1.  Title: Spontaneous vesicovaginal fistula caused by genitourinary aspergillosis. Author: Agarwal N; Seth A; Kulshrestha V; Kochar S; Kriplani A Source: International Journal of Gynaecology and Obstetrics. 2009 Apr;105(1):63-4. Abstract: Genitourinary aspergillosis is rare in patients who are not immunocompromised. A 39-year-old woman presented with vaginal urinary leakage with no history of previous trauma, procedure, or fever. The patient's last delivery had been by cesarean 12 years previously and she had no history of difficult labor. Six months prior to presenting, the patient had been scheduled to undergo abdominal hysterectomy for menorrhagia along with repair of a surgical hernia; only the hernia was repaired at that time as dense adhesions prevented the hysterectomy. The patient had been amenorrheic since that surgery and her incontinence began 6 days prior to presentation. (excerpt) Language: English Keywords: INDIA | SUMMARY REPORT | CASE HISTORIES | CLIENTS | FISTULA | AMENORRHEA | VAGINAL ABNORMALITIES | SURGERY | BACTERIAL AND FUNGAL DISEASES | UROGENITAL EFFECTS | Asia, Southern | Asia | Developing Countries | Data Collection | Research Methodology | Program Activities | Programs | Organization and Administration | Diseases | Menstruation Disorders | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Infections | Urogenital System | Physiology | Biology Document Number: 341383 |
| 2. Peer Reviewed Title: Risk factors for the development of vesicovaginal fistula after incidental cystotomy at the time of a benign hysterectomy. Author: Duong TH; Gellasch TL; Adam RA Source: American Journal of Obstetrics and Gynecology. 2009 Aug 14; Abstract: OBJECTIVE: We sought to evaluate risk factors for vesicovaginal fistula (VVF) after incidental cystotomy during benign hysterectomies. STUDY DESIGN: All benign hysterectomies between January 2000 and May 2004 were reviewed. Demographic and operative data were abstracted. Cystotomies were graded using the American Association for the Surgery of Trauma (AAST) system. Patients developing VVF after cystotomy were compared to those who did not. Categorical variables were analyzed with Fisher exact test while Student t test was used for continuous data. RESULTS: A total of 1317 benign hysterectomies were reviewed (46% abdominal, 48% vaginal, and 6% laparoscopically assisted vaginal). In all, 34 cystotomies occurred with 4 (11.7%) developing a VVF. Patients developing VVF were more likely to have an AAST grade V cystotomy (75% vs 7%; P = .004). Patients developing VVF trended toward greater tobacco use, larger uterine size, and more operative blood loss. CONCLUSION: Patients with an AAST grade V cystotomy are at increased risk for VVF formation. Language: English Keywords: UNITED STATES OF AMERICA | DEVELOPED COUNTRIES | RESEARCH REPORT | WOMEN | HYSTERECTOMY | FISTULA | RISK FACTORS | North America | Americas | Demographic Factors | Population | Gynecologic Surgery | Urogenital Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Diseases Document Number: 342547 |
| 3. Peer Reviewed Title: Development of a scrotal vasocutaneous fistula producing viable spermatozoa 9 years after vasectomy. Author: Gaden S; Kasraie J Source: Fertility and Sterility. 2009 Mar;91(3):929.e17-9. Abstract: OBJECTIVE: To describe a case of scrotal vasocutaneous fistula discharging viable sperm. DESIGN: Case report. SETTING: A hospital-based assisted conception center. PATIENT(S): A 37-year-old male presenting for fertility treatment 9 years after vasectomy with a scrotal vasocutaneous fistula that caused a painful, intermittently rupturing, subcutaneous cyst. INTERVENTION(S): Analysis of fistula discharge and planned fistula resection with vasovasostomy. MAIN OUTCOME MEASURE(S): Diagnostic semen analysis to determine presence or absence of spermatozoa in fistula discharge. RESULT(S): A very low concentration of live spermatozoa were identified in the fistula discharge. CONCLUSIONS(S): We believe this is the first time that live spermatozoa, potentially suitable for assisted conception treatment using intracytoplasmic sperm injection have been identified in the discharge from a vasocutaneous fistula. Language: English Keywords: UNITED KINGDOM | RESEARCH REPORT | CASE STUDIES | MEN | VASECTOMY | SPERMATOZOA | FISTULA | TREATMENT | Developed Countries | Europe, Western | Europe | Studies | Research Methodology | Demographic Factors | Population | Male Sterilization | Sterilization, Sexual | Family Planning | Germ Cells | Genitalia | Urogenital System | Physiology | Biology | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 341006 |
| 4. Peer Reviewed Title: Severe chronic morbidity following childbirth. Author: Leung TY; Chung H Source: Best Practice and Research. Clinical Obstetrics and Gynaecology. 2009 Jun;23(3):401-423. Abstract: Three special, chronic morbidities of childbirth are reviewed with the most up-to-date knowledge in this article. Firstly, obstetric fistulas secondary to prolonged obstructed labour are still prevalent tragedies in underdeveloped countries. The damage is not only physical but psychosexual and social. The surgical skill and technology required to prevent and to treat obstetric fistulas are simple, but culture-social antagonism, geographic distance, political instability and financial constraint have to be overcome before effective management can take place. Congenital brachial plexus palsy is associated with shoulder dystocia and macrosomia, and both excessive exogenous traction and strong endogenous pushing forces contribute to its occurrence. As shoulder dystocia and macrosomia are not easily predictable, regular training and drill is essential to ensure proper management of shoulder dystocia. Most of the babies with brachial palsy will recover in 3 months but a minority of patients will suffer a more severe degree of damage, requiring early micro-neurosurgical intervention. Finally, although birth asphyxia is not the major cause of cerebral palsy, brain injury resulting from acute intrapartum hypoxic-ischemic insult is potentially alleviated by early neonatal hypothermic therapy. Both clinical and radiological assessments are essential in selecting suitable candidates for this innovative neuroprotective strategy. Language: English Keywords: DEVELOPING COUNTRIES | RESEARCH REPORT | CHILDBIRTH | FISTULA | OBSTETRICAL SURGERY | MORBIDITY | PREVENTION AND CONTROL | Pregnancy Outcomes | Pregnancy | Reproduction | Diseases | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 341305 |
