1. Amref Health Africa Amref Health Africa www.amref.org Charles Suya (Amref Health Africa Malawi) charles.suya@amref.Orgharles.suya@amref.Org Lessons from women identified with fistula in Malawi, a case study of Mangochi district

2. Amref Health Africa www.amref.org Outline Background Coverage Case Identification Process Socio – demographic factors Results Lessons Learnt Recommendations Acknowledgement

3. Amref Health Africa www.amref.org Obstetric fistula is a preventable obstetric complication. In Malawi, a high prevalence of obstetric fistula was reported in the Southern region (1.9%). Mangochi district, where Amref Health Africa is implementing “Staying alive Project” has higher fistula prevalence of 2.7% (NSO, 2004). Population - 948,483 (NSO projections 2013). Work in 32 facilities This case study highlights lessons learnt from fistula identification and management (Mangochi and Blantyre) Background

5. Amref Health Africa www.amref.org Fistula Case Identification-Process Actors Health Surveillance Assistants Fistula repaired clients Community members Health Workers Confirmation of cases Clinicians, specialist surgeons

6. Amref Health Africa www.amref.org Socio-Demographic Factors – Identified Cases (n=91) Most of the women with fistula (98%) did not complete primary education. Average age at which identified women developed fistula was 23. The prevalence was higher in women aged between 20 to 34 (54%) than those aged below 19 years. (34% ) Average period the identified women lived with fistula before access to treatment was 10 years 78.3% of these had delivered a maximum of 1 to 4 times 81% of the women did not have a live baby. 54 % of the women who were married at delivery were divorced

8. Amref Health Africa www.amref.org Results First camp was in October 2013 in Blantyre Currently fistula repairs are done in Mangochi district 81 women of 91 confirmed cases were successfully repaired representing a success rate of 89% – 17 (89%) out of 19 - 2013 – 21(88%) out of 24, - 2014 – 16 (94%) of 17 and – 29 (87%) of 31 were successfully repaired.  The 10 cases that were not successfully repaired will be re- booked for another round of surgery

9. Amref Health Africa www.amref.org Lessons learnt Treating women within the district has assisted to increase in number of women accessing treatment; they have evidence to take the courage to come out of hiding Some women developed fistula under skilled delivery Psycho social support offers an opportunity to understand the challenges fistula clients are experiencing Use of district based facilities offers an opportunity to repair more women

10. Amref Health Africa www.amref.org Recommendations Intensification IEC to all women even before they have had the first child. Strengthen health care systems to to support reduction of fistula incidence Establish incidence and magnitude of fistula in Mangochi. Strengthen and support Monkey bay to increase the number of fistula women to repaired within the project span.

11. Amref Health Africa www.amref.org Acknowledgements Dutch Ministry of Foreign Affairs Amref Health Africa Flying Doctors DHMT-Mangochi UNFPA-Malawi CHAM Amref Health Africa Southern Africa Hub Amref Health Africa Malawi Staying Alive Team

12. Thank You for your attention! Zikomo.