Amref Health Africa

Amref Health Africa www.amref.org

Charles Suya(Amref Health Africa Malawi)

charles.suya@amref.Org

Lessons from women identified with fistula in Malawi, a case study of

Mangochi district

Amref Health Africa www.amref.org

Outline

• Background• Coverage• Case Identification Process• Socio – demographic factors• Results• Lessons Learnt• Recommendations• Acknowledgement

Amref Health Africa www.amref.org

• Obstetric fistula is a preventable obstetric complication.

• In Malawi, a high prevalence of obstetric fistula was reported in the Southern region (1.9%).

• Mangochi district, where Amref Health Africa is implementing “Staying alive Project” has higher fistula prevalence of 2.7% (NSO, 2004).

• Population - 948,483 (NSO projections 2013). • Work in 32 facilities• This case study highlights lessons learnt from fistula

identification and management (Mangochi and Blantyre)

Background

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Fistula Case Identification-Process

Actors• Health Surveillance Assistants• Fistula repaired clients• Community members• Health Workers Confirmation of cases• Clinicians, specialist surgeons

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Socio-Demographic Factors –Identified Cases (n=91)

• Most of the women with fistula (98%) did not complete primary education.

• Average age at which identified women developed fistula was 23.

• The prevalence was higher in women aged between 20 to 34 (54%) than those aged below 19 years. (34% )

• Average period the identified women lived with fistula before access to treatment was 10 years

• 78.3% of these had delivered a maximum of 1 to 4 times• 81% of the women did not have a live baby.• 54 % of the women who were married at delivery were

divorced

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Results• First camp was in October 2013 in Blantyre• Currently fistula repairs are done in Mangochi district• 81 women of 91 confirmed cases were successfully

repaired representing a success rate of 89% – 17 (89%) out of 19 - 2013– 21(88%) out of 24, - 2014– 16 (94%) of 17 and – 29 (87%) of 31 were successfully repaired.

The 10 cases that were not successfully repaired will be re-booked for another round of surgery

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Lessons learnt• Treating women within the district has assisted to

increase in number of women accessing treatment; they have evidence to take the courage to come out of hiding

• Some women developed fistula under skilled delivery• Psycho social support offers an opportunity to

understand the challenges fistula clients are experiencing

• Use of district based facilities offers an opportunity to repair more women

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Recommendations• Intensification IEC to all women even before

they have had the first child. • Strengthen health care systems to to support

reduction of fistula incidence• Establish incidence and magnitude of fistula in

Mangochi. • Strengthen and support Monkey bay to

increase the number of fistula women to repaired within the project span.

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Acknowledgements

• Dutch Ministry of Foreign Affairs• Amref Health Africa Flying Doctors• DHMT-Mangochi• UNFPA-Malawi• CHAM• Amref Health Africa Southern Africa Hub• Amref Health Africa Malawi Staying Alive

Team

Thank You for

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on!Zikomo

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