| 5. Peer Reviewed Title: Obstetric fistulae in West Africa: patient perspectives. Author: Nathan LM; Rochat CH; Grigorescu B; Banks E Source: American Journal of Obstetrics and Gynecology. 2009 May;200(5):e40-2. Abstract: OBJECTIVE: The objective of this study is to gain insight into the nature of obstetric fistulae in Africa through patient perspectives. STUDY DESIGN: At l'Hopital Saint Jean de Dieu in Tanguieta, Benin, 37 fistula patients underwent structured interviews about fistula cause, obstacles to medical care, prevention, and reintegration by 2 physicians via interpreters. RESULTS: The majority of participants (43%) thought their fistulae were a result of trauma from the operative delivery. Lack of financial resources (49%) was the most commonly reported obstacle to care, and prenatal care (38%) was most frequently reported as an intervention that may prevent obstetric fistulae. The majority (49%) of the participants requested no further reintegration assistance aside from surgery. CONCLUSION: Accessible emergency obstetric care is necessary to decrease the burden of obstetric fistulae in Africa. This may be accomplished through increased and improved health care facilities and education of providers and patients. Language: English Keywords: AFRICA, WESTERN | RESEARCH REPORT | WOMEN | CLIENTS | FISTULA | MORBIDITY | PUBLIC HEALTH | PREGNANCY COMPLICATIONS | Developing Countries | Africa, Sub Saharan | Africa | Demographic Factors | Population | Program Activities | Programs | Organization and Administration | Diseases | Health Document Number: 341240 |
| 6. Title: [Epidemiology of women suffering from obstetric fistula in Niger] Parcours de la femme souffrant de fistule obstetricale au Niger. Author: Ndiaye P; Amoul Kini G; Abdoulaye I; Diagne Camara M; Tal-Dia A Source: Medecine Tropicale. 2009 Feb;69(1):61-5. Abstract: OBJECTIVE: The purpose of this epidemiological study was to determine factors influencing management of obstetrical fistula (OF) by attempting to understand the itinerary followed by women suffering from OF in Niger. Study was carried out during the surgery session that took place at the Niamey National Hospital from April 18 to 29, 2006. Study variables were socioeconomic profile, obstetric/surgical history, support resources, and level of education. Four trained investigators using a specially designed questionnaire carried out patient interviews. Data were analyzed using the Epi Info 3.3.1 software package. A total of 91 patients with average age of 27.30 years (+/- 8.94) were interviewed. Most patients had no schooling (95%), came from the southwest region of the country (85%), and belonged to the Djerma ethnic group (52%). Most were married (76%) or divorced (19%). In the majority of cases the age at the time of marriage and first childbirth was under 18 years (76% and 55% respectively). The delivery that resulted in OF was the first in 59%, took place in a health care facility in 88%, lasted more than 24 hours in 97%, and took place by the vaginal route in 71%. The delay for the first medical visit was at least 3 months in most cases (66%) usually due to a lack of awareness of treatment availability, or to unavailability of transportation. Most patients had a history of surgery (63%) and were unaware of the probable date of the treatment (99%) with many waiting more than 3 months (44%). Prevention of gainful activity was 4.79 times more frequent after occurrence of OF. Management of OF requires not only qualified personnel but also and especially access to the quality obstetric care and greater awareness among the population. Education for girls is a crucial factor for a better health in Niger. Language: French Keywords: NIGER | RESEARCH REPORT | EPIDEMIOLOGY | WOMEN | FISTULA | OBSTETRICAL SURGERY | SOCIOECONOMIC FACTORS | SOCIOECONOMIC STATUS | HEALTH EDUCATION | AWARENESS | TREATMENT | Africa, Western | Africa, Sub Saharan | Africa | Developing Countries | Public Health | Health | Demographic Factors | Population | Diseases | Surgery | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Economic Factors | Education | Knowledge | Sociocultural Factors Document Number: 342501 |
| 7. Title: [Association of color vision alterations and the use of oral contraceptives] Associacao de alteracoes cromaticas e uso de anticoncepcionais orais. Author: Ventura R; Malta JS; Lyra AF; Danda DM; Urbano LC Source: Arquivos Brasileiros De oftalmologia. 2009 Jan-Feb;72(1):62-4. Abstract: PURPOSE: To evaluate the association between oral low-dose contraceptives and color vision alterations. METHODS: Were included in the study 30 women, sixteen used oral contraceptive for less than five years (Group I) and 14 used it for more than five years (Group II). The Ishihara, City University Color Vision Test, and the D 15 desaturated tests were used. RESULTS: No characteristic alterations in the chromatic perception were found in any of the groups. CONCLUSION: In the studied sample, low-dose oral contraceptive has not influenced color vision, independent of the time of use. Language: Portuguese Keywords: BRAZIL | RESEARCH REPORT | CLINICAL RESEARCH | EPIDEMIOLOGIC METHODS | WOMEN IN DEVELOPMENT | EYESIGHT | ORAL CONTRACEPTIVES, SIDE EFFECTS | CONTRACEPTIVE SAFETY | FISTULA | OPHTHALMOLOGICAL EFFECTS | SENSORY EFFECTS | South America, Eastern | South America | Latin America | Americas | Developing Countries | Research Methodology | Economic Development | Economic Factors | Physiology | Biology | Safety | Public Health | Health | Diseases Document Number: 331007 |
| 8. Title: Obstetric fistula in low-income countries. Author: Zheng AX; Anderson FW Source: International Journal of Gynaecology and Obstetrics. 2009 Feb;104(2):85-9. Abstract: OBJECTIVE: To identify, survey, and systematically review the current knowledge regarding obstetric fistula as a public health problem in low-income countries from the peer-reviewed literature. METHODS: The Medline and Science Citation Index databases were searched to identify public health articles on obstetric fistula in low-income countries. Quantitative evidence-based papers were reviewed. RESULTS: Thirty-three articles met the criteria for inclusion: 18 hospital-based reviews; 6 on risk factors/prevention; 4 on prevalence/incidence measurement; 3 on consequences of obstetric fistula; and 2 on community-based assessments. CONCLUSION: Obstetric fistula has received increased international attention as a public health problem, but reliable research on the burden of disease and interventions is lacking. Language: English Keywords: DEVELOPING COUNTRIES | RESEARCH REPORT | LOW INCOME POPULATION | WOMEN | FISTULA | UROGENITAL EFFECTS | MORBIDITY | PREGNANCY OUTCOMES | CHILDBIRTH | Social Class | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Demographic Factors | Population | Diseases | Urogenital System | Physiology | Biology | Pregnancy | Reproduction Document Number: 330826 |
