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

摘要 女性生殖器瘘是一种使人衰弱的伤害，影响到200万至300万妇女，主要发生在撒哈拉以南非洲地区。 患有瘘管的妇女有无法控制的尿液和/或粪便渗漏(以及其他身体症状)， 严重污名化，精神疾病发病率高。初步证据已确定存在 瘘管修补术后不良妊娠结局。但是，证据基础还不够发达， 对死产和其他不良妊娠结局的可靠估计以及因素的表征 促进修复后妊娠结局对于提供成功的干预措施以改善状况是必要的 瘘管修补后的妇女健康。 为了改善患有瘘管病的妇女的身体和心理社会生活质量，我们建议 通过以下途径解决关于瘘管修补术后不良妊娠结局风险的严重知识空白 一项解释性序贯混合方法项目在200名接受瘘管修补的妇女中进行。 在乌干达的4个瘘管修复机构工作了5年。我们试图定量地估计不良反应的发生率 瘘管修补术后妊娠结局(目标1)；了解修补后妊娠决策 通过对KEY的深入访谈，了解以前修复过生殖器瘘的妇女的保健经验 利益攸关方(妇女和提供者)；目标2)。 本文提出的研究将对瘘管修复后的死产进行可靠的估计，并代表 建立我们对导致不良妊娠结局的因素的理解的第一步 乌干达。它将直接支持开发后续研究提案(R01)，这将使我们能够 评估修复后不良后果的风险因素，并将我们的发现转化为咨询和临床护理 在这一群体中优化妇女健康和福祉的模式。总体而言，我们的研究计划是预期的 在短期和长期内导致更高的身体和心理社会生活质量 在乌干达和其他地方，接受女性生殖器瘘手术修复的妇女人数。

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.