Modelling the Long-Term Reproductive and Psychosocial Outcomes of Obstetric Fistula Repair in Women in North West Nigeria

Successful obstetric fistula repair restores continence but its long-term reproductive, psychological, and social reintegration outcomes for women in northern Nigeria have not been longitudinally characterised, creating a gap in understanding the full burden and recovery trajectory of this condition. This dissertation models the long-term reproductive and psychosocial outcomes of obstetric fistula repair in a cohort of women from Kano, Sokoto, and Zamfara States, North West Nigeria. A prospective longitudinal cohort of 180 women who underwent successful fistula repair at the National Obstetric Fistula Centre, Katsina, and VVF Centre, Kano, was followed for three years post-repair. Outcomes assessed at 6-month intervals included continence status, pregnancy occurrence and outcome, psychosocial wellbeing using the SF-36 and Fistula Impact Questionnaire, social reintegration, and marital status. Durable continence was maintained in 81 percent at three years. Twenty-two percent of women with intact fertility conceived within three years of repair, with 68 percent of pregnancies resulting in term deliveries. Recurrent fistula occurred in 14 percent of women who delivered vaginally following repair. Psychosocial wellbeing improved significantly from baseline across all SF-36 domains, but social reintegration remained incomplete in 39 percent, reflecting persistent community stigma. Marital abandonment after fistula, noted before repair in 44 percent, was partially reversed after repair in 18 percent. The dissertation develops a Long-Term Fistula Recovery Trajectory Model applicable to northern Nigerian rehabilitation programme design. Keywords: obstetric fistula, fistula repair, reproductive outcome, psychosocial recovery, North West Nigeria