9.  Title: Fistula Care. Associate Cooperative Agreement No. GHS-A-00-07-00021-00. Annual Report: October 2007 ? September 2008. Executive SummarySubmitted November 24, 2008 to United States Agency for International Development, Washington, DC. Author: EngenderHealth Source: New York, New York, EngenderHealth, 2008. 25 p. (USAID Associate Cooperative Agreement No. GHS-A-00-07-00021-00) Abstract: I. INTRODUCTION This annual report represents a summary of accomplishments for the first year (October 1, 2007-September 30, 2008) of the Fistula Care project, a five-year Associate Cooperative Agreement (No. GHS-A-00-07-00021-00) supported by USAID.. (Excerpt) Language: English Keywords: DEVELOPING COUNTRIES | ANNUAL REPORT | USAID | FISTULA | OBSTETRICAL SURGERY | TREATMENT | COUNSELING | PREVENTION AND CONTROL | QUALITY OF HEALTH CARE | HEALTH SERVICES | REPRODUCTIVE HEALTH | PROGRAM EVALUATION | Government Agencies | Organizations | Political Factors | Sociocultural Factors | Diseases | Surgery | Medical Procedures | Medicine | Delivery of Health Care | Health | Clinic Activities | Program Activities | Programs | Organization and Administration | Health Services Evaluation Document Number: 331577 |
| 10. Peer Reviewed Title: Fistula and traumatic genital injury from sexual violence in a conflict setting in Eastern Congo: Case studies. Author: Longombe AO; Claude KM; Ruminjo J Source: Reproductive Health Matters. 2008 May;16(31):132-141. Abstract: The Eastern region of the Democratic Republic of Congo (DRC) is currently undergoing a brutal war. Armed groups from the DRC and neighbouring countries are committing atrocities and systematically using sexual violence as a weapon of war to humiliate, intimidate and dominate women, girls, their men and communities. Armed combatants take advantage with impunity, knowing they will not be held to account or pursued by police or judicial authorities. A particularly inhumane public health problem has emerged: traumatic gynaecological fistula and genital injury from brutal sexual violence and gang-rape, along with enormous psychosocial and emotional burdens. Many of the women who survive find themselves pregnant or infected with STIs/HIV with no access to treatment. This report was compiled at the Doctors on Call for Service/Heal Africa Hospital in Goma, Eastern Congo, from the cases of 4,715 women and girls who suffered sexual violence between April 2003 and June 2006, of whom 702 had genital fistula. It presents the personal experiences of seven survivors whose injuries were severe and long-term, with life-changing effects. The paper recommends a coordinated effort amongst key stakeholders to secure peace and stability, an increase in humanitarian assistance and the rebuilding of the infrastructure, human and physical resources, and medical, educational and judicial systems. (author's) Language: English Keywords: DEMOCRATIC REPUBLIC OF THE CONGO | RESEARCH REPORT | CASE STUDIES | WOMEN | ADOLESCENTS, FEMALE | CHILD, FEMALE | FISTULA | GENITAL EFFECTS, FEMALE | VIOLENCE AGAINST WOMEN | RAPE | PSYCHOSOCIAL FACTORS | WAR | Developing Countries | Africa, Central | Africa, Sub Saharan | Africa | Studies | Research Methodology | Demographic Factors | Population | Adolescents | Youth | Age Factors | Population Characteristics | Child | Diseases | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Domestic Violence | Crime | Social Problems | Sociocultural Factors | Behavior | Political Factors Document Number: 327197 |
| 11. Title: Posttraumatic nonischemic priapism treated with autologous blood clot embolization. Author: Numan F; Cantasdemir M; Ozbayrak M; Sanli O; Kadioglu A Source: Journal of Sexual Medicine. 2008 Jan;5(1):173-179. Abstract: High-flow arterial priapism is rare and characterized by a prolonged nonpainful erection. Autologous clot embolization allows complete resolution of the problem in most of the cases. The aim was to review our experience with superselective transcatheter embolization in the treatment of nonischemic priapism. Advances in the understanding of the nonischemic priapism with the aid of newer techniques have altered the current management of nonischemic priapism. Between 2002 and 2006, 11 patients underwent superselective transcatheter embolization of nonischemic priapism with blunt trauma to the penis or perineum. All patients underwent diagnostic evaluation with color-flow Doppler ultrasound and superselective pudendal arteriography, revealing bilateral arteriocorporal fistula and pseudoaneurysm in two cases, bilateral arteriocorporal fistula in one case, unilateral arteriocorporal fistula in one case, and unilateral arteriocorporal fistula and pseudoaneurysm in seven cases. Autologous blood clot was used as an embolization agent in all cases combined with microcatheter guidance. The procedure was technically successful in all cases. In three (27.2%) cases, a second embolization was required due to recurrence of priapism. In all patients, erectile function was restored within 6 weeks of the procedure. Follow-ups at 6 and 12 months after the last procedure revealed that full erectile capacity was restored in 10 of 11 patients, and these patients did not experience further recurrence of priapism. One patient reported a slight decrease in the quality of his penile erection. Our experience revealed that superselective transcatheter embolization and transient occlusion of the fistula with autologous blood clot is an effective therapy for the treatment of nonischemic priapism. Furthermore, recovery of erectile function due to recanalization of the occluded vessel occurred weeks after the procedure. (author's) Language: English Keywords: TURKEY | RESEARCH REPORT | CASE STUDIES | CLINICAL RESEARCH | MEN | EMBOLISM | SURGERY | FISTULA | GENITAL EFFECTS, MALE | Europe, Southeastern | Europe | Developing Countries | Studies | Research Methodology | Demographic Factors | Population | Vascular Diseases | Diseases | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Genitalia, Male | Genitalia | Urogenital System | Physiology | Biology Document Number: 323236 |
