Post-Surgical Outcomes and Social Reintegration Experiences of Women with Obstetric Fistula in Northwest Cameroon. A Mixed-Methods Evaluation

Post-Surgical Outcomes and Social Reintegration Experiences of Women with Obstetric Fistula in Northwest Cameroon. 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A Mixed-Methods Evaluation Jacques Chirac Awa, George Ngock, Signang Alberic Ndonku, Yasemeratu Ayenjika, and 8 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7590836/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 17 You are reading this latest preprint version Abstract Background: Obstetric fistula remains a significant cause of maternal morbidity in sub-Saharan Africa, with long-term physical, psychosocial, and economic consequences. Evidence on integrated recovery outcomes in Cameroon is limited. The aim of this study was to evaluate clinical, psychosocial, and economic outcomes among women treated for obstetric fistula within the Cameroon Baptist Convention Health Services. Methods: A mixed-method design was used to evaluate the experiences of 29 women who had undergone obstetric fistula repair and completed a minimum of six months of follow-up at Mbingo Baptist Hospital. Quantitative data on socio-demographics, fistula type, continence status, and surgical history were analysed descriptively and using chi-square and logistic regression tests. Qualitative data from in-depth interviews conducted between September and November 2024 were analyzed thematically to explore lived experiences of recovery and reintegration. Results: Most participants (72.4%) had vesicovaginal fistula. At discharge, 93.1% were continent; at six-month follow-up, 82.8% reported no leakage. No significant association was found between fistula type and continence at discharge (χ² = 0.82, p = 0.845). The median monthly income was $50 (IQR: $25–$90), and participants had a median of two surgeries (IQR: 1–3). Twelve qualitative themes emerged, including restoration of physical health, respectful care, emotional renewal, family support, community solidarity, persistent stigma, economic disruption, empowerment through livelihood support, leadership, and aspirations for the future. Conclusion: While high rates of anatomical closure and continence were achieved, sustained recovery depended on comprehensive care extending beyond surgery. Respectful treatment, psychosocial counselling, family engagement, community sensitization, and economic empowerment were central to successful reintegration. Fistula care programs should adopt integrated approaches that combine clinical and social models of care, tailored to the specific contexts in which they are implemented obstetric fistula reintegration psychosocial recovery socioeconomic empowerment Cameroon Figures Figure 1 Figure 2 Figure 3 Introduction Obstetric fistula is a severe but mostly preventable childbirth injury that happens mainly in low-resource settings where women cannot get timely skilled obstetric care (1,2). It usually results from prolonged, obstructed labour that may last several days. During this time, the baby’s head presses continuously on the mother’s soft tissues, cutting off blood supply and causing tissue death in the wall between the vagina and bladder (vesicovaginal fistula) or between the vagina and rectum (rectovaginal fistula) (3,4). Less commonly, women may develop urethrovaginal fistula (UVF) or multiple fistulae at once (5). Physical effects include constant leakage of urine and/or stool, frequent urinary and genital infections, skin irritation, infertility, and sometimes nerve damage such as foot drop (4,6). Worldwide, about 2–2.3 million women live with untreated fistula, and every year 50,000–100,000 new cases occur (7,8). Most cases are found in the so-called “fistula belt” across sub-Saharan Africa and parts of South Asia; regions that also have the highest maternal mortality (3,9). Surveys suggest that 0.1–2.0% of women of reproductive age in sub-Saharan Africa have symptoms of fistula (7). In Cameroon, more than 1,900 women are thought to be affected, especially in the northern and rural underserved areas (5). A population survey in 2004 recorded 162 cases in the Adamaoua, North, and Far North regions (9). Several risk factors make women more vulnerable: early marriage and teenage pregnancy, small pelvic size caused by childhood malnutrition and stunting, lack of antenatal care, delays in deciding to seek care, poor transport and referral systems, and weak monitoring during labour (2,10,11). Gender inequality makes things worse, as women may need permission from men to go to the hospital, may not control family money, and often face cultural norms that discourage giving birth in health facilities (12,13). The social and emotional toll is extremely heavy. Many women with fistula are abandoned by their husbands, rejected by relatives, and cut off from their communities (12,14). Constant leakage and bad odour cause stigma, loss of dignity, and sometimes even thoughts of suicide (13). Economically, fistula strikes women in their most productive years, stopping them from earning income and deepening poverty in their households (14). Surgery can repair the hole in most cases, with success rates above 85% in specialised centres (4,15). But even when the fistula is closed, not all women regain full continence or relief from pain, and many still face stigma (11). Problems like residual leakage, discomfort, and limited acceptance in their communities often continue. Without structured post-surgery support, reintegration into work and social life remains difficult (12,15). Research increasingly shows that the best results come from a holistic approach that combines surgery with counselling, livelihood training, and community awareness to tackle the medical, social, and economic challenges of fistula (16). Between 2022 and 2024, the Cameroon Baptist Convention Health Services (CBCHS), with support from Hope and Healing International, ran a comprehensive fistula programme in the Northwest, West, and Adamawa regions. The programme included community case-finding and referral, surgical repair, psychosocial care, and economic empowerment activities such as vocational training (tailoring, hairdressing, poultry farming), educational sponsorship, and small business start-up support. Although many experts agree that post-surgery support is essential, little research from Cameroon has evaluated outcomes that look at clinical, social, and economic dimensions together. Very few studies have used mixed methods to examine the full journey; from identifying cases, to surgery, to life after repair. This study fills that gap by using a mixed-methods approach to evaluate women’s identification, treatment, and outcomes six months after surgery in the CBCHS programme. Quantitative data included demographics, clinical details, surgical history, and continence outcomes. Qualitative interviews and focus group discussions explored women’s recovery experiences, family and community acceptance, and how livelihood support helped them reintegrate. The goal is to provide context-specific evidence that can guide policy and improve comprehensive fistula care in Cameroon. Methodology This study used a mixed-methods approach, combining both quantitative and qualitative methods to understand how women with obstetric fistula were identified, treated, and supported after surgery within the Cameroon Baptist Convention Health Services (CBCHS) fistula programme. The evaluation focused on their presentation, management, outcomes six months after surgery, and their reintegration into society and economic life. Study Setting and Context The research took place in Cameroon’s Northwest region. All surgeries were carried out at Mbingo Baptist Hospital, a referral centre for fistula care, by two surgeons who were specially trained in fistula repair. The CBCHS programme offered a package of services, including community case-finding and referral, surgery, psychosocial support, and economic empowerment to help women recover physically and reintegrate socially. The psychosocial component provided both pre- and post-surgery counselling to address trauma and stigma. Women also participated in group counselling for peer support, and families were engaged to encourage acceptance and reduce discrimination. A “fistula village” rehabilitation centre was used to help women gradually prepare to return to their communities. The economic component included training in trades such as tailoring, hairdressing, poultry farming, petty trade, and other small businesses. Start-up kits, small-business support, and educational sponsorship for school-aged dependents were provided. These activities aimed to restore financial independence, rebuild self-confidence, and strengthen women’s roles in their communities. Study Participants and Sampling The study included all women diagnosed with vesicovaginal fistula (VVF), rectovaginal fistula (RVF), urethrovaginal fistula (UVF), or combined fistula who were referred through the CBCHS programme, underwent surgical repair between 2022 and 2024 at Mbingo Baptist Hospital, and had completed at least six months of follow-up by the time data collection began. Data Collection Quantitative data came from structured questionnaires and medical records. Information collected included socio-demographic details (such as age, marital status, education, occupation, income, religion, and location), clinical presentation (type and duration of fistula, symptoms, previous repairs), surgical management (type and number of repairs, surgeon), and outcomes (continence at discharge, post-operative complications, pain levels, and continence at six months). Follow-up data were gathered during routine clinic visits, or by telephone for women unable to return to the hospital. Qualitative data were collected through in-depth interviews (IDIs) between September and November 2024. These explored the full journey, from case identification to treatment and recovery, as well as women’s experiences with psychosocial and economic reintegration, family and community acceptance, and changes in quality of life. A semi-structured interview guide ensured consistency while allowing flexibility for personal stories. Interviews, held in English or Pidgin by trained qualitative researchers, took place in private settings. Each lasted 45–90 minutes and was audio-recorded with the participants’ consent. Data Management and Analysis Quantitative data were analysed using Python version 3.12. Descriptive statistics were used to summarise demographic and clinical characteristics. Relationships between categorical variables, such as type of fistula and continence at discharge, were tested with Chi-square analysis. Qualitative interviews were transcribed word-for-word and translated into English when needed. Thematic analysis was carried out manually in an iterative process. Researchers began