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

摘要 女性生殖器瘘管病是一种使人衰弱的损伤，影响到200万至300万妇女，主要是在撒哈拉以南非洲。 患有瘘管病的女性会出现无法控制的尿液和/或粪便渗漏（以及其他身体症状）， 严重受到歧视，精神病发病率很高。初步证据表明， 瘘管修补后的不良妊娠结局。然而，证据基础并不完善， 死产和其他不良妊娠结局的可靠估计以及因素的表征 有助于修复后妊娠结局是必要的，以告知成功的干预措施，以改善 瘘管修补后的妇女健康。 为了努力改善受瘘管病影响的妇女的身体和心理生活质量，我们建议 通过以下途径，解决瘘管修补术后不良妊娠结果风险知识方面的重大差距 在200名接受瘘管修补术的妇女中进行了一项解释性顺序混合方法项目， 在乌干达的4个瘘管修复设施工作了5年。我们试图定量估计不良反应的发生率， 瘘管修复后的妊娠结局（目标1）;并了解修复后的妊娠决策 和卫生保健经验的妇女以前修复生殖器瘘通过深入采访的关键 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 这是我们了解导致不良妊娠结局的因素的第一步， 乌干达它将直接支持后续研究提案（R 01）的开发，使我们能够 估计不良修复后结果的风险因素，并将我们的发现转化为咨询和临床护理 优化这一人群中妇女健康和福祉的模式。总的来说，我们的研究计划预计 在短期和长期内， 在乌干达和其他地方，接受女性生殖器瘘管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.