Judith T.W. Goh

Mental health screening in women with genital tract fistulae.

There is little information regarding the mental health status of women with genital tract fistulae in developing countries. The aim of this prospective observational study was to screen women at Dhaka Medical College Hospital, Bangladesh (December 2003 to June 2004), and Addis Ababa Fistula Hospital, Ethiopia (June to July 2004), with genital tract fistula for mental health dysfunction. Women presenting to the above institutions were screened using the General Health Questionnaire (GHQ‐28) prior to fistula surgery. As the women were illiterate, the questionnaire was completed with the assistance of a medical officer, nurse or interpreter. The female staff members acted as controls. Sixty‐eight women with fistulae and 28 controls completed the GHQ‐28. Sixty‐six of the 68 women with fistulae screened positive to probable mental health dysfunction compared with 9 of the 28 controls. We conclude that women with genital tract fistula are at high risk of mental health dysfunction. If the high rates of positive screening are confirmed on psychiatric evaluation, then the management of women with genital tract fistulas must include routine psychological/psychiatric assessment and treatment.

Genital Tract Fistula Repair on 116 Women

Summary: A personal series of 130 genital tract fistula repairs in 116 women is presented. All fistulas were repaired vaginally. The majority of the fistulas were due to obstetric injuries, especially prolonged obstructed labour. Obstetric fistula continue to be a cause of personal and social morbidity to sufferers.

1995 Brown Craig Travelling Fellowship Destination: Ethiopia

Ethiopia, situated in East Africa, has an area of 1,112,OOO square kilometres and a population of 58 million. Much of Ethiopia is on an elevated plateau of 2,0oO to 3,000 metres. Ninety per cent of the population live off the land, mainly as subsistence farmers. Approximately 50% of Ethiopians are under 20 years of age, with the average life expectancy of 47 years. Over 75% of the population have no access to safe drinking water. Health care in Ethiopia is provided by government hospitals, government and private clinics, and nongovemment organizations. Public health care is not free. There are less than 10,OOO hospital beds in Ethiopia and health care covers 38% of the population. In many regions, accessibility to hospital care is often difficult due to the mountainous terrain with few sealed roads, the unavailability of motorized vehicles and the cost of public transport. Less than 15% of expecting mothers receive any antenatal care, and over 90% are delivered by traditional midwives. The crude birthrate is 47.3 per 1,OOO women and average fertility rate is 7.5 children per woman. Contraception is used by only 4% of couples. Accurate perinatal and maternal mortality rates are difficult to obtain as many deaths go unreported. Maternal mortality is estimated at 750820 women per 100,OOO livebirths. Perinatal mortality rate is 60 per 1,ooO livebirths with an infant mortality rate of 101 per 1,OOO.

Postpartum urethral prolapse.

Case report A 25-year-old para 4 Ethiopian woman presented 6 days following confinement at home with urinary incontinence and pain in the vaginal area. The labour had lasted 2 days and a live baby girl was delivered vaginally. The past obstetric history included 3 previous vaginal deliveries at home with 2 of the infants being stillborn. There was no significant past medical or surgical history. Examination revealed an intact perineum and a small amount of dark, nonoffensive lochia was present. A urethral prolapse was seen (figure I ) . About 2 cm of circumferential, prolapsed, oedematous, and congested urethral mucosa extruded from the external urethral meatus and this bled easily o n contact. It was also tender to touch. Further examination revealed a small 0.5 cm mid-vaginal vesicovaginal fistula.

SHORT COMMUNICATION: Mental health screening in women with genital tract fistulae: SHORT COMMUNICATION

There is little information regarding the mental health status of women with genital tract fistulae in developing countries. The aim of this prospective observational study was to screen women at Dhaka Medical College Hospital, Bangladesh (December 2003 to June 2004), and Addis Ababa Fistula Hospital, Ethiopia (June to July 2004), with genital tract fistula for mental health dysfunction. Women presenting to the above institutions were screened using the General Health Questionnaire (GHQ‐28) prior to fistula surgery. As the women were illiterate, the questionnaire was completed with the assistance of a medical officer, nurse or interpreter. The female staff members acted as controls. Sixty‐eight women with fistulae and 28 controls completed the GHQ‐28. Sixty‐six of the 68 women with fistulae screened positive to probable mental health dysfunction compared with 9 of the 28 controls. We conclude that women with genital tract fistula are at high risk of mental health dysfunction. If the high rates of positive screening are confirmed on psychiatric evaluation, then the management of women with genital tract fistulas must include routine psychological/psychiatric assessment and treatment.