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Trop Med Int Health. 2015 Nov;20(11):1454-1461. doi: 10.1111/tmi.12584. Epub 2015 Aug 27.

Factors associated with loss to follow-up in women undergoing repair for obstetric fistula in Guinea.

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Ecole de Santé Publique, Université Libre de Bruxelles (ULB), Bruxelles, Belgium.
Centre national de formation et de recherche en santé rurale de Maferinyah, Maferinyah, Guinea.
Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
EngenderHealth, New York, NY, USA.
EngenderHealth, Conakry, Guinea.
Hopital Prefectoral de Kissidougou, Kissidougou, Guinea.
Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA.



To analyse the trend of loss to follow-up over time and identify factors associated with women being lost to follow-up after discharge in three fistula repair hospitals in Guinea.


This retrospective cohort study used data extracted from medical records of fistula repairs conducted from 1 January 2007 to 30 September 2013. A woman was considered lost to follow-up if she did not return within 4 months post-discharge. Factors associated with loss to follow-up were identified using a subsample of the data covering the period 2010-2013.


Over the study period, the proportion of loss to follow-up was 21.5% (448/2080) and varied across repair hospitals and over time with an increase from 2% in 2009 to 52% in 2013. After adjusting for other variables in a multivariate logistic regression model, women who underwent surgery at Labe hospital and at Kissidougou hospital were more likely to be lost to follow-up than women operated at Jean Paul II hospital (OR: 50.6; 95% CI: 24.9-102.8) and (OR: 11.5; 95% CI: 6.1-22.0), respectively. Women with their fistula closed at hospital discharge (OR: 3.2; 95% CI: 2.1-4.8) and women admitted for repair in years 2011-2013 showed higher loss to follow-up as compared to 2010. Finally, loss to follow-up increased by 2‰ for each additional kilometre of distance a client lived from the repair hospital (OR: 1.002; 95% CI: 1.001-1.003).


Reimbursement of transport was the likely reason for change over time of LTFU. Reducing geographical barriers to care for women with fistula could sustain fistula care positive outcomes.


Conakry; Fistula care; Guinea; Guinée Conakry; Obstetric fistula; fistula obstétrica; fistule obstétricale; loss to follow-up; perte au suivi; pérdida durante el seguimiento; reparación de fístula; soins de la fistule

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