Stakeholders’ perceptions on improving women’s health after obstetric fistula repair: results from a qualitative study in Guinea

Alexandre Delamou, Moussa Douno, Alison M. El Ayadi, Aissatou Diallo, Thérèse Delvaux, Vincent De Brouwere


The holistic care of obstetric fistula remains a significant public health concern in developing countries. Improving women’s outcomes after repair requires perspectives on post-surgical period within which women have to fulfil their social roles and expectations, mainly becoming pregnant, cooking, resuming farming activities or sexual intercourse. Our objective was to explore stakeholders’ perceptions of women’s health and well-being after fistula repair, and their perspectives on strategies for improving their quality of life in Guinea. A qualitative study involving representatives from the Ministry of Health, regional, district and hospital managers, representatives of NGOs and funding bodies, local leaders, women who underwent fistula surgery and their relatives (husbands, family members), health providers and community health workers at different levels was conducted. Thematic analysis was performed using NVivo software. Overall, 41 in-depth interviews and seven focus group discussions were conducted with 83 various stakeholders. Unanimously, respondents perceived women treated for obstetric fistula are “diminished” and “vulnerable”. This “vulnerability” encompasses physical, socio-emotional and economic dimensions. The high risk of maternal and neonatal complications such as fistula recurrence, abortion or stillbirth in these women was mentioned. Stakeholders emphasized the need for a multidisciplinary approach to improve women’s health after repair. Social support, economic empowerment and medical follow-up were identified as key components to mitigate women’s vulnerability for successful post-repair reintegration. The programmatic level in Guinea should consider women’s health after fistula repair a vital component of the holistic fistula care. (Afr J Reprod Health 2022; 26[8]: 30-40).

Full Text:



Capes T, Ascher-Walsh C, Abdoulaye I and Brodman M.

Obstetric fistula in low and middle income countries.

Mt Sinai J Med 2011; 78(3), 352-61.

Wall LL. A framework for analyzing the determinants of

obstetric fistula formation. Stud Fam Plann 2012;

(4), 255-72.


Duko B, Wolka S, Seyoum M and Tantu T. Prevalence of

depression among women with obstetric fistula in

low-income African countries: a systematic review

and meta-analysis. Arch Womens Ment Health 2020.

Adler A J, Ronsmans C, Calvert C and Filippi V. Estimating

the prevalence of obstetric fistula: a systematic review

and meta-analysis. BMC Pregnancy Childbirth 2013;

, 246.

Maheu-Giroux M, Filippi V, Samadoulougou S, Castro MC,

Maulet N, Meda N and Kirakoya-Samadoulougou F.

Prevalence of symptoms of vaginal fistula in 19 subSaharan Africa countries: a meta-analysis of national

household survey data. Lancet Glob Health 2015;

(5), e271-8.


Institut National de la Statistique, Enquête Démographique et

de Santé, Guinée (EDS V) 2018. 2019. p. 650.

Osotimehin B. Seizing the moment to end obstetric fistula.

Lancet Glob Health 2014; 2(7), e381-2.

Hawkins L, Spitzer RF, Christoffersen-Deb A, Leah J and

Mabeya H. Characteristics and surgical success of

patients presenting for repair of obstetric fistula in

western Kenya. Int J Gynaecol Obstet 2013; 120(2),


Delamou A, Diallo M, Beavogui AH, Delvaux T, Millimono

S, Kourouma M, Beattie K, Barone M, Barry TH,

Khogali M, Edginton M, Hinderaker SG, Ruminjo J,

Zhang WH and De Brouwere V. Good clinical

outcomes from a 7-year holistic programme of fistula

repair in Guinea. Trop Med Int Health 2015; 20(6),


Barone MA, Frajzyngier V, Ruminjo J, Asiimwe F, Barry

TH, Bello A, Danladi D, Ganda SO, Idris S, Inoussa

M, Lynch M, Mussell F and Podder DC. Determinants

of postoperative outcomes of female genital fistula

repair surgery. Obstet Gynecol 2012; 120(3), 524-31.

FistulaCare/EngenderHealth., Final Project Report: October

to December 2013, Part 1I: Country

Accomplishments 2013.


Lombard L, de St. Jorre J, Geddes R, El Ayadi AM and

Grant L. Rehabilitation experiences after obstetric

fistula repair: systematic review of qualitative studies.

Trop Med Int Health 2015; 20(5), 554-568.

Delamou A, Utz B, Delvaux T, Beavogui AH, Shahabuddin

A, Koivogui A, Levêque A, Zhang WH and De

Brouwere V. Pregnancy and childbirth after repair of

obstetric fistula in sub-Saharan Africa: Scoping

Review. Trop Med Int Health 2016; 21(11), 1348-

Frajzyngier V, Ruminjo J and Barone MA. Factors

influencing urinary fistula repair outcomes in

developing countries: a systematic review. Am J

Obstet Gynecol 2012; 207(4), 248-58.

Delamou A, Delvaux T, El Ayadi AM, Tripathi V, Camara

BS, Beavogui AH, Romanzi L, Cole B, Bouedouno P,

Diallo M, Barry TH, Camara M, Diallo K, Leveque A,

Zhang WH and De Brouwere V. Fistula recurrence,

pregnancy, and childbirth following successful

closure of female genital fistula in Guinea: a

longitudinal study. Lancet Glob Health 2017; 5(11),



Frajzyngier V, Ruminjo J, Asiimwe F, Barry TH, Bello A,

Danladi D, Ganda SO, Idris S, Inoussa M, Lynch M,

Delamou et al. Women’s health after fistula repair

African Journal of Reproductive Health August 2022; 26 (8):40

Mussell F, Podder DC and Barone MA. Factors

influencing choice of surgical route of repair of

genitourinary fistula, and the influence of route of

repair on surgical outcomes: findings from a

prospective cohort study. BJOG 2012; 119(11), 1344-


Ahmed S and Holtz SA. Social and economic consequences of obstetric fistula: life changed forever? Int J

Gynaecol Obstet 2007; 99 Suppl 1, S10-5.