| 12. Peer Reviewed Title: Sexual violence-related fistulas in the Democratic Republic of Congo. Author: Onsrud M; Sjoveian S; Luhiriri R; Mukwege D Source: International Journal of Gynecology and Obstetrics. 2008 Sep 22;:[5] p. Abstract: Objective: To determine the magnitude of traumatic gynecologic fistulas caused by sexual violence in the Democratic Republic of Congo. Methods: A retrospective analysis of hospital records from 604 consecutive patients who received treatment for gynecologic fistulas at Panzi Hospital between November 2005 and November 2007. Results: Of the 604 patients, 24 (4%) reported that their fistulas had been caused by sexual violence; of these, 5 (0.8%) had developed fistulas as a direct result of forced penetration with foreign objects and/or gang rapes. Of the remaining patients, 6 had a fistula before they were raped, 9 developed iatrogenic fistulas following inappropriate instrumentation to manage rape-induced spontaneous abortion or stillbirth, or after abdominal hysterectomy, and 4 developed fistulas after prolonged and obstructed labor. Conclusion: Traumatic fistulas are rare compared to obstetric fistulas. Fistulas indirectly related to sexual violence are likely to be more common than those directly related. All fistulas resulting from sexual violence, whether direct or indirect, should be considered traumatic and special care should be given to these women. Language: English Keywords: DEMOCRATIC REPUBLIC OF THE CONGO | RESEARCH REPORT | RETROSPECTIVE STUDIES | EXAMINATIONS AND DIAGNOSES | RECORDS | SEXUAL ABUSE | SEX BEHAVIOR | VIOLENCE | VIOLENCE AGAINST WOMEN | RAPE | FISTULA | ABORTION, SPONTANEOUS | HYSTERECTOMY | Africa, Central | Africa, Sub Saharan | Africa | Developing Countries | Studies | Research Methodology | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Information Processing | Information | Crime | Social Problems | Sociocultural Factors | Behavior | Domestic Violence | Diseases | Pregnancy Complications | Gynecologic Surgery | Urogenital Surgery | Surgery | Treatment Document Number: 328492 |
| 13. Peer Reviewed Title: An audit of obstetric fistulae in a teaching hospital in South Africa. Author: Ramphal SR; Kalane G; Fourie T; Moodley J Source: Tropical Doctor. 2008 Jul;38(3):162-3. Abstract: Obstetric fistulae are still common in the rural areas of South Africa. This study describes the demographic and clinical characteristics of 41 women with obstetric urinary fistulae. All were from poor socioeconomic backgrounds and had limited or no access to antenatal care. (author's) Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | CLINICAL RESEARCH | WOMEN | RURAL POPULATION | FISTULA | EPIDEMIOLOGY | EDUCATIONAL STATUS | PREGNANCY OUTCOMES | PREGNANCY COMPLICATIONS | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Demographic Factors | Population | Population Characteristics | Diseases | Public Health | Health | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Pregnancy | Reproduction Document Number: 328300 |
| 14. Title: The ACQUIRE Project final report: Obstetric Fistula in Amhara Regional State, Ethiopia, January 2006 - March 2007. Under Cooperative Agreement No. GPO-A-00-03600006-00. Author: EngenderHealth. ACQUIRE Project Source: [New York, New York], EngenderHealth, ACQUIRE Project, 2007. 47 p. (USAID Cooperative Agreement No. GPO-A-00-03600006-00) Abstract: Obstetric fistula is one of the devastating complications of ignored and/or mismanaged labor. It is simply an abnormal opening between the vagina and adjourning organs created by the pressure of the unborn baby's head on the mother's bony pelvis and the surrounding tissues. Though obstructed labor is the main causative factor, accidental surgical injuries, pelvic infections such as tuberculosis, pelvic cancers and pelvic traumas (physical injuries or radiation) are some of the physical factors that might also result in obstetric fistula. Poverty, malnutrition, child marriage, teenage delivery, unattended labor/delivery, illiteracy, unhealthy traditional practices and the different forms of gender inequality also play major direct and indirect roles in the development of obstetric fistula. Established in 1974, the Addis Ababa Fistula Hospital (AAFH) has been the only center in Ethiopia dedicated for treating obstetric fistula victims. Taking into consideration the inaccessibility of the sole centerfor most of the fistula patients, the Addis Ababa Fistula Hospital has opened obstetric fistula centers in different parts of the country. The Amhara Regional State is one of the regions in which the AAFH has opened a branch obstetric fistula repair center. (excerpt) Language: English Keywords: ETHIOPIA | SUMMARY REPORT | PREGNANT WOMEN | HEALTH PERSONNEL | FISTULA | OBSTETRICS | PREVENTION AND CONTROL | DELIVERY OF HEALTH CARE | MATERNAL HEALTH | PROGRAM DEVELOPMENT | PROGRAM EFFECTIVENESS | HEALTH SERVICES EVALUATION | USAID | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Population Characteristics | Demographic Factors | Population | Health | Diseases | Medicine | Health Services | Programs | Organization and Administration | Program Evaluation | Government Agencies | Organizations | Political Factors | Sociocultural Factors Document Number: 327094 |
| 15. Title: How to end child marriage: Action strategies for prevention and protection. Author: International Center for Research on Women [ICRW] Source: Washington, D.C., ICRW, 2007. [5] p. Abstract: Child marriage perpetuates an unrelenting cycle of gender inequality, sickness and poverty. Its consequences ripple through the world's poorest regions devastating the lives of girls, their families and their communities. Despite nearly universal condemnation, this harmful tradition thrives: 51 million girls are married. If nothing changes, another 100 million girls will be married within the decade. This policy brief outlines what we can and should be doing to end child marriage: changing harmful cultural norms, supporting community programs, maximizing foreign assistance, increasing access to girls' education, providing young women with economic opportunities, addressing the unique needs of child brides and evaluating programs to determine what works. (excerpt) Language: English Keywords: AFRICA | ASIA | TECHNICAL REPORT | CHILD | CHILD MARRIAGE | COMMUNITY PARTICIPATION | RISK FACTORS | FISTULA | POVERTY | DOMESTIC VIOLENCE | EDUCATION | SOCIOECONOMIC STATUS | INCENTIVES | MARRIAGE POSTPONEMENT | SOCIAL DEVELOPMENT | PREVENTION AND CONTROL | PROGRAM EVALUATION | Developing Countries | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Marriage Patterns | Marriage | Nuptiality | Organization and Administration | Biology | Diseases | Socioeconomic Factors | Economic Factors | Crime | Social Problems | Sociocultural Factors | Policy | Political Factors | Programs Document Number: 320949 |