with open coding to identify key points in the data, then grouped these into broader themes representing women’s experiences. Two researchers coded independently, and disagreements were resolved through discussion. The final themes were reviewed and validated by two additional researchers. Ethical Considerations The Cameroon Baptist Convention Health Services Institutional Review Board (CBCHS IRB) approved the study (IRB2024-17). All participants gave written informed consent after the study was explained to them in detail. Confidentiality was maintained by anonymising data and securely storing all records. All ethical norms were upheld in accordance with the Declaration of Helsinki. Results A total of 29 women who had completed at least six months of post-surgical follow-up were included in the quantitative analysis. Nearly half of the participants (14; 48.3%) were aged 45 years or older, followed by those aged 25–34 years (8; 27.6%). Participants aged 18–24 years comprised 4 (13.8%) of the sample, while the smallest group was aged 35–44 years (3; 10.3%). Most participants were married (12; 41.4%) or single (9; 31.0%), with 6 (20.7%) widowed, and small proportions cohabiting (1; 3.45%) or divorced (1; 3.45%). Over half of the patients (16; 55.2%) had attained only primary education, 8 (27.6%) had secondary education, and 5 (17.2%) had tertiary-level qualifications. None reported any disability other than their fistula condition. The majority identified as Christian (27; 93.1%), with 2 (6.9%) identifying as Muslim. Most patients (21; 72.4%) were from Mezam Division, followed by Bui (3; 10.3%), Momo (3; 10.3%), and Donga Mantung (2; 6.9%). (Table 1 ) Table 1 Socio-demographic characteristics of study participants (n = 29) Variable Category Count Percentage Age ≥ 45 14 48.28% 25–34 8 27.59% 18–24 4 13.79% 35–44 3 10.34% Marital Status Married 12 41.38% Single 9 31.03% Widowed 6 20.69% Cohabiting 1 3.45% Divorced 1 3.45% Education Primary 16 55.17% Secondary 8 27.59% Tertiary 5 17.24% Religion Christian 27 93.10% Muslim 2 6.90% Division Mezam 21 72.41% Bui 3 10.34% Momo 3 10.34% Donga Mantung 2 6.90% Clinical Presentation and Fistula Type The most common type of fistula was vesicovaginal fistula (VVF) (21; 72.4%), followed by rectovaginal fistula (RVF) (6; 20.7%). Ureterovaginal fistula (UVF) and combined VVF/RVF were rare, each representing 1 (3.45%) of cases. (Table 2 ) Table 2 Type of fistula among study participants Fistula Type Count Percentage VVF 21 72.41% RVF 6 20.69% UVF 1 3.45% VVF/RVF 1 3.45% Continence and Leakage Outcomes At discharge, 27 (93.1%) of patients were continent, while 2 (6.9%) remained incontinent. At six-month follow-up, 24 (82.8%) were continent for both urine and faeces i.e. 18 (62.1%) reported no urine leakage and 6 (20.7%) had no faecal leakage. Five (17.2%) reported current urine leakage, and no patients reported current faecal leakage at 6 months follow-up. (Fig. 1 ) Household Income and Distribution Change Distribution The median monthly household income was $ 50 (IQR: $ 25– $ 90). Patients underwent a median of 2 surgeries (IQR: 1–3). Among those with stool leakage before surgery, the mean number of diaper changes per day was 5.29 (SD = 2.29), while among those with urine leakage before surgery, the mean was 6.52 (SD = 1.93). (Fig. 2 ) Association Between Fistula Type and Continence Chi-square analysis showed no significant association between type of fistula and continence at discharge (χ² = 0.82, p = 0.845). Surgical Management by Fistula Type The distribution of the number of surgeries by fistula type showed that the majority of VVF patients (9; 42.9%) required one surgery, 3 (14.3%) had two surgeries, 7 (33.3%) had three surgeries, and 2 (9.5%) had four surgeries. Among RVF patients, 4 (66.7%) underwent one surgery and 2 (33.3%) underwent two surgeries. The single UVF patient had one surgery, while the combined VVF/RVF patient required three surgeries. (Fig. 3 ) The in-depth interviews with 29 women and girls treated for obstetric fistula within the CBCHS programme revealed a wide range of experiences across their journey from illness to post-surgical reintegration. Through iterative thematic analysis, twelve themes were identified, each capturing a distinct aspect of their recovery and reintegration. Restoration of Physical Health and Symptom Relief For most participants, surgery marked the beginning of a dramatic physical transformation. Many described the cessation of constant leakage, reduction in pain, and return of mobility as life changing. “What do you want me to say? See how I can jump up! I am completely satisfied. May God bless you people.” (P07) “I had 10 operations before this one, but I kept going because I wanted the outcome to be perfect, and that is exactly what I have obtained.” (P14) However, recovery was not uniform. Some reported partial relief, while a few continued to struggle with persistent symptoms: “I am satisfied but still leaking a little… not like before.” (P03) “I still feel pains sometimes, maybe because of the surgery, but I am much better than before.” (P18). Treatment Satisfaction Linked to Respectful Care Satisfaction was often tied not just to physical outcomes but to the respect, dignity, and compassion shown by healthcare staff. “I was respected throughout the process; taken like a family member. The project officer was like a mother to me.” (P12) “Here they don’t treat you like an outcast… even when you are smelling, they don’t make you feel bad.” (P05) The patient-provider relationship appeared to be a therapeutic element, helping restore trust in the health system. Emotional Rebirth and Relief from Shame For many, successful treatment brought a deep sense of emotional renewal; a feeling of regaining their former selves after years of shame. “Before, I could not go anywhere because of the smell. Now I can go to church, market, anywhere, without fear.” (P02) “I can now sleep without worrying about wetting the bed.” (P11) Women described feeling “reborn” and “like a human being again,” signalling the profound psychological weight lifted through physical healing. Family Support as a Catalyst for Recovery Family acceptance, particularly from parents, siblings, and in some cases spouses, was described as essential for recovery. Eight participants (28%) said their families had been supportive from the start, offering financial help, emotional reassurance, and protection from external stigma. “I had all the support from my family and they did not want anyone around to know the situation… the community might laugh at us.” (P02) “My mother was the one who took me to the hospital and stayed with me until I was healed.” (P19) Rejection and Abandonment by Spouses and In-laws In contrast, 72% (21 participants) described being abandoned or mistreated by husbands or partners after developing fistula. “My husband refused me… after a while, for the sake of my children, I went back to him.” (P16) “My husband and in-laws rejected me, saying I had brought bad luck to their family.” (P21) “He told me to leave because I was a shame to him.” (P08) Such rejection not only deepened the women’s psychological distress but also left them financially vulnerable. Community Acceptance and Solidarity While some communities perpetuated stigma, others rallied around affected women, especially through organised groups such as churches, mosques, and women’s associations. “After my husband abandoned me, my community accepted me and gave me all the support… food, financial help… they saved my life.” (P09) “When I needed 10 pints of blood, my community mobilised to make it available.” (P13) “My pastor and Christians gave me space to sit comfortably and supported me until I was healed.” (P05) Persistent Stigma and Social Avoidance Not all reintegration stories were positive. Some participants continued to face rejection from neighbours and the wider community, particularly before surgery and in cases of persistent leakage. “Whenever I sit somewhere, people will just run away… some call me names, ‘that smelling woman.’” (P23) “I kept my condition secret for years because I feared how people would treat me.” (P17) Such stigma reinforced social isolation and, in some cases, delayed treatment-seeking. Economic Disruption and Loss of Livelihood Before surgery, nearly all participants had lost income-generating opportunities due to their condition. Businesses failed, farm work stopped, and jobs were abandoned because of mobility limitations, stigma, and physical discomfort. “I owned a booming restaurant before, but when people discovered I had this condition, they ran away… that is how my business crumbled.” (P20) “I could no longer work in people’s farms because of the smell and the leaking.” (P06) Empowerment through Livelihood Support The programme’s livelihood component, vocational training, micro-business start-up kits, agricultural support, and educational sponsorship; was credited with restoring economic independence and self-worth. “I sell smoked fish… I also work my farm to feed myself and my family. It’s not easy, but I am grateful because the NGO gave us hope again.” (P04) “I now feel important in my community… the little money I make helps me and my family.” (P06) “I am back in school with my mates. I want to be a medical doctor.” (P15) Economic activity also became a pathway to social reintegration. “My husband who abandoned me has heard how I am doing well in business and now wants me back.” (P10) Leadership, Advocacy, and New Social Roles With post-recovery, several women assumed leadership positions in community organisations, becoming advocates for fistula awareness and support. “I am now vice president of a community organisation. People listen to me now, unlike before.” (P11) “I talk about fistula in my meetings so other women can seek help early.” (P07) This newfound status not only boosted self-esteem but also contributed to dismantling stigma in their communities. Psychological Healing and Identity Reconstruction Beyond the tangible outcomes of surgery and livelihood support, many participants described a journey of personal transformation, from being invisible to being recognised and valued. “I am now recognised as an important person… when I am not in my shop, people complain they miss me.” (P28) “I now believe I can achieve something in life, even after what I went through.” (P02) For some, the trauma of years with fistula still lingered, but hope for the future had replaced the despair of the past. Aspirations for the Future Looking forward, participants expressed ambitions grounded in their restored health and new opportunities. “I want to expand my shop so I can employ others like me.” (P08) “I want to complete my studies and work in a hospital to help women with fistula.” (P15) These aspirations reflected a shift from survival to planning and self-determination. Discussion This study is among the few mixed-methods