Factors Associated With Obstetric Fistula Among

Reproductive Age Women in Ethiopia, Community Based,

Case Control Study
ATAKLTI Weldegebriel Gebertsadik  (  [email protected] )
Tigray Health Research Institute, Mekelle, Tigray, Ethiopia
Gebremedhin Gebreegziabiher Gebrehiwot 
Tigray health reserch institute
Abraham Aregay Desta 
Tigray health reserch instiute
Kiros Fenta Ajemu 
Tigray health reserch instiute
Asfawosen Aregay Berhe 
Tigray health reserch institute
Tewolde Wubayehu Woldearegay 
Tigray health reserch instiute
Kiros Demoz Ghebremedhin 
Tigray health reserch instute
Nega Mamo Bezabih 
Tigray health reserch institute

Research

Keywords: Obstetric stula, maternal morbidity, Ethiopia

DOI: https://doi.org/10.21203/rs.3.rs-61513/v1

License:   This work is licensed under a Creative Commons Attribution 4.0 International License.   Read Full License

Page 1/15
Abstract
Background: Obstetric stula is major public and reproductive health concerns in Ethiopia .It are most disturbing  among
all maternal morbidities.

Method: A community-based unmatched case control study was conducted from the EDHS, 2016 dataset. All 70 cases
and 210 non cases were selected using random number table from the dataset. Reproductive age mothers who had
experiencing lifelong obstetric stula were considered as cases .Logistic regression was used to identify factors
associated with obstetric stula at 95% con dence interval. Factors signi cant at p value of ≤ 0.05 were included into
multivariable logistic regression model to generate adjusted odds ratios.

Results: The majority of stula cases were from rural residences. Independent risk factors associated with obstetric stula
included age at rst marriage, rural residence, poorest wealth index and decision making for contraceptive use mainly
husband partner.

Conclusion

Obstetric stula is a major public and reproductive health concern in Ethiopia. Majority of women with obstetric stula
were from rural areas. Comprehensive intervention strategies should be in place customized to different government
hierarchies (national, regional and district level) including household and individual level interventions for combating
obstetric stula by giving an emphasis on the identi ed risks.

Plain English Summary

Globally, each year between 2-3 million women are affected by obstetric stula. It is common in developing nations, mainly
in sub-Saharan Africa and Southeast Asia where suitable and timely care and treatment are hard to nd for this case. This
devastating condition adversely affects women’s physical and mental health. There is little research concerning the
experiences of women living with leakage of urine and/or feces in Ethiopia .Therefore, this article provides a better
understanding of identifying factors associated experienced a constant leakage of urine or stool from the vagina.

We collected data from the women reproductive age group from the Ethiopia demographic health survey and the factors
associated with the disease. Our ndings show that, obstetric stula was a signi cantly high rural residence, poorest
wealth index, age at rst marriage less than 18 years ,and decision making for contraceptive use mainly husband partner.
Comprehensive intervention strategies should be in place customized to different government hierarchies for combating
the adverse condition.

Background
Obstetric stula is an atypical link between the vagina, rectum , and/or bladder that may arise after protracted and
obstructed labor. Among all maternal morbidities, obstetric stula is one of the most disturbing for the maternal health.
Childbirth encounters momentous risks for women and new born. (1).Globally, each year between 50 000 to 100 000
women are pretentious by obstetric stula (2).

These risks re ect global inequity: Obstetric stula (OF) is a situation that residue prevalent in developing nations, mainly
in sub-Saharan Africa and Southeast Asia where suitable and timely obstetrical care is hard to nd or scarce. It is
anticipated that more than two million young women survive with untreated obstetric stula in Asia and sub-Saharan
Africa (3).

Ethiopia’s fertility rate is among the uppermost countries in the world and only 50% of births attend by a skilled birth
attendant. Besides, rural areas where 80% of the population resides, poor and under-nourished women countenance
Page 2/15
superior risk and challenges to obstetric stula reduction (4).

Women victumed by obstetric stula are often deserted by their husbands, stigmatized by the community. Hence, leads to
low self-esteem, depression and long lasting emotional trauma (5).According the USAID report ,it is estimated that nine
thousand women in Ethiopia develop obstetric stula every year, and that up to hundred thousand women are living with
untreated stula (6).

