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Obstetric fistula admissions at Komfo Anokye Teaching Hospital, Kumasi, Ghana
International Journal of Gynecology and Obstetrics (2007) 99, S69–S70
a v a i l a b l e a t w w w. s c i e n c e d i r e c t . c o m
w w w. e l s e v i e r. c o m / l o c a t e / i j g o
ISSUES IN CLINICAL MANAGEMENT
Obstetric fistula admissions at Komfo Anokye Teaching Hospital, Kumasi, Ghana K.A. Danso ⁎, H.S. Opare-Addo, C.A. Turpin Department of Obstetrics and Gynecology, School of Medical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology/Komfo Anokye Teaching Hospital, Kumasi, Ghana
KEYWORDS Genitourinary fistula; Obstetric fistula; Obstetric injury
Obstetric fistulas are a distressing and unresolved contributor to reproductive health morbidity among women in developing countries [1], and they are solely caused by neglected or prolonged obstructed labor [2]. As in all other developing countries, their incidence and burden are unknown in Ghana and obtaining national data is fraught with major challenges. This presentation summarizes and discusses the trends observed on admission at Komfo Anokye Teaching Hospital, Kumasi, Ghana. This is a 1000-bed general and tertiary referral hospital, the second largest in the country and the Teaching Hospital of the Kwame Nkrumah University of Science and Technology School of Medical Sciences. More than 10,000 deliveries are preformed annually at Komfo Anokye Teaching Hospital, where the cesarean delivery rate now stands at 18%. Data on all genitourinary fistulas seen at the hospital were obtained retrospectively from the patients’ records for 1977 through 1998, and prospectively for 1999 through 2004. The total number of deliveries for each year was also recorded. The cases of obstetric fistulas were then analyzed for trends.
⁎ Corresponding author. Department of Obstetrics and Gynecology, School of Medical Sciences, College of Health Sciences, KNUST, University Post Office, Kumasi, Ghana. Tel.: +233 5122308, +233 208183408, +233 243047264; fax: +233 5122308. E-mail address: [email protected] (K.A. Danso).
Of the 313 genitourinary fistulas recorded from 1977 through 2004, 295 (94.2%) were of obstetric origin. The distribution can be seen in Table 1. The rates of obstetric fistula cases per 1000 deliveries, calculated over 5-year periods, are shown in Table 2. For the 56 cases prospectively documented for 1999 through 2004, fistula duration on admission was the following: less than 1 year in 11 patients (19.6%); 1 to 2 years in 23 patients (41%); 3 to 4 years in 7 patients (12.6%); 5 to 10 years in 9 patients (16.1%); and longer than 10 years in 6 patients (10.7%). The observed trends in the incidence of obstetric fistulas in Ghana indicate that, even though high maternal mortality rates remain the most important issue concerning women’s health today, the problem posed by obstetric injury in its most dreaded form, a genital fistula, is also serious. Many women could be living with and suffering from the physical, psychological, and socio-economic consequences of uncontrolled urine loss due to obstetric fistulas, surely many more than the current facility-based data suggest. This is because the greatest numbers of obstetric injuries occur in the most remote rural areas where appropriate medical care is not readily accessible, and the affected women are usually Table 1 Cases of genitourinary fistula at Komfo Anokye Hospital, 1977–2004 Origin
No. (%)
Obstetric fistula Complications of gynecologic surgery Advanced genital malignancy Lymphogranuloma verereum infection Total
295 (94.2) 14 (4.5) 2 (0.64) 2 (0.64) 313 (100)
0020-7292/$ - see front matter © 2007 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijgo.2007.06.029
S70
K.A. Danso et al.
Table 2 Trends for obstetric fistulas treated at Komfo Anokye Hospital, 1977–2004 Period
1977–1981 1982–1986 1987–1991 1992–1996 1997–2001 2002–2004
No. of obstetric fistulas
No. of deliveries
36 43 76 58 60 22
46,269 49,658 51,988 42,507 50,453 33,051
No. of fistulas per 1000 deliveries 0.78 0.87 1.46 1.36 1.20 0.66
poor, without the means to travel to the teaching hospital to seek treatment. Outreach fistula repair services to remote parts of the country always result in the treatment of relatively large numbers of women. The need therefore exists for policies acknowledging obstetric fistula and other birth injuries as a national problem, and dedicating a program for the prevention and treatment of obstetric fistula within the Reproductive Health and Safe Motherhood strategies. By virtue of the epidemiological determinants of obstetric fistula [3], such a
program would inevitably reach Ghana’s less privileged women. It would be a step toward the realization of the Millennium Development Goals on maternal health. Conflict of interest None of the authors have any personal or financial relationships with other people or organisations that could have influenced this paper. Role of the funding source No funding source supported data collection for this paper or any aspect of its preparation.
