“Counting those never bubble over” Estimated prevalence and its determinants of obstetric fistula among childbearing women in 14 African countries: Multilevel Analysis
Authors: Alie Melsew Setegn 
Published: November 2021

Abstract
Background
Obstetric fistula is a leakage between genital tract and urinary tract and/or between genital tract and rectum. The commonest cause of obstetric fistula is prolonged labour which magnify in the areas of poor prenatal and emergency obstetric care. In Africa, there is poor of quality of obstetric care and poor social support for those who faced fistula. Obstetric fistula shatters the life of the women and the consequence is nasty while multicounty level estimate on the magnitude and determinates of fistula were nil. Multicounty level of estimate of the magnitude of fistula is important to design and fill the gaps of quality of obstetric care and design the appropriate corrective intervention mechanisms of obstetric fistula. Therefore, this study aimed the estimate the magnitude of obstetric fistula and its determinants among childbearing women in 14 Africa countries based on recent demographic and health survey data.
Methods
Secondary data were used from 14 African demographic and health survey database. The data were extracted based on the objective the study and previous literatures. Data were weighted using sampling weight before any statistical analysis to account the sampling design. STATA version 15 was used for extracting, recoding, and for further multilevel analysis. The appropriateness of multilevel analysis were checked by Median odds ratio (MOR), proportional change in Variance (PCV), Intraclass correlation coefficient (ICC), and Akaike Information Criteria (AIC). Four model was build and the best model was selected based on the smallest Akaike Information Criteria (AIC). Both bivariable and multivariable multilevel analysis was done accordingly. Variables with p-value ≤0.05 declared as statistical significant with outcome variable for the study. The adjusted odds ratio with 95% confidence interval was used as measure of association.
Results
The magnitude of obstetric fistula was 0.84 [95%CI: 0.79, 0.88]. Maternal age >=41 years [AOR=1.38; 95% CI:1.01,1.93], urban residence [AOR=0.69; 95%CI: 0.53,0.89], women who attended secondary education [AOR=0.59; 95% CI: 0.45,0.77], women who attended higher education [AOR=0.40; 95% CI: 0.25,0.65], female household head [AOR=0.78; 95% CI: 0.64,0.95], husbands who attended primary education [AOR=0.80; 95% CI: 0.65, 0.98], women who give their first birth 16-20years [AOR=0.78; 95% CI: 0.66,0.92], 21-25 years [AOR=0.66; 95% CI: 0.53,0.84], ≥26 years [AOR=0.67; 95% CI: 0.48, 0.92], history of terminating pregnancy [AOR=1.51; 95% CI: 1.29, 1.77] and awareness on fistula [AOR=0.35; 95% CI: 0.26,0.45) were the determinants of obstetric fistula identified in this study.
Conclusion
The magnitude of obstetric fistula in 14 African countries were high as compared with the world health organization estimate. Maternal age, residence, educational status, husband’s educational status, sex of household head, age at first birth, history of terminating pregnancy and awareness on obstetric fistula were the determinants identified in this study. Therefore, health interventions that reduce the occurrence of obstetric fistula could be designed to address the women who lives in rural area, no formal education, male-headed household, husbands who never attended formal education, and women who had terminated pregnancy should be addressed in advance. Policies and programs of fistula should be tailored the women which characterized as living in rural area, non-educated, young age at first birth and no awareness on fistula as well as male headed households. Evidence based multicounty interventions were highly recommended to eliminate obstetric fistula and to achieve sustainable development goal.