Information from different literature indicated that obstetric stula linked to social-economic and cultural factors including
poverty, illiteracy, accessibility of health facilities, duration of labour, respondent height, young age at marriage, place of
residence with lack of emergence obstetric care (7-11).

Community-based surveys generally provide wider coverage, better representation of national population and more
opportunities to collect a wide range of data. Due to nationally representative samples and use of similar questions across
surveys, the EDHS surveys provide a unique set of data to asses factors associated with obstetric stula. Identi ng factors
associated with obstetric stula using various study design is mandatory.

To our knowledge, no nationally representative community based study with case control study design has documented to
identify risk factors for obstetric stula in Ethiopia. The aim of this study was therefore to identify the risk factors for
obstetric stula from a local context among women in Ethiopia.

Methods
Data source and sampling techniques

The study participants chosen using a strati ed, two stage cluster design, and enumeration areas were the sampling units
for the rst stage. In the rst stage, 645 enumeration areas were randomly selected: 202 in urban areas and 443 in rural
areas. In the second stage, a xed number of 28 households per cluster were selected randomly for each enumeration
areas. The 18,060 households were randomly selected and 16,650 households were eligible and interviewed. Additional
information about the methodology of EDHS 2016 can be accessed in the published report of the main ndings of the
survey [12].

Every selected reproductive age women was included and data were collected on various socioeconomic, obstetric and
nutrition variables. As our focus in this study was 15-49 years aged women, we extracted the EDHS 2016 data set. We
found in the data set 70 women with experienced obstetric stula (Cases) and 210 (Controls) selected from the data set
using random number table and 280 women were included in the nal analysis showed sampling techniques (Figure :1).

Sample design

A community-based unmatched case-control study was conducted among reproductive age women.

Variables and measurements:

 Dependent variable:

The outcome variable was stula, which is de ned as reproductive aged women experiencing lifelong obstetric stula.

Independent variables:

The selection of the independent variables was guided by the literature and availability of the variables in the data set.
Some of the independent variables for obstetric stula among reproductive age women 15-49 years.

Page 3/15
Maternal characteristics: maternal age, maternal educational status, maternal antenatal care follow up, whether the
mother is currently living with her husband or not, whether the mother is engaged in income generating work or not.

Household characteristics: number of household members, residence, wealth index ranked in to ve (poorest, poorer,
middle, richer and richest) , sex of household head.

Obstetric characteristics: Place of delivery, ANC follow up, size of child at birth, postnatal check up, Preceding birth interval,
Height(Cm) and ever had a terminated pregnancy.

Anthropometric measurements:

The nutritional category of women was measured by use of height and body mass index (BMI). To calculate BMI, during
EDHS measured the height and weight of women age 15–49 years. BMI is used to measure thinness or obesity. BMI is
de ned as weight in kilograms divided by height in meters squared (kg/m2). A BMI below 18.5 kg/m2 shows thinness. A
BMI below 12- 17 kg/m2 indicates severe undernutrition BMI of 25.0 kg/m2 or above shows overweight or obesity. Height
was also categorized in a single cut off point < 145 cm as short stature.

Wealth index

A wealth index in the EDHS survey was measure based on household asset data to classify individuals into 5 wealth
indeces (poorest, poorer, medium, richer and richest). Variables incorporated in the wealth index were ownership of chosen
household assets (television, bicycle or car), size of agricultural land, number of livestock and materials used for house
construction [13].

Data Analysis

EDHS have developed recode les in order to facilitate data analysis. All data tartan for its completeness and reliability.
Preliminary analysis was done to check the rst round nding. In all analysis, sample weights have done due to two stage
cluster sampling design in the EDHS data set to adjust for the imbalance probability selection among the strata [12]. All
the analyses were performed using STATA version 14.0 Categorical type of data was analyzed by descriptive statistics
(frequency and percentage).