| 16. Title: Extensive groin and perineal hidradenitis suppurativa complicated by high fistula in ano. Author: Aduful HK; Paintsil A Source: Ghana Medical Journal. 2007 Mar;41(1):30-32. Abstract: Hidradenitis suppurativa is a chronic suppurating infection that affects the apocrine glands of the axilla, groin and the perineum. The disease begins with the obstruction of the apocrine gland duct, resulting in the infection of the retained secretions. Following gland obstruction, there is rupture of the gland with spread of infection into the dermis leading to abscess formation and involvement of other apocrine glands. There is the formation of multiple intradermal abscesses which lead to the development of multiple sinuses, fistulae and scarring of the skin. Occasionally the disease extends beyond the dermis into the subcutaneous fat, fascia and muscle. Alternatively the disease is thought to originate from follicular occlusion with secondary involvement of the apocrine glands. Aetiology may also have a genetic component whose expression is probably influenced by sex hormones. The organisms involved are mixed but the presence of anaerobic organisms impart an offensive smell to the pus discharge. (excerpt) Language: English Keywords: GHANA | RESEARCH REPORT | CLIENTS | MEN | FISTULA | SIGNS AND SYMPTOMS | SURGERY | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Program Activities | Programs | Organization and Administration | Demographic Factors | Population | Diseases | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 319375 |
| 17. Title: Dead women walking: Neglected millions with obstetric fistula [editorial] Author: Ahmed S; Genadry R; Stanton C; Lalonde AB Source: International Journal of Gynecology and Obstetrics. 2007 Nov;99 Suppl 1:S1-S3. Abstract: For each maternal death, 20 women experience serious complications related to pregnancy. Fistula is considered the most debilitating and devastating of maternal morbidities and it is directly caused by prolonged and obstructed labor, a condition leading almost invariably to fetal death and often to maternal death. When the woman survives the ordeal and is left with an obstetric fistula, she experiences constant leakage of urine and/or feces. Once her fistula is established, her life is changed forever as she is no longer able to fulfill her societal roles of wife and mother, and is often deserted by her husband and stigmatized by society. Fistula is preventable and treatable, but still millions of women in developing countries suffer from this dreadful condition. It was virtually eliminated a century ago in developed countries by improved and universally accessible obstetric care. It is estimated that the unmet need for the surgical treatment of obstetrical fistula could be as high as 99%. (excerpt) Language: English Keywords: DEVELOPING COUNTRIES | TECHNICAL REPORT | WOMEN | FISTULA | CHILDBIRTH | FEMALE ROLE | PSYCHOLOGICAL FACTORS | UROGENITAL EFFECTS | UROGENITAL SURGERY | DATA QUALITY | RELIABILITY | ETHICS | TREATMENT | Demographic Factors | Population | Diseases | Pregnancy Outcomes | Pregnancy | Reproduction | Social Behavior | Behavior | Urogenital System | Physiology | Biology | Surgery | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Data Analysis | Research Methodology | Measurement | Sociocultural Factors Document Number: 320826 |
| 18. Peer Reviewed Title: Social and economic consequences of obstetric fistula: Life changed forever? Author: Ahmed S; Holtz SA Source: International Journal of Gynecology and Obstetrics. 2007 Nov;99 Suppl 1:S10-S15. Abstract: The objectives were to summarize the social, economic, emotional, and psychological consequences incurred by women with obstetric fistula; present the results of a meta-analysis for 2 major consequences, divorce/separation and perinatal loss; and report on improvements in health and self-esteem and on the possibility of social reintegration following successful fistula repair. We conducted a review of the literature published between 1985 and 2005 on fistula in developing countries. We then performed a meta-analysis for 2 of the major consequences of having a fistula, divorce/separation and perinatal child loss. Studies suggest that surgical treatment usually closes the fistula and improves the physical and mental health of affected women. With additional social support and counseling, women may be able to successfully reintegrate socially following fistula repair. (author's) Language: English Keywords: DEVELOPING COUNTRIES | LITERATURE REVIEW | WOMEN | FISTULA | CHILDBIRTH | INFANT MORTALITY | PREGNANCY OUTCOMES | IMPACT | SOCIOECONOMIC FACTORS | PSYCHOLOGICAL FACTORS | QUALITY OF LIFE | SOCIAL DISCRIMINATION | Demographic Factors | Population | Diseases | Pregnancy | Reproduction | Mortality | Population Dynamics | Communication | Economic Factors | Behavior | Social Welfare | Social Problems | Sociocultural Factors Document Number: 320828 |
| 19. Title: Treatment of refractory urethrovaginal fistula using rectus abdominis muscle flap in a six-year-old girl. Author: Atan A; Tuncel A; Aslan Y Source: Urology. 2007 Feb;69(2):384.e11-384.e13. Abstract: Urethrovaginal fistula usually occurs after urethrovaginal injury, resulting in urinary incontinence. Several modalities to treat urethrovaginal fistula have been reported. We describe a treatment in which we used a rectus abdominis muscle flap in a 6-year-old girl with refractory urethrovaginal fistula. (author's) Language: English Keywords: TURKEY | RESEARCH REPORT | CHILD, FEMALE | UROGENITAL EFFECTS | FISTULA | SURGERY | COMPLICATIONS | Developing Countries | Europe, Southeastern | Europe | Child | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Urogenital System | Physiology | Biology | Diseases | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 312786 |
