A population based survey in Ethiopia using questionnaire as proxy to estimate obstetric fistula prevalence: Results from demographic and health survey

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Study Justification:
– Obstetric Fistula (OF) is a significant public health issue in areas with high maternal mortality rates and unattended obstructed labor.
– OF has been eradicated in high-income countries but still affects many women in low-income countries.
– Limited studies have described the prevalence and factors associated with OF in Ethiopia.
– This study aims to fill this knowledge gap and provide valuable information for addressing OF in Ethiopia.
Study Highlights:
– The study used data from the 2005 Ethiopian Demographic and Health Survey.
– A total of 14,070 women of reproductive age were included in the survey.
– 23.2% of women had heard of obstetric fistula.
– Among women who had given birth, 1.06% (103 women) had experienced obstetric fistula in their lifetime.
– It is estimated that there are nearly 142,387 obstetric fistula patients in Ethiopia.
– Factors associated with obstetric fistula include circumcision and the number of births.
Recommendations for Lay Reader and Policy Maker:
– Increase access to emergency obstetric care to prevent obstetric fistula.
– Expand fistula repair services to provide treatment for women with obstetric fistula.
– Implement active campaigns to identify and support women with obstetric fistula.
– Work towards ending obstetric fistula in Ethiopia.
Key Role Players:
– Ethiopian Ministry of Health
– Ethiopian Central Statistical Agency
– Healthcare providers and facilities
– Non-governmental organizations (NGOs) working in reproductive health
– Community health workers and volunteers
Cost Items for Planning Recommendations:
– Training and capacity building for healthcare providers
– Equipment and supplies for emergency obstetric care and fistula repair services
– Awareness campaigns and community outreach programs
– Monitoring and evaluation of interventions
– Research and data collection on obstetric fistula prevalence and factors

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is based on a population-based survey using a questionnaire. The study provides prevalence estimates and identifies factors associated with obstetric fistula in Ethiopia. However, the evidence is from a secondary analysis of data from the 2005 Ethiopia National Demographic and Health Survey, which may limit its relevance to current conditions. To improve the strength of the evidence, conducting a new survey with updated data would be beneficial. Additionally, including a larger sample size and using more rigorous statistical methods could enhance the reliability of the findings.

Background: Obstetric Fistula (OF) remains a major public health problem in areas where unattended obstructed labor is common and maternal mortality is high. Obstetric Fistula was able to be prevented, treated and eradicated in high-income countries; however, it still affects many women in low-income countries. To our knowledge, only few studies have described the prevalence and factors associated with Obstetric Fistula in Ethiopia in population-based surveys. Objective. The aim of this study is to describe the prevalence and factors associated with Obstetric Fistula in Ethiopia. Methods. The study used women’s dataset from the 2005 Ethiopian Demographic and Health Survey. The survey sample was designed to provide national, urban/rural, and regional representative estimates of key health and demographic indicators. The sample was selected using a two-stage stratified sampling process. OF was measured using questionnaire. The data is analyzed using descriptive and multivariate statistical methods to determine factors associated with Obstetric Fistula. Results: A total of 14,070 women of reproductive age group were included in the survey. Of which 23.2% ever heard of obstetric fistula. Among women who ever given birth (9,713), some 103 (1.06%, 95% CI; 0.89%-1.31%) experienced obstetric fistula in their lifetime, which means 10.6 per 1000 women who ever gave birth. It is estimated that in Ethiopia nearly 142,387 (95% CI: 115,080-169,694) of obstetric fistula patients exist. Those women who are circumcised had higher odds of reporting the condition (Chi square = 4.41, p-value = 0.036). In the logistic regression model women from rural areas were less likely to report obstetric fistula than their urban counterparts (OR = 0.21, 95% CI: 0.06-0.69). Women who gave birth 10 or more had higher odds of developing obstetric fistula than women with 1-4 child (OR = 4.34; 95% CI; 1.29-14.55). Conclusions: Obstetric fistula is a major public and reproductive health concern in Ethiopia. This calls for increased access to emergency obstetric care, expansion of fistula repair service and active finding of women with OF with campaigns of ending fistula is recommended. © 2013 Biadgilign et al; licensee BioMed Central Ltd.