Logistic regression analysis was used to identify factors associated with obstetric stula. Bivariate analysis was carried
out to see the crude association of each independent variable with the outcome variable (Obstetric stula). Those
independent variable variables with 𝑃-value ≤ 0.05 in the bivariate analysis were included in the nal multivariable logistic
regression analysis to adjust for confounding and to identify the nal factors associated with obstetric stula. Logistic
regression method was used during the multivariable logistic regression analysis. Before inclusion of predictors to the nal
logistic regression model, the multi-collinearity was checked using VIF<10/Tolerance >0.1 for continuous independent
variables. The goodness of t of the nal logistic model was tested using Hosmer and lemeshow test at p value of >0.05.
The strength of association of the predictors and outcome variable have been indicated by Adjusted odds ratio at 95%
con dence interval. The signi cant association was declared at p≤ 0.05 for the nal logistic regression model

Ethical Considerations:

The study proposal got ethical approval from Tigray health research institute and formal letter of permission was obtained
from measure DHS project website to access the dataset (http://www.measuredhs.com).

Results
Socio-demographic and other characteristics for cases and controls of the mothers

Page 4/15
From a total of 280 samples size, (70 cases and 210 controls) were included in the nal analysis. Majority of the case
were aged 34-49 (44%) while controls were aged 15-23 years 37.1%. More than half 57.1% of mothers in cases and 42.4%
controls have no education attainment. Majority of cases 84.3% and 64.8 % controls were living in rural residence.

Regarding, wealth index poorest 30% of mothers in cases and 24.3% in controls. Majority of number of house hold
members have equal or greater than four 62.1% of cases and 63.3%.non controls. The majority of mothers in cases and
control group (68.6% and 58.6% respectively) were married. More than half numbers 52.9% of mothers in cases and 43.3%
in controls were Orthodox believers .One third number of mothers 38.6% in cases and 46.7 % in non controls had work
(Table:1).

Obstetrics characteristics of cases and controls

More than half 58.6% in cases and 62.9% in controls place of delivery in home. One from four mothers 27.6% in cases and
24.7% in controls were not following Antenatal care.Size of baby very larger 18% and larger than average 16 % in cases
and 21.6% and 18.9% in controls respectively. Majority of mothers 96.6% in cases and 86.6 in controls were not follow
postnatal check up. Greater than One fourth number of mothers 31.3% in cases and 23.6% in controls were less than 24
months birth interval. Almost majority of the cases 85.7% and 88.1% in controls were taller than 150 cm. Majority of
mothers in cases 80% and 90.5% in controls not ever had a terminated pregnancy (Table:2).

Factors Associated with obstetric stula among mothers aged 15– 49 years:

In bivariate logistic regression analysis age at rst marriage, Height, wealth index place of residence, has television,
literacy, number of house hold members, ever had a terminated and decision maker for using contraceptive pregnancy
signi cant associated with obstetric stula. In multivariable logistic regression analysis age at rst marriage, wealth index
poorest, rural residence and decision maker for using contraceptive mainly husband, partner signi cant associated with
obstetric stula.

In multivariable analysis age at rst marriage less than 18 years were 3.3 times (AOR = 3.39; 95% CI: 2.832, 4.601) more
likely with developing stula than greater than 18 years aged. Wealth index poorest category 4.6 times (AOR = 4.62; 95%
CI: 2, 238, 5.015) more likely with developing f stula than richest wealth index. Rural residences 5.14 times (AOR = 4.62;
95% CI: 4.262, 7.521) more likely with developing stula than urban residence. Decision making for contraceptive use
mainly husband, partner 1.3 times (AOR = 4.62; 95% CI: 1.124, 1.670) more likely with developing stula than joint decision
(Table 3).

Discussion
The main goal of this unmatched case control study was to identify factors associated with obstetrics stula in Ethiopia.
Despite, substantial efforts by the Ethiopia government and non-governmental organizations to raise health facilities,
improve quality of services, and increase access to care, inequalities in maternal healthcare obstetric stula is still the
main concern in Ethiopia.

Our analysis identi ed age at rst marriage, rural residence, poorest wealth index and decision making to use
contraceptive husband only risk factors for developing obstetrics stula. Age at rst marriage less than 18 years were 3.3
times (AOR = 3.39; 95% CI: 2.832, 4.601) more likely with developing stula than greater than 18 years aged. This nding
also corresponds to studies in developing countries, in Tigray, Ethiopia (7), in Sub-Saharan Africa (14) and Uganda
Demographic and Health Survey (15).

The possible reason might be due to before the pelvic girdle is fully developed in young adolescent may explain the
elevated risk of distress from obstetric stula women bearing children apparently. Besides, when labor happen in

Page 5/15
situations not equipped to deal with dystocia.