| 20. Peer Reviewed Title: Genital fistula -- our experience. Author: Biswas A; Bal R; Alauddin M; Saha S; Kanti M Source: Journal of the Indian Medical Association. 2007 Mar;105(3):[4] p. Abstract: Genital fistulas cause immense physical and psychosocial problem in women's life. The present study was conducted to note the varieties of genital fistula as well as their causative factors and the results of the operative corrections. Altogether 42 patients with different varieties of genital fistula were enrolled in the study. The causative factors of the genital fistulas, specially, that of vesicovaginal fistulas were thoroughly enquired. After confirming the diagnosis, the operative corrections were undertaken. Among the varieties of genital fistula, 76.19% were vesicovaginal fistula, 11.90% were rectovaginal fistula and 4.76%, 4.76% and 2.38% cases of ureterovaginal, urethrovaginal and vesicocervical fistulas respectively. The primipara women were the major sufferers of genital fistulas due to obstetric grounds. Regarding aetiologies of vesicovaginal fistulas, 71.87% patients had obstetric reasons, after prolonged labour, instrumental delivery and after caesarean section due to obstructed labour. Abdominal hysterectomy (44.44%) topped the list of the gynaecological causes of vesicovaginal fistulas. The cases of ureterovaginal fistulas were after abdominal hysterectomy. One case of urethrovaginal fistula was due to some chemical application for correction of genital prolapses. The rectovaginal fistulas were mostly due to obstetric reasons. The success rate after the first attempt of repair of vesicovaginal fistula was 82.75% and overall failure was 10.34%. The other varieties of fistulas were repaired with 100% success rate. The incidence of genital fistulas can be reduced by vigilant obstetric care and meticulous surgery. (author's) Language: English Keywords: INDIA | RESEARCH REPORT | WOMEN | FEMALE GENITAL CUTTING | FISTULA | TREATMENT | SURGERY | Asia, Southern | Asia | Developing Countries | Demographic Factors | Population | Harmful Traditional Practices | Traditional Health Practices | Culture | Sociocultural Factors | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 317787 |
| 21. Peer Reviewed Title: Obstetric fistula: Clinical considerations in the creation of a new urethra and the management of a subsequent pregnancy. Author: Browning A Source: International Journal of Gynecology and Obstetrics. 2007 Nov;99 Suppl 1:S94-S97. Abstract: The paper presents two case studies to illustrate the complexity of repairing obstetric fistula (OF) with neourethral construction when complete circumferential destruction occurred. Using fictitious names, the author describes the personal story and contexts leading to OF development and depression, surgical options, and the prognosis of repair. These cases were documented at the Barhirdar Hamlin Fistula Center in Northern Ethiopia. (author's) Language: English Keywords: ETHIOPIA | RESEARCH REPORT | CASE STUDIES | WOMEN | PREGNANCY | OBSTETRICAL SURGERY | FISTULA | MANAGEMENT | DEPRESSION | TREATMENT | PREGNANCY OUTCOMES | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Studies | Research Methodology | Demographic Factors | Population | Reproduction | Surgery | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Diseases | Organization and Administration | Mental Disorders Document Number: 320844 |
| 22. Peer Reviewed Title: Obstetric fistulas: A clinical review. Author: Creanga AA; Genadry RR Source: International Journal of Gynecology and Obstetrics. 2007 Nov;99 Suppl 1:S40-S46. Abstract: A high proportion of genitourinary fistulas have an obstetric origin. Obstetric fistulas are caused by prolonged obstructed labor coupled with a lack of medical attention. While successful management with prolonged bladder drainage has occasionally been reported, mature fistulas require formal operative repair, and it is crucial that the first repair is done properly. The literature reports 3 approaches to fistula repair: vaginal, abdominal, and combined vaginal and abdominal. Many authors report high success rates for the surgical closure of obstetric fistulas at the time of hospital discharge, without further evaluation of the repair's effect on urinary continence or subsequent quality of life. Data on obstetric fistulas are scarce, and thus many questions regarding fistula management remain unanswered. A standardized terminology and classification, as well as a data reporting system on the surgical management of obstetric fistulas and its outcomes, are critical steps that need to be taken immediately. (author's) Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | LITERATURE REVIEW | STANDARDS | WOMEN | CHILDBIRTH | PREGNANCY OUTCOMES | FISTULA | VESICOVAGINAL FISTULA | OBSTETRICAL SURGERY | Developed Countries | North America | Americas | Research Methodology | Demographic Factors | Population | Pregnancy | Reproduction | Diseases | Urogenital Effects | Urogenital System | Physiology | Biology | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 320834 |
| 23. Peer Reviewed Title: Prevention and treatment of obstetric fistula: Identifying research needs and public health priorities. Author: Creanga AA; Ahmed S; Genadry RR; Stanton C Source: International Journal of Gynecology and Obstetrics. 2007 Nov;99 Suppl 1:S151-S154. Abstract: From July 28 to 29, 2005, The Bill and Melinda Gates Institute for Population and Reproductive Health at Johns Hopkins Bloomberg School of Public Health hosted a meeting on the prevention and treatment of obstetric fistula (OF). The 2-day meeting was cosponsored by the United Nations Population Fund (UNFPA), the World Health Organization (WHO), and the International Federation of Gynecology and Obstetrics (FIGO). More than 70 clinicians and public health experts from the United States, Canada, the United Kingdom, Benin, Côte d'Ivoire, Eritrea, Ethiopia, Ghana, India, Malawi, Myanmar, Niger, Nigeria, Peru, Romania, and Tanzania participated in the meeting to discuss the extent of the problem and the best ways to address it. The meeting continued on July 30 with a subgroup to review the meeting deliberations, define country-specific research priorities and needs, and outline a multicountry research plan. The meeting had several objectives: (A) Advance scientific knowledge on OF risk and treatment; (B) prioritize research questions concerning clinical and public health responses to OF; (C) inform the design of a study addressing one or more key research needs; and (D) inform the public health response to and management of OF. (excerpt) Language: English Keywords: GLOBAL | TECHNICAL REPORT | CONFERENCES AND CONGRESSES | NEEDS ASSESSMENT | PUBLIC HEALTH | RESEARCH AND DEVELOPMENT | FISTULA | OBSTETRICAL SURGERY | UROGENITAL EFFECTS | TREATMENT | PREVENTION AND CONTROL | Evaluation | Health | Technology | Economic Factors | Diseases | Surgery | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Urogenital System | Physiology | Biology Document Number: 320852 |
