joint-aus-us-gov-review-hamlin-fistula-ethiopia-final-report.doc

The situation assessment reported fistula incidence

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The situation assessment reported fistula incidence of 3,500 per year (2010 baseline) with a prevalence of 37,500 untreated fistula and 161,000 urinary incontinence cases in 20 Ethiopia Demographic Health Survey. 2011. AusAID Health Resource Facility 1 Managed by HLSP in association with IDSS
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AID and USAID Review of Support to Hamlin Fistula Ethiopia (Ethiopia) 31/05/2018 Services Order 230 Draft report 2010. Women with obstetric fistula suffer multifaceted health, psychological and socio- economic consequences 21 . One study reported that close to 70 per cent of the women had been divorced, over 92 per cent had suffered depression and 19 per cent were not allowed to eat with family members 22 . A comprehensive approach including treatment/repair of fistula as well as prevention of new cases is critical. Box 1: Projected Fistula Cases According to the best case scenario there were 3,300 new OFs at baseline in 2010 and there will be 1,300 in 2015, 400 in 2020 and 0 in 2021. The most likely case scenario, however, predicts 2,200 new cases by 2015 and 1,750 in 2020 with eradication by 2025. Source: USAID assessment 2013 Lack of both skilled attendance at birth and access to safe emergency obstetric services are the main challenges to obstetric fistula reduction in Ethiopia. Harmful traditional practices, including female genital mutilation and early marriage contribute to the problem. Most common risk factors include rural habitat, young age, short stature (mostly resulting from nutritional stunting), illiteracy, and poverty. 23 The consultants for this AusAID-supported review concur with the findings of the situation analysis summarised in Annex 1. Highlights are presented below: Obstetric fistula (OF) is likely to remain a problem in Ethiopia for at least another 10 years in the best case scenario and 15 years in the most likely case scenario. Female Urinary Incontinence (FUI) is the presenting symptom of obstetric fistula, but which has many causes. There are about 5 cases of general FUI to every case of OF. Case detection remains the main bottleneck, associated with transport. The Integrated Family Health Project (IFHP) coverage is 38 per cent of all districts, and IntraHealth 19 per cent of districts in Amhara, so coverage is around 40 per cent of the country but with major gaps. Government is not sufficiently involved in OF and FUI and there is no national coordination. There has been successful reintegration into communities, with safe pregnancies post fistula repair, but the social reintegration of patients with complex fistulas has reached its limits and often fails. Hopes for ex-fistula patients with remaining dysfunctions are bleak 24 . Knowledge of the epidemiology and socio-cultural features of FUI, including fistulas of all causes, is still scanty and incomplete. Incidence and prevalence is still not well known for lack of proper studies.
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