Risk factors for vaginal fistula symptoms in Sub-Saharan Africa: a pooled analysis of national household survey data.
BACKGROUND
Vaginal fistula (VF) is one of the most severe maternal morbidities with the immediate consequence of chronic urinary and/or fecal incontinence. The epidemiological evidence regarding risk factors for VF is dominated by facility-based studies. Our aim is to estimate the effect size of selected risk factors for VF using population-based survey data.


METHODS
We pooled all available Demographic and Health Surveys and Multiple Indicators Cluster Surveys carried out in sub-Saharan Africa that collected information on VF symptoms. Bayesian matched logistic regression models that accounted for the imperfect sensitivity and specificity of self-reports of VF symptoms were used for effect size estimation.


RESULTS
Up to 27 surveys were pooled, including responses from 332,889 women. Being able to read decreased the odds of VF by 13% (95% Credible Intervals (CrI): 1% to 23%), while higher odds of VF symptoms were observed for women of short stature (<150 cm) (Odds Ratio (OR) = 1.31; 95% CrI: 1.02-1.68), those that had experienced intimate partner sexual violence (OR = 2.13; 95% CrI: 1.60-2.86), those that reported sexual debut before the age of 14 (OR = 1.41; 95% CrI: 1.16-1.71), and those that reported a first birth before the age of 14 (OR = 1.39; 95% CrI: 1.04-1.82). The effect of post-primary education, female genital mutilation, and having problems obtaining permission to seek health care were not statistically significant.


CONCLUSIONS
Increasing literacy, delaying age at first sex/birth, and preventing sexual violence could contribute to the elimination of obstetric fistula. Concomitant improvements in access to quality sexual and reproductive healthcare are, however, required to end fistula in sub-Saharan Africa.
Department of Infectious Disease Epidemiology, Imperial College London, St Mary's Hospital, London, UK.
Mathieu
M
Maheu-Giroux
Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
Véronique
V
Filippi
Institute of Health and Society, Université Catholique de Louvain, Clos Chapelle-aux-champs, Brussels, Belgium.
Nathalie
N
Maulet
Pôle Épidemiologie et Biostatistique, Institute de recherche expérimentale et Clinique, Université Catholique de Louvain, Clos Chapelle-aux-champs, Brussels, Belgium.
Sékou
S
Samadoulougou
Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA.
Marcia C
MC
Castro
Centre Muraz, Ministry of Health, Bobo-Dioulasso, Burkina Faso.|UFR Sciences de la Santé, Université de Ouagadougou, Ouagadougou, Burkina Faso.
Nicolas
N
Meda
Institute of Food and Resources Economics, Section for Global Development, University of Copenhagen, Copenhagen, Denmark.
Mariève
M
Pouliot
Faculté de Santé Publique, Université catholique de Louvain, Brussels, Belgium. fati.kirakoya@uclouvain.be.
Fati
F
Kirakoya-Samadoulougou
D000293:Adolescent; D000328:Adult; D017954:Africa South of the Sahara / Q000453:epidemiology; D001499:Bayes Theorem; D019093:Circumcision, Female; D004522:Educational Status; D005191:Family Characteristics; D005260:Female; D006306:Health Surveys; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D016017:Odds Ratio; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology / Q000209:etiology*; D012307:Risk Factors; D012742:Sex Offenses; D014624:Vaginal Fistula / Q000453:epidemiology / Q000209:etiology*; D055815:Young Adult
Obstetric fistula; rectovaginal fistula; reproductive health; sexual health; vesicovaginal fistula; women’s health