title: Factors associated with obstetric fistulae occurrence among patients attending selected hospitals in Kenya, 2010: a case control study.
abstract: BACKGROUND
  In Kenya, about 3000 fistula cases are estimated to occur every year with an incidence of 1/1000 women. This study sought to identify risk factors associated with developing obstetrics fistula in order to guide implementation of appropriate interventions.
  
  
  METHODS
  An unmatched case control study was conducted in three major hospitals in Kenya between October and December 2010. Cases were patients who had fistula following delivery within the previous five years. Controls were systematically selected from women who attended obstetrics and gynecology clinics at these hospitals, and did not have present or past history of fistula. Odds ratio was used as measure of association with their corresponding 95% confidence interval. Factors with p value of <0.1 were included into forward additive logistic regression model to generate adjusted odds ratios.
  
  
  RESULTS
  Seventy cases and 140 controls were included in the study. Independent risk factors associated with obstetrics fistula included duration of labour of >24 hours (OR = 4.7, 95% CI = 2.4 -9.2), seeking delivery services after 6 hours of labour onset (OR = 6.9, 95% CI = 2.2-21.3), taking more than 2 hours to reach a health facility (OR = 5.7, 95% CI = 2.9 -11.5), having none or primary education (OR = 9.6, 95% CI = 3.3 -27.9) and being referred to another facility for emergency obstetrics services (OR = 8.6, 95% CI = 2.7 -27).
  
  
  CONCLUSIONS
  Risk factors for developing obstetrics fistula were delays in care seeking including delay in making decision to seek delivery servers after six hours of labour onset, taking more than two hours to reach a health facility, labour duration of more than 24 hours and having no formal or primary education. Efforts geared at strengthening all levels of the health system to reduce delays in access to emergency obstetric care are needed.
authors: Kenya Field epidemiology and laboratory program Ministry of Public Health and Sanitation Kenya, P.O. BOX 21691-00100, Nairobi, Kenya. qallygr@yahoo.co.uk
authors: Zeinab Gura
authors: ZG
authors: Roka
authors: Mathias
authors: M
authors: Akech
authors: Peter
authors: P
authors: Wanzala
authors: Jared
authors: J
authors: Omolo
authors: Sheba
authors: S
authors: Gitta
authors: Peter
authors: P
authors: Waiswa
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D036861:Delivery, Obstetric / Q000009:adverse effects*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007630:Kenya / Q000453:epidemiology; D007743:Labor, Obstetric / Q000502:physiology*; D016015:Logistic Models; D007744:Obstetric Labor Complications / Q000453:epidemiology / Q000209:etiology*; D011247:Pregnancy; D011644:Puerperal Disorders / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D014624:Vaginal Fistula / Q000453:epidemiology / Q000209:etiology*