The persistent challenges and strategies for effective rehabilitation among obstetric fistula patients at Kitovu Mission Hospital, Uganda: a qualitative study

Shallon Atuhaire, Akin-Tunde A. Odukogbe, John F. Mugisha, Oladosu A. Ojengbede


Background: Obstetric fistula poses a great physical, psychosocial and economic burden to girls and women in low and middle-income countries. About 53% of the obstetric fistula patients may live with untreated fistula for more than a year, thus patients require rehabilitation as they await repair and after repair. Little qualitative research exists on rehabilitation particularly on the challenges and effective strategies that inspired this study.

Methods: A cross-sectional qualitative research approach used in-depth interviews and key informant interviews to collect data from 10 obstetric fistula patients who had been registered by the Urogynecology Department, Kitovu Hospital within two years before the time of data collection status and 12 key informants who include hospital staffs engaged in the management of fistula and patients’ partners who were involved in caregiving. Data were analyzed thematically using ATLAS.ti 7.5.

Results: The major constraints encountered during rehabilitation were limited resources for practice, inadequate counseling especially among immediate relatives, and inadequate capital for self-sustainability and limited employment opportunities. Key informants also mentioned the issue of limited resources, budget constraints, inadequate supervision and follow up of patients. Only one patient who had not had fistula repair had knowledge of rehabilitation. To address the challenges, the participants suggested the need for rehabilitation despite repair status. They required more knowledge about sustainable livelihood programs and cash grants.

Conclusions: The patients identified socioeconomic, institutional and political challenges to their rehabilitation.  They emphasized the need for improved political commitment, adequate budget, and resource allocation and regular support supervision to ensure their effective rehabilitation.


Fistula, Kitovu Hospital, Obstetric fistula, Rehabilitation, Social reintegration, Uganda

Full Text:



Ahmed S, Tuncalp O. Burden of obstetric fistula: from measurement to action. Global Health. 2015;3(5):243-4.

El Ayadi AM, Painter CE, Delamou A, Barr‐Walker J, Korn A, Obore S, et al. Rehabilitation and reintegration programming adjunct to female genital fistula surgery: A systematic scoping review. Int J Gynecol Obstet. 2020;148:42-58.

United Nations Population Fund. End the shame, end isolation, end fistula. Concept note: Partnership with the private sector foundation in Uganda in the campaign to end fistula. UNFPA Uganda; 2011.

Bomboka JB, N-Mboowa MG, Nakilembe J. Post- effects of obstetric fistula in Uganda; a case study of fistula survivors in Kitovu Mission Hospital (Masaka), Uganda. BMC Public Health. 2019;19:696.

Emasu A, Ruder B, Wall LL, Matovu A, Alia G, Barageine KJ. Reintegration of needs of young women following genitourinary fistula surgery in Uganda. Int Urogynecol J. 2019;30(7):1101-10.

Dennis AC, Wilson SM, Mosha MV, Masenga GG, Sikkema KJ, Terroso KE, et al. Experiences of social support among women presenting for obstetric fistula repair surgery in Tanzania. Int J Women Health. 2016;8:429.

Lombard L, de St. Jorre J, Geddes R, Alison M, El Ayadi A, Grant L. Rehabilitation experiences after obstetric fistula repair: Systematic review of qualitative studies. Trop Med Int Health. 2015;20(5):554-68.

Gebresilase TY. A qualitative study of the experience of obstetric fistula survivors in Ethiopia. Int. J Women Health. 2014;6:1033-43.

Lyimo MA, Mosha IH. Reasons for delay in seeking treatment among women with obstetric fistula in Tanzania: a qualitative study. BMC Women Health. 2019;19(1):93.

WHO. Chapter 4: "Rehabilitation", in World Report on Disability. The World Bank. 2011: 93-134.

McCurdie KF, Moffatt J, Jones K. Vesicovaginal fistula in Uganda. J Obstet Gynaecol. 2018;38(6):822-7.

Wilson SM, Sikkema KJ, Watt MH, Masenga GG. Psychological symptoms among obstetric fistula patients compared to gynecology outpatients in Tanzania. Int J Behav Med. 2015;22(5):605-13.

Siddle K, Vieren L, Fiander A. Characterising women with obstetric fistula and urogenital tract injuries in Tanzania. Int Urogynecol J. 2014;25:249-55.

Kabayambi J, Barageine KJ, Matovu KBJ, Beyeza J, Ekirapa E, Wanyenze KR. Living with obstetric fistula: Perceived causes, challenges, and coping strategies among women attending the fistula clinic at Mulago Hospital, Uganda. Int J Trop Dis Health. 2014;4(3):352-61.

Donnelly K, Oliveras E, Tilahun Y, Belachew M, Asnake M. Quality of life of Ethiopian women after fistula repair: implications on rehabilitation and social reintegration policy and programming. Cult Health Sex. 2015;17(2):150-64.

Anzaku SA, Lengmang SJ, Mikah S, Shephard SN, Edem BE. Sexual activity among Nigerian women following successful obstetric fistula repair. Int J Obstetr Gynecol. 2017;137(1):67-71.

UNFPA. Report on the burden of obstetric fistula in Ghana. Report on the assessment of obstetric fistula in Ghana. Ghana Health Services; 2015.

Bashah TD, Worku GA, Yitayal M, Azale T. The loss of dignity: social experience and copying of women with obstetric fistula in Northwest Ethiopia. BMC Women Health. 2018;18(1):106.

UNFPA. Obstetric fistula: The road to recovery and respect. Dhaka, Bangladesh. UNFPA; 2015.

Heller A, Hannig A. Unsettling the fistula narrative: cultural pathology, biomedical redemption, and inequities of health access in Niger and Ethiopia. Anthropol Med. 2017;24(1):81-95.

Khisa, MA, Isaac K. Nyamongo, KI, Omoni MG, Rachel F, Spitzer FR. A grounded theory of regaining normalcy and reintegration of women with obstetric fistula in Kenya. Reprod Health. 2019;16:29.