Medicine - Gynecology & Obstetrics
Obstetric Fistula in Rural Nepal: Prevalence and Risk Factors.
Obstetric fistula is estimated to affect 3.5 million women in the developing world, with an estimated incidence of 1-10/1000 births in Sub-Saharan Africa. Most experts agree that these figures may be underestimates as they are based on the number of women with fistula that present for care in a population. As women afflicted with this condition have constant leakage of urine/ stool, they often become social outcasts, making it difficult for them to seek care and be diagnosed. Furthermore, there is currently no widely used, validated screening questionnaire for obstetric fistula. Obstetric fistulae occur when women experience prolonged, obstructed labor without access to emergency obstetric care; however, the risks factors that lead to fistula development are incompletely understood. Most of the literature on obstetric fistulae is from countries of Sub-Saharan Africa. The prevalence of women suffering from this condition and the risk factors leading to obstetric fistula in developing countries in South Asia, specifically Nepal, are unknown. Preliminary data from our group suggest that the prevalence of fistula development in other South Asian countries such as Bangladesh is similar to that found in Sub-Saharan Africa; however, in that research no examinations were performed to confirm the presence of fistula. We propose to screen a population of reproductive age women in rural Nepal with an obstetric fistula questionnaire and confirm positive and negative cases with clinical examinations. During the time of examination, we will also assess for risk factors for fistula development including anthropomorphic parameters such as height and pelvic dimensions.
Luke Mullany, PhD, MHS; Bloomberg, International Health Joanne Katz, ScD; Bloomberg, International Health James Tielsch, PhD; Bloomberg, International Health