabs were taken from 199 pregnant women and 156 non-pregnant patients attending an STD clinic in Zimbabwe. T. vaginalis was isolated from 31 of preganant women and 37 of STD patients. The bacterial flora in both groups was similar to that found in women from developed countries except that faecal organisms were more and lactobacilli less commonly isolated. Yeasts; mainly C. albicans were isolated from 39 of pregnant women and 26 of STD patients