L Lewis Wall1,2,3, Shewaye Belay4, Tesfahun Haregot5, Jonathan Dukes6, Eyoel Berhan7, Melaku Abreha5. 1. Department of Obstetrics and Gynecology, Ayder Referral Hospital, College of Health Sciences, Mekelle University, Mekelle, Ethiopia. WALLL@wustl.edu. 2. Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, MO, USA. WALLL@wustl.edu. 3. Department of Anthropology, Washington University, Campus Box 1114, One Brookings Drive, St Louis, MO, 63130-8159, USA. WALLL@wustl.edu. 4. Department of Microbiology, College of Health Sciences, Mekelle University, Mekelle, Ethiopia. 5. Mekelle Hamlin Fistula Center, Mekelle, Ethiopia. 6. Performance Solution, Data Engineering and Analytics, Mercy Health, Chesterfield, MO, USA. 7. St Paul's Millennium Medical School, Addis Ababa, Ethiopia.
Abstract
INTRODUCTION AND HYPOTHESIS: We tested the null hypothesis that there were no differences between patients with obstetric fistula and parous controls without fistula. METHODS: A unmatched case-control study was carried out comparing 75 women with a history of obstetric fistula with 150 parous controls with no history of fistula. Height and weight were measured for each participant, along with basic socio-demographic and obstetric information. Descriptive statistics were calculated and differences between the groups were analyzed using Student's t test, Mann-Whitney U test where appropriate, and Chi-squared or Fisher's exact test, along with backward stepwise logistic regression analyses to detect predictors of obstetric fistula. Associations with a p value <0.05 were considered significant. RESULTS: Patients with fistulas married earlier and delivered their first pregnancies earlier than controls. They had significantly less education, a higher prevalence of divorce/separation, and lived in more impoverished circumstances than controls. Fistula patients had worse reproductive histories, with greater numbers of stillbirths/abortions and higher rates of assisted vaginal delivery and cesarean section. The final logistic regression model found four significant risk factors for developing an obstetric fistula: age at marriage (OR 1.23), history of assisted vaginal delivery (OR 3.44), lack of adequate antenatal care (OR 4.43), and a labor lasting longer than 1 day (OR 14.84). CONCLUSIONS: Our data indicate that obstetric fistula results from the lack of access to effective obstetrical services when labor is prolonged. Rural poverty and lack of adequate transportation infrastructure are probably important co-factors in inhibiting access to needed care.
INTRODUCTION AND HYPOTHESIS: We tested the null hypothesis that there were no differences between patients with obstetric fistula and parous controls without fistula. METHODS: A unmatched case-control study was carried out comparing 75 women with a history of obstetric fistula with 150 parous controls with no history of fistula. Height and weight were measured for each participant, along with basic socio-demographic and obstetric information. Descriptive statistics were calculated and differences between the groups were analyzed using Student's t test, Mann-Whitney U test where appropriate, and Chi-squared or Fisher's exact test, along with backward stepwise logistic regression analyses to detect predictors of obstetric fistula. Associations with a p value <0.05 were considered significant. RESULTS:Patients with fistulas married earlier and delivered their first pregnancies earlier than controls. They had significantly less education, a higher prevalence of divorce/separation, and lived in more impoverished circumstances than controls. Fistulapatients had worse reproductive histories, with greater numbers of stillbirths/abortions and higher rates of assisted vaginal delivery and cesarean section. The final logistic regression model found four significant risk factors for developing an obstetric fistula: age at marriage (OR 1.23), history of assisted vaginal delivery (OR 3.44), lack of adequate antenatal care (OR 4.43), and a labor lasting longer than 1 day (OR 14.84). CONCLUSIONS: Our data indicate that obstetric fistula results from the lack of access to effective obstetrical services when labor is prolonged. Rural poverty and lack of adequate transportation infrastructure are probably important co-factors in inhibiting access to needed care.
Authors: Blake C Alkire; Jeffrey R Vincent; Christy Turlington Burns; Ian S Metzler; Paul E Farmer; John G Meara Journal: PLoS One Date: 2012-04-25 Impact factor: 3.240
Authors: Milton W Musaba; Grace Ndeezi; Justus K Barageine; Andrew Weeks; Victoria Nankabirwa; Felix Wamono; Daniel Semakula; James K Tumwine; Julius N Wandabwa Journal: PLoS One Date: 2020-02-10 Impact factor: 3.240