Frequency and management of non-obstetric fistula in the Democratic Republic of Congo: experience from Fistula Care Plus project


  • Alexandre Delamou
  • Michel Mpunga
  • Félicien Banze
  • Dolores Nembunzu
  • Kenny Raha
  • Justin Paluku
  • Rachel Kinja
  • Esther Kitambala
  • Brian Tena-Tena Aussak
  • Ruth Bulu Bobina
  • A Notia
  • Anne Mukuliboy
  • Altine Diop
  • Vandana Tripathi
  • Lauri Romanzi


cohort, DRC, frequency, management, non-obstetric fistula


Aims: To describe the frequency and management of non-obstetric fistula (NOF) in Democratic Republic of Congo (DRC).

Methods: A retrospective cohort study reviewed patients’ medical records in three fistula repair sites supported by the USAID-funded Fistula Care Plus (FC+) Project, covering 1 January 2015 to 31 December 2017. Study variables included demographic characteristics, fistula etiology as reported by surgeon, fistula type (Waaldijk classification), and treatment outcomes.

Results: Of 1984 women treated for female genital fistula between 2015 and 2017 in the three sites, 384 (19%) were considered to be NOF cases. 91% of these women resided in rural areas. 49.3% were married/in relationship at time of treatment compared to 69% before the fistula (p<0.001). Most (n=316; 82.3%) had no previous repair attempts and 96.2% had an intact urethra. Type III (n=247; 64.3%) and type I (n=121; 31.5%) fistulas (Waaldijk classification) were most common. The main causes of NOF were medical procedure (n=305; 79.4%), congenital origin (41; 10.7%) or sexual assault (28; 7.3%). Caesarean section (n=234; 76.7%) and hysterectomy (n=54; 17.7%) were the most common causative procedures. 369 women with NOF received surgical repair (96%), mainly through routine services (n=317; 85.9%). At discharge, 353 women were closed and dry (95.7%) and 11 were closed with residual incontinence (3.0%).

Conclusions: NOF, particularly due to iatrogenic causes, was relatively common in DRC. Surgical repair at FC+-supported sites led to good clinical outcomes. However, to achieve a fistula-free generation in DRC, prevention of iatrogenic fistula is needed, requiring improved quality of maternal care.


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How to Cite

Delamou, A., Mpunga, M., Banze, F., Nembunzu, D., Raha, K., Paluku, J., Kinja, R., Kitambala, E., Aussak, B. T.-T., Bobina, R. B., Notia, A., Mukuliboy, A., Diop, A., Tripathi, V., & Romanzi, L. (2018). Frequency and management of non-obstetric fistula in the Democratic Republic of Congo: experience from Fistula Care Plus project. Nepal Journal of Obstetrics and Gynaecology, 13(2). Retrieved from