Obstetric fistula is a birth related

Obstetric fistula is a birth-related pelvic injury resulting from prolonged and obstructed labour and is characterised by involuntary loss of urine, faecal matter, or both. Obstetric fistula affects more than 2 million women residing mainly in low-income countries located in sub-Saharan Africa and Asia who do not have access to proper care during pregnancy and childbirth. Between 50 000 and 100 000 new cases occur each year. In Rwanda, a central and east African nation of 11 million people, soil-transmitted helminthiasis is endemic, with prevalence reported to be more than 50% of the population. As a result, soil-transmitted helminthiasis is a frequent comorbidity in patients with obstetric fistula admitted to Kibagabaga District Hospital for surgical intervention. Despite a risk profile unique to patients infected with soil-transmitted helminths in perioperative settings that E64d manufacturer suggests the potential for serious complications, there is no consensus among practitioners who specialise in management of patients with pelvic floor disorders on the best way to handle patients with both obstetric fistula and soil-transmitted helminthiasis. In a randomised controlled trial Koul and colleagues found that patients diagnosed with pulmonary hydatid disease treated with combined albendazole and praziquantel for 4 weeks before surgery showed the greatest decrease in scolice viability compared with untreated patients and those treated for 2 weeks. Our working group extrapolated from this finding that, in surgical candidates with soil-transmitted helminthiasis, treatment of infection should take place before elective, non-emergency surgery. We identified additional compelling evidence to support the decision to delay surgery even when anthelmintic chemotherapy has been initiated, in the observed physiological response to anthelmintic agents. First, anthelmintic chemotherapy induces hyperactivity in parasites as they seek other sites to invade in a bid to escape death. In the perioperative context, parasite hyperactivity poses a threat to the integrity of the airway. When parasites migrate up the oesophagus, pulmonary aspiration of scolices can occur. Second, persistent emesis in the perioperative period can result in underdosing, thus reducing the efficacy of anthelmintic agents. Third, some antibiotics and anti-inflammatory drugs administered during the perioperative period can interfere with the bioavailability of anthelmintic drugs. Creation of synergy between the host and visiting providers through respectful interdisciplinary partnerships facilitated shared resources to develop and implement a sustainable solution to a complex surgical problem. Most importantly, strong relationships that continue to bridge the divides between high-income and low-income countries and between non-governmental organisations and governments form the building blocks for an integrated, high-value global health delivery system.