Procesamiento y análisis de resultados

Project Co- ordinator, WHO/UNFPA Mogadishu, SOMALIA. 1. Safe Motherhood in Somalia. 2. FGM in Somalia Memo to Maternal Health/Safe Motherhood, WHO Geneva Unpublished Somalia Review of Maternal Mortality and Morbidity in Somalia

Merka Hospital maternal and infant morbidity/mortality 12 months

January - December 1995.

Type of FGM: not

recorded (usually Type III in Somalia).

· Neonatal deaths · Maternal deaths · Births by sex gender · Caesarean section and

deaths

· Frequency of FGM

· Beliefs for performing FGM · Consequences of FGM

Reviews Somali FGM data from Abdalla, 1982.

Not clear if section on FGM is a review or relates to personal observation.

Not extracted:

Details of death rates

Describes complications of possibly all types of FGM.

Before operation on children

Worry, anxiety, sleeplessness, nightmares and panic.

At the time of the marriage

· Perineal, urethral, rectal laceration by force by husband i.e. defloration trauma/haemorrhage

Obstetric

· Prolonged/ obstructed labour No cases or data to substantiate reports:

Maternal/perinatal morbidity statistics present but no inference can be made regarding risk attributable to FGM

Not extracted:

Immediate complications or those within the first 10 days

Table 12

Summary of studies included in the review arranged alphabetically by author

Study Review categories, study population, country, study design, study size

Outcome measures, follow-up

Results Commentary and implications

SILBERSTEIN, A.J. 1977 Circoncision Feminine en Cote d'Ivoire.

Ann Soc Belge Med Trop 1977 57 : 129 - 135 Review Case Reports N = 4 immediate complications N = 4 obstetric Cote d'Ivoire Odienne Hospital

Ethnic group

North west Malinke (Muslim originating in Mali

Guere (non Muslim)

FGM Type II. Age at FGM: 6, 13, 16 years Immediate complications Haemorrhage 4/4. Long term

· Secondary scarring following excision leading to vulval adhesions

Obstetric

Need for anterior episiotomy: 4 cases seen

Urinary disturbance

Not extracted:

List of review complications.

Francophone Africa

Long term sequelae of FGM II

Gynaecological

Secondary scarring and adhesions. Obstetric

Table 12

Summary of studies included in the review arranged alphabetically by author

Study Review categories, study population, country, study design, study size

Outcome measures, follow-up

Results Commentary and implications TAHZIB, F. 1983 Epidemiological determinants of vesico-vaginal fistulas. British Journal of Obstetrics and Gynaecology 1983 90 : 387 - 391 Case series:

Ahmadu Bello University, Kaduna State, Northern Nigeria

Patients operated on for vesico-vaginal fistula from January 1969 to December 1980. N = 1443 Questionnaire in 54 parts. FGM Type IV (Gishiri cuts).

Ethnic groups using Gishiri cutting: Hausa

Fulani Kanuri

Age at FGM: IV;

depends on indication for gishiri cut.

· Aetiological factors leading to fistulas. · Duration of labour

and mode of delivery in patients with fistula caused by labour.

· Age and parity when the fistula occurred. · Relational between

incidence of age on severity of VVF lesions for those with labour as the

aetiological factor. · Age of gishiri cutting

in Hausa patients, and gishiri cuts as direct cause of VVF. · Social determinants

of gishiri cuts (FGM Type IV).

Aetiological factors leading to fistulas.

Prolonged labour 1209/1443 (83.8 %) Surgical trauma 14/1443 ( 1.0 %) Infection 10/1443 ( 0.7 %) Gishiri cut 188/1443 (13.0 %) Others (including 22/1443 ( 1.5 %) coitus, pelvic fracture,

insertion of caustic materials into vagina)

Age and Parity

Nullips 63/1443 (4.4%) Nullips aged less than 13 years 31/63

Primips 751/1443 (52%) Other details not extracted

Traditional practice of Gishiri cutting and frequency of fistulas

13% of all fistulas due to Gishiri cutting, increasing significantly in frequency and importance as a direct cause of fistulas with increasing age.

Age and experience of having had gishiri cutting in Hausa patients. (Hausa N = 1068).

% with Gishiri cuts but as

Age Yes gishiri cut No gishiri cut Not certain direct aetiological factor 13 yrs. 18/61 (30%) 19/61 (31.1%) 24/61 (39%) 16% 14-19 124/513 (24%) 131/513 (26%) 258/513 (50%) 7% 20-30 111/301 (37.%) 79/301 (26%) 111/301 (37%) 15% 31-39 35/66 (52%) 11/66 (17%) 20/66 (31%) 35% >40 yrs. 26/29 (90%) 2/29 (6.9%) 1/29 (3.4%) 90% not known 33/98 (33%) 21/98 (21%) 44 /98 (45%) 21% Total 347/1068 (33%) 263/1068 (25%) 458/1068 (43%) 161/1068 (15%) Useful information on FGM IV, Gishiri cutting in Northern Nigeria. Social determinants/ Indications for Gishiri cuts Obstructed labour. · Infertility · Dyspareunia · Amenorrhoea · Goitre · Backache · Dysuria Gishiri cuts in under 13 years often for dyspareunia, occasion-ally by husband when wife could not be penetrated Suggests sequelae of Gishiri cuts Gynaecological and Obstetric (N = 188) · 13% of Vesico- vaginal fistulae N = 1443) due to

Not extracted:

· Education.

· Environment and the quality and utilization of medical services. · Other outcome measures listed.

Caustic materials in vagina mentioned as cause of fistula used for infertility, dyspareunia and other complaints.

Table 12

Summary of studies included in the review arranged alphabetically by author

Study Review categories, study population, country, study design, study size

Outcome measures, follow-up

Results Commentary and implications

TAHZIB, F. 1985 Vesico-vaginal Fistula in Nigerian Children. Lancet 2 (II) : 1291-1293, 1985 Report of vesico-vaginal fistula (VVF) in children less than 13 years From large VVF Case series.

All patients operated on for genitourinary fistula in Ahmadu Bello University, Northern Nigeria, from 1969 - 1980

N = 1443, with 54 page proforma

Current report on under 13 years. Of these, the number under the age of thirteen when they become incontinent N = 80.

FGM Type IV (Gishiri

cuts, “anterior and occasionally the posterior aspect of vagina is incised by a sharp instrument”)

Ethnic groups

Hausa, Fulani, Kanuri tribes · Aetiology of VVF · Duration · Description · Type of Operation. Aetiology of VVF

· Gishiri cuts (FGM Type IV) 12/80 (15%) · prolonged labour 48/80 (60%) · infection 8/80 (10%) · other causes 12/80 (15%) (including coitus 4/12) Important information.

Describes general indications for Gishiri cuts (FGM IV) · prevention and treatment of obstructed labour. · amenorrhoea · dyspareunia · coital difficulties · infertility · high fever · goitre

· generalised body aches and pains · ill health

· vulval rash

Paediatric gishiri cuts mostly for · dyspareunia

· amenorrhoea · coital dysfunction

· also for abdominal pain, vulval rashes, ill health, high fever

· infertility; one case done by husband to under introitus.

Suggests sequelae of Gishiri cuts.

· Vesico-vaginal fistulae mainly mid-vaginal. · Total or partial destruction of the urethra. · Haemorrhage.

Table 12

Summary of studies included in the review arranged alphabetically by author

Study Review categories, study population, country, study design, study size

Outcome measures, follow-up

Results Commentary and implications

WILLIAMS N. D.