This study is based on a secondary analysis of data from the 2005 Ethiopia National Demographic and Health Survey (EDHS). The survey was the second round in Ethiopia that fielded from April 27 to August 30, 2005. In the first round 15,365 women were interviewed while in the 2005 (second round) the survey was administered to 14,070 women aged 15-49 within 13,928 sampled households. Standardized questions developed by ORC Macro DHS for developing countries that were administered by the Ethiopian Central Statistical Agency. The survey questionnaire was pretested using major local languages. We used some specific questions that were included in the survey instrument and directly related towards OF such as have you ever heard of obstetric fistula (have you ever heard of a condition in which a woman continuously leaks urine and/or faces following childbirth, have you yourself experienced obstetric fistula and have you ever been treated for obstetric fistula? Responses were collected through face to face interview mode. The sample was selected using a two-stage stratified sampling process. In the first stage, 540 clusters were selected from the list of enumeration areas from the Population and Housing Census. Fieldwork was successfully completed in 535 of the 540 clusters. In the second stage, 24 to 32 households were selected systematically from each cluster for the survey sample. In brief, the survey sample was intended to provide national, urban/rural, estimates of health and demographic parameters. The survey administered the Women’s Questionnaire to all eligible women age 15-49 in the sampled households. The dependent variable for this study was women ever experienced obstetric fistula whereas the main independent variables were social-demographic, economic and maternal health care services that are expected to have association with obstetric fistula. Operationally, we define the following terms. Circumcision – a circumcised woman is said to be reported that their vagina had been sewn closed (infibulations) and untreated fistula- those women who had developed OF but they are not getting any surgical interventions. The survey data were entered and processed using CSPro statistical software that was developed jointly by the U.S. Census Bureau, Macro International Inc., and Serpro, SA (Census and Survey Processing System, 2007). We analyzed the final data using STATA® version 10.0 for windows. To examine factors associated with OF; we used both the descriptive and multivariate statistical methods. Multivariable analysis was conducted using logistic regression models. In the descriptive analysis, the distribution of respondents by the key variables and the prevalence of OF was presented by the categories of each variable. In the multivariate or adjusted logistic regression models, the outcome variable (OF) was regressed on the selected predictor variables. The statistical tests were reported as significant if the level of confidence was 95 percent or greater. The prevalence data were entered using a Microsoft Excel 2007 spreadsheet and exported into ArcGIS to visualize key estimations. The regional prevalence and household prevalence were used to develop OF prevalence map using the ArcGIS® software. The study protocol was approved by the National Ethics Review Committee of the Ethiopia Science and Technology Commission in Addis Ababa, Ethiopia and the ORC Macro Institutional Review Board in Calverton, USA.

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Based on the information provided, here are some potential innovations that could improve access to maternal health:

1. Mobile Health (mHealth) Technology: Develop and implement mobile applications or text messaging services to provide information and reminders about prenatal care, childbirth, and postnatal care. This can help educate and empower pregnant women, especially in remote areas, to make informed decisions about their health.

2. Telemedicine: Establish telemedicine services to connect pregnant women in rural or underserved areas with healthcare providers who can provide remote consultations, advice, and monitoring. This can help overcome geographical barriers and improve access to specialized care.

3. Community Health Workers: Train and deploy community health workers who can provide basic prenatal and postnatal care, as well as education and support to pregnant women in their communities. These workers can also identify high-risk pregnancies and refer women to appropriate healthcare facilities.

4. Maternal Waiting Homes: Establish maternal waiting homes near healthcare facilities to accommodate pregnant women who live far away and need to travel for childbirth. These homes can provide a safe and comfortable place for women to stay before and after delivery, reducing the risk of complications during transportation.

5. Public-Private Partnerships: Foster collaborations between government agencies, non-profit organizations, and private healthcare providers to improve access to maternal health services. This can involve subsidizing or providing financial incentives for private providers to offer affordable and quality maternal healthcare.

6. Transportation Solutions: Develop transportation systems or initiatives specifically designed to transport pregnant women to healthcare facilities quickly and safely. This can include ambulances, community transport services, or partnerships with ride-sharing companies.

