Risk factors for early and late failures following repair of urogenital fistulas.

INTRODUCTION AND HYPOTHESIS: In Sub-Saharan Africa, obstetric fistulas are a health crisis of extensive proportions. Although risk factors for failure are described, little data exist regarding differences in risk factors for early and late recurrences. METHODS: A retrospective cohort study was conducted to evaluate risk factors for fistula recurrence. Inclusion criteria included women who underwent repair of urogenital fistula at a Fistula Hospital in Uganda between 2013 and 2019. Our primary objective was to determine the incidence of both early and late failures and to identify and compare risk factors for each. Logistic regression was used to calculate crude odds ratios (ORs) and 95% confidence intervals (CIs) representing the association between each risk factor for early and late failures. Covariates significantly associated with early or late failure in univariate analyses were included in multivariate logistic regression models. RESULTS: A total of 541 patients were included. The incidence of early failure was 10.9%. Risk factors for early failure included stillbirth (aOR = 3.71, 95% CI: 1.38-9.96), fistula larger than 3 cm, (aOR = 3.12 95% CI: 1.40-6.93), presence of foot drop (aOR = 4.74, 95% CI:1.88-11.97), and perioperative blood transfusion (aOR = 3.10, 95% CI: 1.11-8.66). Risk factors for late failures included stillbirth (aOR = 4.63, 95% CI:1.04-20.51), and previous fistula repairs (aOR = 3.13, 95% CI:1.30-7.56). CONCLUSION: Both early and late failures can occur and risk factors for each may be different. Identifying patients at risk for late failures is important for improved counseling and highlights the importance of developing risk-reducing strategies to improve patient outcomes after discharge.

Knowledge, Attitude, and Self-Reported Practice Toward Measures for Prevention of the Spread of COVID-19 Among Ugandans: A Nationwide Online Cross-Sectional Survey.

Background: The world is facing the Coronavirus pandemic, which is highly infectious. Several measures have been put in place to prevent its spread among the population. However, for these preventive measures to be effective, the population requires appropriate and sufficient knowledge, attitude, and practices. Thus, a survey to assess knowledge, attitude, and self-reported practice toward measures for prevention of the spread of COVID-19 was conducted among Ugandans. Methods: This was a cross-sectional study conducted among during the lockdown in Uganda. An online structured questionnaire was used, applying a snowballing sampling approach for recruitment of participants 18 years and above and residing in Uganda. Data collection was done from 6th to 15th April 2020, during which 1,763 people participated. We analyzed all data using STATA 14.2, applying appropriate statistical tests. Results: Out of 1,763 participants, 80% were highly knowledgeable. For attitude, 72.4% reported following recommendations given by the Ministry of health to prevent the spread of COVID-19; 89.0% were worried about contracting COVID-19 and 73.3% agreed that COVID-19 can be cured and 99.3% reported good practice toward measures to prevent the spread of COVID-19. According to ordered logistic regression, health workers were 6 times more knowledgeable [aOR:6 (3.51-10.09), p < 0.001] followed by teachers [aOR:5.2 (2.6-10.32), p < 0.001]; students [aOR:3.2 (1.96-5.33), p < 0.001]. On the contrary, the drivers, business entrepreneurs, and security personnel had less knowledge. Conclusion: The results show that the participating Ugandans were knowledgeable and had a positive attitude and good practices. However, there is still a gap in knowledge among drivers, business entrepreneurs, and security personnel. Therefore, there is a need to mobilize the country's population to have the same degree of knowledge, which will have an impact on the attitude and practices toward prevention of the spread of COVID-19.