The Ministry of Health has availed free treatment for obstetric fistula across regional referral and mission hospitals in Uganda. A recent press indicated that the mission hospitals include Lacor in Gulu, Kagando, Kitovu in Masaka and Kamuli. Others are Kisiizi, Kumi and Virika mission hospitals.
According to information from the health ministry, the services will be provided by 23 fistula surgeons, who can perform both simple and complex repairs.
In addition, the health state minister for general duties, Sarah Opendi, noted equipment for obstetric fistula repair has also been procured and health workers such as anaesthetists and nurses have been trained to manage the condition.
The disclosure was made as Uganda commemorated the International Day to End Obstetric Fistula recently. National celebrations were held at Mbarara Regional Referral Hospital, in Mbarara district recently.
Worldwide, the International Day to End Obstetric Fistula is commemorated on May 23. The day was set aside to raise awareness about obstetric fistula and intensify actions towards ending it. This year’s theme was “Hope, Healing and Dignity for All”.
According to Vivian Serwanjja, the public relations officer in the health ministry, the theme emphasises the role of stakeholders and the public in the fight against fistula to reduce new cases, provide treatment to those with fistula and reintegrate those who have undergone repair back into the community.
According to Opendi, obstetric fistula is an abnormal opening between the birth canal and the bladder/ureter or rectum of a woman that results in constant leakage of urine and/or faeces through the birth canal. Most fistulas are as a result of difficult childbirth and obstructed labour lasting more than 24 hours. The pressure of the baby’s head or any presenting part of the baby can injure the tissue in the birth canal creating a hole between the birth canal and bladder or rectum, causing an uncontrollable leakage of urine, faeces or both.
According to the World Health Organisation, globally about two million women are living with fistula. Between 50,000 and 100,000 new cases occur annually, most of which are in sub-Saharan Africa and Asia.
According to the health ministry, in Uganda, between 140,000 and 200,000 (about 2%) of women of reproductive age suffer from the condition and there are 1,900 new cases per year.
Serwanjja acknowledged that although 2,000 repairs are carried out annually, a good proportion of women affected by obstetric fistula are not receiving treatment, leaving a massive backlog in the communities.
Information from the Ministry of Health shows that causes and risk factors of developing fistula are:
- Young age: women who give birth when they are below 20 years are at greatest risk of fistula because their pelvis is not developed enough to handle childbirth
- Complications during pregnancy and delivery such as prolonged labour and not getting professional care during delivery
- Poor nutrition during a girl’s childhood can also cause stunted growth and increase her risk for fistula.
Officiating at the national celebrations in Mbarara, Opendi emphasised the need for all mothers to deliver from a health unit. “Any woman could be at risk of fistula during delivery if she is not assisted by a skilled health worker who can recognise complications quickly and take action,” Opendi explained.
She appealed to general public to observe the following:
- If a woman suspects that she is pregnant, she should visit the nearest health facility or health worker for proper check-up and care
- During pregnancy, a woman must attend at least all four antenatal visits
- All pregnant women should deliver at a health facility under a skilled birth attendant
- All mothers are encouraged to use a suitable family planning method to space their pregnancies appropriately.
In addition to free services, the Government has put in place other interventions to address the growing problem of obstetric fistula. According to information from the health ministry, the interventions include:
- Commencing a multifaceted fistula management programme aimed at prevention, treatment and rehabilitation of fistula clients
- Providing more skilled health personnel to perform fistula repairs and reintegrate those who have undergone repairs back into their communities
- Training of community extension workers to enhance mobilisation for skilled delivery attendance
- Building capacity for districts and health facilities countrywide in emergency obstetrics care and management including use of partographs to detect deviation from normal labour