By B. Armon. Christian Brothers University. 2019.

These countries accounted for more than two-thirds of the total number of publications in the 54 African countries dostinex 0.25mg without a prescription. Overall dostinex 0.25mg line, the number of papers on anal incontinence purchase generic dostinex on-line, prolapse, and sexual function was low. The Central African Republic produced the only paper on patients’ perceptions of prolapse, while South Africa produced the only paper in Africa on complications of vaginal mesh. The majority of the published research on sexual dysfunction was on postmenopausal women or in women following genital cutting. Maki’s paper highlights the fact that very little is known regarding pelvic floor dysfunction for large areas of the continent. It is important to appreciate that there are significant hurdles associated with obtaining useful epidemiological data in Africa. Another issue is a lack of appropriate funding to perform good, representative epidemiological studies. The field of urogynecology and pelvic floor dysfunction is in its infancy on the continent, and until the region develops a sizeable cohort of clinicians with an interest in this specialty, good epidemiological data will not be available. Similarly, the extent of bothersome pelvic organ prolapse in Africa remains unknown. Most doctors underestimate the impact of pelvic organ prolapse, stress, and urgency incontinence in 109 African women because the number of women seeking care for pelvic floor disorders is significantly lower than those in well-resourced settings. The limited number of prevalence studies, however, suggests that the proportion of women suffering with these problems is comparable to other regions. The reasons for these women failing to seek help have not been properly determined. It may be that women lack the financial resources for a problem that only has an impact on her quality of life. Another possibility is the perception that nothing can be done about the problem and this may be reinforced by the relative lack of training in managing female pelvic floor dysfunction in large parts of Africa. Women on the continent also play an important socioeconomic role in their respective communities and may not prioritize seeking help for quality of life issues such as incontinence or pelvic organ prolapse. It is also important to note that in many parts of Africa, women are not empowered regarding their health and their reproductive health in particular. Fistula-Related Incontinence Obstetric fistulas are overwhelmingly the most important problem in female pelvic floor dysfunction in Africa. They are a devastating condition that leave women profoundly stigmatized and isolated from their communities. When one considers the pathophysiological mechanism responsible for the development of an obstetric fistula, the patient experience in the evolution of a fistula is horrifying. Prolonged, neglected obstructed labor will result in the fetal head being wedged into the maternal pelvis, leading to increasing tissue necrosis. Fetal death then occurs and macerates results in softening and eventual passage of the soft, macerated body [9]. If the woman survives this ordeal, the ensuing maternal injuries are often extensive. Many urogynecologists working in well-developed settings will be astounded by the extent of bladder and urethral injuries incurred by many of these women. This often includes either partial or total necrosis of the urethra, total avulsion of the urethra from the bladder, and extensive defects of the bladder itself. In addition to vesicovaginal fistula, many women have severe vaginal scarring and the cervix is often destroyed. A study in Nigeria found that 32% of women with fistula also had significant skeletal injuries, including symphyseal separation with gait abnormalities, marginal fractures, bone spurs, and complete obliteration of the symphysis [10]. The United Nations Population Fund in 2003 launched a global campaign to end fistula [11]. This was calculated from data extrapolated from two studies that included 28,128 participants. One of the largest studies was a prospective population study of 19,342 women in west Africa [13], and this reported a prevalence for fistulas of 10. Extrapolating from these data, the authors estimate a prevalence of 33,451 new obstetric fistulas per year for sub-Saharan Africa. Another cross-sectional study [14], this time reporting on data captured in Ethiopia, found a prevalence of 2. The 2005 Malawi Demographic and Health Survey [15] collected national prevalence data on fistula through a proxy measure of symptoms. After interviewing 11,698 women, a crude rate of 1,557 per 100,000 live births and a lifetime prevalence of 4. Sobering demographic data on fistula emerged from a sample of women treated at the renowned Addis Ababa Fistula Hospital between 1983 and 1988 [16]. The mean age was 22 years, 42% were younger than 20 years of age, 52% had been deserted by their husbands, and 21% lived by begging. Furthermore, 30% had delivered without assistance and the average labor had lasted 3. Kelly and Kwast [17] also reported on a sample of 309 women attending in the Hamlin Bahir Dar Fistula Centre in Ethiopia and found that 82% had travelled at least 700 km for treatment, walking an average of 12 hours, and spending an average of 34 hours on a bus, before arriving at the treatment center. Wall and colleagues [18] analyzed 899 obstetric fistula patients from Jos, Nigeria, and found that women with fistulas tended to have been married early (often before menarche), to be short (nearly 80% were less than 150cm tall) and small (mean weight less than 44 kg), to be impoverished and poorly educated, and to live in rural areas. Kelly [16] report that more than 50% of women with fistulas had been rejected by their husbands. Urinary incontinence may occur if there is direct injury to the bladder or urethra. It may also obstruct the vaginal outlet and hence make fistulas more common following delivery. Peterman and Johnson [20] could not find a significant relationship in their Demographic and Health Surveys study in Malawi, Rwanda, Uganda, and Ethiopia. Eighty-eight percent of women had undergone excision and infundibulation is 88%, 6. Thirteen percent of the women experienced late complications including pain at micturition, dribble incontinence, and poor urine flow. Various traditional African remedies are also associated with the development of fistulas. The Northern Nigerian practice of “gishri cutting” involves making a series of vaginal incisions with a glass, a blade, or a knife.

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