Risk factors for vaginal fistula symptoms in Sub-Saharan Africa: a pooled analysis of national household survey data

Mathieu Maheu-Giroux; Véronique Filippi; Nathalie Maulet; Sékou Samadoulougou; Marcia C. Castro; Nicolas Meda; Mariéve Pouliot; Fati Kirakoya-Samadoulougou

doi:10.1186/s12884-016-0871-6

Risk factors for vaginal fistula symptoms in Sub-Saharan Africa: a pooled analysis of national household survey data

Mathieu Maheu-Giroux, Véronique Filippi, Nathalie Maulet, Sékou Samadoulougou, Marcia C. Castro, Nicolas Meda, Mariéve Pouliot, Fati Kirakoya-Samadoulougou^*

^*Corresponding author for this work

Section for Global Development

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Abstract

Background
Vaginal fistula (VF) is one of the most severe maternal morbidities with the immediate consequence of chronic urinary and/or fecal incontinence. The epidemiological evidence regarding risk factors for VF is dominated by facility-based studies. Our aim is to estimate the effect size of selected risk factors for VF using population-based survey data.
Methods
We pooled all available Demographic and Health Surveys and Multiple Indicators Cluster Surveys carried out in sub-Saharan Africa that collected information on VF symptoms. Bayesian matched logistic regression models that accounted for the imperfect sensitivity and specificity of self-reports of VF symptoms were used for effect size estimation.
Results
Up to 27 surveys were pooled, including responses from 332,889 women. Being able to read decreased the odds of VF by 13 % (95 % Credible Intervals (CrI): 1 % to 23 %), while higher odds of VF symptoms were observed for women of short stature (<150 cm) (Odds Ratio (OR) = 1.31; 95 % CrI: 1.02-1.68), those that had experienced intimate partner sexual violence (OR = 2.13; 95 % CrI: 1.60-2.86), those that reported sexual debut before the age of 14 (OR = 1.41; 95 % CrI: 1.16-1.71), and those that reported a first birth before the age of 14 (OR = 1.39; 95 % CrI: 1.04-1.82). The effect of post-primary education, female genital mutilation, and having problems obtaining permission to seek health care were not statistically significant.
Conclusions
Increasing literacy, delaying age at first sex/birth, and preventing sexual violence could contribute to the elimination of obstetric fistula. Concomitant improvements in access to quality sexual and reproductive healthcare are, however, required to end fistula in sub-Saharan Africa.

Original language	English
Article number	82
Journal	BMC Pregnancy and Childbirth
Volume	16
Number of pages	10
ISSN	1471-2393
DOIs	https://doi.org/10.1186/s12884-016-0871-6
Publication status	Published - 2016

Keywords

Obstetric fistula
Rectovaginal fistula
Reproductive health
Sexual health
Vesicovaginal fistula
Women's health

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10.1186/s12884-016-0871-6

Risk factors for vaginal fistula symptoms in Sub-Saharan Africa: a pooled analysis of national household survey dataFinal published version, 488 KB

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@article{58c10ffd233d41899d6a15bbfb2a7ba3,

title = "Risk factors for vaginal fistula symptoms in Sub-Saharan Africa: a pooled analysis of national household survey data",

abstract = "BackgroundVaginal fistula (VF) is one of the most severe maternal morbidities with the immediate consequence of chronic urinary and/or fecal incontinence. The epidemiological evidence regarding risk factors for VF is dominated by facility-based studies. Our aim is to estimate the effect size of selected risk factors for VF using population-based survey data. MethodsWe pooled all available Demographic and Health Surveys and Multiple Indicators Cluster Surveys carried out in sub-Saharan Africa that collected information on VF symptoms. Bayesian matched logistic regression models that accounted for the imperfect sensitivity and specificity of self-reports of VF symptoms were used for effect size estimation. ResultsUp to 27 surveys were pooled, including responses from 332,889 women. Being able to read decreased the odds of VF by 13 % (95 % Credible Intervals (CrI): 1 % to 23 %), while higher odds of VF symptoms were observed for women of short stature (<150 cm) (Odds Ratio (OR) = 1.31; 95 % CrI: 1.02-1.68), those that had experienced intimate partner sexual violence (OR = 2.13; 95 % CrI: 1.60-2.86), those that reported sexual debut before the age of 14 (OR = 1.41; 95 % CrI: 1.16-1.71), and those that reported a first birth before the age of 14 (OR = 1.39; 95 % CrI: 1.04-1.82). The effect of post-primary education, female genital mutilation, and having problems obtaining permission to seek health care were not statistically significant.ConclusionsIncreasing literacy, delaying age at first sex/birth, and preventing sexual violence could contribute to the elimination of obstetric fistula. Concomitant improvements in access to quality sexual and reproductive healthcare are, however, required to end fistula in sub-Saharan Africa.",

keywords = "Obstetric fistula, Rectovaginal fistula, Reproductive health, Sexual health, Vesicovaginal fistula, Women's health",

