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Open Access High loss to follow-up following obstetric fistula repair surgery in rural Burundi: is there a way forward?

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SETTING: Gitega Fistula Centre (GFC), a dedicated obstetric fistula repair centre providing comprehensive care at the Gitega District Hospital, rural Burundi.

OBJECTIVES: To describe 1) the proportion who returned for scheduled 3- and 6-month follow-up visits and 2) outcomes (fistula closure rates and continence status) at discharge from hospital and after 3 and 6 months among patients who underwent fistula repair surgery.

DESIGN: Retrospective cohort analysis using programme data from April 2010 to December 2011.

RESULTS: A total of 475 women with obstetric fistula underwent surgical repair. At discharge from hospital, 415 (87%) had a closed fistula, of whom 318 (77%) were continent of urine and/or faeces, while 97 (23%) remained incontinent despite closure. Of the 415 patients with closed fistula, only 244 (59%) were followed up at 3 months and 73 (18%) at 6 months (2 for linear trend 576, P < 0.0001). This indicates progressive loss to follow-up, reaching 82% by 6 months.

CONCLUSION: Women undergoing obstetric fistula repair surgery at GFC achieve good hospital exit outcomes. Thereafter, substantial and progressive loss to follow-up hinder the ability to judge programme success over time. Steps to address this operational problem are discussed.
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Keywords: Burundi; loss to follow-up; obstetric fistula; operational research

Document Type: Research Article

Affiliations: 1: Médecins Sans Frontières, Operational Center Brussels, Burundi-Gitega, Burundi 2: Medical Department (Operational Research), Operational Center Brussels, Médecins Sans Frontières–Luxembourg 3: University of Bergen, Bergen, Norway 4: Institute of Tropical Medicine, Antwerp, Belgium 5: Médecins Sans Frontières, Bujumbura, Burundi 6: Ministry of Health, Bujumbura, Burundi

Publication date: June 21, 2013

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