Risk factors for obstetric fistula in Manicaland Province, 2019.

Abstract

Obstetric fistula is a tragic childbirth injury caused by prolonged obstructed labour that leaves women with urinary or faecal incontinence. A repair camp was set up in 2015 at Chinhoyi Provincial hospital for all obstetric fistula repair surgeries. From August 2015 to December 2018, a total of 600 fistula have been repaired and 276 (46%) of them were from Manicaland Province, the highest in the country. We therefore conducted the study to identify the risk factors for obstetric fistula in Manicaland Province. Methods: We conducteda 1:1 unmatched case-control study. A case was a woman who gave birth and developed obstetric fistula in Manicaland Province from 01 January 2015 to 31 December 2018.We used an interview guide to collect data from key informants and interviewer administered questionnaires to collect data from cases and controls. Epi Info 7 was used for analysis. Univariate, bivariate and multivariate analysis was done to determine risk factors for obstetric fistula. Results: A total of 52 cases and 52 controls were recruited in the study. A total of 37 (71.2%) cases and 46 (88.5%)controls were married. Marriage at age less than 18 years [OR=2.38, 95% (1.03 –5.47)], first pregnancy at age less than 18years, being apostolic [OR=4.9, 95% (2.03 –11.80)]and use of herbs during pregnancy [OR=3.40, 95% (1.21 –9.50)] were significant risk factors for obstetric fistula. Duration of labour less than 20 hours [OR = 0.18, 95% (0.06 –0.47)]and delivery at a health facility[OR=0.19, 95% (0.07 –0.47)] were protective. Age at first delivery of less than 18 years[AOR = 2.72, 95% CI (1.12 –6.60)] was an independent predictor for obstetric fistula. Independent protective factors were: duration of labour less than 20 hours[AOR = 0.24, 95% (0.08 –0.68] and delivery at a health facility [AOR = 0.28, 95%(0.10 –0.73)]. The socio-demographic and cultural factors which are low level of education, use of herbs during pregnancy, early marriage and pregnancy, belonging to the apostolic sect increased the risk for obstetric fistula development among the women while health services factors such as delivery in a health facility with the help of skilled birth attendants and ANC booking were protective factors for obstetric fistula. Addressing these socio-demographic and cultural factors will help to reduce the magnitude of obstetric fistula among the women.