Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, Mulago Hill, Kampala, Uganda.
Department of Obstetrics, Gynaecology and Reproductive Sciences, University of California, San Francisco, 550 16th Street, San Francisco, USA.
Afr J Reprod Health. 2020 Jun;24(2):129-140. doi: 10.29063/ajrh2020/v24i2.13.
Many obstetric fistula patients remain untreated or present late to treatment despite increasing surgical availability in Uga nda. We explored women's perceptions of the cause of their obstetric fistula and their treatment seeking behaviours, including barriers and facilitators to timely care access. In-depth interviews and focus group discussions were conducted from June-August 2014 among 33 women treated for obstetric fistula at Mulago Hospital, Kampala. Data were analysed to describe dimensions and commonalities of themes identified under perceived causes and treatment seeking experiences, and their intersection. Perceived obstetric fistula causes included delays in deciding on hospital delivery, lengthy labour, injury caused by the baby, health worker incompetence, and traditional beliefs. Treatment seeking timing varied. Early treatment seeking was facilitated by awareness of treatment availability through referral, the media, community members, and support by partners and children. Barriers to early treatment seeking included inadequate financial and social support, erroneous perceptions about fistula causes and curability, incorrect diagnoses, and delayed or lack of care at health facilities. Our study supports broad educational and awareness activities, facilitation of social and financial support for accessing care, and improving the quality of emergency obstetric care and fistula treatment surgical capacity to reduce women's suffering.
尽管乌干达的外科手术资源不断增加，但仍有许多产科瘘患者未得到治疗或治疗时间较晚。我们探讨了女性对其产科瘘病因的认知，以及她们的求诊行为，包括及时获得护理的障碍和促进因素。2014 年 6 月至 8 月，我们在坎帕拉的穆拉戈医院对 33 名接受产科瘘治疗的女性进行了深入访谈和焦点小组讨论。对数据进行了分析，以描述确定病因和治疗经历以及它们之间的交集方面的主题维度和共性。认为导致产科瘘的原因包括决定住院分娩的时间延迟、分娩时间长、婴儿造成的伤害、医务人员的无能以及传统观念。求诊时间不一。早期求诊的原因包括通过转诊、媒体、社区成员以及伴侣和孩子的支持而了解到治疗的可及性。早期求诊的障碍包括经济和社会支持不足、对瘘管病因和可治愈性的错误认识、误诊以及医疗机构护理延迟或缺乏。我们的研究支持广泛的教育和宣传活动，为获得护理提供社会和经济支持，并提高紧急产科护理和瘘管治疗外科能力，以减轻女性的痛苦。
