Beyond surgical repair: A quantitative analysis of improved dignity and self-image among VVF survivors following holistic intervention in Sierra Leone

Abstract

**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