author = "Mathieu Maheu-Giroux and V{\'e}ronique Filippi and Nathalie Maulet and S{\'e}kou Samadoulougou and Castro, {Marcia C.} and Nicolas Meda and Mari{\'e}ve Pouliot and Fati Kirakoya-Samadoulougou",

year = "2016",

doi = "10.1186/s12884-016-0871-6",

language = "English",

volume = "16",

journal = "BMC Pregnancy and Childbirth",

issn = "1471-2393",

publisher = "BioMed Central Ltd.",

}

TY - JOUR

T1 - Risk factors for vaginal fistula symptoms in Sub-Saharan Africa

T2 - a pooled analysis of national household survey data

AU - Maheu-Giroux, Mathieu

AU - Filippi, Véronique

AU - Maulet, Nathalie

AU - Samadoulougou, Sékou

AU - Castro, Marcia C.

AU - Meda, Nicolas

AU - Pouliot, Mariéve

AU - Kirakoya-Samadoulougou, Fati

PY - 2016

Y1 - 2016

N2 - BackgroundVaginal fistula (VF) is one of the most severe maternal morbidities with the immediate consequence of chronic urinary and/or fecal incontinence. The epidemiological evidence regarding risk factors for VF is dominated by facility-based studies. Our aim is to estimate the effect size of selected risk factors for VF using population-based survey data. MethodsWe pooled all available Demographic and Health Surveys and Multiple Indicators Cluster Surveys carried out in sub-Saharan Africa that collected information on VF symptoms. Bayesian matched logistic regression models that accounted for the imperfect sensitivity and specificity of self-reports of VF symptoms were used for effect size estimation. ResultsUp to 27 surveys were pooled, including responses from 332,889 women. Being able to read decreased the odds of VF by 13 % (95 % Credible Intervals (CrI): 1 % to 23 %), while higher odds of VF symptoms were observed for women of short stature (<150 cm) (Odds Ratio (OR) = 1.31; 95 % CrI: 1.02-1.68), those that had experienced intimate partner sexual violence (OR = 2.13; 95 % CrI: 1.60-2.86), those that reported sexual debut before the age of 14 (OR = 1.41; 95 % CrI: 1.16-1.71), and those that reported a first birth before the age of 14 (OR = 1.39; 95 % CrI: 1.04-1.82). The effect of post-primary education, female genital mutilation, and having problems obtaining permission to seek health care were not statistically significant.ConclusionsIncreasing literacy, delaying age at first sex/birth, and preventing sexual violence could contribute to the elimination of obstetric fistula. Concomitant improvements in access to quality sexual and reproductive healthcare are, however, required to end fistula in sub-Saharan Africa.

AB - BackgroundVaginal fistula (VF) is one of the most severe maternal morbidities with the immediate consequence of chronic urinary and/or fecal incontinence. The epidemiological evidence regarding risk factors for VF is dominated by facility-based studies. Our aim is to estimate the effect size of selected risk factors for VF using population-based survey data. MethodsWe pooled all available Demographic and Health Surveys and Multiple Indicators Cluster Surveys carried out in sub-Saharan Africa that collected information on VF symptoms. Bayesian matched logistic regression models that accounted for the imperfect sensitivity and specificity of self-reports of VF symptoms were used for effect size estimation. ResultsUp to 27 surveys were pooled, including responses from 332,889 women. Being able to read decreased the odds of VF by 13 % (95 % Credible Intervals (CrI): 1 % to 23 %), while higher odds of VF symptoms were observed for women of short stature (<150 cm) (Odds Ratio (OR) = 1.31; 95 % CrI: 1.02-1.68), those that had experienced intimate partner sexual violence (OR = 2.13; 95 % CrI: 1.60-2.86), those that reported sexual debut before the age of 14 (OR = 1.41; 95 % CrI: 1.16-1.71), and those that reported a first birth before the age of 14 (OR = 1.39; 95 % CrI: 1.04-1.82). The effect of post-primary education, female genital mutilation, and having problems obtaining permission to seek health care were not statistically significant.ConclusionsIncreasing literacy, delaying age at first sex/birth, and preventing sexual violence could contribute to the elimination of obstetric fistula. Concomitant improvements in access to quality sexual and reproductive healthcare are, however, required to end fistula in sub-Saharan Africa.

KW - Obstetric fistula

KW - Rectovaginal fistula

KW - Reproductive health

KW - Sexual health

KW - Vesicovaginal fistula

KW - Women's health

U2 - 10.1186/s12884-016-0871-6

DO - 10.1186/s12884-016-0871-6

M3 - Journal article

C2 - 27098261

AN - SCOPUS:84963851538

SN - 1471-2393

VL - 16

JO - BMC Pregnancy and Childbirth

JF - BMC Pregnancy and Childbirth

M1 - 82

ER -

Risk factors for vaginal fistula symptoms in Sub-Saharan Africa: a pooled analysis of national household survey data

Abstract

Keywords

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