Treatment-seeking for vaginal fistula in sub-Saharan Africa

Abstract

Background: There is dearth of data regarding the treatment-seeking practice of women living with vaginal fistula. The paper describes the health-seeking behaviour of fistula cases in the sub-Saharan Africa (SSA) where the burden of the problem is high. Methods:We analysed the data of 1,317 women who ever experienced vaginal fistula, extracted from 16 national Demographic and Health Surveys carried out in SSA between 2010 and 2017. The association between treatment-seeking and basic socio-demographic characteristics assessed via mixed-effects logistic regression and the outputs are provided using adjusted odds ratio (AOR) with 95% confidence intervals (CI).Results: Two-thirds (67.6%) of the women encountered the fistula soon after delivery implying obstetric fistula. Fewer identified sexual assault (3.8%) and pelvic surgery (2.7%) as the cause. In 25.8% of the cases clear-cut causes couldn't be ascertained and excluding these ambiguous causes, 91.2% of the women had obstetric fistula. Among those who ever had fistula, 60.3% (95% CI: 56.9-63.6%) sought treatment and 28.5% (95% CI: 25.3-31.6%) underwent fistula-repair surgery. The leading reasons for not seeking treatment were:unaware that it can be repaired (21.4%), don't know where to get the treatment (17.4%), economic constraints (11.9%), healed by itself (11.9%) and embarrassment (7.9%). The regression analysis indicated, teenagers as compared to adults 35 years or older [AOR=0.31 (95 % CI: 0.20-47)]; and women devoid of formal education when compared to women with any formal education [AOR=0.69 (95% CI: 0.51-0.93)], had reduced odds of treatmentseeking. In 25.9% of the women who underweight fistula-repair surgery, complete continence after surgery was not achieved.Conclusion: Treatment-seeking for fistula remains low and it should be augmented via mix of strategies for abridging health-system, psycho-social, economic and awareness barriers.