Rural residence more likely with developing stula than urban residence in line with study in Eretria (16) and Democratic
Republic of the Congo (17).This might be in the rural residence

shortage of antenatal care, extended labor and deprived health seeking behavior such as delay in accessing emergency
care due to intriguing more than one move from home to reach the delivery place and no lack of decision making in
emergency by family members were associated with the occurrence of obstetric stula. Besides, in rural areas associated
with lower geographical ease of access to health facilities. Besides economic troubles, there are also socio-cultural issues
related to lower male involvement and support for women's health care access. Wealth index poorest category more likely
with developing stula than richest wealth index.This result is in agreement with the study in South-eastern rural
community of India (18), Tanzania (19), Uganda: demographic and health survey data (20) and Nairobi, Kenya (21).The
possible reasons might be that women who had a better wealth index may assist them easily reach to the health facilities
for their paramount health outcomes. Besides, a better wealth index may lessen the di culty of obtaining resource to
easily reach health care. As a result, women, who could not have enough money to pay for these expenses found it
complicated or even impossible to visit health facilities.

Decision making for contraceptive use mainly by husband, partner 1more likely with developing stula than Joint decision
.This nding is concurrent with in sub-Saharan Africa (22) and North Western , Nigeria (21).The possible reason might be
the women for non-use of modern contraceptive methods was husband antagonism, desire for additional children,
religious ban. This is not amazing as culture and religion has positioned men as the top of the family and women can not
make decisions in relation to their own health.

The desire for more children given by some of the women is not surprising as the majority of the women with obstetric
stula delivered a stillbirth. These study ndings present the evidence for the need of male participation in contraception
and other reproductive health issues like the prevention of obstetric stula were men play an important role.

In spite of the limitations of our study, this is community based case-control study to identify

factors associated with obstetric stula development and it is the only national representative and community base case
control study taking place in Ethiopia. These ndings can assist and identify women who are at increased risk for
developing an Obstetric stula and educate them about the risks of becoming pregnant before their bodies have matured
and to identify the signs and symptoms associated with obstructed labor and emergency delivery.

Besides, the detection of at risk individuals may also help identify those who have developed obstetric stula and help
them seek care more quickly to reduce morbidity in the population. Resources aimed at helping child-bearing women can
also be oriented to reduce risk factors in target populations and increase protective factors to lower obstetric stula rates.
We hope that the ndings of this study will bring much needed attention to this serious condition and provide information
to help those who are most likely to develop an obstetric stula. Further longutidail study needed.

Strengths And Limitations Of The Study

The strength of this study was; it used national representative data which permit to generalize the results. It also functional
all the DHS data principles like weighting. The limitation of this study was its cross-sectional design, cannot examine
causation of the precedence in time between exposure and outcome. There were some missing values for some variables
in the dataset .Being; the cases for obstetric stula were lifelong.Therefore, the authors might be fail to consider some
factors which could affect the interpretation of the results and the retrospective nature of the data and maternal verbal
reports, recall bias might have been introduced.

Page 6/15
Conclusions
Obstetric stula is a major public and reproductive health concern in Ethiopia. Majority of women with obstetric stula
were from rural areas. This analysis provides evidence that experience of obstetric stula signi cant associated with age
at rst marriage, rural residence, poorest wealth index and decision making by husband alone. Comprehensive intervention
strategies should be in place customized to different government hierarchies (national, regional, district level, house hold
and individual level) including interventions for combating obstetric by giving stress on the identi ed risk factors. We
advise health authorities at different hierarchies to design different intervention activities like to educating the community
to avoid the risk of obstetric stula due to pregnancy and delivery, strengthening family planning, antenatal care services
and increased access to emergency obstetric care should be addressed extensively.

Abbreviations
ANC-Antenatal care, BMI-Body mass index, DHS-Demographic health survey, EDHS- Ethiopia demographic health survey,
OF- Obstetric stula, VIF-variance in ation factor, SAID- United States Agency for International Development.

Declarations
Acknowledgements:

Not applicable.

Funding:

Not applicable.

Availability of data and materials

All data supporting our ndings will be shared upon request.

