Abstract
Vaginal fistula is a serious medical disorder characterised by an abnormal opening between the vagina and the bladder or rectum, which results in continuous leakage of urine or stool. The burden of this disorder in sub-Saharan Africa is uncertain. We estimated the lifetime and point prevalence of symptoms of vaginal fistula in this region using national household surveys based on self-report of symptoms. We considered all Demographic and Health Surveys (DHS) and Multiple Indicators Cluster Surveys (MICS) from sub-Saharan Africa and included data for women of reproductive age (15-49 years). We estimated lifetime prevalence and point prevalence of vaginal fistula with use of Bayesian hierarchical meta-analysis. We included 19 surveys in our analysis, including 262,100 respondents. Lifetime prevalence was 3.0 cases (95% credible interval 1.3-5.5) per 1000 women of reproductive age. After imputation of missing data, point prevalence was 1.0 case (0.3-2.4) per 1000 women of reproductive age. Ethiopia had the largest number of women who presently have symptoms of vaginal fistula. This study is the first to estimate the burden of vaginal fistula in 19 sub-Saharan Africa countries using nationally representative survey data. Point prevalence was slightly lower than previously estimated but these earlier estimates are within the prevalence's credible intervals. Although vaginal fistula is relatively rare, it is still too common in sub-Saharan Africa. None.
Highlights
Vesicovaginal or rectovaginal fistula is a serious disorder in which an abnormal opening exists between the vagina and the bladder or rectum
Data sources We considered all nationally representative Demographic and Health Surveys (DHS) and Multiple Indicators Cluster Surveys (MICS) reports with available individual-data records from sub-Saharan Africa
29 population-based surveys done in sub-Saharan Africa included questions about vaginal fistula
Summary
Vesicovaginal or rectovaginal fistula (vaginal fistula) is a serious disorder in which an abnormal opening (fistula) exists between the vagina and the bladder or rectum. Vaginal fistula in resource-poor settings usually results from prolonged or obstructed labour (obstetric fistula), but can be the result of sexual assault or inadvertent injuries during surgery, among other reasons. It is a highly debilitating condition, with women often ostracised because of the resulting constant leakage of urine or stool through the vagina.[1,2] Eliminating obstetric fistula has been on the agenda of the United Nations Population Fund, through its Campaign to End Fistula, and the US Agency for International Development (USAID) programme for almost a decade.[3,4] quantifying progress through reliable health indicators is difficult. The most recent community-based estimate of prevalence, using data from only two African countries (Ethiopia and The Gambia), is 1·60 (95% CI 1·16–2·10) obstetric fistulas per 1000 women of reproductive age.[5]
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