| 24. Peer Reviewed Title: Obstetric fistula: Guiding principles for clinical management and programme development, a new WHO guideline. Author: de Bernis L Source: International Journal of Gynecology and Obstetrics. 2007 Nov;99 Suppl 1:S117-S121. Abstract: It is estimated that more than 2 million women are living with obstetric fistulas (OFs) worldwide, particularly in Africa and Asia, and yet this severe morbidity remains hidden. As a contribution to the global Campaign to End Fistula, the World Health Organization (WHO) published Obstetric fistula: Guiding principles for clinical management and programme development, a manual intended as a practical working document. Its 3 main objectives are to draw attention to the urgency of the OF issue and serve as an advocacy document for prompt action; provide policy makers and health professionals with brief, factual information and principles that will guide them at the national and regional levels as they develop strategies and programs to prevent and treat OFs; and assist health care professionals as they acquire better skills and develop more effective services to care for women treated for fistula repair. (author's) Language: English Keywords: GLOBAL | SWITZERLAND | TEACHING MATERIALS | MANUAL | WHO | DATA COLLECTION | FISTULA | OBSTETRICAL SURGERY | SOCIAL ADJUSTMENT | MORBIDITY | PREGNANCY OUTCOMES | TRAINING ACTIVITIES | MONITORING | EVALUATION | MATERNAL HEALTH SERVICES | Europe, Central | Europe | Developed Countries | UN | International Agencies | Organizations | Political Factors | Sociocultural Factors | Research Methodology | Diseases | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Social Behavior | Behavior | Pregnancy | Reproduction | Training Programs | Education | Maternal-Child Health Services | Primary Health Care Document Number: 320847 |
| 25. Peer Reviewed Title: Spontaneous enterocutaneous fistula in an HIV positive patient. Author: Elusoji SO; Osime OC; Iribhogbe PE; Egwaikhide EO; Egbagbe EE Source: Pakistan Journal of Medical Sciences. 2007 Oct-Dec;23(5):788-789. Abstract: A 35 years old woman presented with a periumbilical abscess that later developed into an enterocutaneous fistula. She was found to be HIV positive and responded promptly to antibiotics and antiretroviral drugs. We conclude that in situations where there is enterocutaneous fistula of unknown aetiology, HIV screening should be strongly recommended. (author's) Language: English Keywords: NIGERIA | RESEARCH REPORT | CLINICAL RESEARCH | CASE STUDIES | WOMEN IN DEVELOPMENT | PERSONS LIVING WITH HIV/AIDS | FISTULA | ANTIBIOTICS | ANTIRETROVIRAL THERAPY | COMPLICATIONS | HIV INFECTIONS | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Research Methodology | Studies | Economic Development | Economic Factors | Persons Living With HIV/AIDS | Viral Diseases | Diseases | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | HIV Document Number: 323567 |
| 26. Peer Reviewed Title: Complex obstetric fistulas. Author: Genadry RR; Creanga AA; Roenneburg ML; Wheeless CR Source: International Journal of Gynecology and Obstetrics. 2007 Nov;99 Suppl 1:S51-S56. Abstract: Obstetric fistulas are rarely simple. Most patients in sub-Saharan Africa and parts of Asia are carriers of complex fistulas or complicated fistulas requiring expert skills for evaluation and management. A fistula is predictably complex when it is greater than 4 cm and involves the continence mechanism(the urethra is partially absent, the bladder capacity is reduced, or both); is associated with moderately severe scarring of the trigone and urethrovesical junction; and/or has multiple openings. A fistula is even more complicated when it is more than 6 cm in its largest dimension, particularly when it is associated with severe scarring and the absence of the urethra, and/or when it is combined with a recto-vaginal fistula. The present article reviews the evaluation methods and main surgical techniques used in the management of complex fistulas. The severity of the neurovascular alterations associated with these lesions, as well as inescapable limitations in staff, health facilities, and supplies, make their optimal management very challenging. (author's) Language: English Keywords: AFRICA, SUB SAHARAN | ASIA | RESEARCH REPORT | WOMEN | HEALTH PERSONNEL | OBSTETRICAL SURGERY | UROGENITAL SURGERY | UROGENITAL EFFECTS | FISTULA | VESICOVAGINAL FISTULA | EQUIPMENT AND SUPPLIES | HEALTH SERVICES | MANAGEMENT | EVALUATION | Developing Countries | Africa | Demographic Factors | Population | Delivery of Health Care | Health | Surgery | Treatment | Medical Procedures | Medicine | Urogenital System | Physiology | Biology | Diseases | Organization and Administration Document Number: 320836 |
| 27. Peer Reviewed Title: Diagnosis of uteroperitoneal fistula through color Doppler hysterosonography. Author: Guimaraes Filho HA; da Costa LL; Araujo Junior E; Zanforlin Filho SM; Pires CR Source: Archives of Gynecology and Obstetrics. 2007 Jul;276(1):85-86. Abstract: Uterine fistulas are infrequent pathologic entities characterized by abnormal communication of the uterus with any other organ or structure through a perforation formed due to traumatic and infectious conditions among others. The use of hysterosonography as method of diagnosis for that pathologic entity has few descriptions in medical literature. MEDLINE search resulted in only two cases reporting the use of HS in the diagnosis of uterine fistula. Our objective is to report a case of uteroperitoneal fistula caused by uterine trauma during curettage, diagnosed by color Doppler hysterosonogrphy. The importance of our report lies on HS as a simple, safe and low cost method, which can be used for the diagnosis of fistulous processes involving the uterus. (author's) Language: English Keywords: BRAZIL | RESEARCH REPORT | PREGNANT WOMEN | CURETTAGE | ABORTION | MENSTRUATION DISORDERS | ULTRASONICS | EXAMINATIONS AND DIAGNOSES | UTERUS | PERITONEAL DISEASES | FISTULA | South America, Eastern | South America | Latin America | Americas | Developing Countries | Population Characteristics | Demographic Factors | Population | Obstetrical Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Fertility Control, Postconception | Family Planning | Diseases | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology Document Number: 317652 Notification |
