Prevalence of obstetric fistula: a population‐based study in rural Pakistan

Abstract

Objective To estimate the prevalence of obstetric fistula, its duration and impact on women's daily life using robust data collection methods in a population-based sample in rural Pakistan.Design A population-based, cross-sectional study.Setting A rural community in Sindh Province, Pakistan.Population Randomly selected women aged 15 years or older.Methods A multistage random sampling strategy was used to recruit the women. Lady Health Workers interviewed women in their own homes using a structured questionnaire to obtain symptom data. Women with symptoms of incontinence were then examined by female gynaecologists in their local health facilities to confirm obstetric fistula.Main outcome measure Obstetric fistula confirmed by gynaecological examination.Results Among the 5064 women interviewed (96% response rate), 20 women with obstetric fistula were identified, showing a prevalence of 0.39% of all women (95% confidence interval [95% CI] 0.22-0.57%) and 0.45% of parous women (95% CI 0.25-0.65%). Significantly more of the women with obstetric fistula compared with parous women without fistula were primiparae and aged <20 years. Of the women with obstetric fistula, 40% had had this for >5 years and 90% reported a major impact on their lives, yet only four had consulted a doctor, three of whom had failed repairs.Conclusions The prevalence of obstetric fistula is high in rural Pakistan. Appropriate provision is needed for fistula repair to reduce the burden of the condition. Alongside this, the improvement of maternity care services is urgently needed to prevent its continued occurrence.

Validation of an obstetric fistula screening questionnaire in rural Nepal: a community‐based cross‐sectional and nested case–control study with clinical examination

“…A 2013 systematic review and meta‐analysis found only ten studies that used clinically confirmed cases to estimate community‐based OF prevalence; four of these were conducted in sub‐Saharan Africa or South Asia . Subsequent to the review, two population‐based cross‐sectional studies from southern Sudan and Pakistan used confirmatory clinical examinations; however, neither of these studies used a control population to assess the validity of the screening questions used to identify cases . At present, there is no widely used, well‐validated fistula screening tool.…”

“…The OF prevalence estimates from other population‐based studies with confirmatory clinical examinations from sub‐Saharan Africa and South Asia vary widely, and were significantly higher than those found in our study: 162 per 100 000 women (95% CI 153–264) in Ethiopia ( n = 19 153); 95 per 100 000 women (95% CI 2–526) in Gambia ( n = 1038); 30 per 100 000 women (95% CI 10–100) in Southern Sudan ( n = 8865); 86 per 100 000 (95% CI 2–480) in Maharashtra, India ( n = 1167); 260 per 100 000 (95% CI 7–1439) in Karnataka, India; and 390 per 100 000 women (95% CI 220–570) or 450 per 100 000 parous women (95% CI 250–650) in Pakistan ( n = 5064) . Notably, these studies used different sampling methodologies and none of the studies examined controls (women who did not report symptoms of OF).…”

Perceptions and experiences of women seeking treatment for obstetric fistula

“…In this study of 215 Indian women presenting for obstetric fistula care/repair, key findings were generally similar to studies from Pakistan and Bangladesh, including maternal characteristics such as illiteracy or low level of education, low age of marriage (median 18 years), and residing in rural areas or urban slums. In our study, the median age at development of fistula was 26 years, with a median parity of 2.0.…”

Association between parity and fistula location in women with obstetric fistula: a multivariate regression analysis

“…In Malawi, the prevalence of OF is estimated to be 1.6 per 1000 women (1, 2), one of the highest estimates in the world. Previous descriptive studies in sub-Saharan Africa have found that a majority of fistula patients are young, primiparous women with short stature – all factors that contribute to an immature and contracted pelvis, cephalopelvic disproportion, and obstructed labor (3, 4). However, older and multiparous women also develop OF, even though they are less likely to have risk factors for obstructed labor.…”