Uterine artery embolization in Tanzania: a procedure with major public health implications

Uterine artery embolization in Tanzania: a procedure with major public health implications

Background The burden of uterine fibroids is substantial in sub-Saharan Africa (SSA), with up to 80% of black women harboring them in their lifetime. While uterine artery embolization (UAE) has emerged as an effective alternative to surgery to manage this condition, the procedure is not available to...

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Bibliographic Details
Published in:CVIR endovascular Vol. 6; no. 1; p. 40
Main Authors: Musa, Balowa, Alswang, Jared Mark, Di Ioia, Rose, Grubic, Lydia, Naif, Azza, Mbuguje, Erick Michael, Vuong, Victoria, Newsome, Janice, Shaygi, Behnam, Ramalingam, Vijay, Gaupp, Fabian Max Laage
Format: Journal Article
Language:English
Published: Cham Springer International Publishing 07-08-2023
Springer Nature B.V
SpringerOpen
Subjects:
Adenomyosis
Embolization
Fibroids
Imaging
Interventional Radiology
Medicine
Medicine & Public Health
Original
Original Article
Postpartum hemorrhage
Public health
Radiology
Uterine artery embolization
Uterine fibroid embolization
Uterine fibroids
Tanzania
Reproductive health
Uterine fibroids
Interventional radiology
Postpartum hemorrhage
Tanzania
Uterine artery embolization
Adenomyosis
Sub-Saharan Africa
Uterine fibroid embolization
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Summary:Background The burden of uterine fibroids is substantial in sub-Saharan Africa (SSA), with up to 80% of black women harboring them in their lifetime. While uterine artery embolization (UAE) has emerged as an effective alternative to surgery to manage this condition, the procedure is not available to the vast majority of women living in SSA due to limited access to interventional radiology (IR) in the region. One of the few countries in SSA now offering UAE in a public hospital setting is Tanzania. This study aims to assess the safety and effectiveness of UAE in this new environment. Methods From June 2019 to July 2022, a single-center, retrospective cohort study was conducted at Tanzania’s first IR service on all patients who underwent UAE for the management of symptomatic fibroids or adenomyosis. Patients were selected for the procedure based on symptom severity, imaging findings, and medical management failure. Procedural technical success and adverse events were recorded for all UAEs. Self-reported symptom severity and volumetric response on imaging were compared between baseline and six-months post-procedure using paired sample t-tests. Results During the study period, 92.1% ( n  = 35/38) of patients underwent UAE for the management of symptomatic fibroids and 7.9% ( n  = 3/38) for adenomyosis. All ( n  = 38/38) were considered technically successful and one minor adverse event occurred (2.7%). Self-reported symptom-severity scores at six-months post-procedure decreased in all categories: abnormal uterine bleeding from 8.8 to 3.1 (-5.7), pain from 6.7 to 3.2 (-3.5), and bulk symptoms from 2.8 to 1 (-1.8) ( p  < 0.01). 100% of patients reported satisfaction with outcomes. Among the nine patients with follow-up imaging, there was a mean volumetric decrease of 35.5% ( p  = 0.109). Conclusions UAE for fibroids and adenomyosis can be performed with high technical success and low complication rates in a low-resource setting like Tanzania, resulting in significant symptom relief for patients. Building capacity for UAE has major public health implications not only for fibroids and adenomyosis, but can help address the region’s leading cause of maternal mortality, postpartum hemorrhage.
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ISSN:2520-8934
2520-8934
DOI:10.1186/s42155-023-00384-9