Treatment Of Vesico-Vaginal Fistula By General Practitioners Trained In Fistula Repair Owing To A Lack Of Surgeons In Rural Areas In Burundi

Background:Burundi is an east African country with about 12 million inhabitants.The country shares borders with Rwanda,Tanzania,and the Democratic Republic of the Congo.Burundi has few surgeons,many concentrated in cities,and medical care in rural areas is done by most of general practitioners.Introduction:Vesicovaginal fistula(VVF)is an abnormal epithelialized or fibrous connection between the bladder and vagina,which results in continuous and unremitting urinary incontinence.At least 3 million women worldwide,most of them in Africa and southern Asia,have an untreated VVF,whilst between 30 000 and 130 000 new VVFs develop annually in Africa alone.In Burundi,the annual incidence of obstetric fistula has been estimated to be 0.20.5%of all deliveries,with 1000-2000 new cases per year.Objective:The aim of this study is to assess the contribution of general practitioners trained in fistula repair in Burundi.Material and Methods:We conducted a retrospective and descriptive study using data extracted from medical records of fistula repairs.The study was conducted over a period of twelve months from June 2020 to May 2021 at Gitega Regional Hospital,dedicated to VVF patients.The questionnaire sought to obtain data on socio-demographic characteristics,effect of VVF,as well as success with VVF repair.Data processing was done by SPSS.Results:We analyzed data from 70 cases collected.Half of them were under 30 years old(47,1%),and were divorced from their husbands(75,7%).The majority of the cases attended Antenatal Consultation service(91,4%),and delivered at the hospital(80%)in the preceding pregnancy.The route of surgery was vaginal surgery for more than half of them(51,4%).The majority of cases(77,1%)were successful repaired and continent with follow-up within 6 months.Vaginal scarring and status of the urethra were statistically significantly associated with fistula incontinence.Conclusion:In our study,most of the cases were successfully repaired and continent.This demonstrates that training of general practitioners in vesico-vaginal fistula repair has filled a gap resulting from the lack of surgeons in Burundi.The majority of women were divorced from their husbands which indicates need for awareness to support these women who suffer from this lack of moral support.