References [1] Waaldijk K, Armiya’u YD. The obstetric fistula: a major health problem still unresolved. Int Urogynecol J 1993;4:126–8. [2] Danso KA, Martey JO, Wall LL, Elkins TE. The epidemiology of genitourinary fistulae in Kumasi, Ghana. Int Urogynecol J 1996;7:117–20. [3] Briggs N. Illiteracy and maternal health: educate or die. Lancet 1993;1:1063–4.
a v a i l a b l e a t w w w. s c i e n c e d i r e c t . c o m
w w w. e l s e v i e r. c o m / l o c a t e / i j g o
ISSUES IN CLINICAL MANAGEMENT
Obstetric fistula admissions at Komfo Anokye Teaching Hospital, Kumasi, Ghana K.A. Danso ⁎, H.S. Opare-Addo, C.A. Turpin Department of Obstetrics and Gynecology, School of Medical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology/Komfo Anokye Teaching Hospital, Kumasi, Ghana
KEYWORDS Genitourinary fistula; Obstetric fistula; Obstetric injury
Obstetric fistulas are a distressing and unresolved contributor to reproductive health morbidity among women in developing countries [1], and they are solely caused by neglected or prolonged obstructed labor [2]. As in all other developing countries, their incidence and burden are unknown in Ghana and obtaining national data is fraught with major challenges. This presentation summarizes and discusses the trends observed on admission at Komfo Anokye Teaching Hospital, Kumasi, Ghana. This is a 1000-bed general and tertiary referral hospital, the second largest in the country and the Teaching Hospital of the Kwame Nkrumah University of Science and Technology School of Medical Sciences. More than 10,000 deliveries are preformed annually at Komfo Anokye Teaching Hospital, where the cesarean delivery rate now stands at 18%. Data on all genitourinary fistulas seen at the hospital were obtained retrospectively from the patients’ records for 1977 through 1998, and prospectively for 1999 through 2004. The total number of deliveries for each year was also recorded. The cases of obstetric fistulas were then analyzed for trends.
⁎ Corresponding author. Department of Obstetrics and Gynecology, School of Medical Sciences, College of Health Sciences, KNUST, University Post Office, Kumasi, Ghana. Tel.: +233 5122308, +233 208183408, +233 243047264; fax: +233 5122308. E-mail address: [email protected] (K.A. Danso).
Of the 313 genitourinary fistulas recorded from 1977 through 2004, 295 (94.2%) were of obstetric origin. The distribution can be seen in Table 1. The rates of obstetric fistula cases per 1000 deliveries, calculated over 5-year periods, are shown in Table 2. For the 56 cases prospectively documented for 1999 through 2004, fistula duration on admission was the following: less than 1 year in 11 patients (19.6%); 1 to 2 years in 23 patients (41%); 3 to 4 years in 7 patients (12.6%); 5 to 10 years in 9 patients (16.1%); and longer than 10 years in 6 patients (10.7%). The observed trends in the incidence of obstetric fistulas in Ghana indicate that, even though high maternal mortality rates remain the most important issue concerning women’s health today, the problem posed by obstetric injury in its most dreaded form, a genital fistula, is also serious. Many women could be living with and suffering from the physical, psychological, and socio-economic consequences of uncontrolled urine loss due to obstetric fistulas, surely many more than the current facility-based data suggest. This is because the greatest numbers of obstetric injuries occur in the most remote rural areas where appropriate medical care is not readily accessible, and the affected women are usually Table 1 Cases of genitourinary fistula at Komfo Anokye Hospital, 1977–2004 Origin
No. (%)
Obstetric fistula Complications of gynecologic surgery Advanced genital malignancy Lymphogranuloma verereum infection Total
295 (94.2) 14 (4.5) 2 (0.64) 2 (0.64) 313 (100)
0020-7292/$ - see front matter © 2007 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijgo.2007.06.029
S70
K.A. Danso et al.
Table 2 Trends for obstetric fistulas treated at Komfo Anokye Hospital, 1977–2004 Period
1977–1981 1982–1986 1987–1991 1992–1996 1997–2001 2002–2004
No. of obstetric fistulas
No. of deliveries
36 43 76 58 60 22
46,269 49,658 51,988 42,507 50,453 33,051
No. of fistulas per 1000 deliveries 0.78 0.87 1.46 1.36 1.20 0.66
poor, without the means to travel to the teaching hospital to seek treatment. Outreach fistula repair services to remote parts of the country always result in the treatment of relatively large numbers of women. The need therefore exists for policies acknowledging obstetric fistula and other birth injuries as a national problem, and dedicating a program for the prevention and treatment of obstetric fistula within the Reproductive Health and Safe Motherhood strategies. By virtue of the epidemiological determinants of obstetric fistula [3], such a
program would inevitably reach Ghana’s less privileged women. It would be a step toward the realization of the Millennium Development Goals on maternal health. Conflict of interest None of the authors have any personal or financial relationships with other people or organisations that could have influenced this paper. Role of the funding source No funding source supported data collection for this paper or any aspect of its preparation.
References [1] Waaldijk K, Armiya’u YD. The obstetric fistula: a major health problem still unresolved. Int Urogynecol J 1993;4:126–8. [2] Danso KA, Martey JO, Wall LL, Elkins TE. The epidemiology of genitourinary fistulae in Kumasi, Ghana. Int Urogynecol J 1996;7:117–20. [3] Briggs N. Illiteracy and maternal health: educate or die. Lancet 1993;1:1063–4.