evaluations of obstetric fistula care and reintegration outcomes in Cameroon, combining both clinical data and women lived experiences. Quantitatively, continence at discharge was high (93.1%), but by six months, 17.2% of women still reported urine leakage. Importantly, there was no significant link between fistula type and continence outcomes. Most cases were vesicovaginal fistula (72.4%), and many women required more than one surgery, underscoring the complexity of managing long-standing or recurrent fistula. The qualitative findings revealed that while surgical repair often brought dramatic physical and emotional relief, recovery was shaped by several factors: respectful treatment from providers, acceptance by family and community, freedom from stigma, and access to economic opportunities. Livelihood support stood out as a key driver of reintegration, helping women regain financial independence and social status. Taken together, the findings show that fistula care in Cameroon needs to go beyond surgery, addressing psychological, social, and economic dimensions to achieve lasting recovery. Socio-demographic Profile The 29 women in this study reflected patterns like those seen in other research across Sub-Saharan Africa, but with some notable differences. Nearly half (48.3%) were aged 45 years or older, higher than the younger age profile (adolescents and women in their twenties) commonly reported in earlier literature (2,5). This older age distribution likely reflects delayed access to surgery, with women living for years with fistula before repair, as also documented in Ethiopia and Tanzania (6,12). Education levels were low, 55.2% had only primary education. Limited schooling is well known to increase fistula risk and delay access to treatment, as it restricts women’s autonomy, health literacy, and economic independence (5,11). Most participants (72.4%) came from Mezam Division, where Mbingo Baptist Hospital is located, suggesting that proximity to surgical centres remains a key determinant of care access, consistent with the “three delays” model (10). Clinical Characteristics and Surgical Outcomes Most women presented with vesicovaginal fistula (72.4%), followed by rectovaginal fistula (20.7%), while urethrovaginal and combined fistulae were rare (3.45% each). This distribution is consistent with findings from Cameroon’s Far North Province and other Sub-Saharan countries, where prolonged obstructed labour is the leading cause of VVF (4,5). Surgical outcomes were encouraging. At discharge, 93.1% of women were continent, similar to results reported from high-volume fistula centres across Africa (4,15). However, continence dropped to 82.8% at six months, with 17.2% reporting persistent urine leakage. This decline highlights the gap between immediate closure and long-term continence, a challenge well documented in follow-up studies (17). Residual incontinence is often linked to severe tissue damage, urethral involvement, or reduced bladder capacity after repair (4). Statistical analysis found no significant link between fistula type and continence at discharge (χ² = 0.82, p = 0.845). This suggests that factors such as the extent of tissue damage, number of prior surgeries, or post-operative care may be more important predictors of outcome. Similar findings have been reported in Guinea and Uganda (15,18). The median number of surgeries per woman was two (IQR: 1–3), reflecting the difficulty of treating chronic or recurrent fistula. Repeated operations are common in cases with scarring or failed previous repairs, as also seen in Malawi and Ethiopia (19). These findings highlight the need for both high-quality initial surgery and ongoing access to follow-up care. Economically, participants were severely disadvantaged, with a median monthly household income of 25,000 CFA francs (~ USD 50). Poverty limits access to treatment and undermines reintegration after repair. Survivors of fistula are often unable to resume work due to stigma, residual symptoms, or lack of resources (20,21). This strengthens the argument for economic empowerment programmes as an essential component of fistula care. Women’s Lived Experiences Women frequently described surgery as life-changing, echoing reports from other African contexts where stopping constant leakage allowed them to regain mobility, comfort, and participation in daily life (19,22). Yet, some continued to struggle with stress incontinence or pelvic pain, consistent with challenges seen even after successful repair (19). Satisfaction with treatment was closely tied to being treated with dignity and empathy. Respectful, compassionate care built trust, encouraged adherence to follow-up, and supported psychosocial recovery, findings consistent with studies in Tanzania and Uganda (12,18,23). Many women spoke of a sense of “rebirth,” reflecting relief from years of shame and isolation. This transformation has been similarly described in Kenya and Guinea, where surgical repair marks a turning point in women’s lives (21,22). Post-surgical counselling was critical to consolidate this emotional healing. Family acceptance played a vital role in recovery, providing emotional and material support. However, 72% of women reported spousal abandonment or rejection by in-laws, similar to findings elsewhere in Africa (12,20). Such losses make reintegration harder and worsen survivors’ economic vulnerability. Some women benefited from solidarity from churches or community groups, but many still faced stigma and exclusion, often driven by misconceptions about the causes of fistula. This stigma has been reported in Cameroon and other regions (23). Evidence shows that community sensitisation can reduce these negative attitudes (24). The loss of livelihoods before surgery, and the restoration of income-generating activities through vocational training and small-business support, mirrored findings from Uganda and Malawi (18,19). In this study, economic empowerment not only restored financial independence but also improved women’s social status and sometimes led to reconciliation with estranged husbands. These results confirm the strong role of livelihood support in sustaining reintegration (15,21). Some women emerged as leaders and advocates, helping to challenge stigma and encourage early treatment, similar to experiences reported in Kenya and Guinea (21,22). This shift illustrates how survivors can move from marginalisation to empowerment, rebuilding their identity and contributing to their communities. Many participants expressed ambitions to grow businesses, return to school, or support other women, reflecting a shift from survival to self-determination. Such forward-looking perspectives have also been noted in long-term studies where health recovery and economic stability fuel personal growth and community contribution (19,20). Limitations This study involved only 29 women, which limited the statistical power, especially when comparing subgroups. Because all participants were recruited from one referral programme, the findings may not conveniently apply to other parts of Cameroon or to women treated under different care models. Continence outcomes at six months were partly based on self-reports, which may have introduced recall bias and did not allow us to measure longer-term results. Interviews took place in a hospital-affiliated setting, which may have influenced women to give more positive answers (social desirability bias). In addition, translation from local languages could have caused small losses of meaning. Despite these limitations, the mixed-methods design strengthened the study by capturing both clinical outcomes and women’s personal recovery experiences. Conclusion This mixed-methods study shows that while surgical repair in Cameroon can achieve high rates of closure and immediate continence, long-term recovery is shaped by much more than surgery alone. Six months after repair, some women still experienced leakage, while many continued to face social and economic hardships. The qualitative findings highlight that respectful and compassionate care, family and community acceptance, and access to livelihood opportunities are critical for full recovery. At the same time, stigma and poverty remain major barriers. Together, these results make clear that obstetric fistula care in Cameroon needs a holistic model; one that combines surgical expertise with ongoing follow-up, counselling, community sensitisation, and economic empowerment. Learning from successful approaches in other Sub-Saharan African countries, such a model could not only improve clinical outcomes but also help restore women’s dignity, rebuild their social identity, and support their full participation in community life. Abbreviations CBCHS Cameroon Baptist Convention Health Services CFA Communauté Financière Africaine (Central African CFA franc) IDI In-depth Interview IQR Interquartile Range IRB Institutional Review Board NGO Non-Governmental Organization RVF Rectovaginal Fistula SD Standard Deviation UNFPA United Nations Population Fund UVF Urethrovaginal Fistula VVF Vesicovaginal Fistula WHO World Health Organization Declarations Ethics approval and consent to participate This study was approved by the Cameroon Baptist Convention Health Services Institutional Review Board (CBCHS IRB) (Reference: IRB2024-17). All participants provided written informed consent prior to inclusion in the study. All ethical norms were upheld with accordance to the Declaration of Helsinki. Consent for publication All participants gave consent for anonymised data and quotes to be used in publications. No identifying information is included in this manuscript. Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding This research was undertaken within the framework of the Socio-Economic Empowerment of Females of Fistula Project funded by Hope and Healing International. Hope and Healing is a faith-driven charity dedicated to improving the lives of children with disabilities in some of the world’s poorest communities. Their mission is rooted in compassion, inclusion, and the belief that every child is loved and valued by God. Authors’ contributions G.N. and E.N. contributed to the study concept, data collection, clinical review, and validation of the manuscript. J.C.A. contributed to the study concept, supervision, writing, and validation. L.M., J.T., and D.N. participated in the implementation of the study, writing, and validation. A.N., Y.A., and G.M.A. were responsible for data collection, analysis, writing, and validation. D.W., S.N., and P.M. contributed to the study concept, supervision, writing, review, and validation of the manuscript. All authors read and approved of the final manuscript. Acknowledgements The authors thank the study participants for sharing their experiences, the staff of Mbingo Baptist Hospital and the Socio-Economic Development of Persons with Disabilities programme, for their support with clinical care, follow-up and interviews. References Hilton P. Vesico-vaginal fistulas in developing countries. Int J Gynaecol Obstet Off Organ Int Fed Gynaecol Obstet. 