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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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