7. Maternal Health Vouchers: Implement voucher programs that provide pregnant women with financial assistance to access maternal health services. These vouchers can cover the cost of prenatal care, delivery, and postnatal care, ensuring that women can afford the necessary healthcare.

8. Maternal Health Education: Increase awareness and education about maternal health through community outreach programs, workshops, and media campaigns. This can help dispel myths, promote healthy practices, and encourage women to seek timely and appropriate care.

It is important to note that these recommendations are general and may need to be adapted to the specific context and needs of Ethiopia.
AI Innovations Description
Based on the information provided, the recommendation to improve access to maternal health and address the issue of obstetric fistula in Ethiopia is as follows:

1. Increase access to emergency obstetric care: Ensure that women have access to quality emergency obstetric care services, especially in areas where unattended obstructed labor is common and maternal mortality is high. This can be achieved by improving the availability and accessibility of healthcare facilities, training healthcare providers, and equipping facilities with necessary medical supplies and equipment.

2. Expand fistula repair services: Increase the availability and accessibility of fistula repair services to ensure that women who have experienced obstetric fistula can receive appropriate treatment and care. This can be done by establishing specialized fistula treatment centers, training healthcare providers in fistula repair techniques, and raising awareness among affected women about the availability of these services.

3. Conduct active finding campaigns: Implement campaigns to actively identify and reach out to women who may be suffering from obstetric fistula but have not sought treatment. This can involve community outreach programs, awareness campaigns, and partnerships with local organizations and community leaders to identify and refer affected women to appropriate healthcare services.

4. Promote ending fistula: Raise awareness about obstetric fistula and its prevention through targeted campaigns and education programs. This can include educating women and communities about the importance of skilled birth attendance, access to emergency obstetric care, and the harmful effects of harmful traditional practices such as female genital mutilation/cutting.

By implementing these recommendations, it is hoped that access to maternal health services will be improved, and the prevalence of obstetric fistula in Ethiopia will be reduced.
AI Innovations Methodology
Based on the information provided, here are some potential recommendations to improve access to maternal health:

1. Increase access to emergency obstetric care: This could involve improving the availability and quality of healthcare facilities that can provide emergency obstetric services, such as skilled birth attendants, emergency obstetric surgery, and blood transfusion services.

2. Expand fistula repair services: Given the high prevalence of obstetric fistula in Ethiopia, there is a need to increase the availability of fistula repair services. This could involve training more healthcare providers in fistula repair techniques and establishing specialized fistula treatment centers.

3. Conduct campaigns to raise awareness and end fistula: Public awareness campaigns can help educate communities about obstetric fistula, its causes, and available treatment options. These campaigns can also help reduce the stigma associated with obstetric fistula and encourage affected women to seek treatment.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could be developed as follows:

1. Define the indicators: Identify key indicators that can measure the impact of the recommendations, such as the number of women accessing emergency obstetric care, the number of fistula repair surgeries performed, and changes in awareness and knowledge about obstetric fistula.

2. Collect baseline data: Gather data on the current status of maternal health access, including the availability of emergency obstetric care facilities, the number of fistula repair surgeries performed, and the level of awareness about obstetric fistula among the target population.

3. Develop a simulation model: Create a simulation model that incorporates the baseline data and simulates the impact of the recommendations over a specific time period. The model should consider factors such as population demographics, healthcare infrastructure, and the effectiveness of awareness campaigns.

4. Input intervention scenarios: Input different scenarios into the simulation model to assess the potential impact of the recommendations. For example, simulate the effect of increasing the number of healthcare facilities providing emergency obstetric care or expanding the availability of fistula repair services.

5. Analyze the results: Evaluate the simulation results to determine the potential impact of the recommendations on improving access to maternal health. This could involve comparing the indicators before and after implementing the interventions or comparing different intervention scenarios to identify the most effective strategies.

6. Refine and iterate: Based on the simulation results, refine the recommendations and simulation model as needed. Iterate the process to further optimize the interventions and assess their potential impact on improving access to maternal health.

It is important to note that the methodology described above is a general framework and may need to be adapted based on the specific context and available data.

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