OBSTETRIC FISTULA: THE MALAWI SITUATION

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OBSTETRIC FISTULATHE MALAWI SITUATION

• Paper presented at the obstetric Fistula
  Conference in Nouakchott Mauritania
• December 10-13, 2007
• Dr. Bailah Leigh - MOH
• Mrs. Anna Chinombo - UNFPA
• Mr. Joseph Chelewani CHAM

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Maternal Health Situation Some indicators

• High maternal mortality - MMR 984 / 100,000
  
• live
  births
• 40 of major obstetric complications due to
  obstructed labour
• Low Caesarean Section rate 2.8
• CPR 28 and TFR 6
• This suggests Obstetric Fistula must be a common
  occurrence
• However, prevalence not known.

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Needs Assessment

• UNFPA and EngenderHealth assisted Malawi to
  conduct Needs Assessment of Obstetric Fistula in
  2004.

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Needs Assessment Where?

• The needs assessment was conducted in six
  hospitals
• Queen Elizabeth Central Hospital (QECH), Blantyre
• Zomba Central Hospital
• Mzuzu Central Hospital
• Mulanje Mission Hospital
• Nkhoma Mission Hospital
• Ekwendedni Mission Hospital

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Findings

• Poor knowledge among policy makers about fistula
  as a key reproductive health morbidity in Malawi
• Fistula services are available in all six
  hospitals visited
• Fistula services are provided free of charge in
  all six hospitals
• Only three surgeons formally trained in fistula
  repair (now only 1 who is retiring in Dec 07)

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Where do we stand now?

• In phase two, addressing Capacity Building
• A. The Process and strategies adopted
• Task Force for Fistula Management established
• Dissemination of findings of needs assessment
  done
• Training materials from various countries
  reviewed and adapted to Malawi situation

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Where do we stand now?

• Plan of action for fistula management developed
  to be implemented within the National Road Map
  for maternal mortality reduction
• Identified one Central Hospital as national
  training centre

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B. Training of Health Providers

• One Malawi based trainer an Expatriate
  Consultant Obstetrician and Gynaecologist
• Hired an International Trainer to train with the
  Malawi based trainer
• Selected Health workers from 5 hospitals for
  training
• Conducted three weeks training

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C. Major Results

• 10 Health workers trained
• - 1 Obstetrician
• - 4 Clinical Officers
• - 3 Nurses
• - 2 Anaesthetists
• 44 Women with Obstetric Fistula successfully
  repaired during training

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D. Strengthening of treatment services

• Equipment and supplies for obstetric fistula
  repair has been provided to all hospitals with
  trained health workers
• The newly trained Clinicians are a major strength
  for the treatment and management of obstetric
  fistula in Malawi
• Improving availability of Emergency Obstetric
  Care (EmOC) and utilization of skilled
  attendants during pregnancy and childbirth
  especially at health centre level
• In the context of BEmOC, upgraded 27 sites

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E. Lessons Learned

• There are many women who require obstetric
  fistula services but have no access to the
  services
• in one week, one district was able to recruit 25
  women with fistula for repair during the training
  period and identified another 50 for subsequent
  repair
• Most people do not know that women with obstetric
  fistula can be helped
• one of the women repaired during the training
  had lived with fistula for over 20 years
• another woman had lived with fistula for 33
  years got repaired only in October 2007

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Lessons Learned

• You dont have to be an Obstetrician or Urologist
  or even a Medical Doctor to repair (simple)
  obstetric fistula. Clinical Officers who were
  trained in Malawi are doing a good job. Since
  they got trained in July 2007, one has already
  done 27 fistula repairs

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F. Constraints for implementation

• Human resource to provide obstetric fistula
  repair services is a major problem.
• only very few health workers have been trained
• from January 2008, there will be no Malawi based
  Specialist to train others in the repair of
  Obstetric Fistula
• Need for equipment and supplies for new repair
  sites
• Additional supporting services required
• physiotherapy especially for those repaired
  after living with fistula for a long time!

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G. Facilitating Factors

• Willing and supportive partners
• UNFPA for Training and equipment
• ADB for BEmOC services
• Training non physicians is a motivator (elevating
  factor)
• IEC materials developed to create demand for
  obstetric fistula services in the community

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Facilitating Factors

• Prevention and Management of Obstetric Fistula
  is an integral component of Sexual and
  Reproductive Health Services in Malawi

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Group of women who were repaired during 2007
obstetric fistula training
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The End

• Thank You!
• God Bless!