Survival Modeling on the Determinants of Time to Recovery from Obstetric Fistula: The Case of Mekelle Hamlin Fistula Center, Ethiopia

Abstract

Background. An obstetric fistula is an abnormal opening between the vagina, rectum, and/or bladder. Obstetric fistula has a devastating impact on women’s physical, social, and psychological health. Despite the numerous health consequences in developing countries, including Ethiopia, there have been few studies on the determinants of time to recovery from obstetric fistula. Therefore, this study is aimed at addressing the gap. Methods. A retrospective cohort study was employed to include 328 randomly selected records of women admitted for obstetric fistula treatment at Mekelle Hamlin Fistula Center from January 2015 to 2020. Data collected from the medical records was coded and entered into SPSS software version 20 and exported to STATA 10 and R statistical software for data cleaning and data analysis. The Kaplan-Meier and log-rank tests were computed to explore the data. The log-logistic inverse Gaussian shared frailty model was employed using a 95% CI, and variables with a p value < 0.05 were declared as determinants of recovery time. Results. Of 328 fistula patients, 293 (89.33%) were physically cured. The Kaplan-Meier result showed that the overall mean and median survival time of time to recovery from obstetric fistula patients at Mekelle Hamlin Fistula Center is 42 and 33 days, respectively. In a log-logistic inverse Gaussian shared frailty model analysis, extensive fistula size (AHR : 1.282; 95% CI = 1.175-1.388), secondary and above education level (AHR : 0.830; 95% CI = 0.693-0.967), rural residence (AHR : 1.357; 95% CI = 1.236-1.479), and physiotherapy use ( AHR : 0.801 , 95% CI = 0662 -0.940, 95% CI = 1.175 -1.388) were statistically significant predictors of recovery from obstetrics fistula. Conclusion. Rural place of residence, home delivery, and large and extensive size of the fistula prolong the timing of healing from the obstetric fistula. However, having tall height, physiotherapy treatment, secondary and above-educated women, and RVF type of fistula has a short time of healing for obstetric fistula in Mekelle Hamlin Fistula Center. Therefore, we recommend that health professionals promote institutional delivery and physiotherapy, shorten the duration of catheterization, and manage urine incontinence. In addition, we recommend that the regional health bureau promotes female education and pregnancy after 18 years. The survival probability of patients with obstetric fistulas is better predicted by the log-logistic inverse Gaussian shared frailty model. Therefore, it would be good for future researchers to take this model into account.

Successful surgical closure and continence rate of obstetric fistula in Africa: systematic review and meta-analysis

“…This review includes studies from 24 different African nations. Of the total, 4 (4.71%) were from Northern Africa ( 26 – 29 ), 10 (11.76%) were from Central Africa ( 13 , 16 , 30 – 37 ), 31 (34.12%) were from West Africa ( 38 – 68 ), and 40 (47.06%) ( 19 , 69 – 107 ) were from East Africa ( Figure 2 ). The majority of the included articles were from Sub-Saharan African countries such as Ethiopia, Nigeria, and the Democratic Republic of Congo.…”

The Silent Suffering: Obstetric Fistula in Ethiopia

“…In Ethiopia, there has been a dedicated effort to opening fistula centers and decreasing the prevalence of obstetric fistula. Located in Northern Ethiopia, the Mekelle Hamlin Fistula Center was recorded to have conducted 2000 surgeries per year from 2010 through 2013; of these operations, 89.3% were successful (Bihon et al, 2022;Kumsa Meikena et al, 2023). In Southern Ethiopia, the Yirgalem Hamlin fistula center had less success, with a rate of repair failure of 28.8%.…”

“…With an estimated 80% of its population residing in rural areas, Ethiopia's population distribution may contribute to the prevalence of obstetric fistula in rural regions. Home delivery is likely more common in rural areas, and has been shown to be a risk factor for obstetric fistula (OECD & Policy Studies Institute, 2020b, 2020a; Bihon et al, 2022).…”