title: Obstetric fistulae: a study of women managed at the Monze Mission Hospital, Zambia.
abstract: OBJECTIVE
  The objective of this study was to describe and compare characteristics of women with obstetric fistula.
  
  
  METHODS
  Retrospective cross-sectional study.
  
  
  METHODS
  Zambia's primary fistula repair centre, Monze Mission Hospital.
  
  
  METHODS
  All women, August 2003 to December 2005.
  
  
  METHODS
  Review of case notes to obtain data on socio-demographic and obstetric characteristics, causative pregnancy, clinical details, and treatment. Comparison of characteristics with national data was undertaken.
  
  
  RESULTS
  Of 259 women, 239 had socio-demographic and obstetric records and 254 had surgical records. Educational status and height of women were significantly below the national averages, while antenatal care uptake (97.5%) and proportion from the Northern Province were significantly above. Most women (77.9%) weighed < or = 50 kg. Median age at marriage was 18 and at development of fistula was 22 years. 15.1% of women were divorced, 49.0% were primiparous, and 27.6% were parity four +. 67.5% of women had spent 2 days or longer in labour. Delays in receiving emergency obstetric care (EmOC) were experienced at home (67.5%) and at clinics (49.4%), usually due to transport difficulties. 89.1% delivered in a health facility, 50.2% of deliveries were by caesarean section, and 78.1% of babies were stillborn. 72.9% of repairs were successful, 17.3% resulted in residual stress incontinence, and 9.8% failed. Failure was significantly associated with previous repair.
  
  
  CONCLUSIONS
  More obstetric fistulae occur in areas where early marriage and pregnancy before pelvic maturity is attained is common and where obstetric care is inaccessible. In this study, age at marriage and fistula development was older than usually found, which may indicate that poor access to EmOC contributes more to this problem within Zambia.
authors.affiliation: Department of Public Health and Epidemiology, The Medical School, University of Birmingham, Edgbaston, Birmingham, UK. arh362@bham.ac.uk
authors.forename: A
authors.initials: A
authors.lastname: Holme
authors.forename: M
authors.initials: M
authors.lastname: Breen
authors.forename: C
authors.initials: C
authors.lastname: MacArthur
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D017668:Age of Onset; D001827:Body Height; D003430:Cross-Sectional Studies; D005260:Female; D005402:Fistula / Q000453:epidemiology* / Q000601:surgery; D006801:Humans; D008875:Middle Aged; D010298:Parity; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology* / Q000601:surgery; D011256:Pregnancy Outcome; D011295:Prenatal Care / Q000706:statistics & numerical data; D012006:Rectovaginal Fistula / Q000453:epidemiology / Q000601:surgery; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D014719:Vesicovaginal Fistula / Q000453:epidemiology / Q000601:surgery; D015024:Zambia / Q000453:epidemiology