2003 Sep;82(3):285–95. Wall LL. A framework for analyzing the determinants of obstetric fistula formation. Stud Fam Plann. 2012 Dec;43(4):255–72. Arrowsmith S, Hamlin EC, Wall LL. Obstructed labor injury complex: obstetric fistula formation and the multifaceted morbidity of maternal birth trauma in the developing world. Obstet Gynecol Surv. 1996 Sep;51(9):568–74. Waaldijk K. Surgical classification of obstetric fistulas. Int J Gynaecol Obstet Off Organ Int Fed Gynaecol Obstet. 1995 May;49(2):161–3. Tebeu PM, de Bernis L, Doh AS, Rochat CH, Delvaux T. Risk factors for obstetric fistula in the Far North Province of Cameroon. Int J Gynaecol Obstet Off Organ Int Fed Gynaecol Obstet. 2009 Oct;107(1):12–5. Muleta M, Hamlin EC, Fantahun M, Kennedy RC, Tafesse B. Health and social problems encountered by treated and untreated obstetric fistula patients in rural Ethiopia. J Obstet Gynaecol Can JOGC J Obstet Gynecol Can JOGC. 2008 Jan;30(1):44–50. Maheu-Giroux M, Filippi V, Samadoulougou S, Castro MC, Maulet N, Meda N, et al. Prevalence of symptoms of vaginal fistula in 19 sub-Saharan Africa countries: a meta-analysis of national household survey data. Lancet Glob Health. 2015 May;3(5):e271-278. World Health Organisation. Obstetric fistula [Internet]. 2018 [cited 2025 Aug 16]. Available from: https://www.who.int/news-room/facts-in-pictures/detail/10-facts-on-obstetric-fistula UNFPA. End Fistula. 2025 [cited 2025 Aug 16]. Some problems don’t have an answer - this one does. Available from: https://endfistula.org/about-campaign Thaddeus S, Maine D. Too far to walk: maternal mortality in context. Soc Sci Med 1982. 1994 Apr;38(8):1091–110. Bangser M. Obstetric fistula and stigma. Lancet Lond Engl. 2006 Feb 11;367(9509):535–6. Mselle LT, Kohi TW. Living with constant leaking of urine and odour: thematic analysis of socio-cultural experiences of women affected by obstetric fistula in rural Tanzania. BMC Womens Health. 2015 Nov 24;15(1):107. Goh JTW, Sloane KM, Krause HG, Browning A, Akhter S. Mental health screening in women with genital tract fistulae. BJOG Int J Obstet Gynaecol. 2005 Sep;112(9):1328–30. Debela TF, Hordofa ZA, Aregawi AB, Sori DA. Quality of life of obstetrics fistula patients before and after surgical repair in the Jimma University Medical Center, Southwest Ethiopia. BMC Womens Health. 2021 May 21;21(1):212. Delamou A, Delvaux T, Beavogui AH, Toure A, Kolié D, Sidibé S, et al. Factors associated with the failure of obstetric fistula repair in Guinea: implications for practice. Reprod Health. 2016 Nov 8;13(1):135. Khisa AM, Nyamongo IK, Omoni GM, Spitzer RF. A grounded theory of regaining normalcy and reintegration of women with obstetric fistula in Kenya. Reprod Health. 2019 Mar 8;16(1):29. Drew LB, Wilkinson JP, Nundwe W, Moyo M, Mataya R, Mwale M, et al. Long-term outcomes for women after obstetric fistula repair in Lilongwe, Malawi: a qualitative study. BMC Pregnancy Childbirth. 2016 Jan 5;16:2. Oluwasola TAO, O.Bello O. Clinical and Psychosocial Outcomes of Obstetrics Fistulae in Sub-Saharan Africa â A Review of Literature. J Basic Clin Reprod Sci [Internet]. 2020 May 11 [cited 2025 Aug 16];9(1). Available from: https://www.jbcrs.org//abstract/clinical-and-psychosocial-outcomes-of-obstetrics-fistulae-in-subsaharan-africa--a-review-of-literature-5653.html Bigley R, Barageine J, Nalubwama H, Neuhaus J, Mitchell A, Miller S, et al. Factors associated with reintegration trajectory following female genital fistula surgery in Uganda. AJOG Glob Rep. 2023 Aug 12;3(4):100261. Wilson K, Mazhar W, Rojas-Cooley T, De Rosa V, Van Cleve L. A glimpse into the lives of 3 children: their cancer journey. J Pediatr Oncol Nurs Off J Assoc Pediatr Oncol Nurses. 2011 Apr;28(2):100–6. Pollaczek L, El Ayadi AM, Mohamed HC. Building a country-wide Fistula Treatment Network in Kenya: results from the first six years (2014-2020). BMC Health Serv Res. 2022 Mar 1;22(1):280. Kaba H, Touré MA, Camara M, Johri M. Experiences of community reintegration after obstetric fistula repair at Jean Paul 2 hospital, Conakry, Guinea. PLOS Glob Public Health. 2024 Aug 6;4(8):e0003581. Tayler-Smith K, Zachariah R, Manzi M, van den Boogaard W, Vandeborne A, Bishinga A, et al. Obstetric fistula in Burundi: a comprehensive approach to managing women with this neglected disease. BMC Pregnancy Childbirth. 2013 Aug 21;13:164. Tseunwo C, Mail SHW, Antaon JSS, Obama CM, Tebeu PM, Rochat CH. Obstetric Fistula Knowledge, Attitudes and Practices among the Professionals of Communication in Yaounde. Health Sci Dis [Internet]. 2020 May 20 [cited 2025 Aug 16];21(6). Available from: https://www.hsd-fmsb.org/index.php/hsd/article/view/2048 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 23 Oct, 2025 Reviewers agreed at journal 22 Oct, 2025 Reviews received at journal 21 Oct, 2025 Reviewers agreed at journal 19 Oct, 2025 Reviews received at journal 18 Oct, 2025 Reviewers agreed at journal 18 Oct, 2025 Reviewers agreed at journal 18 Oct, 2025 Reviewers agreed at journal 18 Oct, 2025 Reviewers agreed at journal 17 Oct, 2025 Reviewers agreed at journal 16 Oct, 2025 Reviewers agreed at journal 16 Oct, 2025 Reviewers agreed at journal 06 Oct, 2025 Reviewers invited by journal 18 Sep, 2025 Editor invited by journal 17 Sep, 2025 Editor assigned by journal 15 Sep, 2025 Submission checks completed at journal 15 Sep, 2025 First submitted to journal 11 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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1","display":"","copyAsset":false,"role":"figure","size":52469,"visible":true,"origin":"","legend":"\u003cp\u003eContinence and leakage outcome at 6 months follow-up\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7590836/v1/d57a7127f0a856326cef7a42.png"},{"id":92475359,"identity":"eaa5f7af-5973-47c6-bd9f-2521230425bf","added_by":"auto","created_at":"2025-09-30 07:16:29","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":26385,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eDistribution of Daily Diaper Changes Due to Stool and Urine Leakage Before Surgery\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7590836/v1/d8398c4314ef181a74dcaede.png"},{"id":92475360,"identity":"449de259-d472-4036-a077-f6acedfb53c2","added_by":"auto","created_at":"2025-09-30 07:16:29","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":29177,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eDistribution of number of surgeries by fistula type\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7590836/v1/5dd95bdfd61be7f679b3adff.png"},{"id":92480265,"identity":"48ff3e5d-e8ef-4ba8-922f-e241efbb843f","added_by":"auto","created_at":"2025-09-30 07:40:30","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1207148,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7590836/v1/d2515a1e-5cea-4661-8c3c-d1474022f1d2.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Post-Surgical Outcomes and Social Reintegration Experiences of Women with Obstetric Fistula in Northwest Cameroon. A Mixed-Methods Evaluation","fulltext":[{"header":"Introduction","content":"\u003cp\u003eObstetric fistula is a severe but mostly preventable childbirth injury that happens mainly in low-resource settings where women cannot get timely skilled obstetric care (1,2). It usually results from prolonged, obstructed labour that may last several days. During this time, the baby\u0026rsquo;s head presses continuously on the mother\u0026rsquo;s soft tissues, cutting off blood supply and causing tissue death in the wall between the vagina and bladder (vesicovaginal fistula) or between the vagina and rectum (rectovaginal fistula) (3,4). Less commonly, women may develop urethrovaginal fistula (UVF) or multiple fistulae at once (5). Physical effects include constant leakage of urine and/or stool, frequent urinary and genital infections, skin irritation, infertility, and sometimes nerve damage such as foot drop (4,6).\u003c/p\u003e\u003cp\u003eWorldwide, about 2\u0026ndash;2.3\u0026nbsp;million women live with untreated fistula, and every year 50,000\u0026ndash;100,000 new cases occur (7,8). Most cases are found in the so-called \u0026ldquo;fistula belt\u0026rdquo; across sub-Saharan Africa and parts of South Asia; regions that also have the highest maternal mortality (3,9). Surveys suggest that 0.1\u0026ndash;2.0% of women of reproductive age in sub-Saharan Africa have symptoms of fistula (7). In Cameroon, more than 1,900 women are thought to be affected, especially in the northern and rural underserved areas (5). A population survey in 2004 recorded 162 cases in the Adamaoua, North, and Far North regions (9).\u003c/p\u003e\u003cp\u003eSeveral risk factors make women more vulnerable: early marriage and teenage pregnancy, small pelvic size caused by childhood malnutrition and stunting, lack of antenatal care, delays in deciding to seek care, poor transport and referral systems, and weak monitoring during labour (2,10,11). Gender inequality makes things worse, as women may need permission from men to go to the hospital, may not control family money, and often face cultural norms that discourage giving birth in health facilities (12,13).\u003c/p\u003e\u003cp\u003eThe social and emotional toll is extremely heavy. Many women with fistula are abandoned by their husbands, rejected by relatives, and cut off from their communities (12,14). Constant leakage and bad odour cause stigma, loss of dignity, and sometimes even thoughts of suicide (13). Economically, fistula strikes women in their most productive years, stopping them from earning income and deepening poverty in their households (14).\u003c/p\u003e\u003cp\u003eSurgery can repair the hole in most cases, with success rates above 85% in specialised centres (4,15). But even when the fistula is closed, not all women regain full continence or relief from pain, and many still face stigma (11). Problems like residual leakage, discomfort, and limited acceptance in their communities often continue. Without structured post-surgery support, reintegration into work and social life remains difficult (12,15). Research increasingly shows that the best results come from a holistic approach that combines surgery with counselling, livelihood training, and community awareness to tackle the medical, social, and economic challenges of fistula (16).\u003c/p\u003e\u003cp\u003eBetween 2022 and 2024, the Cameroon Baptist Convention Health Services (CBCHS), with support from Hope and Healing International, ran a comprehensive fistula programme in the Northwest, West, and Adamawa regions. The programme included community case-finding and referral, surgical repair, psychosocial care, and economic empowerment activities such as vocational training (tailoring, hairdressing, poultry farming), educational sponsorship, and small business start-up support.