Knowledge of obstetric fistula and its associated factors among women of reproductive age in Northwestern Ethiopia: a community-based cross-sectional study

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Study Justification:
– Obstetric fistula is a significant maternal health challenge in low and middle-income countries, particularly in Ethiopia.
– High child marriage rates and poor access to healthcare contribute to the prevalence of obstetric fistula.
– There is a lack of research evidence on women’s knowledge about obstetric fistula in Ethiopia.
– This study aimed to assess women’s knowledge about obstetric fistula and its associated factors in Banja District, Northwestern Ethiopia.
Study Highlights:
– A community-based cross-sectional study was conducted in Banja District, Awi Zone, Amhara Regional State, Northwestern Ethiopia.
– The study was conducted from 1st – 21st July 2021.
– A total of 773 women in the reproductive age participated, with a response rate of 98.6%.
– One-third (36.4%) of the women had good knowledge about obstetric fistula.
– Factors significantly associated with good knowledge about obstetric fistula included education level, being a student, receiving counseling, participating in pregnant women’s discussion forums, having antenatal care follow-up, urban residence, and access to television/radio.
Recommendations for Lay Reader and Policy Maker:
– Enhance awareness creation programs to improve women’s knowledge about obstetric fistula.
– Strengthen antenatal care services to provide education and information about obstetric fistula.
– Provide counseling services to pregnant women to increase awareness and knowledge.
– Promote and support women’s discussion forums to facilitate information sharing and education.
– Improve access to education, particularly for women, to increase knowledge about obstetric fistula.
– Increase access to television and radio, as they were associated with better knowledge about obstetric fistula.
Key Role Players:
– Ministry of Health: Responsible for developing and implementing awareness creation programs, strengthening antenatal care services, and providing counseling services.
– Health Centers and Hospitals: Provide antenatal care services and counseling to pregnant women.
– Non-Governmental Organizations (NGOs): Support awareness creation programs and education initiatives.
– Community Health Workers: Engage in community-level education and awareness activities.
– Media Organizations: Collaborate to disseminate information through television and radio.
Cost Items for Planning Recommendations:
– Development and implementation of awareness creation programs.
– Training and capacity building for healthcare providers and community health workers.
– Provision of counseling services.
– Organization of pregnant women’s discussion forums.
– Production and dissemination of educational materials.
– Collaboration with media organizations for information dissemination.
– Monitoring and evaluation of the interventions.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study design is a community-based cross-sectional study, which allows for data collection from a representative sample. The sample size of 784 women is adequate for this type of study. The study used systematic sampling to recruit participants and provided training to research assistants. Data were collected using face-to-face interviews, which can provide reliable information. Descriptive statistics and logistic regression analysis were performed to identify associated factors. The study also reported adjusted odds ratios with 95% confidence intervals. However, the study is limited to a specific district in Northwestern Ethiopia, which may limit the generalizability of the findings. To improve the strength of the evidence, future studies could consider expanding the sample to include multiple districts or regions in Ethiopia. Additionally, using a longitudinal study design could provide more robust evidence on the knowledge of obstetric fistula over time.

