Centro de Investigação em Saúde de Manhiça (CISM), Rua 12, Vila da Manhiça, 1121, Manhiça, Mozambique.
Department of Obstetrics and Gynaecology, Faculty of Medicine, Universidade Eduardo Mondlane (UEM), Av. Agostinho Neto 679, 1100, Maputo, Mozambique.
Reprod Health. 2020 Jan 31;17(1):21. doi: 10.1186/s12978-020-0860-0.
Obstetric fistula is still common in low- and middle-income countries (LMIC) despite the on-going shift to increased facility deliveries in the same settings. The social behavioural circumstances in which fistula, as well as its consequences, still occur are poorly documented, particularly from the perspective of the experiences of women with obstetric fistula. This study sought to describe women's experiences of antenatal, partum and post-partum care in southern Mozambique, and to pinpoint those experiences that are unique to women with fistula in order to understand the care-seeking and care provision circumstances which could have been modified to avoid or mitigate the onset or consequences of fistula.
This study took place in Maputo and Gaza provinces, southern Mozambique, in 2016-2017. Qualitative data were collected through in-depth interviews conducted with 14 women with positive diagnoses of fistula and an equal number of women without fistula. All interviews were audio-recorded and transcribed verbatim prior to thematic analysis using NVivo11.
Study participants had all attended antenatal care (ANC) visits and had prepared for a facility birth. Prolonged or obstructed labour, multiple referrals, and delays in receiving secondary and tertiary health care were common among the discourses of women with fistula. The term "fistula" was rarely known among participants, but the condition (referred to as "loss of water" or "illness of spillage") was recognised after being prompted on its signs and symptoms. Women with fistula were invariably aware of the links between fistula and poor birth assistance, in contrast with those without fistula, who blamed the condition on women's physiological and behavioural characteristics.
Although women do seek antenatal and peri-partum care in health facilities, deficiencies and delays in birth assistance, referral and life-saving interventions were commonly reported by women with fistula. Furthermore, weaknesses in quality of care, not only in relation to prevention, but also the resolution of the damage, were evident. Quality improvement of birth care is necessary, both at primary and referral level. There is a need to increase awareness and develop guidelines for prevention, early detection and management of obstetric fistula, including early postpartum treatment, availability of fistula repair for complex cases, and rehabilitation, coupled with the promotion of community consciousness of the problem.
尽管中低收入国家（LMIC）仍在不断增加医疗机构分娩，但产科瘘管仍很常见。在这些国家，导致瘘管形成及其后果的社会行为环境记录不佳，尤其是从患有产科瘘管的女性的经历角度来看。本研究旨在描述莫桑比克南部女性在产前、分娩和产后期间的护理经历，并确定那些与瘘管女性特有的经历，以了解寻求护理和提供护理的情况，这些情况可能已经被修改以避免或减轻瘘管的发生或后果。
本研究于 2016 年至 2017 年在莫桑比克南部的马普托省和加扎省进行。通过对 14 名确诊为瘘管的女性和 14 名无瘘管的女性进行深入访谈，收集了定性数据。所有访谈均进行了录音，并在使用 NVivo11 进行主题分析之前进行了逐字转录。
研究参与者都参加了产前保健（ANC）就诊，并为在医疗机构分娩做了准备。长时间或受阻的分娩、多次转诊以及在获得二级和三级卫生保健方面的延迟在瘘管女性的讨论中很常见。参与者中很少有人知道“瘘管”这个术语，但在提示其体征和症状后，都能识别出这种疾病（称为“漏水”或“渗漏病”）。瘘管女性总是意识到瘘管与分娩辅助不足之间的联系，而没有瘘管的女性则将这种疾病归咎于女性的生理和行为特征。
尽管女性确实在卫生机构寻求产前和围产期护理，但瘘管女性普遍报告了分娩辅助、转诊和救生干预方面的缺陷和延迟。此外，不仅在预防方面，而且在解决损伤方面，护理质量都存在不足。需要提高初级和转诊水平的分娩护理质量。需要提高认识，并制定预防、早期发现和管理产科瘘管的指南，包括对复杂病例进行早期产后治疗、提供瘘管修复以及康复，同时提高社区对该问题的认识。