\u003c/p\u003e\u003cp\u003e Although many experts agree that post-surgery support is essential, little research from Cameroon has evaluated outcomes that look at clinical, social, and economic dimensions together. Very few studies have used mixed methods to examine the full journey; from identifying cases, to surgery, to life after repair.\u003c/p\u003e\u003cp\u003eThis study fills that gap by using a mixed-methods approach to evaluate women\u0026rsquo;s identification, treatment, and outcomes six months after surgery in the CBCHS programme. Quantitative data included demographics, clinical details, surgical history, and continence outcomes. Qualitative interviews and focus group discussions explored women\u0026rsquo;s recovery experiences, family and community acceptance, and how livelihood support helped them reintegrate. The goal is to provide context-specific evidence that can guide policy and improve comprehensive fistula care in Cameroon.\u003c/p\u003e"},{"header":"Methodology","content":"\u003cp\u003eThis study used a mixed-methods approach, combining both quantitative and qualitative methods to understand how women with obstetric fistula were identified, treated, and supported after surgery within the Cameroon Baptist Convention Health Services (CBCHS) fistula programme. The evaluation focused on their presentation, management, outcomes six months after surgery, and their reintegration into society and economic life.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy Setting and Context\u003c/h2\u003e\u003cp\u003eThe research took place in Cameroon\u0026rsquo;s Northwest region. All surgeries were carried out at Mbingo Baptist Hospital, a referral centre for fistula care, by two surgeons who were specially trained in fistula repair. The CBCHS programme offered a package of services, including community case-finding and referral, surgery, psychosocial support, and economic empowerment to help women recover physically and reintegrate socially.\u003c/p\u003e\u003cp\u003eThe psychosocial component provided both pre- and post-surgery counselling to address trauma and stigma. Women also participated in group counselling for peer support, and families were engaged to encourage acceptance and reduce discrimination. A \u0026ldquo;fistula village\u0026rdquo; rehabilitation centre was used to help women gradually prepare to return to their communities.\u003c/p\u003e\u003cp\u003eThe economic component included training in trades such as tailoring, hairdressing, poultry farming, petty trade, and other small businesses. Start-up kits, small-business support, and educational sponsorship for school-aged dependents were provided. These activities aimed to restore financial independence, rebuild self-confidence, and strengthen women\u0026rsquo;s roles in their communities.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eStudy Participants and Sampling\u003c/h3\u003e\n\u003cp\u003eThe study included all women diagnosed with vesicovaginal fistula (VVF), rectovaginal fistula (RVF), urethrovaginal fistula (UVF), or combined fistula who were referred through the CBCHS programme, underwent surgical repair between 2022 and 2024 at Mbingo Baptist Hospital, and had completed at least six months of follow-up by the time data collection began.\u003c/p\u003e\n\u003ch3\u003eData Collection\u003c/h3\u003e\n\u003cp\u003eQuantitative data came from structured questionnaires and medical records. Information collected included socio-demographic details (such as age, marital status, education, occupation, income, religion, and location), clinical presentation (type and duration of fistula, symptoms, previous repairs), surgical management (type and number of repairs, surgeon), and outcomes (continence at discharge, post-operative complications, pain levels, and continence at six months). Follow-up data were gathered during routine clinic visits, or by telephone for women unable to return to the hospital.\u003c/p\u003e\u003cp\u003eQualitative data were collected through in-depth interviews (IDIs) between September and November 2024. These explored the full journey, from case identification to treatment and recovery, as well as women\u0026rsquo;s experiences with psychosocial and economic reintegration, family and community acceptance, and changes in quality of life. A semi-structured interview guide ensured consistency while allowing flexibility for personal stories. Interviews, held in English or Pidgin by trained qualitative researchers, took place in private settings. Each lasted 45\u0026ndash;90 minutes and was audio-recorded with the participants\u0026rsquo; consent.\u003c/p\u003e\n\u003ch3\u003eData Management and Analysis\u003c/h3\u003e\n\u003cp\u003eQuantitative data were analysed using Python version 3.12. Descriptive statistics were used to summarise demographic and clinical characteristics. Relationships between categorical variables, such as type of fistula and continence at discharge, were tested with Chi-square analysis.\u003c/p\u003e\u003cp\u003eQualitative interviews were transcribed word-for-word and translated into English when needed. Thematic analysis was carried out manually in an iterative process. Researchers began with open coding to identify key points in the data, then grouped these into broader themes representing women\u0026rsquo;s experiences. Two researchers coded independently, and disagreements were resolved through discussion. The final themes were reviewed and validated by two additional researchers.\u003c/p\u003e\n\u003ch3\u003eEthical Considerations\u003c/h3\u003e\n\u003cp\u003e The Cameroon Baptist Convention Health Services Institutional Review Board (CBCHS IRB) approved the study (IRB2024-17). All participants gave written informed consent after the study was explained to them in detail. Confidentiality was maintained by anonymising data and securely storing all records. All ethical norms were upheld in accordance with the Declaration of Helsinki.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 29 women who had completed at least six months of post-surgical follow-up were included in the quantitative analysis. Nearly half of the participants (14; 48.3%) were aged 45 years or older, followed by those aged 25\u0026ndash;34 years (8; 27.6%). Participants aged 18\u0026ndash;24 years comprised 4 (13.8%) of the sample, while the smallest group was aged 35\u0026ndash;44 years (3; 10.3%). Most participants were married (12; 41.4%) or single (9; 31.0%), with 6 (20.7%) widowed, and small proportions cohabiting (1; 3.45%) or divorced (1; 3.45%). Over half of the patients (16; 55.2%) had attained only primary education, 8 (27.6%) had secondary education, and 5 (17.2%) had tertiary-level qualifications. None reported any disability other than their fistula condition. The majority identified as Christian (27; 93.1%), with 2 (6.9%) identifying as Muslim. Most patients (21; 72.4%) were from Mezam Division, followed by Bui (3; 10.3%), Momo (3; 10.3%), and Donga Mantung (2; 6.9%). (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSocio-demographic characteristics of study participants (n\u0026thinsp;=\u0026thinsp;29)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCategory\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCount\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePercentage\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e48.28%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25\u0026ndash;34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e27.59%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18\u0026ndash;24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e13.79%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e35\u0026ndash;44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e10.34%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMarital Status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e41.38%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSingle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e31.03%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWidowed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e20.69%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCohabiting\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3.45%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDivorced\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3.45%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEducation\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePrimary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e55.17%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSecondary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e27.59%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTertiary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e17.24%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eReligion\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eChristian\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e93.10%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMuslim\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6.90%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDivision\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMezam\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e72.41%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBui\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e10.34%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMomo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e10.34%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDonga Mantung\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6.90%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003eClinical Presentation and Fistula Type\u003c/h3\u003e\n\u003cp\u003eThe most common type of fistula was vesicovaginal fistula (VVF) (21; 72.4%), followed by rectovaginal fistula (RVF) (6; 20.7%). Ureterovaginal fistula (UVF) and combined VVF/RVF were rare, each representing 1 (3.45%) of cases. (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eType of fistula among study participants\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFistula Type\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCount\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePercentage\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVVF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e72.41%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRVF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e20.69%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUVF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.45%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVVF/RVF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.45%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003eContinence and Leakage Outcomes\u003c/h3\u003e\n\u003cp\u003eAt discharge, 27 (93.1%) of patients were continent, while 2 (6.9%) remained incontinent. At six-month follow-up, 24 (82.8%) were continent for both urine and faeces i.e. 18 (62.1%) reported no urine leakage and 6 (20.7%) had no faecal leakage. Five (17.2%) reported current urine leakage, and no patients reported current faecal leakage at 6 months follow-up. (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eHousehold Income and Distribution Change Distribution\u003c/h2\u003e\u003cp\u003eThe median monthly household income was \u003cspan\u003e$\u003c/span\u003e50 (IQR: \u003cspan\u003e$\u003c/span\u003e25\u0026ndash;\u003cspan\u003e$\u003c/span\u003e90). Patients underwent a median of 2 surgeries (IQR: 1\u0026ndash;3). Among those with stool leakage before surgery, the mean number of diaper changes per day was 5.29 (SD\u0026thinsp;=\u0026thinsp;2.29), while among those with urine leakage before surgery, the mean was 6.52 (SD\u0026thinsp;=\u0026thinsp;1.93). (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eAssociation Between Fistula Type and Continence\u003c/h2\u003e\u003cp\u003eChi-square analysis showed no significant association between type of fistula and continence at discharge (χ\u0026sup2; = 0.82, p\u0026thinsp;=\u0026thinsp;0.845).