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
Ahmed S, Tunçalp Ö. The burden of obstetric fistula: from measurement to action. Lancet Glob Health. 2015;3(5):e243–4. https://doi.org/10.1016/S2214-109X(15)70105-1.
Rock JA, Jones HW. Te Linde’s operative gynecology. Philadelphia: Lippincott Williams & Wilkins; 2003. p. 1099–120.
Amna A, Sirichand P, Nadeem F. Women perception and awareness about genitourinary fistula. J Liaquat Uni Med Health Sci. 2015;14(03):129–32.
Zeleke BM, Ayele TA, Woldetsadik MA, et al. Depression among women with obstetric fistula, and pelvic organ prolapse in Northwest Ethiopia. BMC Psychiatry. 2013;13:236. https://doi.org/10.1186/1471-244X-13-236.
Mubikayi L, Chow E, Matson D, Nzau E, Tandu B. A case-control study of obstetric fistula risk factors in the Democratic Republic of the Congo. Open J Obstet Gynecol. 2016;6:740–53. https://doi.org/10.4236/ojog.2016.612092.
World Health Organization. WHO country cooperation strategy 2008-2013 (Gambia). Brazaville: World Health Organization; 2009. Available from: http://www.afro.who.int/en/gambia/country-cooperation-strategy.html
Biadgilign S, Lakew Y, Reda AA, et al. A population-based survey in Ethiopia using questionnaire as a proxy to estimate obstetric fistula prevalence: results from demographic and health survey. Reprod Health. 2013;10:14. https://doi.org/10.1186/1742-4755.
Semere L, Nour NM. Living with incontinence and shame. Rev Obstet Gynecol. 2008;1(4):3–10.
Ten Facts on Obstetric Fistula, World Health Organization Available at https://www.who.int/features/factfiles/obstetric_fistula/en/. Accessed 15 Nov 2019.
Thematic Evaluation of National Programmes and UNFPA Experience in the Campaign to End Fistula; 2010. Available at http://www.endfistula.org
Daniel NT, Mengistu AK. Causes and consequences of obstetric fistula in Ethiopia. IJMRHS. 2013;2(2):262–5.
Fekadu GA, Ambaw F, Kidanie SA. Facility delivery, and postnatal care services use among mothers who attended four or more antenatal care visits in Ethiopia: further analysis of the 2016 demographic and health survey. BMC Pregnancy Childbirth. 2019;19:64. https://doi.org/10.1186/s12884-019-2216-8.
Ampofo K, Otu T, Uchebo G. Epidemiology of vesicovaginal fistulae in northern Nigeria. West Afr J Med. 1990;9(2):98–102.
Roka ZG, Akech M, Wanzala P, et al. Factors associated with obstetric fistulae occurrence among patients attending selected hospitals in Kenya, 2010: a case-control study. BMC Pregnancy Childbirth. 2013;13:56. https://doi.org/10.1186/1471-2393-13-56.
Harrison MS, Mabeya H, Goldenberg RL et al Maternal health, neonatal, and perinatal. 2015;1: 20. https://doi.org/10.1186/s40748-015-0020-7.
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. 2017;28:1817. https://doi.org/10.1007/s00192-017-3368-6.
Okud A, Ali AA. Epidemiology of obstetric fistula in Kassala, eastern Sudan. Current Women’s Health Rev. 2013;9:223. https://doi.org/10.2174/1573404810999140303111725.
Banke-Thomas AO, Kouraogo SF, Siribie A, Taddese HB, Mueller JE. Knowledge of obstetric fistula prevention amongst young women in urban and rural Burkina Faso: a cross-sectional study. PLoS One. 2013;8(12):e85921. https://doi.org/10.1371/journal.pone.0085921.
Tebeu PM, Fomulu JN, Khaddaj S, de Bernis L, Delvaux T, Rochat CH. Risk factors for obstetric fistula: a clinical review. Int Urogynecol J. 2012;23(4):387–94. https://doi.org/10.1007/s00192-011-1622-x.
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.
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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Tilahun, T., Sura, B. & Merdassa, E. Determinants of obstetric fistula in South-western Ethiopia. Int Urogynecol J 32, 2505–2510 (2021). https://doi.org/10.1007/s00192-021-04690-5
- Obstetric fistula
- Risk factors
- South-western Ethiopia