Determinants and Heterogeneity of Time -to- Recovery from Obstetric Fistula Patients; Comparison of Acceleration Failure Time and Parametric Shared Frailty Models.

Abstract

Obstetric Fistula is a medical condition that involves an opening or perforation between the vagina and the bladder or the vagina and the rectum. It is a serious, life threatening and often debilitating medical condition that affects thousands of women in developing countries.The study consists of 270 obstetric fistula patients having all required information who were taking treatment at Jimma University Specialized Hospital in south west Ethiopia from January, 2011 to January ,2017. The log-rank and generalized wilcoxon test were used to explore the association between the recovery time and different independent categorical covariates. Then using different baseline distribution parametric models were employed to have an appropriate model for the recovery time/status of the patients based on Akaike information criteria (AIC) of the model. Result of Both log-rank and generalized wilcoxon test showed that there were significant differences among obstetric fistula patients in survival experience of weight , marital status, Residence, Incontinence, Antenatal care, mode of delivery, status of urethra and types of fistula of patients at 5% level of significance. Based on AIC log-normal gamma shared frailty model is an appropriate model and there is heterogeneity between patients with zone. The final model showed that marital status, Residence, Incontinence, Antenatal care, status of urethra and types of fistula were the determinants of recovery status of the patients at 5% level of significance. In Conclusion, the result showed that married women, rural residence, incontinence of urine more than 3 months, hadn't antenatal care and completely damaged urethra were prolonged time recovery time of patients whereas having recto-vaginal-fistula shorten recovery status than vesico-vaginal fistula group of patients.

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

“…A similar conclusion was drawn from research carried out in Gondar [15], Addis Ababa, and developing countries [14,22,23]. Moreover, similar to the results of the present study, a study from Jimma University revealed that RVF patients recover more quickly than VVF patients [24].…”

Effect of vaginal scarring on the recovery of surgical repair of obstetric fistula in Northern Ethiopia

“…Data were collected by four data collectors using an English‐version structured data abstraction checklist, after review of different kinds of literature and previous similar studies, 8–12 which was organized according to the objective of the study. The collected data were coded, entered, cleaned, and checked for clarity, consistency, and completeness up to the end of each data collection period.…”

“…If the patient was recovered from a surgical repair of obstetric fistula within 21 days following surgery it was considered as an event of interest, and if the patient was not recovered from a surgical repair of obstetric fistula within 21 days following surgery or if the patient had died following an operation it was considered as censored. 15 Data were collected by four data collectors using an Englishversion structured data abstraction checklist, after review of different kinds of literature and previous similar studies, [8][9][10][11][12]…”

“…There are also differences in the length of follow‐up of patients to estimate the median time to recovery. Some studies used a shorter end point to declare patients as recovered or censored 8–12 …”

“…Some studies used a shorter end point to declare patients as recovered or censored. [8][9][10][11][12] In Ethiopia, there is a paucity of information regarding the recovery rate of patients with obstetric fistula and predictors of successful repair of obstetric fistula, and the current study intended to determine the predictors of recovery from obstetric fistula. This will guide health professionals and health policymakers to identify indicators for monitoring women with obstetric fistula and applying necessary preventive measures to decrease the time to recovery.…”