This is one of the stories from the September 2012 issue of International News. Sayeba Akhter writes from Dhaka Medical College in Bangladesh about recent developments in fistula care in the country.
Use the table below to access other stories in this issue.
Bangladesh is a small, subtropical country with a population of 15.8 million. The prevalence of obstetric fistulae is not exactly known although approximately 71 000 women are estimated to be affected. In a 2003 study,1 it was found that vesicovaginal fistulae had a prevalence of 1.9 per 100 respondents. In response to the problem, Bangladesh has taken the global approach of prevention, treatment and rehabilitation. Fistula care is included in the National Maternal Health Strategy. Bangladesh is one of the 20 countries where a campaign to end fistulae is continuing. A National Fistula Centre was established in 2003 to provide a service to patients and training to doctors and nurses. Eight public and seven private fistula centres have been established. Services are free for patients, paid for by the United Nations Population Fund in the public hospitals, and EngenderHealth in non-governmental hospitals. The training of surgeons and nurses in fistula surgery is structured and conducted by using training manuals and logbooks. In addition to training of local personnel, this centre has also trained international trainees and piloted the International Federation of Gynecology and Obstetrics Fistula Training Manual.2
The rehabilitation programme for patients with fistulae started in 2005 coordinated by the Fistula Training and Rehabilitation Centre. It has 28 beds and 12 staff, including trainers and counsellors. Up until 2011, 372 patients with fistulae have been treated and have received training on income-generating activities such as tailoring, home gardening, animal husbandry, baking and so on. Eighty-six patients whose fistulae have been cured have been rehabilitated in their own community and 30 community fistula advocates have been trained and work in the community for Campaign to End Fistula.
In terms of preventive care many efforts have been made including having skilled attendants at birth, using a special voucher scheme for poor pregnant women, increased awareness among stakeholders including religious leaders and the legalisation of age of marriage (18 years for women and 21 years for men).
Sayeba Akhter, Consultant Gynaecologist and Head of Department, Dhaka Medical College, Bangladesh
1. EngenderHealth Bangladesh Country Office. Situation Analysis of Obstetric Fistula in Bangladesh: Report. Bangladesh: EngenderHealth; 2003.
2. International Federation of Gynecology and Obstetrics. Fistula Training Manual.