Abstract
BackgroundVaginal fistula (VF) is one of the most severe maternal morbidities with the immediate consequence of chronic urinary and/or fecal incontinence. The epidemiological evidence regarding risk factors for VF is dominated by facility-based studies. Our aim is to estimate the effect size of selected risk factors for VF using population-based survey data.MethodsWe pooled all available Demographic and Health Surveys and Multiple Indicators Cluster Surveys carried out in sub-Saharan Africa that collected information on VF symptoms. Bayesian matched logistic regression models that accounted for the imperfect sensitivity and specificity of self-reports of VF symptoms were used for effect size estimation.ResultsUp to 27 surveys were pooled, including responses from 332,889 women. Being able to read decreased the odds of VF by 13 % (95 % Credible Intervals (CrI): 1 % to 23 %), while higher odds of VF symptoms were observed for women of short stature (<150 cm) (Odds Ratio (OR) = 1.31; 95 % CrI: 1.02-1.68), those that had experienced intimate partner sexual violence (OR = 2.13; 95 % CrI: 1.60-2.86), those that reported sexual debut before the age of 14 (OR = 1.41; 95 % CrI: 1.16-1.71), and those that reported a first birth before the age of 14 (OR = 1.39; 95 % CrI: 1.04-1.82). The effect of post-primary education, female genital mutilation, and having problems obtaining permission to seek health care were not statistically significant.ConclusionsIncreasing literacy, delaying age at first sex/birth, and preventing sexual violence could contribute to the elimination of obstetric fistula. Concomitant improvements in access to quality sexual and reproductive healthcare are, however, required to end fistula in sub-Saharan Africa.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-016-0871-6) contains supplementary material, which is available to authorized users.
Highlights
Vaginal fistula (VF) is one of the most severe maternal morbidities with the immediate consequence of chronic urinary and/or fecal incontinence
Surveys characteristics A total of 31 surveys collected information on VF symptoms in sub-Saharan Africa
A little over a third of women were able to read (38.6 %), a quarter had completed post-primary education (26.8 %), 42.2 % had experienced female genital mutilation (FGM), 8.7 % had a height below 150 cm, 9.0 % of ever married women had experienced intimate partner sexual violence, 11.0 % of sexually active women had their first sexual intercourse before the age of 14, 3.8 % of primi/multiparous women had their first birth before the age of 14, and 18.3 % of women reported that obtaining permission to seek health care was a big problem for them
Summary
Vaginal fistula (VF) is one of the most severe maternal morbidities with the immediate consequence of chronic urinary and/or fecal incontinence. The epidemiological evidence regarding risk factors for VF is dominated by facility-based studies. Our aim is to estimate the effect size of selected risk factors for VF using population-based survey data. In sub-Saharan Africa, maternal disorders are the second most important cause of death among women of reproductive age (15-49 years old) [1]. The etiology of vaginal fistula (VF), an abnormal hole between the bladder (vesico-vaginal fistula) and/ or rectum (recto-vaginal fistula) and the reproductive tract of a woman, is divided into two main categories: obstetric and traumatic. The vast majority of VF in sub-Saharan Africa are of obstetric origins and prevalence of this condition in this region was recently estimated to be between 1.0 and 1.6 per 1,000 women of reproductive age depending on methodology [10, 11]
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