Birth-Aid is a charity established by a team of urogynaecologists from the Warrell Unit, Saint Mary's Hospital, Manchester in April 2016 (http://www.birth-aid.org.uk/). The charity helps women with childbirth injuries by providing surgical treatment and training for local health professionals in the prevention and treatment of future birth injuries. Before formal registration of the charity, teams of consultants and junior doctors from gynaecology, obstetrics, neonatal medicine and colorectal surgery had been holding two surgical camps a year at Holy Family Virika Hospital in Uganda for the previous 3 years, and this pattern has continued (with a pause due to COVID-19).
Uganda is located within the central east of Africa and had a population of over 39 million in 2017 (Institute for Health Metrics and Evaluation (IHME), 2021). Despite significant improvements reducing the level of poverty in Uganda, 20% of Ugandans live below the national poverty line, with 35% of the population living on US$1.90 or less per person per day (World Bank, 2016). Total annual expenditure on health per person is US$43 compared with US$4315 in the UK (World Health Organization (WHO), 2021). There is a high fertility rate (IHME, 2021) coupled with delayed or limited access to emergency obstetric care, for geographical, financial or cultural reasons (Kyei-Nimakoh et al, 2017). Data are limited regarding the prevalence of birth injuries such as obstetric fistula and obstetric anal sphincter injuries in Uganda, as with many low-income countries (Tunçalp et al, 2015). However, the causative factors behind birth injuries, such as delayed or limited access to antenatal or emergency obstetric care and unsupervised deliveries, correlate with increased maternal mortality (Browning and Patel, 2004; Wall et al, 2005). In fact, it is estimated that for each maternal death, 30 women will suffer ‘injuries, infection and disabilities’.
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