Nielsen HS, Lindberg L, Nygaard U, Aytenfisu H, Johnston

OL, Sørensen B, Rudnicki M, Crangle M, Lawson R

and Duffy S. A community-based long-term follow up

of women undergoing obstetric fistula repair in rural

Ethiopia. BJOG 2009; 116(9), 1258-64.

Institut National de la Statistique, Pauvreté et inégalités en

Guinée de 1994 à 2012: Analyse à partir d'enquêtes

auprès des ménages. , I.P.B.B.P. EU, Editor. 2013.

Guinée/UNFPA, Ministère de la Santé. Rapport de

l'évaluation des besoins en soins obstétricaux et

néonataux d'urgence en Guinée, Conakry 2014,

Ministère de la santé de Guinée et UNFPA

Ministère de la santé. Stratégie nationale de prevention et de

prise en charge des fistules obstetricales en Guinee. ,

Editor. 2012.

Guinée, Ministère de la Santé, Plan Strategique National de

la Santé Maternelle , du Nouveau-né et des Jeunes

(SRMNIA) 2016-2020. 2016. p. 1-76.

Delamou A, Douno M, Bouédouno P, Millimono S, Barry

TH, Tripathi V and Diallo M. Social Immersion for

Women After Repair for Obstetric Fistula: An

Experience in Guinea. Front Glob Women’s Heal.


Carr LT. The strengths and weaknesses of quantitative and

qualitative research: what method for nursing? J Adv

Nurs 1994; 20(4), 716-21.


Flick U. An introduction to qualitative research. SAGE

Publications 2009; 518.

Russell BH. Analyzing qualitative data : systematic

approaches. Gery W. Ryan, ed. G.W. Ryan 2010,

Thousand Oaks, Calif: Sage.

Anastasi E, Romanzi L, Ahmed S, Knuttson AT, Ojengbede

O and Grant K. Ending fistula within a generation:

making the dream a reality. Lancet Glob Health 2017;

(8), e747-e748.


Browning A and Menber B. Women with obstetric fistula in

Ethiopia: a 6-month follow up after surgical treatment.

BJOG 2008; 115(12), 1564-9.

Degge HM, Hayter M and Laurenson M. An integrative

review on women living with obstetric fistula and

after treatment experiences. J Clin Nurs 2017; 26(11-

, 1445-1457.

Anzaku SA, Lengmang SJ, Mikah S, Shephard SN and

Edem BE. Sexual activity among Nigerian women

following successful obstetric fistula repair. Int J

Gynaecol Obstet 2016; 137(1), 67-71.

Tembely A, Diarra A and Berthé H. Sexuality and fertility

of women operated for obstetric urogenital fistulae.

Prog Urol 2014; 24(13), 876.

Weston K, Mutiso S, Mwangi JW, Qureshi Z, Beard J and

Venkat P. Depression among women with obstetric

fistula in Kenya. Int J Gynaecol Obstet 2011; 115(1),


Désalliers J, Paré ME, Kouraogo S and Corcos J. Impact of

surgery on quality of life of women with obstetrical

fistula: a qualitative study in Burkina Faso. Int

Urogynecol J 2017; 28(7), 1091-1100.

Pope R, Bangser M and Requejo JH. Restoring dignity:

social reintegration after obstetric fistula repair in

Ukerewe, Tanzania. Glob Public Health (2011); 6(8),


Mselle LT, Evjen-Olsen B, Moland KM, Mvungi A and

Kohi TW. "Hoping for a Normal Life Again":

Reintegration After Fistula Repair in Rural Tanzania.

Journal of Obstetrics and Gynaecology Canada 2012;

(10), 927-938.


Lindsay MKJ. The tragedy of childbirth vesicovaginal

fistula: time for action. J Natl Med Assoc 2009;

(6), 596.


El Ayadi AM, Painter CE, Delamou A, Barr-Walker J, Korn

A, Obore S, Byamugisha J and Barageine JK.

Rehabilitation and reintegration programming adjunct

to female genital fistula surgery: A systematic scoping

review. Int J Gynaecol Obstet 2020; 148 Suppl 1, 42-

FistulaCare, Beyond repair: Involving communities in

fistula prevention and social reintegration—

Experience from Kissidougou, Guinea. New York

, Fistula Care/EngenderHealth.

guinea_brief_beyond_repair.pdf (

Imoto A, Matsuyama A, Ambauen-Berger B and Honda S.

Health-related quality of life among women in rural

Bangladesh after surgical repair of obstetric fistula. Int

J Gynaecol Obstet 2015; 130(1), 79-83.

Wilson SM, Sikkema KJ, Watt MH, Masenga GG and

Mosha MV. Psychological Symptoms and Social

Functioning Following Repair of Obstetric Fistula in

a Low-Income Setting. Matern Child Health J 2016;

(5), 941-5.


Delamou A, Delvaux T, Utz B, Camara BS, Beavogui AH,

Cole B, Levin K, Diallo M, Millimono S, Barry TH,

El Ayadi AM, Zhang WH and De Brouwere V.

Factors associated with loss to follow-up in women

undergoing repair for obstetric fistula in Guinea. Trop

Med Int Health 2015; 20(11), 1454-1461.

Wright JT. Prevention and management of obstetric fistulae

requires both a long-term strategy and long-term care.

Lancet Glob Health 2017; 5(11), e1062-e106


  • There are currently no refbacks.