| 28. Peer Reviewed Title: Obstetric fistulae: A study of women managed at the Monze Mission Hospital, Zambia. Author: Holme A; Breen M; MacArthur C Source: BJOG: An International Journal of Obstetrics and Gynaecology. 2007 Aug;114(8):1010-1017. Abstract: The objective of this study was to describe and compare characteristics of women with obstetric fistula. The design of the used was a retrospective cross-sectional study. The setting for the study was Zambia's primary fistula repair centre, Monze Mission Hospital. The sample taken was all women, August 2003 to December 2005. Review of case notes to obtain data on sociodemographic and obstetric characteristics, causative pregnancy, clinical details, and treatment. Comparison of characteristics with national data was undertaken. Of 259 women, 239 had socio-demographic and obstetric records and 254 had surgical records. Educational status and height of women were significantly below the national averages, while antenatal care uptake (97.5%) and proportion from the Northern Province were significantly above. Most women (77.9%) weighed less than or equal to 50 kg. Median age at marriage was 18 and at development of fistula was 22 years. 15.1% of women were divorced, 49.0% were primiparous, and 27.6% were parity four +. 67.5% of women had spent 2 days or longer in labour. Delays in receiving emergency obstetric care (EmOC) were experienced at home (67.5%) and at clinics (49.4%), usually due to transport difficulties. 89.1% delivered in a health facility, 50.2% of deliveries were by caesarean section, and 78.1% of babies were stillborn. 72.9% of repairs were successful, 17.3% resulted in residual stress incontinence, and 9.8% failed. Failure was significantly associated with previous repair. More obstetric fistulae occur in areas where early marriage and pregnancy before pelvic maturity is attained is common and where obstetric care is inaccessible. In this study, age at marriage and fistula development was older than usually found, which may indicate that poor access to EmOC contributes more to this problem within Zambia. (author's) Language: English Keywords: ZAMBIA | RESEARCH REPORT | RETROSPECTIVE STUDIES | CROSS SECTIONAL ANALYSIS | WOMEN | CHILDBIRTH | EMERGENCY SERVICES | OBSTETRICAL SURGERY | FISTULA | VESICOVAGINAL FISTULA | EDUCATIONAL STATUS | AGE FACTORS | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Studies | Research Methodology | Demographic Factors | Population | Pregnancy Outcomes | Pregnancy | Reproduction | Health Services | Delivery of Health Care | Health | Surgery | Treatment | Medical Procedures | Medicine | Diseases | Urogenital Effects | Urogenital System | Physiology | Biology | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Population Characteristics Document Number: 313514 |
| 29. Title: Living testimony: Obstetric fistula and inequities in maternal health. Author: Jones DA Source: New York, New York, Family Care International, 2007. [38] p. Abstract: This publication explores knowledge, attitudes, and perspectives on pregnancy, delivery, and fistula from 31 country-level needs assessments conducted in 29 countries in the Campaign to End Fistula (see inside back cover for the complete list). Experiences of women living with obstetric fistula, their families, community members, and health care providers are brought to light. This information represents important research on the social, cultural, political, and economic dimensions of obstetric fistula, drawing attention to the factors underlying maternal death and disability. We hope this publication will serve as an advocacy tool to strengthen existing programmes and encourage further research on how to increase access to vital maternal health services, including fistula prevention and treatment. We implore policy makers, programmers, and researchers to listen to these women's voices and consider the promising practices and strategic recommendations described herein. What we have learned so far can help point the way, but much more still needs to be done. We cannot afford to wait-the costs to women, communities, and health systems are simply too great to delay action. Too many of the world's most disadvantaged and vulnerable women have suffered this preventable and treatable condition in silence. Too many women are dying unnecessarily in childbirth. It is time to put an end to the injustice of fistula and maternal death. (author's) Language: English Keywords: AFRICA, SUB SAHARAN | ASIA, SOUTHERN | RECOMMENDATIONS | OBSTETRICS | FISTULA | CAMPAIGNS | UNFPA | INEQUALITIES | SOCIOCULTURAL FACTORS | MATERNAL MORTALITY | NEEDS ASSESSMENT | TREATMENT | MATERNAL HEALTH SERVICES | PROGRAM ACCESSIBILITY | Developing Countries | Africa | Asia | Medicine | Health Services | Delivery of Health Care | Health | Diseases | Communication Programs | Communication | UN | International Agencies | Organizations | Political Factors | Socioeconomic Factors | Economic Factors | Mortality | Population Dynamics | Demographic Factors | Population | Evaluation | Medical Procedures | Maternal-Child Health Services | Primary Health Care | Program Evaluation | Programs | Organization and Administration Document Number: 325479 |
| 30. Peer Reviewed Title: USAID program for the prevention and treatment of vaginal fistula. Author: MacDonald P; Stanton ME Source: International Journal of Gynecology and Obstetrics. 2007 Nov;99 Suppl 1:S112-S116. Abstract: The cornerstone of the US Agency for International Development (USAID) fistula program is to support and strengthen local capacity for fistula repair. The USAID program includes support to upgrade facilities, enhance local surgical repair capability, allocate equipment and supplies to operating rooms, implement quality improvement systems, and cover the women's transportation costs to and from the treatment facilities. The program also offers training in clinical and counseling skills; transferring skills South-to-South; and monitoring and evaluating the program's effectiveness. As new fistula cases continually increase the backlog of untreated cases, its efforts are also directed toward the prevention of fistula and the reintegration of treated women into their communities. Furthermore, the program challenges the culture of sexual violence against women that leads to traumatic gynecologic fistulas. (author's) Language: English Keywords: DEVELOPING COUNTRIES | UNITED STATES OF AMERICA | DISTRICT OF COLUMBIA | TECHNICAL REPORT | USAID | WOMEN | SEXUAL ABUSE | VIOLENCE | FISTULA | OBSTETRICAL SURGERY | PREVENTION AND CONTROL | TREATMENT | MONITORING | EVALUATION | PROGRAM DEVELOPMENT | PROGRAM ACTIVITIES | Developed Countries | North America | Americas | Government Agencies | Organizations | Political Factors | Sociocultural Factors | Demographic Factors | Population | Crime | Social Problems | Behavior | Diseases | Surgery | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Programs | Organization and Administration Document Number: 320846 |
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