Background: Obstetric fistula has been a major maternal health challenges in low and middle-income countries, especially in Ethiopia, due to high child marriage and poor access to healthcare. Obstetric fistula is common among teenage mothers that results in a vast social, economic and cultural sequel. In Ethiopia, there is a paucity of research evidence on women’s knowledge about obstetric fistula. Therefore, this study aimed to assess women’s knowledge about obstetric fistula and its associated factors at Banja District, Northwestern Ethiopia. Methods: A community-based cross-sectional study design was conducted from 1st -21th July 2021. Systematic sampling method was used to recruit 784 women in the reproductive age from six rural and one urban sub-districts. Two days of training was given to research assistants regarding the objective of the study, inclusion and exclusion criteria, checking completeness and ways of protecting confidentiality. Data were collected using face-to-face interview method. Collected data were entered into EpiData and exported into SPSS version 24 for cleaning and analysis. Descriptive statistics, binary and multivariable logistic regression analysis were performed to identify associated factors. Adjusted odds ratio (AOR) at 95% CI with p < 0.05 was used to declare significant association with women’s knowledge of obstetric fistula. Results: A total of 773 women gave a complete response with response rate of 98.6% (773/784). One-third (36.4%; 95%CI: 32.9-39.7%) had good knowledge about obstetric fistula. Women who had completed primary education (AOR:3.47, 95%CI:2.01–5.98), secondary and above (AOR:3.30, 95%CI:1.88–5.80), being a student (AOR: 6.78, 95%CI:3.88–11.86), get counseling about obstetric fistula (AOR:6.22, 95%CI: 3.78–10.24), participated in pregnant women’s discussion forum (AOR:3.36, 95%CI: 1.99–5.66), had antenatal care follow-up (AOR: 2.40, 95% CI: 1.39–4.13), being an urban resident (AOR: 3.19, 95% CI: 1.33–7.66), and having access to Television/Radio (AOR:1.68, 95%CI:1.10–2.60) were significantly associated with women’s good knowledge about obstetric fistula. Conclusion: Women’s knowledge about obstetric fistula is unacceptably low. Therefore, concerned stakeholders should enhance awareness creation programs, strengthen antenatal care, counselling and women’s discussion forum that could substantially optimize women’s knowledge about obstetric fistula and its risk factors of obstetric fistula.

A community-based cross-sectional study was conducted at Banja District, Awi Zone, Amhara Regional State, Northwestern Ethiopia from 1st -21st July 2021. Banja District is one of the districts in Awi zone located 447 km away from Addis Ababa, and 120 km away from Bahir Dar in Northwestern Ethiopia. According to the Zonal Health Department report (2020), Banja District had a total of 100,836 population, of these, women (15-49years) account for 23,777 (23.6%). The district, comprised of 25 rural and 2 urban sub-districts/kebeles (smallest administrative unit in Ethiopia). Banja district has 6 functional health centers, 25 satellite health posts, 3 private medium clinics, and 2 private drug stores and one general hospital [20].

Based on the provided information, here are some potential innovations that can be used to improve access to maternal health in Northwestern Ethiopia:

1. Mobile Health (mHealth) Solutions: Implementing mobile health technologies, such as text messaging and mobile applications, to provide pregnant women with important information about obstetric fistula, antenatal care, and other maternal health topics. This can help increase knowledge and awareness among women in remote areas.

2. Community Health Workers: Training and deploying community health workers who can educate women about obstetric fistula, provide counseling, and facilitate discussions on maternal health topics. These workers can also help identify and refer women in need of antenatal care or other healthcare services.

3. Strengthening Antenatal Care Services: Improving the quality and accessibility of antenatal care services in Banja District by ensuring that all pregnant women have access to regular check-ups, screenings, and counseling on obstetric fistula prevention and management.

4. Media Campaigns: Launching media campaigns, including radio and television programs, to raise awareness about obstetric fistula, its causes, and available treatment options. These campaigns can also promote the importance of antenatal care and encourage women to seek timely healthcare services.

5. Partnerships with Non-Governmental Organizations (NGOs): Collaborating with NGOs that specialize in maternal health to provide resources, training, and support to healthcare providers in Banja District. This can help improve the overall quality of maternal healthcare services and increase knowledge about obstetric fistula.

It is important to note that these recommendations are based on the provided information and may need to be further assessed and tailored to the specific context and needs of Banja District in Northwestern Ethiopia.
AI Innovations Description
The study titled “Knowledge of obstetric fistula and its associated factors among women of reproductive age in Northwestern Ethiopia: a community-based cross-sectional study” aimed to assess women’s knowledge about obstetric fistula and its associated factors in Banja District, Northwestern Ethiopia.

