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Determinants of obstetric fistula in South-western Ethiopia


Introduction and hypothesis

Obstetric fistula, despite improved obstetric care, remains a real threat to poor women in rural Ethiopia. This study aimed to identify the risk factors that predispose women to obstetric fistula in South-western Ethiopia.


An unmatched case-control study design was employed in which 48 cases (women with obstetric fistula) and 188 controls (women without obstetric fistula) were included. Data were collected using a pre-tested structured questionnaire and organized using Epidata version 3.1. Univariate, bivariate, and multivariate analysis was conducted using SPSS version 20.0. Adjusted odds ratio, 95% confidence level, and p-values were used as the main measure of association.


The study revealed that age at pregnancy of < 18 years (AOR = 5, 95% CI = 2–13), residing in rural areas (AOR = 4, 95% CI 1.6–11), lack of antenatal care (AOR = 5, 95% CI 2–14), no history of modern contraception utilization (AOR = 5, 95% CI = 2–13), post-term pregnancy (AOR = 8, 95% CI 3–22), and duration of labor > 24 hours (AOR = 4, 95% CI 2–9) were associated with obstetric fistula.


The majority of fistula survivors were teenagers who were living in rural areas. Mothers having no antenatal care, not using modern contraception, having a post-term pregnancy, and having prolonged labor were at increased risk of developing obstetric fistula. Thus, delaying the age of first pregnancy, improving access to basic obstetric care, and advocating the use of modern contraceptive methods are crucial for teenage women residing in rural areas.

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Adjusted odds ratio


Antenatal care


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The authors would like to thank Wollega University Institute of Health Sciences for funding this study. Our sincere gratitude also goes to all supervisors, data collectors, and study participants for their cooperation and support during the study period.

Authors’ participation

TT participated in project development, data analysis, drafting, and finalizing of the manuscript.

BS participated in project development, data collection, data analysis, and manuscript editing.

EM participated in project development, supervision, data analysis, and manuscript editing.


Wollega University Institute of Health Sciences.

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Correspondence to Temesgen Tilahun.

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Tilahun, T., Sura, B. & Merdassa, E. Determinants of obstetric fistula in South-western Ethiopia. Int Urogynecol J 32, 2505–2510 (2021).

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  • Obstetric fistula
  • Risk factors
  • South-western Ethiopia