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Objective: We evaluated residual incontinence, depression, and quality of life among Malawian women who had undergone vesicovaginal fistula (VVF) repair 12 or more months previously.Design: Prospective cohort study.Setting: Fistula Care Centre in Lilongwe, Malawi.Population: Women who had undergone VVF repair in Lilongwe, Malawi at least 12 months prior to enrolment.Methods: Self-report of urinary leakage was used to evaluate for residual urinary incontinence; depression was evaluated with the Patient Health Questionnaire-9; quality of life was evaluated with the King's Health Questionnaire.Main Outcome Measures: Prevalence and predictors of residual incontinence, quality of life scores, and prevalence of depression and suicidal ideation.Results: Fifty-six women (19.3%) reported residual urinary incontinence. In multivariable analyses, predictors of residual urinary incontinence included: pre-operative Goh type 3 [adjusted risk ratio (aRR) 2.82; 95% confidence interval (CI) 1.61-5.27) or Goh type 4 1.08-2.78), positive postoperative cough stress test (aRR = 2.42; 95% CI 1.24-4.71) and the positive 1-hour postoperative pad test (aRR = 2.20; 95% CI 1.08-4.48). Women with Goh types 3 and 4 VVF reported lower quality of life scores. Depressive symptoms were reported in 3.5% of women; all reported residual urinary incontinence.Conclusions: While the majority of women reported improved outcomes in the years following surgical VVF repair, those with residual urinary incontinence had a poorer quality of life. Services are needed to identify and treat this at-risk group.Tweetable Abstract: Nearly one in five women reported residual urinary incontinence at follow up, 12 or months after vesicovaginal fistula repair. [ABSTRACT FROM AUTHOR]

This paper draws on the narrative of a Samburu woman, whom we call Sasha, from northern Kenya. She has been living with recto- and vesico-vaginal fistula for more than ten years. Her homeland is characterized by abject poverty, patriarchy and traditional practices involving witchcraft, which is intertwined with the teachings of Christian evangelist missionaries that traverse the last two centuries. Sasha's research interview offered representations of the broader social and political aspects affecting women with vaginal fistula and how this influences their lived experiences. We suggest that this condition is more than a biomedical issue, which we explain through our interpretive feminist analysis of Sasha's story. An African feminist lens enables attention towards the influences of patriarchy, African ethnicities and underdevelopment of the African continent. [ABSTRACT FROM AUTHOR]

All Black women have experienced living in a society that devalues them. The scholarship of bell hooks submits that the control of Black women ideologically, economically, socially and politically functions perfectly to form a highly discriminative but effective system that is designed to keep them in a submissive and subordinate place. As a Ph.D. student, in a reflective journey with my research supervisor, I engage in a struggle to define my own feminist perspective in as I prepare to explore the oppression, disadvantage and discrimination experienced by Kenyan women living with vaginal fistulas. I examine how poor and socially disadvantaged Kenyan women are forced to lead lives or engage in practices that predispose them to poor sexual and reproductive health. Such practices include child rape, child marriage and female genital mutilation. While academic theorizing considers socio-cultural practices that contribute to women's oppression in Kenya, I seek to locate my position as a Black African feminist to enable my contribution to these debates. [ABSTRACT FROM AUTHOR]

Globally, the prevalence of, and support for, female genital mutilation/cutting ( FGM/C) is declining. However, the entrenched sense of social obligation that propagates the continuation of this practice and the lack of open communication between men and women on this sensitive issue are two important barriers to abandonment. There is limited evidence on the role of men and their experiences in FGM/C. Marriageability of girls is considered to be one of the main driving forces for the continuation of this practice. In some countries, more men than women are advocating to end FGM/C. Moreover, men, as partners to women with FGM/C, also report physical and psychosexual problems. The abandonment process involves expanding a range of successful programs, addressing the human rights priorities of communities and providing power over their own development processes. Anecdotal evidence exists that FGM/C is practised amongst African migrant populations in Australia. The Australian Government supports a taskforce to improve community awareness and education, workforce training and evidence building. Internationally, an African Coordinating Centre for abandonment of FGM/C has been established in Kenya with a major global support group to share research, promote solidarity, advocacy and implement a coordinated and integrated response to abandon FGM/C. [ABSTRACT FROM AUTHOR]

Objective: To present a summary of the findings of the fistula needs assessments that have been conducted through the Campaign to End Fistula in 25 countries in Africa and Asia to expand knowledge on the issue related to causes and impact, country capacity to manage the problem and clinical and programmatic gaps.Method: The methodology of the assessments was qualitative and quantitative, and included focus group discussions; in-depth interviews/narratives; key informant interviews; and review of medical records, with slight variations by country.Results: Analysis of 20 of these assessments provides insight into the capacities, gaps, and perspectives specific to each country regarding fistula prevention and treatment and the social reintegration of treated women.Conclusion: Needs assessment findings have been key tools to spark action and guide the implementation of national programs to eliminate obstetric fistulas throughout Africa and Asia. [ABSTRACT FROM AUTHOR]

Background: Obstetrical fistula (OF) is a public health challenge that is among the previously neglected components of maternal health in the developing world. The condition, which in the recent past has increasingly drawn more attention from the public, has a devastating impact on the health and wellbeing of both women and girls worldwide. The most common cause of obstetric fistula in developing countries is prolonged obstructed labor affecting approximately 2 million women and girls across Africa and Asia. The objective of this study was to examine the post-effects of fistula and reintegration strategies of fistula survivors in Uganda.Methods: A descriptive case study design was used to collect data from women aged 15-49 years who had experienced OF and been successfully treated/repaired. Data collection was aided by in-depth interview guides designed for collecting qualitative data which was analyzed using thematic and content analysis.Results: The study results showed that 45.6% were aged 18-24 years, 43% had only primary level education and 55.7% of the women were married. Fistula survivors continue to suffer from shame, rejection, isolation and stigma, trauma and disgrace among other effects even after successful repair/surgery. Some of the reintegration strategies for fistula survivors include; seeking for successful repair, remarriage and relocation from their parent communities to new environments.Conclusion: In addition to capacity building, changing attitudes and strengthening the health system, a comprehensive and holistic fistula care approach is required to facilitate the reintegration process and restoration of women dignity. [ABSTRACT FROM AUTHOR]