https://worldwidefistulafund.org/docs/resources/lancet-obstetric-fistula-as-a-public-health-proble.aspx

Obstetric vesicovaginal fistula as an international public-health problem.

Northern Nigeria has a maternal mortality ratio greater than 1,000 maternal deaths per 100,000 live births. Serious maternal morbidity (for example, vesico-vaginal fistula) is also common. Among the most important factors contributing to this tragic situation are: an Islamic culture that undervalues women; a perceived social need for women's reproductive capacities to be under strict male control; the practice of purdah (wife seclusion), which restricts women's access to medical care; almost universal female illiteracy; marriage at an early age and pregnancy often occurring before maternal pelvic growth is complete; a high rate of obstructed labor; directly harmful traditional medical beliefs and practices; inadequate facilities to deal with obstetric emergencies; a deteriorating economy; and a political culture marked by rampant corruption and inefficiency. The convergence of all of these factors has resulted in one of the worst records of female reproductive health existing anywhere in the world.

Dead mothers and injured wives: the social context of maternal morbidity and mortality among the Hausa of northern Nigeria

Prolonged obstructed labor may produce injuries to multiple organ systems. The best known, and most common, of these injuries is obstetric fistula formation. When obstructed labor is unrelieved, the presenting fetal part is impacted against the soft tissues of the pelvis and a widespread ischemic va

Obstructed labor injury complex: obstetric fistula formation and the multifaceted morbidity of maternal birth trauma in the developing world.

"In vast areas of the world, in South East Asia, in Burma, in India, 'in parts of Central America, South America and Africa 50 million women will bring forth their children this year in sorrow, as in ancient Biblical times, and exposed to grave dangers. In consequence, today as ever in the past, uncounted hundreds of thousands of young mothers annually suffer childbirth injuries; injuries which reduce them to the ultimate state of human wretchedness. Consider these young women. Belonging generally to the age group 15-23 years, and thus at the very beginning of their reproductive lives, they are more to be pitied even than the blind, for the blind can sometimes work and marry. Their desolation descends below that of the lepers, who though scarred, crippled and shunned, may still marry and find useful work to do. The blind, the crippled and the lepers, with lesions obvious to the eye and therefore appealing to the heart, are all remembered and cared for by great charitable bodies, national and international. Constantly in pain, incontinent of urine or faeces, bearing a heavy burden of sadness in discovering their child stillborn, ashamed of a rank personal offensiveness, abandoned therefore by their husbands, outcasts of society, unemployable except in the fields, they live, they exist, without friends and without hope. Because their injuries are pudendal, affecting those parts of the body which must be hidden from view and which a woman may not in modesty easily speak, they endure their injuries in silent shame. No charitable organization becomes aware of them. Their misery is utter, lonely, and complete."

The obstetric vesicovaginal fistula in the developing world.

Surgery for the obstetric vesicovaginal fistula: a review of 100 operations in 82 patients.

The results of treatment of' 11 gynaecological fistulae and 150 obstetrical fistulae over a period of 6¼ years is presented. Postoperative stress incontinence was the most serious complication. Its incidence following repair of obstetrical fistulae has been reduced to 7.3 per cent in this series. Meticulous technique, combining the appropriate operation for bladder neck reinforcement with the initial flap-splitting repair, contributed to the low incidence of postoperative stress incontinence. Suprapubic operations were utilized in 20 cases (13.3 per cent). Gross vesical contraction associated with incontinence in 7 cases responded to ileocystoplasty or sigmoidocystoplasty. The final functional cure rate in the series was 873 per cent. Closure was accomplished in about 95 per cent of fistulae. In 8 cases closure was unsuccessful; 4 of these were inoperable. There was I death due to endotoxic shock after ureterosigmoidostomy.

Reduction in the incidence of stress incontinence complicating fistula repair

The place of the "ventouse" in developing Africa.

Bilharzial contracted bladder treated by ileocystoplasty

The purpose of this paper is to outline a practical approach to the management of anteand postpartum hremorrhage for the doctor in a peripheral hospital in a developing country. The consequences of hsemorrhage are much more serious in the tropics for the following reasons: I. Pre-existing ansemia. This may be due to such conditions as poor diet, inadequate intake of iron and folic acid; parasitic infestation such as Ancylostoma; malaria and schistosomiasis. 2. Unavailability ofstored blood for immediate use. 3. Poor transport and communications. 4. Inadequate hospital facilities, and the almost permanent shortage of medical, nursing, and para-medical staff.

Abu M. Hassim

Papers

Reduction in the incidence of stress incontinence complicating fistula repair

The place of the "ventouse" in developing Africa.

Bilharzial contracted bladder treated by ileocystoplasty

Antepartum and Postpartum Hæmorrhage in the Tropics