Prevalence and correlates of adverse pregnancy outcomes following female genital fistula repair in Uganda: a mixed-methods study

乌干达女性生殖器瘘修复术后不良妊娠结局的患病率和相关性：一项混合方法研究

• 批准号: 10455568
• 负责人: Alison M El Ayadi
• 金额: $ 17.32万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-01 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10455568
• 关键词: Address; Affect; Africa South of the Sahara; Age; Attention; Cervical spinal cord injury; Cesarean section; Childbirth; Clinical; Clinical Services; Communities; Confidence Intervals; Continuity of Patient Care; Counseling; Country; Data Collection; Decision Making; Desired Family Sizes; Development; Discipline of obstetrics; Economics; Emergency Situation; Ensure; Extravasation; Face; Feces; Female genitalia; Fertility; Fistula; Gait abnormality; General Population; Genital; Genitalia; Guidelines; Healthcare; Hospitals; Household; Iatrogenesis; Incidence; Individual; Infection; Injury; Intervention; Interview; Knowledge; Labor Onset; Literature; Mental Depression; Methods; Modeling; Morbidity - disease rate; Obstructed labor; Operative Surgical Procedures; Outcome; Pain; Participant; Patients; Personal Satisfaction; Population; Pregnancy; Pregnancy Outcome; Pregnancy Rate; Premature Birth; Prenatal care; Prevalence; Provider; Quality of life; Religion and Spirituality; Reporting; Research; Research Infrastructure; Research Proposals; Retrospective cohort; Risk; Risk Estimate; Risk Factors; Role; Sampling; Social Values; Social Work; Spontaneous abortion; Stigmatization; Surveys; System; Translating; Trauma; Uganda; Urine; Vaginal delivery procedure; Woman; Women' s Health; adverse outcome; adverse pregnancy outcome; aged; base; behavior change; behavior influence; care outcomes; child bearing; clinical care; design; evidence base; experience; follow-up; hip bone; implementation science; improved; interest; maternal morbidity; nerve damage; perinatal outcomes; physical symptom; pregnant; prevent; primary outcome; programs; provider factors; psychosocial; recruit; repaired; reproductive; secondary infertility; secondary outcome; service providers; social; stillbirth; success; successful intervention; tissue repair

ABSTRACT Female genital fistula is a debilitating injury that affects 2 to 3 million women, mostly in sub-Saharan Africa. Women with fistula have uncontrollable leakage of urine and/or feces (among other physical symptoms), are heavily stigmatized, and experience high psychiatric morbidity. Preliminary evidence has identified risk of adverse pregnancy outcomes following fistula repair. However, the evidence base is not well developed, and robust estimation of stillbirth and other adverse pregnancy outcomes as well as characterization of factors contributing to post-repair pregnancy outcome is necessary for informing successful interventions to improve women's health following fistula repair. In an effort to improve the physical and psychosocial quality of life for women affected by fistula, we propose to address the critical gaps in knowledge on risk of adverse pregnancy outcomes following fistula repair through an explanatory sequential mixed-methods project among 200 women who have undergone fistula repair in the past 5 years at 4 fistula repair facilities in Uganda. We seek to quantitatively estimate the incidence of adverse pregnancy outcomes following fistula repair (Aim 1); and understand post-repair pregnancy decision-making and health care experiences of women previously repaired for genital fistula through in-depth interview with key stakeholders (women and providers); Aim 2). The research proposed herein will develop a robust estimate of stillbirth following fistula repair, and represents a first step toward establishing our understanding of factors contributing to adverse pregnancy outcomes in Uganda. It will directly support the development of a subsequent research proposal (R01) which will allow us to estimate risk factors of adverse post-repair outcomes and translate our findings into counseling and clinical care models for optimizing women's health and wellbeing in this population. Overall, our research program is expected to result in higher physical and psychosocial quality of life in both the short and long term for the increasing number of women undergoing surgical repair of female genital fistula, in Uganda and elsewhere.

抽象的 女性生殖器瘘是一种令人衰弱的伤害，影响2至300万妇女，主要是撒哈拉以南非洲。 瘘管的女性尿液和/或粪便（除其他身体症状）是否无法控制 严重的污名化并经历了高精神病发病率。初步证据已经确定了 瘘管修复后不良怀孕结果。但是，证据基础的发展不佳，并且 对死产和其他不良妊娠结局的强大估计以及因素的表征 为了告知成功的干预措施以改善，有必要为修正后的怀孕结局做出贡献 瘘管修复后的妇女健康。 为了改善受瘘管影响的女性的身体和心理社会生活质量，我们建议 解决瘘管修复后不良妊娠结局风险的知识的关键差距 在200名在瘘管修复的女性中，一个解释性的顺序混合方法项目 过去5年在乌干达的4个瘘管维修设施。我们试图定量估计不良的发生率 瘘管修复后的妊娠结局（AIM 1）；并了解后修正后怀孕决策 以及以前通过与Key进行深入的访谈，以前修复了生殖器瘘的妇女的医疗保健经验 利益相关者（妇女和提供者）；目标2）。 本文提出的研究将在瘘管修复后对死产进行强有力的估计，并代表 建立我们对导致不良怀孕后果因素的理解的第一步 乌干达。它将直接支持随后的研究建议（R01）的制定，这将使我们能够 估计不利后预后结果的危险因素，并将我们的发现转化为咨询和临床护理 在该人群中优化妇女健康和福祉的模型。总体而言，我们的研究计划是可以的 在短期和长期的长期中，都会导致更高的身体和社会心理生活质量 在乌干达和其他地方接受女性生殖瘘手术修复手术修复的妇女人数。