Peer-reviewed article
Spatial disparities and determinants of obstetric fistula among childbearing women in sub-Saharan Africa: A geospatial regression approach.
Adane KC, Abuhay HW, Abate BJ, Nigatu SG ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined obstetric fistula—a serious childbirth injury—across 14 sub-Saharan African countries using data from 146,000 women aged 15-49. The prevalence was 7 cases per 1,000 women, with significant variation by country and location. Sierra Leone, Chad, Uganda, Côte d'Ivoire, Ethiopia, Cameroon, and Mozambique had the highest rates. Key risk factors included adolescent pregnancy, unskilled birth attendants, cesarean sections, rural residence, and poor access to health facilities.
Key points
- Pooled prevalence of obstetric fistula in sub-Saharan Africa was 7 per 1,000 women (95% CI: 0.5-10.0)
- Obstetric fistula cases clustered geographically, with hotspots in Sierra Leone, Chad, Uganda, Côte d'Ivoire, Ethiopia, Cameroon, and Mozambique
- Cold spots (lowest rates) were in Burkina Faso, Gambia, Zambia, and Senegal
- Adolescent childbearing, unskilled birth attendants, and poor access to health facilities were major spatial predictors
- Geographically targeted interventions focusing on skilled maternity care and emergency obstetric services are recommended
Limitations
The study relies on DHS data which may have limitations in capturing all cases of obstetric fistula due to underreporting or stigma. The cross-sectional design cannot establish causality, only association with spatial risk factors.
Abstract
Objective Obstetric fistula is a leading cause of maternal mortality and morbidity and continues to pose a significant public health challenge in sub-Saharan Africa (SSA). Despite its serious and devastating effects, there are a few studies that describe the spatial distribution, pooled prevalence, and factors associated with obstetric fistula in SSA. Understanding the burden and geographic variation is important for targeted interventions, efficient resource allocation, and progress toward Sustainable Development Goal 3. The aim of the present study was to assess geospatial variations, pooled prevalence, and factors associated with obstetric fistula in SSA using Demographic and Health Survey (DHS) data from 2015 and 2024. Methods This study utilized a community-based cross-sectional design, which drew from DHS data collected from 14 SSA countries over a nine-year range (2015-2024). The sample consisted of 146 023 weighted women ages 15-49 with a childbirth history, sampled from a two-stage stratified cluster sampling framework. The data were processed using STATA 17. Spatial analysis included Global Moran's I for clustering, Getis-Ord Gi* for hotspot detection, and Kriging interpolation to predict prevalence in the unsampled areas using ArcGIS. Both global (ordinary least squares [OLS], spatial lag, spatial error) and local (geographically weighted regression, multiscale geographically weighted regression) spatial regression models were used to identify predictors, with model fit assessed by Akaike information criterion (AICc) and adjusted R.2 Significant predictors (P < 0.05) were mapped to illustrate spatial distribution. Results The pooled prevalence of obstetric fistula in SSA was seven per 1000 women (95% CI: 0.5, 10.00), and its spatial distribution was found to be clustered (Global Moran's I = 0.07, P < 0.01). Hotspot areas were located in Sierra Leone, Chad, Uganda, Côte d'Ivoire, Ethiopia, Cameroon, and Mozambique; cold spot areas were Burkina Faso, Gambia, Zambia, and Senegal. The multiscale geographically weighted regression model explained 86% of the spatial variation of obstetric fistula in SSA. Adolescent childbearing, unskilled birth attendants, women undergoing cesarean section delivery, rural residency, and living in areas where distance to health facilities is a big problem were significant spatial predictors of obstetric fistula in SSA. Conclusion The study showed that the prevalence of obstetric fistula varies significantly across SSA countries. Due to the spatial clustering of obstetric fistula, a geographically targeted intervention is crucial, especially in hotspot areas. To address this issue, policymakers and health planners should implement focused strategies that improve access to skilled maternity care, prevent adolescent pregnancies, strengthen rural healthcare infrastructure, and ensure timely access to emergency obstetric services.