Paluku Justin Lussy, Bartels Susan A, Kataliko Benjamin Kasereka, Furaha Cathy Mufungizi, Aksanti Barthelemy Kasi, Kalole Benjamin Kambale, Kamabu Eugénie Mukekulu, Lwanzo Chrispin Musubao, Kasereka Jonathan M L, Mukuku Olivier, Tsongo Zacharie Kibendelwa, Wembonyama Stanis Okitotsho, Mpoy Charles Wembonyama, Juakali Jeannot Sihalikyolo
Department of Obstetrics and Gynecology, University of Goma, Goma, Democratic Republic of the Congo.
Department of Obstetrics and Gynecology, HEAL Africa Hospital, Goma, Democratic Republic of the Congo.
Int J Womens Health. 2024 Apr 17;16:645-653. doi: 10.2147/IJWH.S451929. eCollection 2024.
The aim of this study was to assess quality of life (QoL) using the WHOQOL-BREF questionnaire among obstetric fistula (OF) patients before and after surgical repair of OF (SROF).
A longitudinal cohort study was conducted between November 2022 and October 2023 in the Democratic Republic of the Congo (DRC) among OF patients to assess their QoL before and after SROF. A systematic sampling technique was used to recruit a total of 158 OF patients. The WHOQOL-BREF questionnaire assessed general health, life experience, as well as physical, social, psychological, and environmental domains.
The mean age among the 158 respondents was 33.51 ± 9.63 years, and 77.85% of them lived in rural areas. In terms of surgical outcomes, 80.38% had closure of the OF with regained continence, 5.7% had closure of the OF with persistent incontinence, and 13.9% had a failed surgical repair. Overall mean QoL scores were higher after OF surgical repair (3.83, standard deviation [SD]=0.89) in comparison to pre-operative (1.58, SD=0.63) (p<0.001). These QoL improvements included physical (mean score 66.32 post-surgery versus 28.37 before, p<0.001), social (mean score 64.92 post-surgery versus 27.90 before, p<0.001), psychological (mean score 68.09 post-surgery versus 21.28 before, p<0.001), environmental (mean score 48.41 post-surgery versus 16.91 before p<0.001), and general domains. Patients with a successful OF repair had a better QoL score than those with a closed fistula but ongoing incontinence or those for whom surgery failed to close the fistula.
The present study showed that among OF patients, all QoL domains were impaired before surgical repair and significantly improved after surgery. Successful OF closure alleviates the consequences of OF and helps to restore patients' wellbeing. Our findings call for improved access to high-quality surgical repair services as a fundamental right for OF patients.
本研究旨在使用世界卫生组织生活质量简表（WHOQOL - BREF），评估产科瘘（OF）患者在产科瘘手术修复（SROF）前后的生活质量（QoL）。
2022年11月至2023年10月在刚果民主共和国（DRC）对OF患者进行了一项纵向队列研究，以评估他们在SROF前后的QoL。采用系统抽样技术共招募了158名OF患者。WHOQOL - BREF问卷评估了总体健康、生活体验以及身体、社会、心理和环境领域。
158名受访者的平均年龄为33.51±9.63岁，其中77.85%生活在农村地区。在手术结果方面，80.38%的患者瘘口闭合且恢复了控尿功能，5.7%的患者瘘口闭合但仍有持续性尿失禁，13.9%的患者手术修复失败。与术前（1.58，标准差[SD]=0.63）相比，OF手术修复后的总体平均QoL得分更高（3.83，SD = 0.89）（p<0.001）。这些QoL的改善包括身体领域（术后平均得分66.32，术前为28.37，p<0.001）、社会领域（术后平均得分64.92，术前为27.90，p<0.001）、心理领域（术后平均得分68.09，术前为21.28，p<0.001）、环境领域（术后平均得分48.41，术前为16.91，p<0.001）以及总体领域。OF修复成功的患者的QoL得分高于瘘口闭合但仍有尿失禁的患者或手术未能闭合瘘口的患者。
本研究表明，在OF患者中，所有QoL领域在手术修复前均受损，术后显著改善。成功闭合OF可减轻OF的后果，并有助于恢复患者的健康。我们的研究结果呼吁改善获得高质量手术修复服务的机会，将其作为OF患者的一项基本权利。
