Uterine artery embolization in Tanzania: a procedure with major public health implications

• Type of Material: Article
• Authors: Balowa Musa, Muhimbili University; Jared Mark Alswang, Harvard Medical School; Rose Di Ioia, Université McGill; Lydia Grubic, Marian University; Azza Naif, Muhimbili National Hospital; Erick Michael Mbuguje, Muhimbili National Hospital; Victoria Vuong, University of California San Diego; Janice Newsome, Emory University; Behnam Shaygi, London North West University Healthcare NHS Trust; Vijay Ramalingam, Harvard Medical School; Fabian Max Laage Gaupp, Yale School of Medicine
• Language: English
• Date: 2023-12-01
• Publisher: Springer
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2023
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1186/s42155-023-00384-9
• Title of Journal or Parent Work: CVIR Endovascular
• Volume: 6
• Issue: 1
• Start Page: 40
• End Page: 40
• Grant/Funding Information: This work has received no specific funding. The training program in which this work took place in was supported by the RSNA Research and Education Foundation (#6614).
• Keywords: Tanzania; Sub-Saharan Africa; Uterine artery embolization; Postpartum hemorrhage; Adenomyosis; Uterine fibroid embolization; Uterine fibroids; Reproductive health; Interventional radiology
• Research Categories: Health Sciences, Radiology; Health Sciences, Obstetrics and Gynecology

Abstract

Background: The burden of uterine fibroids is substantial in sub-Saharan Africa (SSA), with up to 80% of black women harboring them in their lifetime. While uterine artery embolization (UAE) has emerged as an effective alternative to surgery to manage this condition, the procedure is not available to the vast majority of women living in SSA due to limited access to interventional radiology (IR) in the region. One of the few countries in SSA now offering UAE in a public hospital setting is Tanzania. This study aims to assess the safety and effectiveness of UAE in this new environment. Methods: From June 2019 to July 2022, a single-center, retrospective cohort study was conducted at Tanzania’s first IR service on all patients who underwent UAE for the management of symptomatic fibroids or adenomyosis. Patients were selected for the procedure based on symptom severity, imaging findings, and medical management failure. Procedural technical success and adverse events were recorded for all UAEs. Self-reported symptom severity and volumetric response on imaging were compared between baseline and six-months post-procedure using paired sample t-tests. Results: During the study period, 92.1% (n = 35/38) of patients underwent UAE for the management of symptomatic fibroids and 7.9% (n = 3/38) for adenomyosis. All (n = 38/38) were considered technically successful and one minor adverse event occurred (2.7%). Self-reported symptom-severity scores at six-months post-procedure decreased in all categories: abnormal uterine bleeding from 8.8 to 3.1 (-5.7), pain from 6.7 to 3.2 (-3.5), and bulk symptoms from 2.8 to 1 (-1.8) (p < 0.01). 100% of patients reported satisfaction with outcomes. Among the nine patients with follow-up imaging, there was a mean volumetric decrease of 35.5% (p = 0.109). Conclusions: UAE for fibroids and adenomyosis can be performed with high technical success and low complication rates in a low-resource setting like Tanzania, resulting in significant symptom relief for patients. Building capacity for UAE has major public health implications not only for fibroids and adenomyosis, but can help address the region’s leading cause of maternal mortality, postpartum hemorrhage.