title: Health and social problems encountered by treated and untreated obstetric fistula patients in rural Ethiopia.
abstract: OBJECTIVE
  To assess health, social, and psychological problems encountered by women with treated and untreated obstetric fistula (OF).
  
  
  METHODS
  A cross-sectional study consisting of quantitative and qualitative components was conducted in seven administrative regions of rural Ethiopia. Fifty-two women with OF were interviewed on the subjects of their socioeconomic status and history of the development of OF. Qualitative in-depth interviews were conducted with 27 of the untreated women and seven of the treated women.
  
  
  RESULTS
  A total of 19 153 houses were surveyed, and 55 women with fistulae were identified, of whom 52 were interviewed. Thirty-six of the interviewed women (69.2%) were divorced, 10 (19.2%) were not allowed to eat with family members, and 23 (44.2%) were not members of any community associations. Of the 48 women with feelings of depression, 28 (54.2%) had suicidal ideation. Twenty-four women attributed their development of a fistula to evil spirits, to a curse, or to sin. The in-depth interviews revealed that treatment improved family and social life; however, some health, social, and sexual problems remained.
  
  
  CONCLUSIONS
  Women with OF encounter health, psychological, and social consequences that are not completely resolved by repairing the fistula. The care of women with OF should go beyond surgical treatment and should include support for their reintegration into the community with proper follow-up.
authors.affiliation: Addis Ababa Fistula Hospital, Addis Ababa, Ethiopia.
authors.forename: Mulu
authors.initials: M
authors.lastname: Muleta
authors.affiliation: Addis Ababa Fistula Hospital, Addis Ababa, Ethiopia.
authors.forename: E Catherine
authors.initials: EC
authors.lastname: Hamlin
authors.affiliation: Department of Reproductive Health, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.
authors.forename: Mesganaw
authors.initials: M
authors.lastname: Fantahun
authors.affiliation: Addis Ababa Fistula Hospital, Addis Ababa, Ethiopia.
authors.forename: Ruth C
authors.initials: RC
authors.lastname: Kennedy
authors.affiliation: Addis Ababa Fistula Hospital, Addis Ababa, Ethiopia.
authors.forename: Biruk
authors.initials: B
authors.lastname: Tafesse
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D001294:Attitude to Health; D003430:Cross-Sectional Studies; D005002:Ethiopia; D005260:Female; D006801:Humans; D008875:Middle Aged; D007744:Obstetric Labor Complications; D011247:Pregnancy; D012006:Rectovaginal Fistula / Q000150:complications*; D012424:Rural Population; D012918:Social Alienation; D012944:Social Support; D012959:Socioeconomic Factors; D014719:Vesicovaginal Fistula / Q000150:complications*