Health Workers’ Assessment of the Frequency of and Caring for Urinary and Fecal Incontinence among Female Victims of Sexual Violence in the Eastern Congo: An Exploratory Study

Gunnel Andersson¹, Berthollet Bwira Kaboru^1*, Annsofie Adolfsson^1,2, Edmond Ntabe Namegabe³

¹School of Health and Medical Sciences, Fakultetsgatan 1, Örebro University, Örebro, Sweden.
²The Centre for Women’s, Family and Child Health, Faculty of Health Sciences, Buskerud & Vestfold University College, Kongsberg, Norway.
³Faculty of Community Health and Development, Université Libre des Pays des Grands Lacs, Goma, Congo Democratic Republic.

DOI: 10.4236/ojn.2015.54038                

Abstract

Background: Throughout the long war that the Democratic Republic of Congo (DRC) has endured, women and children have been depicted as the primary victims of widespread sexual violence. In some settings women have been raped in entire villages, with devastating physical and psychological consequences, which include sexually transmitted infections such as HIV, trauma and fistulas, as well as social isolation and involuntary pregnancies. The aim of this study was to assess the prevalent perceptions of health professionals on the magnitude of urine and/or fecal incontinence among assaulted women, caused by sexual violence, as well as the opinions regarding the type of care provided to affected women. Methods: The study was part of a larger pilot study that had a cross-sectional design and a descriptive approach, which explored health professionals’ views regarding their own levels of competence at responding to the health needs of victims of sexual violence, in the form of a semi-structured questionnaire. Results: 104 health workers responded to the questionnaire. Nurses reported seeing raped women more frequently on a day-to-day basis (69.2%), in comparison to medical doctors and social workers (11.5%). Urinary incontinence was common according to 79% of health workers, who estimated that up to 15% of the women affected experienced huge amounts of urine leakage. Only 30% of the care seekers underwent in depth investigations, but the majority of the victims were not offered any further examination or appropriate treatments. Conclusion: Urinary and fecal incontinence due to urogenital or colorectal fistulas among women exposed to sexual violence is a common in the specified setting, but lack of systematic investigation and appropriate treatment means that the quality of life of the victims may be negatively affected. An improvement in the ability of health workers to manage these complex diagnoses is urgently needed, as well as adequately equipping health services in the affected settings.

Keywords

Sexual Violence, Fistulas, Urinary Incontinence, Fecal Incontinence, Congo

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Nyago, K. (2003) Congo-Kinshasa: The Forgotten Holocaust. In the Monitor, Kampala.
[2]	Coghlan, B. Brennan, R.J., Ngoy, P., Dofara, D., Otto, B., Clements, M. and Stewart, T. (2006) Mortality in the Democratic Republic of Congo: A Nationwide Survey. The Lancet, 367, 44-51. http://dx.doi.org/10.1016/S0140-6736(06)67923
[3]	Longombe, A.O., Claude, K.M. and Ruminjo, J. (2008) Fistula and Traumatic Genital Injury from Sexual Violence in a Conflict Setting in Eastern Congo: Case Studies. Reproductive Health Matters, 16, 132-141. http://dx.doi.org/10.1016/S0968-8080(08)31350-0
[4]	Omba Kalonda, J.C. (2008) Sexual Violence in the Democratic Republic of Congo: Impact on Public Health? Medecine tropicale, 68, 576-578.
[5]	Harvard Humanitarian Initiative (2010) “Now the World is Without Me”: An Investigation of Sexual Violence in Eastern Democratic Republic of Congo. In: A Report by the Harvard Humanitarian Initiative with Support from Oxfam America, Harvard Humanitarian Initiative & Oxfam International, Boston, 32-38.
[6]	Wakabi, W. (2008) Sexual Violence Increasing in Democratic Republic of Congo. The Lancet, 371, 15-16. http://dx.doi.org/10.1016/S0140-6736(08)60051-3
[7]	De Ridder, D., et al. (2009) Fistulas in the Developing World. In: Abrams, P., et al., Eds., Incontinence, Health Publications Ltd., Paris.
[8]	Onsrud, M., et al. (2008) Sexual Violence-Related Fistulas in the Democratic Republic of Congo. International Journal of Gynecology & Obstetrics, 103, 265-269. http://dx.doi.org/10.1016/j.ijgo.2008.07.018
[9]	Steiner, B., Benner, M.T., Sondorp, E., Schmitz, U.M. and Rosenberger, S. (2009) Sexual Violence in the Protracted Conflict of DRC Programming for Rape Survivors in South Kivu. Conflict and Health, 3, 3-12.
[10]	Onsrud, M., et al. (2008) Sexual Violence-Related Fistulas in the Democratic Republic of Congo. International Journal of Gynecology & Obstetrics, 103, 265-269. http://dx.doi.org/10.1016/j.ijgo.2008.07.018
[11]	Kelly, J.T., Betancourt, T.S., Mukwege, D., Lipton, R. and Vanrooyen, M.J. (2011) Experiences of Female Survivors of Sexual Violence in Eastern Democratic Republic of the Congo: A Mixed-Methods Study. Conflict and Health, 5, 25-25. http://dx.doi.org/10.1186/1752-1505-5-25
[12]	Abrams, P., et al. (2009) Incontinence in 4th International Consultation on Incontinence. Health Publication Ltd., Paris.
[13]	WHO (2004) Global Burden of Disease 2004 Update: Disability Weights for Diseases and Conditions. WHO, Geneva.
[14]	Teunissen, D., et al. (2006) Urinary Incontinence in the Elderly: Attitudes and Experiences of General Practitioners. A Focus Group Study. Scandinavian Journal of Primary Health Care, 24, 56-61. http://dx.doi.org/10.1080/02813430500417920
[15]	Andersson, G., Johansson, J.-E., Nilsson, K. and Sahlberg-Blom, E. (2008) Accepting and Adjusting: Older Women’s Experiences of Living with Urinary Incontinence. Urologic Nursing, 28, 115-121.
[16]	Bartels, S.A., et al. (2012) Demographics and Care-Seeking Behaviors of Sexual Violence Survivors in South Kivu province, Democratic Republic of Congo. Disaster Medicine and Public Health Preparedness, 6, 393-401. http://dx.doi.org/10.1001/dmp.2012.66
[17]	Kaboru, B.B., Andersson, G., Borneskog, C., Adolfsson A. and Namegabe, E.N. (2014) Knowledge and Attitudes toward Sexual Violence in Conflict-Affected Rural Communities in the Walikale District, DR Congo: Implications for Rural Health Services. Annals of Public Health and Research, 1, 1009-1015.
[18]	Bartels, S., et al. (2013) Militarized Sexual Violence in South Kivu, Democratic Republic of Congo. Journal of Interpersonal Violence, 28, 340-358. http://dx.doi.org/10.1177/0886260512454742