Obstetric fistula in rural Ethiopia.

OBJECTIVES: To determine the prevalence of obstetric fistula in rural Ethiopia and identify the circumstances and barriers to care that enhance development of obstetric fistula and its health and social consequences. DESIGN: A cross-sectional study. SETTING: The study was conducted in seven out of eleven administrative regions of Ethiopia by visiting randomly selected houses in rural areas and identifying women who have or had obstetric fistula and interviewing them. RESULTS: A total of 19,153 houses were visited. Untreated fistula prevalence was about 1.5 per 1000 amounting to approximately 26,819 women. Most of the patients were young women who delivered for the first time. Marriage took place early in life mostly through family arrangements or abduction. The median number of days in labour was three to eight. CONCLUSION: Promotive measures such as increasing age at marriage, and identification and treatment of patients should be intensified. There is a great need in improving accessibility and affordability of basic and emergency obstetric services for rural communities. Curving the situation in the long run requires dealing with the problem of poverty and improvement in the status of women.

Postcoital injuries treated at the Addis Ababa Fistula Hospital, 1991-97.

91 young Ethiopian women who had developed total faecal incontinence from injuries sustained from sexual intercourse within marriage or rape were successfully treated at this hospital.

PIP: The article reports on the occurrence of postcoital injuries in 91 women treated at the Addis Ababa Fistula Hospital between 1991 and 1997. Among the 91 women, 78 had been sexually abused under the cover of marriage; 9 were kidnapped with the intention of marriage, raped, and then discarded by their would-be husbands; and 4 were kidnapped and raped. These Ethiopian women were victims of societal tradition which condone forced abduction and rape by men who cannot afford a wife, and a society where young girls were forced to perform domestic duties resulting to vesicovaginal fistula or rectovaginal fistula. Moreover, women who develop such injuries were usually perceived to have no further value as a wife. Of the 78 married women in the study who were injured, 59 were divorced and 19 were abandoned. Their total fecal incontinence means that these girls and young women were regarded as outcasts by society. In view of this, a need for a change in attitudes and behavior within traditional societies was considered. These changes would include education, amendment of policies and laws and interventions from the government and health workers.

Obstetric fistulae: a retrospective study of 1210 cases at the Addis Ababa Fistula Hospital.

The results of surgery in new patients presenting with a vesico-vaginal fistula are presented to relate the outcome to age, parity and aetiology of the fistula. Of the 1435 patients admitted to the hospital from January 1991 to December 1992, 1210 had had no previous attempt to repair the fistula and are included in the study. The data were collected from the patients records and a specially designed admission and treatment form. Of the 1210 cases analysed, the fistula was caused by obstructed labour in 96% (1160), and in the majority of these, labour was obstructed for more than 3 days. Half of the patients (598) were aged between 13 and 20 years on admission to hospital. Fifty-five per cent (649) developed a fistula during their first delivery and in 93% the fetal outcome was a still-birth. Of the operated 1210 cases, 1120 (92.6%) were successfully repaired. Five hundred and thirty patients were divorced by their husbands following development of the fistula. Illiteracy as common among the patients. Improvements in maternity services, development of communication networks and eradication of illiteracy are essential for the prevention of obstetric fistula. The role of reconstructive vaginal fistula surgery and the further training in this field is also emphasised.