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eSurgical Management by Fistula Type\u003c/h2\u003e\u003cp\u003eThe distribution of the number of surgeries by fistula type showed that the majority of VVF patients (9; 42.9%) required one surgery, 3 (14.3%) had two surgeries, 7 (33.3%) had three surgeries, and 2 (9.5%) had four surgeries. Among RVF patients, 4 (66.7%) underwent one surgery and 2 (33.3%) underwent two surgeries. The single UVF patient had one surgery, while the combined VVF/RVF patient required three surgeries. (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThe in-depth interviews with 29 women and girls treated for obstetric fistula within the CBCHS programme revealed a wide range of experiences across their journey from illness to post-surgical reintegration. Through iterative thematic analysis, twelve themes were identified, each capturing a distinct aspect of their recovery and reintegration.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eRestoration of Physical Health and Symptom Relief\u003c/h2\u003e\u003cp\u003eFor most participants, surgery marked the beginning of a dramatic physical transformation. Many described the cessation of constant leakage, reduction in pain, and return of mobility as life changing. \u0026ldquo;What do you want me to say? See how I can jump up! I am completely satisfied. May God bless you people.\u0026rdquo; (P07) \u0026ldquo;I had 10 operations before this one, but I kept going because I wanted the outcome to be perfect, and that is exactly what I have obtained.\u0026rdquo; (P14)\u003c/p\u003e\u003cp\u003eHowever, recovery was not uniform. Some reported partial relief, while a few continued to struggle with persistent symptoms: \u0026ldquo;I am satisfied but still leaking a little\u0026hellip; not like before.\u0026rdquo; (P03) \u0026ldquo;I still feel pains sometimes, maybe because of the surgery, but I am much better than before.\u0026rdquo; (P18).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eTreatment Satisfaction Linked to Respectful Care\u003c/h2\u003e\u003cp\u003eSatisfaction was often tied not just to physical outcomes but to the respect, dignity, and compassion shown by healthcare staff. \u0026ldquo;I was respected throughout the process; taken like a family member. The project officer was like a mother to me.\u0026rdquo; (P12) \u0026ldquo;Here they don\u0026rsquo;t treat you like an outcast\u0026hellip; even when you are smelling, they don\u0026rsquo;t make you feel bad.\u0026rdquo; (P05) The patient-provider relationship appeared to be a therapeutic element, helping restore trust in the health system.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eEmotional Rebirth and Relief from Shame\u003c/h2\u003e\u003cp\u003eFor many, successful treatment brought a deep sense of emotional renewal; a feeling of regaining their former selves after years of shame. \u0026ldquo;Before, I could not go anywhere because of the smell. Now I can go to church, market, anywhere, without fear.\u0026rdquo; (P02) \u0026ldquo;I can now sleep without worrying about wetting the bed.\u0026rdquo; (P11) Women described feeling \u0026ldquo;reborn\u0026rdquo; and \u0026ldquo;like a human being again,\u0026rdquo; signalling the profound psychological weight lifted through physical healing.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003eFamily Support as a Catalyst for Recovery\u003c/h2\u003e\u003cp\u003eFamily acceptance, particularly from parents, siblings, and in some cases spouses, was described as essential for recovery. Eight participants (28%) said their families had been supportive from the start, offering financial help, emotional reassurance, and protection from external stigma. \u0026ldquo;I had all the support from my family and they did not want anyone around to know the situation\u0026hellip; the community might laugh at us.\u0026rdquo; (P02) \u0026ldquo;My mother was the one who took me to the hospital and stayed with me until I was healed.\u0026rdquo; (P19)\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003eRejection and Abandonment by Spouses and In-laws\u003c/h2\u003e\u003cp\u003eIn contrast, 72% (21 participants) described being abandoned or mistreated by husbands or partners after developing fistula. \u0026ldquo;My husband refused me\u0026hellip; after a while, for the sake of my children, I went back to him.\u0026rdquo; (P16) \u0026ldquo;My husband and in-laws rejected me, saying I had brought bad luck to their family.\u0026rdquo; (P21) \u0026ldquo;He told me to leave because I was a shame to him.\u0026rdquo; (P08)\u003c/p\u003e\u003cp\u003eSuch rejection not only deepened the women\u0026rsquo;s psychological distress but also left them financially vulnerable.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003eCommunity Acceptance and Solidarity\u003c/h2\u003e\u003cp\u003eWhile some communities perpetuated stigma, others rallied around affected women, especially through organised groups such as churches, mosques, and women\u0026rsquo;s associations.\u003c/p\u003e\u003cp\u003e\u0026ldquo;After my husband abandoned me, my community accepted me and gave me all the support\u0026hellip; food, financial help\u0026hellip; they saved my life.\u0026rdquo; (P09) \u0026ldquo;When I needed 10 pints of blood, my community mobilised to make it available.\u0026rdquo; (P13) \u0026ldquo;My pastor and Christians gave me space to sit comfortably and supported me until I was healed.\u0026rdquo; (P05)\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\u003ch2\u003ePersistent Stigma and Social Avoidance\u003c/h2\u003e\u003cp\u003eNot all reintegration stories were positive. Some participants continued to face rejection from neighbours and the wider community, particularly before surgery and in cases of persistent leakage. \u0026ldquo;Whenever I sit somewhere, people will just run away\u0026hellip; some call me names, \u0026lsquo;that smelling woman.\u0026rsquo;\u0026rdquo; (P23) \u0026ldquo;I kept my condition secret for years because I feared how people would treat me.\u0026rdquo; (P17) Such stigma reinforced social isolation and, in some cases, delayed treatment-seeking.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\u003ch2\u003eEconomic Disruption and Loss of Livelihood\u003c/h2\u003e\u003cp\u003eBefore surgery, nearly all participants had lost income-generating opportunities due to their condition. Businesses failed, farm work stopped, and jobs were abandoned because of mobility limitations, stigma, and physical discomfort. \u0026ldquo;I owned a booming restaurant before, but when people discovered I had this condition, they ran away\u0026hellip; that is how my business crumbled.\u0026rdquo; (P20) \u0026ldquo;I could no longer work in people\u0026rsquo;s farms because of the smell and the leaking.\u0026rdquo; (P06)\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec22\" class=\"Section2\"\u003e\u003ch2\u003eEmpowerment through Livelihood Support\u003c/h2\u003e\u003cp\u003eThe programme\u0026rsquo;s livelihood component, vocational training, micro-business start-up kits, agricultural support, and educational sponsorship; was credited with restoring economic independence and self-worth. \u0026ldquo;I sell smoked fish\u0026hellip; I also work my farm to feed myself and my family. It\u0026rsquo;s not easy, but I am grateful because the NGO gave us hope again.\u0026rdquo; (P04) \u0026ldquo;I now feel important in my community\u0026hellip; the little money I make helps me and my family.\u0026rdquo; (P06) \u0026ldquo;I am back in school with my mates. I want to be a medical doctor.\u0026rdquo; (P15)\u003c/p\u003e\u003cp\u003eEconomic activity also became a pathway to social reintegration. \u0026ldquo;My husband who abandoned me has heard how I am doing well in business and now wants me back.\u0026rdquo; (P10)\u003c/p\u003e\u003cdiv id=\"Sec23\" class=\"Section3\"\u003e\u003ch2\u003eLeadership, Advocacy, and New Social Roles\u003c/h2\u003e\u003cp\u003eWith post-recovery, several women assumed leadership positions in community organisations, becoming advocates for fistula awareness and support. \u0026ldquo;I am now vice president of a community organisation. People listen to me now, unlike before.\u0026rdquo; (P11) \u0026ldquo;I talk about fistula in my meetings so other women can seek help early.\u0026rdquo; (P07) This newfound status not only boosted self-esteem but also contributed to dismantling stigma in their communities.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec24\" class=\"Section2\"\u003e\u003ch2\u003ePsychological Healing and Identity Reconstruction\u003c/h2\u003e\u003cp\u003eBeyond the tangible outcomes of surgery and livelihood support, many participants described a journey of personal transformation, from being invisible to being recognised and valued. \u0026ldquo;I am now recognised as an important person\u0026hellip; when I am not in my shop, people complain they miss me.\u0026rdquo; (P28) \u0026ldquo;I now believe I can achieve something in life, even after what I went through.\u0026rdquo; (P02) For some, the trauma of years with fistula still lingered, but hope for the future had replaced the despair of the past.\u003c/p\u003e\u003cdiv id=\"Sec25\" class=\"Section3\"\u003e\u003ch2\u003eAspirations for the Future\u003c/h2\u003e\u003cp\u003eLooking forward, participants expressed ambitions grounded in their restored health and new opportunities. \u0026ldquo;I want to expand my shop so I can employ others like me.\u0026rdquo; (P08) \u0026ldquo;I want to complete my studies and work in a hospital to help women with fistula.\u0026rdquo; (P15) These aspirations reflected a shift from survival to planning and self-determination.