Authors’ contributions:

A.G contributed to the concept, data extraction tool, conducted data extraction, analysis and interpretation of data, and
wrote the rst draft of the manuscript and revised it.GG, AA2,AA3,KD and TW contributed to the concept and participated in
protocol development and KF reviewed assessment tool, reviewed analysis ndings, and revised the draft and nal
manuscript. All authors read and approved the nal manuscript.

Competing interests:

The authors declare that they have no competing interests.

Consent for publication:

Not applicable.

Ethics approval and consent to participate

Not applicable.

References

Page 7/15
 1. Bulletin of the World Health Organization2015; 93:60-62.
doi: http://dx.doi.org/10.2471/BLT.14.141473.https://www.who.int/bulletin/volumes/93/1/14-141473.pdf?ua=1
2. World health organization (WHO).Obstetric stula.2018.https://www.who.int/news-room/facts-in-pictures/detail/10-
facts-on-obstetric- stula
3. 10 facts on obstetric stula [Internet]. Geneva: World Health Organization; 2014. Available
from: http://www.who.int/features/fact les/obstetric_ stula/en/ [cited 2014 Nov 28].
4. Mini Demographic and Health Survey, 2019. Addis Ababa: Ethiopian Central Statistical Agency
5. Tesfaye G. (2013). Survival Analysis of Time to Recovery from Obstetric Fistula at Yirgalem Hamlin Fistula Hospital,
SNNPR, Ethiopia. MSc Thesis, School of Mathematical and Statistical Science, Hawassa University, Ethiopia.
https://www.hilarispublisher.com/open-access/survival-analysis-of-time-to-recovery-from-obstetric- stula-a-case-
study-at-yirgalem-hamlin- stula-hospital-ethiopia-2155-6180-1000242.pdf
6. USAID situation assessment .Joint AusAID and USAID Review of Support to Hamlin Fistula Ethiopia (Ethiopia). 2013
https://reliefweb.int/sites/reliefweb.int/ les/resources/joint-aus-us-gov-review-hamlin- stula-ethiopia- nal-report.pdf
7. Roka et al. Factors associated with obstetric stulae occurrence among patients attending selectedhospitals in Kenya,
2010: a case control stu .BMC Pregnancy and Childbirth 2013, 13:56
8. L. Lewis Wall & Shewaye Belay & Tesfahun Haregot & Jonathan Dukes & Eyoel Berhan & Melaku Abreha. A case–
control study of the risk factors for obstetric stula in Tigray, Ethiopia. Int Urogynecol J,2017, DOI 10.1007/s00192-
017-3368-6
9. Andargie AA, Debu A. Determinants of obstetric Fistula in Ethiopia. Afri Health Sci. 2017;17(3): 671-680. https://dx.doi.
org/10.4314/ahs.v17i3.9
10. .L. Mubikayi et al. A Case-Control Study of Obstetric Fistula Risk Factors in the Democratic Republic of the Congo.
Open Journal of Obstetrics and Gynecology, 6, 740-753.http://dx.doi.org/10.4236/ojog.2016.612092
11. Bashah et al. Consequences of obstetric stula in sub Sahara African countries, from patients’ perspective: a
systematic review of qualitative studies. BMC Women's Health (2018) 18:106
12. Ethiopia Demographic and Health Survey, 2016. Addis Ababa: Ethiopian Central Statistical Agency.
13. Rahman et al. Wealth inequality and utilization of reproductive health services in the Republic of Vanuatu: insights
from the multiple indicator cluster survey, 2007.International Journal for Equity in Health 2011, 10:58
14. Maheu-Giroux et al. Risk factors for vaginal stula symptoms in Sub-Saharan Africa: a pooled analysis of national
household survey data .BMC Pregnancy and Childbirth (2016) 16:82.
15. Marguerite L. Sagna, Nazrul Hoque,Thankam Sunil. Are some women more at risk of obstetric stula in Uganda?
Evidence from the Uganda Demographic and Health Survey. Journal of Public Health in Africa 2011 ;2:(26)J
16. Samsom M Giliu et al. Factors Associated With Obstetric Fistula Among Women Admitted To Mendefera National
Fistula Center, Eritrea. International Journal of Recent Scienti c Research,2018:9(3ealth in Africa 2011 ; volume 2:e26
17. Mubikayi, L., Chow, E.J., Matson, D.O., Nzau, E. and Tandu, B. (2016) A Case-Control Study of Obstetric Fistula Risk
Factors in the Democratic Republic of the Congo. Open Journal of Obstetrics and Gynecology,2016: 6(740-753).
18. Swain et al. Prevalence and risk factors of obstetric stula: implementation of a need-based preventive action plan in
a South-eastern rural community of India .BMC Women's Health (2020) 20:40
19. Bintabara, D., K. Nakamura, and K. Seino, Improving access to healthcare for women in Tanzania by addressing socio-
economic determinants and health insurance: a population-based cross-sectional survey. BMJ open, 2018. 8(9): p.
e023013.
20. Rutaremwa Gideon . Factors Associated with Adolescent Pregnancy and Fertility in Uganda: Analysis of the 2011
Demographic and Health Survey Data.American Journal of Sociological Research 2013, 3(2): 30-35

