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Prevalence of obstetric fistula and symptomatic pelvic organ prolapse in rural Ethiopia

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Introduction and objective

Little is known about the extent to which women in low- and middle-income countries suffer with urological and urogynaecological complications of childbirth. This study measured the prevalence of obstetric fistula and symptomatic pelvic organ prolapse (POP) in east and north Ethiopia.


We randomly selected 23,023 women of reproductive age (15–49 years) from 113 villages in East Harraghe, South Gondar and West Gojjam, Ethiopia. Trained local health workers administered a validated face-to-face survey and a team of researchers verified data by readministering a random selection (5 %) of the survey. All suspected fistulae were followed up to confirm a clinical diagnosis.


Mean age was 29.5 [standard deviation (SD) 8.05] years. Only 22 % of women were knowledgeable about the symptoms of fistula. The prevalence of all obstetric fistulae was 6:10,000 reproductive-aged women [95 % confidence interval (CI) 3–8], of untreated fistula 2:10,000 (95 % CI 0–4) and of symptomatic POP 100:10,000 (95 % CI 86–114).


The prevalence of obstetric fistula in these rural zones of Ethiopia is relatively low and reflects a substantial reduction from previous reports. Significant numbers of women suffer with symptomatic POP, for which surgical and nonsurgical treatments would be beneficial.

Brief summary

Obstetric fistula in north and east Ethiopia is relatively low; however, the many women with symptomatic pelvic organ prolapse could benefit from treatment.

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  1. Ahmed S, Holtz SA (2007) Social and economic consequences of obstetric fistula: life changed forever? Int J Gynaecol Obstet 99:S10–S15

    Article  PubMed  Google Scholar 

  2. Central Statistical Agency (Ethiopia) (2014) Ethiopia Mini Demographic & Health Survey. Addis Ababa: Ethiopia Accessed September 7 2015

  3. Jelovsek J, Maher C, Barber M (2007) Pelvic organ prolapse. Lancet 369:1027–1038

  4. Adler AJ, Ronsmans C, Calvert C, Filippi V (2013) Estimating the prevalence of obstetric fistula: a systematic review and meta-anaylsis. BMC Pregnancy Childbirth 13:246

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Maheu-Giroux M, Filippi V, Samadoulougou S, Castro M, Maulet N, Kirakoya-Samadoulougou F (2015) Prevalence of symptoms of vaginal fistula in 19 sub-Saharan Africa countries: a meta-analysis of national household survey data. Lancet Glob Health 3(5):e271–78

    Article  PubMed  Google Scholar 

  6. Ballard K, Belete Z, Kinfu H, Tadesse M, Amin M, Atnafu H (2015) The impact of antenatal and intra-partum care on the stillbirth rate among 4,441 women in rural Ethiopia. Int J Gyne & Obs. [Accepted for publication]

  7. Central Statistical Agency (Ethiopia). Ethiopia Demographic & Health Survey (2005) Addis Ababa: Ethiopia

  8. UNFPA. The Campaign to End Fistula; Ten years on. Accessed 10th August 2015

  9. Muleta M, Fantahun M, Tafesse B, Hamlin EC, Kennedy RC (2007) Obstetric fistula in rural Ethiopia. East African Medical Journal. November: 526–534

  10. Ethiopian Ministry of Health (Ethiopia) Health Sector Development Programme IV 2010/11-2014/15. October 2010; Addis Ababa: Ethiopia Accessed September 7th 2015

  11. Ministry of Finance & Economic Development (Ethiopia). Growth and Transformation Plan; Annual Progress Report for financial year 2012/13. (2014) Addis Ababa: Ethiopia Accessed 13th September 2015

  12. Ministry of Health (Ethiopia) Health and Health related indicators 2012/13. Addis Ababa: Ethiopia Accessed September 7 2015

  13. Browning A, Menber B (2008) Women with obstetric fistula in Ethiopia: a 6-month follow-up after treatment. BJOG 115(12):1564–1569

  14. Scherf C, Morison L, Fiander A, Ekpo G, Walraven G (2002) Epidemiology of pelvic organ prolapse in rural Gambia, West Africa. BJOG 109:431–436

    Article  PubMed  Google Scholar 

  15. Akmel M, Segni H (2012) Pelvic organ prolapse in Jimma University specialised hospital, southwest Ethiopia. Ethiop J Health Sci 22(2):85–92

    PubMed  PubMed Central  Google Scholar 

  16. United Nations. Millennium Development Goals Report 2015. United Nations: New York Accessed September 2015.

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We are very grateful to Johnson & Johnson for providing funding for this project and to Hamlin Fistula Ethiopia for supporting the use of valuable resources. Many people contributed to the research, including health extension workers who collected data; health center staff who assisted in data verification; Hirut Kinfu, Mebkyou Tadesse, and Mohammed Amin who trained data collectors; and volunteers Greg Morris, Clara Cantalapiedra, and Jacinta Evans who entered data; and Harriet Andrews, Camilla Ducker, and Ellen Pieterse who assisted with data verification and training of data collectors. Last but not least, we are grateful to the women who kindly allowed us into their homes and their generosity in giving us the time to ask personal questions.

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Correspondence to Karen Ballard.

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The project was supported by resources from Hamlin Fistula Ethiopia and external funding from Johnson & Johnson. The funders had no role in study design, data collection and analysis, decision to publish, or manuscript preparation.

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Details of Ethical Approval

The study was granted ethical approval from the Oromia Health Bureau and the Amhara Health Bureau. Permission to undertake the study was also granted by the heads of each district and Hamlin Fistula Ethiopia.

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Ballard, K., Ayenachew, F., Wright, J. et al. Prevalence of obstetric fistula and symptomatic pelvic organ prolapse in rural Ethiopia. Int Urogynecol J 27, 1063–1067 (2016).

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