The Lancet Global Health
May 2015 Volume 3 Number 5 e240-e296
http://www.thelancet.com/journals/langlo/issue/current
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Comment
Burden of obstetric fistula: from measurement to action
Saifuddin Ahmed, Özge Tunçalp
Open Access
DOI: http://dx.doi.org/10.1016/S2214-109X(15)70105-1
For every maternal death, an additional 20–30 women develop serious pregnancy-related complications. Among all maternal morbidities, obstetric fistula is one of the most devastating. It is caused by injury during childbirth, resulting in an abnormal opening between the vagina and the bladder (vesicovaginal fistula) or rectum (rectovaginal fistula), leading to continuous urinary or fecal incontinence. Obstructed labour is the most common cause of vesicovaginal fistula in low-income countries.1 Worldwide, an estimated 2–3 million women have obstetric fistula,1 almost exclusively in sub-Saharan Africa and south Asia.
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Articles
Prevalence of symptoms of vaginal fistula in 19 sub-Saharan Africa countries: a meta-analysis of national household survey data
Mathieu Maheu-Giroux, ScD, Véronique Filippi, PhD, Sékou Samadoulougou, PhD, Marcia C Castro, PhD, Nathalie Maulet, MPH, Prof Nicolas Meda, MD, Dr Fati Kirakoya-Samadoulougou, PhD
Open Access
DOI: http://dx.doi.org/10.1016/S2214-109X(14)70348-1
Summary
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.
Findings
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.
Interpretation
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.
Funding
None.