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Title Psychological Sequelae of Obstetric Fistula in Tanzanian Women
Publication Date
Date Accessioned
University/Publisher Duke University
Abstract Up to two million women worldwide have obstetric fistula, a maternal morbidity prevalent in developing countries that causes uncontrollable leaking of urine and/or feces and a persistent bad odor. There is both theoretical and empirical evidence for psychopathology in patients presenting for fistula surgery, albeit with methodological limitations. The current studies sought to improve on past limitations of study design. Study A compared psychological symptoms and social support between fistula patients and a comparison group recruited from gynecology outpatient clinics. Measures included previously validated psychometric questionnaires, administered orally by data collectors. Results showed that compared to gynecology outpatients, fistula patients had significantly higher levels of depression, traumatic stress, somatic symptoms and avoidant coping, and had lower social support. Study B investigated changes in psychological symptoms, stigma and social support between the time of admission for fistula repair and 3 months after discharge from the hospital. At follow-up, fistula patients reported significant improvements in all study outcome variables. Exploratory analysis revealed that the extent of leaking was associated with depression and PTSD. These results indicate the potential benefit of mental health interventions for this population. Additionally, future research may clarify the relationship between residual leaking after fistula surgery, and its effect on post-surgery mental health outcomes.
Subjects/Keywords Psychology; Obstetrics and gynecology; African studies; depression; obstetric fistula; psychopathology; psychosocial factors; PTSD=posttraumatic stress disorder; women's health
Contributors Sikkema, Kathleen J (advisor)
Country of Publication us
Record ID handle:10161/10444
Repository duke
Date Retrieved
Date Indexed 2020-04-26
Issued Date 2015-01-01 00:00:00

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Obstetric Fistula in Tanzania Obstetric fistula is a devastating result of childbirth, largely the result of poverty, gender inequality, and poor access to maternal health care (Semere & Nour, 2008; Wall, Arrowsmith, Briggs, Browning, & Lassey, 2005…

…labor leads to obstetric fistula, the pressure of the fetus pushing on the birth canal causes pressure necrosis (i.e., tissue death). The result is a hole between the bladder or rectum and the vagina, which causes uncontrollable leaking of…

…urine or feces and a persistent bad odor. The condition is nearly non-existent in the U.S., where emergency obstetric care is widely available (Wong et al., 2012). There are several demographic characteristics that increase risk for fistula

…to countries in south and southeast Asia, sub-Saharan African countries appear to have the highest incidence of obstetric fistula in the world (Stanton et al., 2007). It is estimated that over 33,000 new cases of fistula develop each year in…

…estimates of rural population, fistula incidence in rural areas, and annual rural births, it can be estimated that there may be up to 1,800 new obstetric fistula cases in Tanzania each year (National Bureau of Statistics of Tanzania & ICF Macro, 2011…

…UNICEF, 2014; Vangeenderhuysen et al., 2001). Given the continuing presence of this maternal health morbidity, the effects of obstetric fistula warrant close inspection. 1.2. Obstetric Fistula and Psychological Disorders A number of features of…

obstetric fistula may increase the likelihood of developing psychological disorders such as depression and posttraumatic stress 2 disorder (PTSD). These features range from fistula risk factors, to labor and delivery circumstances, to post…

…and to develop PTSD following a traumatic event (Seedat et al., 2009; Tolin & Foa, 2006). Since obstetric fistula is exclusively the medical burden of women, it is important to note that this demographic group has a higher risk of developing…