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003e This study is among the few mixed-methods evaluations of obstetric fistula care and reintegration outcomes in Cameroon, combining both clinical data and women lived experiences. Quantitatively, continence at discharge was high (93.1%), but by six months, 17.2% of women still reported urine leakage. Importantly, there was no significant link between fistula type and continence outcomes. Most cases were vesicovaginal fistula (72.4%), and many women required more than one surgery, underscoring the complexity of managing long-standing or recurrent fistula.\u003c/p\u003e\u003cp\u003eThe qualitative findings revealed that while surgical repair often brought dramatic physical and emotional relief, recovery was shaped by several factors: respectful treatment from providers, acceptance by family and community, freedom from stigma, and access to economic opportunities. Livelihood support stood out as a key driver of reintegration, helping women regain financial independence and social status. Taken together, the findings show that fistula care in Cameroon needs to go beyond surgery, addressing psychological, social, and economic dimensions to achieve lasting recovery.\u003c/p\u003e\u003cdiv id=\"Sec27\" class=\"Section2\"\u003e\u003ch2\u003eSocio-demographic Profile\u003c/h2\u003e\u003cp\u003eThe 29 women in this study reflected patterns like those seen in other research across Sub-Saharan Africa, but with some notable differences. Nearly half (48.3%) were aged 45 years or older, higher than the younger age profile (adolescents and women in their twenties) commonly reported in earlier literature (2,5). This older age distribution likely reflects delayed access to surgery, with women living for years with fistula before repair, as also documented in Ethiopia and Tanzania (6,12).\u003c/p\u003e\u003cp\u003eEducation levels were low, 55.2% had only primary education. Limited schooling is well known to increase fistula risk and delay access to treatment, as it restricts women\u0026rsquo;s autonomy, health literacy, and economic independence (5,11). Most participants (72.4%) came from Mezam Division, where Mbingo Baptist Hospital is located, suggesting that proximity to surgical centres remains a key determinant of care access, consistent with the \u0026ldquo;three delays\u0026rdquo; model (10).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec28\" class=\"Section2\"\u003e\u003ch2\u003eClinical Characteristics and Surgical Outcomes\u003c/h2\u003e\u003cp\u003eMost women presented with vesicovaginal fistula (72.4%), followed by rectovaginal fistula (20.7%), while urethrovaginal and combined fistulae were rare (3.45% each). This distribution is consistent with findings from Cameroon\u0026rsquo;s Far North Province and other Sub-Saharan countries, where prolonged obstructed labour is the leading cause of VVF (4,5). Surgical outcomes were encouraging. At discharge, 93.1% of women were continent, similar to results reported from high-volume fistula centres across Africa (4,15). However, continence dropped to 82.8% at six months, with 17.2% reporting persistent urine leakage. This decline highlights the gap between immediate closure and long-term continence, a challenge well documented in follow-up studies (17). Residual incontinence is often linked to severe tissue damage, urethral involvement, or reduced bladder capacity after repair (4).\u003c/p\u003e\u003cp\u003eStatistical analysis found no significant link between fistula type and continence at discharge (χ\u0026sup2; = 0.82, p\u0026thinsp;=\u0026thinsp;0.845). This suggests that factors such as the extent of tissue damage, number of prior surgeries, or post-operative care may be more important predictors of outcome. Similar findings have been reported in Guinea and Uganda (15,18). The median number of surgeries per woman was two (IQR: 1\u0026ndash;3), reflecting the difficulty of treating chronic or recurrent fistula. Repeated operations are common in cases with scarring or failed previous repairs, as also seen in Malawi and Ethiopia (19). These findings highlight the need for both high-quality initial surgery and ongoing access to follow-up care.\u003c/p\u003e\u003cp\u003eEconomically, participants were severely disadvantaged, with a median monthly household income of 25,000 CFA francs (~\u0026thinsp;USD 50). Poverty limits access to treatment and undermines reintegration after repair. Survivors of fistula are often unable to resume work due to stigma, residual symptoms, or lack of resources (20,21). This strengthens the argument for economic empowerment programmes as an essential component of fistula care.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec29\" class=\"Section2\"\u003e\u003ch2\u003eWomen\u0026rsquo;s Lived Experiences\u003c/h2\u003e\u003cp\u003eWomen frequently described surgery as life-changing, echoing reports from other African contexts where stopping constant leakage allowed them to regain mobility, comfort, and participation in daily life (19,22). Yet, some continued to struggle with stress incontinence or pelvic pain, consistent with challenges seen even after successful repair (19).\u003c/p\u003e\u003cp\u003eSatisfaction with treatment was closely tied to being treated with dignity and empathy. Respectful, compassionate care built trust, encouraged adherence to follow-up, and supported psychosocial recovery, findings consistent with studies in Tanzania and Uganda (12,18,23).\u003c/p\u003e\u003cp\u003eMany women spoke of a sense of \u0026ldquo;rebirth,\u0026rdquo; reflecting relief from years of shame and isolation. This transformation has been similarly described in Kenya and Guinea, where surgical repair marks a turning point in women\u0026rsquo;s lives (21,22). Post-surgical counselling was critical to consolidate this emotional healing.\u003c/p\u003e\u003cp\u003eFamily acceptance played a vital role in recovery, providing emotional and material support. However, 72% of women reported spousal abandonment or rejection by in-laws, similar to findings elsewhere in Africa (12,20). Such losses make reintegration harder and worsen survivors\u0026rsquo; economic vulnerability.\u003c/p\u003e\u003cp\u003eSome women benefited from solidarity from churches or community groups, but many still faced stigma and exclusion, often driven by misconceptions about the causes of fistula. This stigma has been reported in Cameroon and other regions (23). Evidence shows that community sensitisation can reduce these negative attitudes (24).\u003c/p\u003e\u003cp\u003eThe loss of livelihoods before surgery, and the restoration of income-generating activities through vocational training and small-business support, mirrored findings from Uganda and Malawi (18,19). In this study, economic empowerment not only restored financial independence but also improved women\u0026rsquo;s social status and sometimes led to reconciliation with estranged husbands. These results confirm the strong role of livelihood support in sustaining reintegration (15,21).\u003c/p\u003e\u003cp\u003eSome women emerged as leaders and advocates, helping to challenge stigma and encourage early treatment, similar to experiences reported in Kenya and Guinea (21,22). This shift illustrates how survivors can move from marginalisation to empowerment, rebuilding their identity and contributing to their communities.\u003c/p\u003e\u003cp\u003eMany participants expressed ambitions to grow businesses, return to school, or support other women, reflecting a shift from survival to self-determination. Such forward-looking perspectives have also been noted in long-term studies where health recovery and economic stability fuel personal growth and community contribution (19,20).\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eLimitations\u003c/h3\u003e\n\u003cp\u003eThis study involved only 29 women, which limited the statistical power, especially when comparing subgroups. Because all participants were recruited from one referral programme, the findings may not conveniently apply to other parts of Cameroon or to women treated under different care models. Continence outcomes at six months were partly based on self-reports, which may have introduced recall bias and did not allow us to measure longer-term results. Interviews took place in a hospital-affiliated setting, which may have influenced women to give more positive answers (social desirability bias). In addition, translation from local languages could have caused small losses of meaning. Despite these limitations, the mixed-methods design strengthened the study by capturing both clinical outcomes and women\u0026rsquo;s personal recovery experiences.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis mixed-methods study shows that while surgical repair in Cameroon can achieve high rates of closure and immediate continence, long-term recovery is shaped by much more than surgery alone. Six months after repair, some women still experienced leakage, while many continued to face social and economic hardships. The qualitative findings highlight that respectful and compassionate care, family and community acceptance, and access to livelihood opportunities are critical for full recovery. At the same time, stigma and poverty remain major barriers.\u003c/p\u003e\u003cp\u003e Together, these results make clear that obstetric fistula care in Cameroon needs a holistic model; one that combines surgical expertise with ongoing follow-up, counselling, community sensitisation, and economic empowerment. Learning from successful approaches in other Sub-Saharan African countries, such a model could not only improve clinical outcomes but also help restore women\u0026rsquo;s dignity, rebuild their social identity, and support their full participation in community life.