The study was conducted from 1st – 21st July 2021 using a community-based cross-sectional study design. A total of 784 women in the reproductive age were recruited using systematic sampling from six rural and one urban sub-districts. Research assistants were trained for two days on the study objectives, inclusion and exclusion criteria, confidentiality, and data collection methods.

Data were collected through face-to-face interviews and entered into EpiData for cleaning and analysis using SPSS version 24. Descriptive statistics, binary, and multivariable logistic regression analysis were performed to identify associated factors. The adjusted odds ratio (AOR) at a 95% confidence interval (CI) with p < 0.05 was used to determine significant associations with women's knowledge of obstetric fistula.

The results showed that one-third (36.4%) of the women had good knowledge about obstetric fistula. Several factors were found to be significantly associated with good knowledge, including completion of primary education, secondary education or higher, being a student, receiving counseling about obstetric fistula, participation in pregnant women’s discussion forums, having antenatal care follow-up, being an urban resident, and having access to television/radio.

The study concluded that women’s knowledge about obstetric fistula in Banja District is unacceptably low. The authors recommended that concerned stakeholders should enhance awareness creation programs, strengthen antenatal care, counseling, and women’s discussion forums to improve women’s knowledge about obstetric fistula and its risk factors.

It is important to note that this study provides valuable insights into the knowledge of obstetric fistula in a specific region of Ethiopia. However, further research and implementation of targeted interventions are needed to address the issue of obstetric fistula and improve access to maternal health services in Ethiopia as a whole.
AI Innovations Methodology
To improve access to maternal health in Banja District, Northwestern Ethiopia, the following innovations and recommendations can be considered:

1. Mobile Health Clinics: Implementing mobile health clinics that can travel to remote areas of the district to provide maternal health services. These clinics can offer antenatal care, postnatal care, family planning services, and education on obstetric fistula prevention.

2. Telemedicine: Introducing telemedicine services to connect pregnant women in remote areas with healthcare professionals. This can enable remote consultations, monitoring, and guidance, reducing the need for women to travel long distances for healthcare.

3. Community Health Workers: Training and deploying community health workers who can provide basic maternal health services, education, and referrals within their communities. These workers can play a crucial role in reaching women who have limited access to healthcare facilities.

4. Health Education Programs: Implementing comprehensive health education programs that focus on obstetric fistula prevention, antenatal care, safe delivery practices, and postnatal care. These programs can be conducted through community workshops, radio broadcasts, and awareness campaigns.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Baseline Data Collection: Gather data on the current state of maternal health access in Banja District, including indicators such as the number of women receiving antenatal care, the distance to the nearest healthcare facility, and the prevalence of obstetric fistula.

2. Define Simulation Parameters: Determine the specific parameters to be simulated, such as the number of mobile health clinics, the coverage area of telemedicine services, the number of trained community health workers, and the reach of health education programs.

3. Data Modeling: Use statistical modeling techniques to simulate the impact of the recommended innovations on maternal health access. This can involve creating mathematical models that take into account factors such as population size, geographical distribution, and healthcare utilization rates.

4. Scenario Testing: Run simulations using different scenarios to assess the potential impact of each innovation. For example, simulate the effect of increasing the number of mobile health clinics or expanding the coverage area of telemedicine services.

5. Impact Evaluation: Analyze the simulation results to determine the projected improvements in access to maternal health. This can include indicators such as increased antenatal care coverage, reduced travel distances for healthcare, and improved knowledge about obstetric fistula.

6. Recommendations and Implementation: Based on the simulation findings, make recommendations for the implementation of specific innovations to improve access to maternal health. Consider factors such as feasibility, cost-effectiveness, and sustainability.

By using this methodology, stakeholders can gain insights into the potential impact of different innovations and make informed decisions on how to allocate resources and prioritize interventions to improve access to maternal health in Banja District, Northwestern Ethiopia.

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