Risk factors for obstetric fistula in Western Uganda: a case control study.
BACKGROUND
Two million women worldwide are living with genital fistula with an annual incidence of 50,000-100,000 women. Risk factors for obstetric fistula are context bound. Studies from other countries show variation in the risk factors for obstetric fistula. This study was conducted to identify risk factors for obstetric fistula in western Ugandan context.


METHODS
A case control study comparing background factors of women with obstetric fistula (cases) and women without fistula (controls) was conducted in western Uganda. Data was collected using face-to-face interviews. Univariate, bivariate and multivariate analysis was conducted using Stata 12.


RESULTS
Altogether, 420 respondents (140 cases and 280 controls) participated in the study. Duration of labour was used to form the product terms when assessing for interaction and confounding since it was one the most significant factors at bivariate level with a narrow confidence interval and was hence considered the main predictor. After adjusting for interaction and confounding, significant risk factors associated with development of obstetric fistula in western Uganda were: Caesarean section (adjusted odds ratio [AOR] = 13.30, 95% CI = 6.74-26.39), respondent height of 150 cm or less (AOR = 2.63, 95% CI = 1.35-5.26), baby weight of 3.5 kg or more (AOR = 1.52, 95% CI = 1.15-1.99), prolonged labour (AOR = 1.06, 95% CI = 1.04-1.08. A quarter of the fistulas had resulted from iatrogenic complication during caesarean section. Compared to no education, post primary level of education was protective against obstetric fistula (AOR = 0.31, 95% CI = 0.13-0.72) and there was no difference between respondents without education and those with primary level education.


CONCLUSIONS
Surgeons contribute to a big proportion (25%) of fistula cases hence caesarean section being a risk factor in this region. Other risk factors include; prolonged labour, weight of the baby of 3.5 kg or more, respondent height of 150 cm or less (short stature), and low or no education are risk factors for obstetric fistula in western Ugandan.
Department of Obstetrics and Gynecology, School of medicine, Makerere University College of Health Sciences/Mulago National Referral Hospital, Kampala, Uganda; Department of Public Health Sciences, Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden.
Justus Kafunjo
JK
Barageine
Department of epidemiology and biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda.
Nazarius Mbona
NM
Tumwesigye
Department of Obstetrics and Gynecology, School of medicine, Makerere University College of Health Sciences/Mulago National Referral Hospital, Kampala, Uganda.
Josaphat K
JK
Byamugisha
Department of Public Health Sciences, Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden.
Lars
L
Almroth
Department of Public Health Sciences, Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden.
Elisabeth
E
Faxelid
D000293:Adolescent; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D002648:Child; D036861:Delivery, Obstetric / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008875:Middle Aged; D011247:Pregnancy; D062486:Public Health Surveillance; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014454:Uganda / Q000453:epidemiology; D014624:Vaginal Fistula / Q000453:epidemiology* / Q000209:etiology*; D055815:Young Adult