1 Department of Nursing, School of Health Sciences, Njala University, Bo, Sierra Leone.
2 Department of Epidemiology and Biostatistics, School of Public Health, Njala University, Bo, Sierra Leone.
3 Chemistry Department, School of Basic Sciences, Njala University, Moyamba District, Sierra Leone.
4 Faculty of Basic Medical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown City, Sierra Leone.
5 Department of Nursing, School of Health Sciences, Central University, Yoni Bana (Mile 91), Sierra Leone.
6 Health System Strengthen and Epidemic Prevention Project, Deutsche Gesellschaft fur Internationale Zusammenarbeit (GIZ), Freetown, Sierra Leone.
World Journal of Advanced Research and Reviews, 2026, 30(03), 821-834
Article DOI: 10.30574/wjarr.2026.30.3.1609
Received on 29 April 2026; revised on 10 June 2026; accepted on 12 June 2026
Background: Vesicovaginal fistula (VVF) is a devastating childbirth injury that inflicts a profound psychosocial toll on women, particularly in low-resource settings. Interventions have historically focused on surgical repair, yet the impact of holistic care which integrates psychosocial support with surgery on survivors' sense of dignity and self-image remains under-quantified. This study aimed to quantitatively measure the change in these psychological outcomes among VVF survivors in Sierra Leone following a holistic intervention.
Methods: We conducted a quantitative, pre-test/post-test study involving 197 VVF survivors admitted to the Aberdeen Women's Centre (AWC) in Freetown, Sierra Leone’s sole national fistula referral hospital. Participants’ self-perceived dignity and self-image were assessed using a structured questionnaire module upon admission (pre-intervention) and again before discharge (post-intervention). The intervention consisted of surgical repair complemented by AWC’s standard psychosocial care package, including counseling and health education. We used a paired-sample t-test to assess the change in scores, with a non-parametric Wilcoxon signed-rank test performed as a robustness check.
Results: We found a statistically significant improvement in mean dignity and self-image scores following the holistic intervention (t(197) = 2.64, p = 0.009). The effect size, as measured by Cohen's d, was 0.188, indicating a small but meaningful improvement. The non-parametric Wilcoxon test confirmed the significance of these findings (W = 1419, p = 0.009).
Conclusion: Beyond closing the physical injury, a holistic care model that combines surgical treatment with dedicated psychosocial support can lead to a statistically significant restoration of dignity and self-image among VVF survivors. While surgical expertise is fundamental, our findings provide quantitative evidence that integrated counseling and support are critical components for psychological recovery. We recommend that fistula care programs globally adopt and fund holistic models as the standard of care to ensure survivors not only heal physically but also reclaim their sense of self-worth
Obstetric Fistula; Vesicovaginal Fistula; Dignity; Self-Image; Psychosocial Support; Surgical Intervention; Maternal Health; Sierra Leone.
Preview Article PDF
Fatmata Gegbe, Alhassan Mayei, Patrick Fatoma, Sahr Emmanuel Lebbie and Joan Shepherd. Beyond surgical repair: A quantitative analysis of improved dignity and self-image among VVF survivors following holistic intervention in Sierra Leone. World Journal of Advanced Research and Reviews, 2026, 30(03), 821-834. Article DOI: https://doi.org/10.30574/wjarr.2026.30.3.1609