title: Prevalence of symptoms of vaginal fistula in 19 sub-Saharan Africa countries: a meta-analysis of national household survey data.
abstract: BACKGROUND
  Vaginal fistula is a serious medical disorder characterised by an abnormal opening between the vagina and the bladder or rectum, which results in continuous leakage of urine or stool. The burden of this disorder in sub-Saharan Africa is uncertain. We estimated the lifetime and point prevalence of symptoms of vaginal fistula in this region using national household surveys based on self-report of symptoms.
  
  
  METHODS
  We considered all Demographic and Health Surveys (DHS) and Multiple Indicators Cluster Surveys (MICS) from sub-Saharan Africa and included data for women of reproductive age (15-49 years). We estimated lifetime prevalence and point prevalence of vaginal fistula with use of Bayesian hierarchical meta-analysis.
  
  
  RESULTS
  We included 19 surveys in our analysis, including 262,100 respondents. Lifetime prevalence was 3.0 cases (95% credible interval 1.3-5.5) per 1000 women of reproductive age. After imputation of missing data, point prevalence was 1.0 case (0.3-2.4) per 1000 women of reproductive age. Ethiopia had the largest number of women who presently have symptoms of vaginal fistula.
  
  
  CONCLUSIONS
  This study is the first to estimate the burden of vaginal fistula in 19 sub-Saharan Africa countries using nationally representative survey data. Point prevalence was slightly lower than previously estimated but these earlier estimates are within the prevalence's credible intervals. Although vaginal fistula is relatively rare, it is still too common in sub-Saharan Africa.
  
  
  BACKGROUND
  None.
authors.affiliation: Department of Global Health & Population, Harvard TH Chan School of Public Health, Boston, MA, USA.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Maheu-Giroux
authors.affiliation: London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: Véronique
authors.initials: V
authors.lastname: Filippi
authors.affiliation: London School of Hygiene & Tropical Medicine, London, UK; Pôle Epidémiologie et Biostatistique, Institut de Recherche Expérimentale et Clinique, Faculté de Santé Publique, Université Catholique de Louvain, Brussels, Belgium.
authors.forename: Sékou
authors.initials: S
authors.lastname: Samadoulougou
authors.affiliation: Department of Global Health & Population, Harvard TH Chan School of Public Health, Boston, MA, USA.
authors.forename: Marcia C
authors.initials: MC
authors.lastname: Castro
authors.affiliation: Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Maulet
authors.affiliation: Centre Muraz, Ministry of Health, Bobo-Dioulasso, Burkina Faso; Université de Ouagadougou, Ouagadougou, Burkina Faso.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Meda
authors.affiliation: London School of Hygiene & Tropical Medicine, London, UK. Electronic address: fati.kirakoya@lshtm.ac.uk.
authors.forename: Fati
authors.initials: F
authors.lastname: Kirakoya-Samadoulougou
mesh_terms: D000293:Adolescent; D000328:Adult; D017954:Africa South of the Sahara / Q000453:epidemiology; D001499:Bayes Theorem; D005260:Female; D006306:Health Surveys; D006801:Humans; D008875:Middle Aged; D015995:Prevalence; D014624:Vaginal Fistula / Q000453:epidemiology*; D055815:Young Adult