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCBCHS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCameroon Baptist Convention Health Services\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCFA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCommunauté Financière Africaine (Central African CFA franc)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eIDI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eIn-depth Interview\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eIQR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eInterquartile Range\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eIRB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eInstitutional Review Board\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNGO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNon-Governmental Organization\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eRVF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eRectovaginal Fistula\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eStandard Deviation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eUNFPA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eUnited Nations Population Fund\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eUVF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eUrethrovaginal Fistula\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eVVF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eVesicovaginal Fistula\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eWHO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eWorld Health Organization\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Cameroon Baptist Convention Health Services Institutional Review Board (CBCHS IRB) (Reference: IRB2024-17). All participants provided written informed consent prior to inclusion in the study. All ethical norms were upheld with accordance to the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll participants gave consent for anonymised data and quotes to be used in publications. No identifying information is included in this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was undertaken within the framework of the Socio-Economic Empowerment of Females of Fistula Project funded by Hope and Healing International. Hope and Healing is a faith-driven charity dedicated to improving the lives of children with disabilities in some of the world’s poorest communities. Their mission is rooted in compassion, inclusion, and the belief that every child is loved and valued by God.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eG.N. and E.N. contributed to the study concept, data collection, clinical review, and validation of the manuscript. J.C.A. contributed to the study concept, supervision, writing, and validation. L.M., J.T., and D.N. participated in the implementation of the study, writing, and validation. A.N., Y.A., and G.M.A. were responsible for data collection, analysis, writing, and validation. D.W., S.N., and P.M. contributed to the study concept, supervision, writing, review, and validation of the manuscript. All authors read and approved of the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors thank the study participants for sharing their experiences, the staff of Mbingo Baptist Hospital and the Socio-Economic Development of Persons with Disabilities programme, for their support with clinical care, follow-up and interviews.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eHilton P. Vesico-vaginal fistulas in developing countries. Int J Gynaecol Obstet Off Organ Int Fed Gynaecol Obstet. 2003 Sep;82(3):285\u0026ndash;95.\u003c/li\u003e\n \u003cli\u003eWall LL. A framework for analyzing the determinants of obstetric fistula formation. Stud Fam Plann. 2012 Dec;43(4):255\u0026ndash;72.\u003c/li\u003e\n \u003cli\u003eArrowsmith S, Hamlin EC, Wall LL. Obstructed labor injury complex: obstetric fistula formation and the multifaceted morbidity of maternal birth trauma in the developing world. Obstet Gynecol Surv. 1996 Sep;51(9):568\u0026ndash;74.\u003c/li\u003e\n \u003cli\u003eWaaldijk K. Surgical classification of obstetric fistulas. Int J Gynaecol Obstet Off Organ Int Fed Gynaecol Obstet. 1995 May;49(2):161\u0026ndash;3.\u003c/li\u003e\n \u003cli\u003eTebeu PM, de Bernis L, Doh AS, Rochat CH, Delvaux T. Risk factors for obstetric fistula in the Far North Province of Cameroon. Int J Gynaecol Obstet Off Organ Int Fed Gynaecol Obstet. 2009 Oct;107(1):12\u0026ndash;5.\u003c/li\u003e\n \u003cli\u003eMuleta M, Hamlin EC, Fantahun M, Kennedy RC, Tafesse B. Health and social problems encountered by treated and untreated obstetric fistula patients in rural Ethiopia. J Obstet Gynaecol Can JOGC J Obstet Gynecol Can JOGC. 2008 Jan;30(1):44\u0026ndash;50.\u003c/li\u003e\n \u003cli\u003eMaheu-Giroux M, Filippi V, Samadoulougou S, Castro MC, Maulet N, Meda N, et al. Prevalence of symptoms of vaginal fistula in 19 sub-Saharan Africa countries: a meta-analysis of national household survey data. Lancet Glob Health. 2015 May;3(5):e271-278.\u003c/li\u003e\n \u003cli\u003eWorld Health Organisation. Obstetric fistula [Internet]. 2018 [cited 2025 Aug 16]. Available from: https://www.who.int/news-room/facts-in-pictures/detail/10-facts-on-obstetric-fistula\u003c/li\u003e\n \u003cli\u003eUNFPA. End Fistula. 2025 [cited 2025 Aug 16]. Some problems don\u0026rsquo;t have an answer - this one does. Available from: https://endfistula.org/about-campaign\u003c/li\u003e\n \u003cli\u003eThaddeus S, Maine D. Too far to walk: maternal mortality in context. Soc Sci Med 1982. 1994 Apr;38(8):1091\u0026ndash;110.\u003c/li\u003e\n \u003cli\u003eBangser M. Obstetric fistula and stigma. Lancet Lond Engl. 2006 Feb 11;367(9509):535\u0026ndash;6.\u003c/li\u003e\n \u003cli\u003eMselle LT, Kohi TW. Living with constant leaking of urine and odour: thematic analysis of socio-cultural experiences of women affected by obstetric fistula in rural Tanzania. BMC Womens Health. 2015 Nov 24;15(1):107.\u003c/li\u003e\n \u003cli\u003eGoh JTW, Sloane KM, Krause HG, Browning A, Akhter S. Mental health screening in women with genital tract fistulae. BJOG Int J Obstet Gynaecol. 2005 Sep;112(9):1328\u0026ndash;30.\u003c/li\u003e\n \u003cli\u003eDebela TF, Hordofa ZA, Aregawi AB, Sori DA. Quality of life of obstetrics fistula patients before and after surgical repair in the Jimma University Medical Center, Southwest Ethiopia. BMC Womens Health. 2021 May 21;21(1):212.\u003c/li\u003e\n \u003cli\u003eDelamou A, Delvaux T, Beavogui AH, Toure A, Koli\u0026eacute; D, Sidib\u0026eacute; S, et al. Factors associated with the failure of obstetric fistula repair in Guinea: implications for practice. Reprod Health. 2016 Nov 8;13(1):135.\u003c/li\u003e\n \u003cli\u003eKhisa AM, Nyamongo IK, Omoni GM, Spitzer RF. A grounded theory of regaining normalcy and reintegration of women with obstetric fistula in Kenya. Reprod Health. 2019 Mar 8;16(1):29.\u003c/li\u003e\n \u003cli\u003eDrew LB, Wilkinson JP, Nundwe W, Moyo M, Mataya R, Mwale M, et al. Long-term outcomes for women after obstetric fistula repair in Lilongwe, Malawi: a qualitative study. BMC Pregnancy Childbirth. 2016 Jan 5;16:2.\u003c/li\u003e\n \u003cli\u003eOluwasola TAO, O.Bello O. Clinical and Psychosocial Outcomes of Obstetrics Fistulae in Sub-Saharan Africa \u0026acirc; A Review of Literature. J Basic Clin Reprod Sci [Internet]. 2020 May 11 [cited 2025 Aug 16];9(1). Available from: https://www.jbcrs.org//abstract/clinical-and-psychosocial-outcomes-of-obstetrics-fistulae-in-subsaharan-africa--a-review-of-literature-5653.html\u003c/li\u003e\n \u003cli\u003eBigley R, Barageine J, Nalubwama H, Neuhaus J, Mitchell A, Miller S, et al. Factors associated with reintegration trajectory following female genital fistula surgery in Uganda. AJOG Glob Rep. 2023 Aug 12;3(4):100261.\u003c/li\u003e\n \u003cli\u003eWilson K, Mazhar W, Rojas-Cooley T, De Rosa V, Van Cleve L. A glimpse into the lives of 3 children: their cancer journey. J Pediatr Oncol Nurs Off J Assoc Pediatr Oncol Nurses. 2011 Apr;28(2):100\u0026ndash;6.\u003c/li\u003e\n \u003cli\u003ePollaczek L, El Ayadi AM, Mohamed HC. Building a country-wide Fistula Treatment Network in Kenya: results from the first six years (2014-2020). BMC Health Serv Res. 2022 Mar 1;22(1):280.\u003c/li\u003e\n \u003cli\u003eKaba H, Tour\u0026eacute; MA, Camara M, Johri M. Experiences of community reintegration after obstetric fistula repair at Jean Paul 2 hospital, Conakry, Guinea. PLOS Glob Public Health. 2024 Aug 6;4(8):e0003581.\u003c/li\u003e\n \u003cli\u003eTayler-Smith K, Zachariah R, Manzi M, van den Boogaard W, Vandeborne A, Bishinga A, et al. Obstetric fistula in Burundi: a comprehensive approach to managing women with this neglected disease. BMC Pregnancy Childbirth. 2013 Aug 21;13:164.\u003c/li\u003e\n \u003cli\u003eTseunwo C, Mail SHW, Antaon JSS, Obama CM, Tebeu PM, Rochat CH. Obstetric Fistula Knowledge, Attitudes and Practices among the Professionals of Communication in Yaounde. Health Sci Dis [Internet]. 2020 May 20 [cited 2025 Aug 16];21(6). Available from: https://www.hsd-fmsb.org/index.php/hsd/article/view/2048\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"discover-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Medicine](https://link.springer.com/journal/44337)","snPcode":"44337","submissionUrl":"https://submission.springernature.com/new-submission/44337/3","title":"Discover Medicine","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"obstetric fistula, reintegration, psychosocial recovery, socioeconomic empowerment, Cameroon","lastPublishedDoi":"10.21203/rs.3.rs-7590836/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7590836/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Obstetric fistula remains a significant cause of maternal morbidity in sub-Saharan Africa, with long-term physical, psychosocial, and economic consequences. Evidence on integrated recovery outcomes in Cameroon is limited. The aim of this study was to evaluate clinical, psychosocial, and economic outcomes among women treated for obstetric fistula within the Cameroon Baptist Convention Health Services.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e A mixed-method design was used to evaluate the experiences of 29 women who had undergone obstetric fistula repair and completed a minimum of six months of follow-up at Mbingo Baptist Hospital. Quantitative data on socio-demographics, fistula type, continence status, and surgical history were analysed descriptively and using chi-square and logistic regression tests. Qualitative data from in-depth interviews conducted between September and November 2024 were analyzed thematically to explore lived experiences of recovery and reintegration.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Most participants (72.4%) had vesicovaginal fistula. At discharge, 93.1% were continent; at six-month follow-up, 82.8% reported no leakage. No significant association was found between fistula type and continence at discharge (χ² = 0.82, p = 0.845). The median monthly income was $50 (IQR: $25–$90), and participants had a median of two surgeries (IQR: 1–3). Twelve qualitative themes emerged, including restoration of physical health, respectful care, emotional renewal, family support, community solidarity, persistent stigma, economic disruption, empowerment through livelihood support, leadership, and aspirations for the future.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e While high rates of anatomical closure and continence were achieved, sustained recovery depended on comprehensive care extending beyond surgery. Respectful treatment, psychosocial counselling, family engagement, community sensitization, and economic empowerment were central to successful reintegration. Fistula care programs should adopt integrated approaches that combine clinical and social models of care, tailored to the specific contexts in which they are implemented\u003c/p\u003e","manuscriptTitle":"Post-Surgical Outcomes and Social Reintegration Experiences of Women with Obstetric Fistula in Northwest Cameroon. 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