背景:产科瘘修复失败可导致抑郁症增加,社会孤立,女人的经济负担,和瘘管护理计划。然而,有限,撒哈拉以南非洲国家产科瘘修复失败的综合证据。本系统评价和荟萃分析旨在确定撒哈拉以南非洲国家接受手术修复的妇女中产科瘘修复失败的汇总患病率和相关因素。
方法:为了识别潜在的文章,利用在线数据库(PubMed,Hinari,和谷歌学者)。使用系统评价和荟萃分析声明(PRISMA)的首选报告项目来报告审查结果。采用I2检验统计来检验研究异质性。随机效应模型用于评估产科瘘修复失败的合并患病率。并且使用对数比值比确定关联。使用漏斗图和Egger的统计检验在5%的显著性水平下调查发表偏倚。进行Meta回归和亚组分析以确定异质性的潜在来源。使用STATA版本17统计软件对数据进行分析。
结果:共有来自13个撒哈拉以南非洲国家的9866名研究参与者的24篇文章被纳入这项荟萃分析。撒哈拉以南非洲产科瘘修复失败的合并患病率为24.92%[95%CI:20.34-29.50%]。按国家分组的分析表明,患病率最高的是安哥拉(58%,95%CI:53.20-62.80%),卢旺达最低(13.9,95%CI:9.79-18.01%)。尿道损伤[OR=3.50,95%CI:2.09,4.91],大瘘[OR=3.09,95%CI:(2.00,4.10)],分娩时间[OR=0.45,95%CI:0.27,0.76],和既往瘘管修复[OR=2.70,95%CI:1.94,3.45]是产科瘘管修复失败的相关因素。
结论:在撒哈拉以南非洲国家接受产科瘘手术治疗的妇女比WHO标准发生的修复失败更多。产科瘘修复失败受尿道损伤影响,瘘管大小,劳动时间,瘘管的类型,和以前的维修历史。因此,我们建议针对每个国家采取特定的政策措施,特别注意预防所有风险因素,包括营养不良,多党,阻碍劳动,和产妇年龄,这可能会导致像大瘘管这样的情况,尿道损伤,并重复修复,以减少产科瘘修复失败。
BACKGROUND: Obstetric fistula repair failure can result in increased depression, social isolation, financial burden for the woman, and fistula care programs. However, there is limited, comprehensive evidence on obstetric fistula repair failure in Sub-Saharan African countries. This systematic
review and meta-analysis aimed to determine the pooled prevalence of obstetric fistula repair failure and associated factors among women who underwent surgical repair in Sub-Saharan African countries.
METHODS: To identify potential articles, a systematic search was done utilizing online databases (PubMed, Hinari, and Google Scholar). The Preferred Reporting Items for Systematic
Review and Meta-Analysis Statement (PRISMA) guideline was used to report the
review\'s findings. I2 test statistics were employed to examine study heterogeneity. A random-effects model was used to assess the pooled prevalence of obstetric fistula repair failure, and the association was determined using the log odds ratio. Publication bias was investigated using the funnel plot and Egger\'s statistical test at the 5% level of significance. Meta-regression and subgroup analysis were done to identify potential sources of heterogeneity. The data were analyzed using STATA version 17 statistical software.
RESULTS: A total of 24 articles with 9866 study participants from 13 Sub-Saharan African countries were included in this meta-analysis. The pooled prevalence of obstetric fistula repair failure in sub-Saharan Africa was 24.92% [95% CI: 20.34-29.50%]. The sub-group analysis by country revealed that the highest prevalence was in Angola (58%, 95% CI: 53.20-62.80%) and the lowest in Rwanda (13.9, 95% CI: 9.79-18.01%). Total urethral damage [OR = 3.50, 95% CI: 2.09, 4.91], large fistula [OR = 3.09, 95% CI: (2.00, 4.10)], duration of labor [OR = 0.45, 95% CI: 0.27, 0.76], and previous fistula repair [OR = 2.70, 95% CI: 1.94, 3.45] were factors associated with obstetric fistula repair failure.
CONCLUSIONS: Women who received surgical treatment for obstetric fistulas in Sub-Saharan African countries experienced more repair failures than the WHO standards. Obstetric fistula repair failure was affected by urethral damage, fistula size, duration of labor, types of fistula, and history of previous repairs. Therefore, we suggest policy measures specific to each country to provide special attention to the prevention of all risk factors, including poor nutrition, multiparty, obstructed labor, and maternal age, which can result in conditions like large fistulas, urethral damage, and repeat repair, in order to reduce obstetric fistula repair failure.