Abstract
Introduction and hypothesis
We tested the null hypothesis that there were no differences between patients with obstetric fistula and parous controls without fistula.
Methods
A unmatched case–control study was carried out comparing 75 women with a history of obstetric fistula with 150 parous controls with no history of fistula. Height and weight were measured for each participant, along with basic socio-demographic and obstetric information. Descriptive statistics were calculated and differences between the groups were analyzed using Student’s t test, Mann–Whitney U test where appropriate, and Chi-squared or Fisher’s exact test, along with backward stepwise logistic regression analyses to detect predictors of obstetric fistula. Associations with a p value <0.05 were considered significant.
Results
Patients with fistulas married earlier and delivered their first pregnancies earlier than controls. They had significantly less education, a higher prevalence of divorce/separation, and lived in more impoverished circumstances than controls. Fistula patients had worse reproductive histories, with greater numbers of stillbirths/abortions and higher rates of assisted vaginal delivery and cesarean section. The final logistic regression model found four significant risk factors for developing an obstetric fistula: age at marriage (OR 1.23), history of assisted vaginal delivery (OR 3.44), lack of adequate antenatal care (OR 4.43), and a labor lasting longer than 1 day (OR 14.84).
Conclusions
Our data indicate that obstetric fistula results from the lack of access to effective obstetrical services when labor is prolonged. Rural poverty and lack of adequate transportation infrastructure are probably important co-factors in inhibiting access to needed care.
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Acknowledgements
The authors gratefully acknowledge the contributions of our data collectors: Haregeweyni Hailu Kasaye, Henok Mulugeta, and Haftom Beyene at Ayder Referral Hospital; Azeb Kalayu, Almaz Teamer, and Hiwot Alemayehu at the Mekelle Hamlin Fistula Centre; and Beletu Tekay at Adikala Health Center, Seanit Tarekegne at the Hewane Health Center, and Etsay Kiros and the Bahir Tsaba Health Center out in the rural weredas. Meseret Tadesse provided inestimable help with data entry. The authors also acknowledge the assistance of Alison Shigo and the Healing Hands of Joy in coordinating recruitment and transportation of the previously treated obstetric fistula patients to the interviews.
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This project was funded through a Fulbright Scholarship awarded to Dr L. Lewis Wall by the Bureau of Educational and Cultural Affairs, United States Department of State, with the cooperation of the Council for the International Exchange of Scholars. Research was carried out through his affiliation with the Department of Obstetrics and Gynecology, Ayder Referral Hospital and the College of Health Sciences, Mekelle University, Mekelle, Ethiopia. None of the authors has any competing interests to disclose.
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Lewis Wall, L., Belay, S., Haregot, T. et al. A case–control study of the risk factors for obstetric fistula in Tigray, Ethiopia. Int Urogynecol J 28, 1817–1824 (2017). https://doi.org/10.1007/s00192-017-3368-6
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DOI: https://doi.org/10.1007/s00192-017-3368-6