Risk Factors for Obstetric Fistual Among Women Seeking Care in the Tamale Metropolis

Abstract

Obstetric fistula is a devastating form of maternal morbidity. It is characterized by an abnormal communication between the vagina and the lower urinary/ gastrointestinal structures or both. It is a result of injury due to pregnancy and its related complications with the resultant effect of continuous leakage of urine or faeces or both into the vagina. It remains a problem in Africa. This study sought to identify predisposing factors to obstetric fistula among women seeking care in the Tamale metropolis. In this matched case control study, cases were from the Tamale fistula center. Controls were matched on the year of delivery, region and district of index delivery. A total of 151 participants made up of 51 cases and 100 controls participated. This study identified three major factors for obstetric fistula; age below 20 years, total labour duration more than 24 hours and height 150 cm and below. It further identified four minor factors which are still birth, delivery by caesarean section, residence in a rural area and lack of formal education. Across both study groups, there is lack of adequate knowledge about obstetric fistula. Findings in this study agree with the literatures that, majority of women who suffer obstetric fistula are young, poor, illiterate, of short stature, resident in remote areas and labour more than 24 hours. Based on the associated factors, an obstetric fistula forecast score (OFFSCORE) was proposed, which is composed of three major criteria, the presence of each which is scored 2 and zero otherwise and four minor criteria each scored one and zero otherwise. A total OFFSCORE of four and above classified as high risk has a sensitivity of 90.2% and a specificity of 86.0% for predicting obstetric fistula. This study recommends immediate prophylactic urethral catheterization for high risk for obstetric fistula post-partum women.