Barriers and facilitators to preventive interventions for the development of obstetric fistulas among women in sub-Saharan Africa: a systematic review

• Published in: BMC pregnancy and childbirth Vol. 18; no. 1; p. 155
• Main Authors: Lufumpa, Eniya, Doos, Lucy, Lindenmeyer, Antje
• Format: Journal Article
• Language: English
• Published: England BioMed Central 10-05-2018; BMC
• Subjects: Africa South of the Sahara; Barriers; Basic and comprehensive emergency obstetric care; Childbirth & labor; Developing Countries; Ethiopia; Evidence-based medicine; Facilitators; Female; Fistula; Gynecology; Health education; Health Facilities - standards; Health Facilities - statistics & numerical data; Health Knowledge, Attitudes, Practice; Health Resources - supply & distribution; Health Services Accessibility - statistics & numerical data; Humans; Injury prevention; Labor, Obstetric - psychology; LDCs; Nigeria; Obstetric fistula; Obstetric Labor Complications - prevention & control; Patient Acceptance of Health Care; Poverty; Pregnancy; Prenatal Care - methods; Prenatal Care - psychology; Prenatal Care - statistics & numerical data; Preventive interventions; Quality of Health Care; Systematic review; Vaginal Fistula - etiology; Vaginal Fistula - prevention & control; Womens health; Zambia; Africa South of the Sahara; Zambia; Nigeria; Ethiopia; Eritrea; Niger; West Africa; Africa; Uganda; Sierra Leone; Sub-Saharan Africa; Facilitators; Basic and comprehensive emergency obstetric care; Obstetric fistula; Barriers; Preventive interventions
• ISSN: 1471-2393; 1471-2393
• DOI: 10.1186/s12884-018-1787-0

Obstetric fistula is a debilitating childbearing injury that results from poorly managed obstructed labour, leading to the development of holes between the vagina and bladder and/or rectum. Effects of this injury are long-lasting, as women become incontinent and are often marginalised from their communities. Despite continuous occurrence of this injury in lower-income countries, it is preventable, as evidenced in high-income countries. This systematic review aims to identify and understand barriers and facilitators to interventions aimed at the prevention of obstetric fistulas in sub-Saharan African women.
Electronic databases and grey literature were searched. We included studies written in English that discussed interventions to prevent obstetric fistulas implemented in sub-Saharan Africa, and their associated barriers and facilitators. Quality of the studies was assessed, and data including: country of implementation, preventive interventions, and barriers and facilitators to the interventions were extracted. They were then categorised based on the Three Phase Delay Model.
Our search yielded 537 studies, of which 18 were included from sub-Saharan countries including Ethiopia, Nigeria, and Zambia. The most noted barrier to prevention addressed the first phase of delay: the decision to seek care, particularly lack of awareness of the dangers of unsupervised labours. The most noted facilitator addressed the decision to seek care and the quality of care received at a facility, through partnerships between health facilities and governments, and other organisations that provided both financial and resource support.
Despite being categorised by the three phases of the delay model, barriers and facilitators were found to play a role in multiple phases. The topic of obstetric fistula needs to be researched more extensively, particularly the effectiveness of preventive interventions.