Page 8/15
21. Jean-Christophe et .al .What does Access to Maternal Care Mean Among the Urban Poor? Factors Associated with Use
of Appropriate Maternal Health Services in the Slum Settlements of Nairobi, Kenya. Matern Child Health J (2009)
13:130–137
22. Yaya et al. Women empowerment as an enabling factor of contraceptive use in sub-Saharan Africa: a multilevel
analysis of cross sectional surveys of 32 countries .Reproductive Health (2018) 15:214
23. Nasir et al. Modern Contraceptives Utilization And Barriers Among Women With Obstetric Fistula In North Western
Nigeria. ejpmr, 2017,5(02), 28-31

Tables
Table 1 Socio-demographic and other characteristics for cases and controls of the mothers, EDHS, 2016

Page 9/15
Variables category Cases (n = 70) Controls (n = 210)
Freq (%) Freq (%)

Maternal current age (years) 15-23 16(22.9) 78(37.1)

24-33 23(32.9) 67(31.9)

34-49 31(44.3) 65(31)

Maternal educational status No education 40(57.1) 89(42.4)

Primary 22(31.4) 74(35.2)

Secondary 6(8.6) 32(15.2)

Higher 2(2.9) 15(7.1)

Residence Urban 11(15.7) 74(35.2)

  Rural 59(84.3) 136(64.8)

Wealth index      

  Poorest 21(30.0) 51(24.3)

  Poorer 10(14.3) 26(12.4)

  Middle 14(20.0) 26(12.4)

  Richer 10(14.3) 27(12.9)

  Richest 15(21.4) 80(38.1)

Number of house hold members      

  1 36(12.9) 29(13.8)

  2-4 70(25.0) 48(22.9)

  >4 174(62.1) 133(63.3)

Maternal occupation      

  No 27(38.6) 98(46.7)

  Yes 43(61.4) 112(53.3)

Marital status      

  Never in union 6(8.6) 56(26.7)

  Married 48(68.6) 123(58.6)

  Living with partner 2(2.9) 4(1.9)

  Widowed 4(5.7) 9(4.3)

  Divorced 8(11.4) 13(6.2)

  No longer living together/separated 2(2.9) 5(2.4)

Religion      

  Orthodox 37(52.9) 91(43.3)

  Catholic 0(0%) 1(0.5)

Page 10/15
   Protestant 7(10.0) 49(23.3)

  Muslin 26(37.1) 68(32.4)

  Other 0(0) 1(0.5)

Table 2: Obstetrics characteristics of cases and controls of the mothers, EDHS, 2016(n=280)

Variables Category Cases (n = 70) Controls (n = 210)

Freq (%) Freq (%)

Place of delivery Home 17(58.6) 61(62.9)

Health facilities 12(41.4) 36(37.1)

ANC follow up No ANC visit 8(27.6) 24(24.7)

One 1(3.4) 8(8.2)

Two 1(3.4) 8(8.2)

Equal or greater Three 19(65.5) 57(58.8)

Size of child at birth      

  Very large 9(18) 8(21.6)

  Larger than average 8(16) 7(18.9)

  Average 20(40) 12(32.4)

  Smaller than average 5(10) 5(13.5)

  Very small 7(14) 5(13.5)

  Don't know 1(2.0) 0(0)

Postnatal check up      

  No 28(96.6) 84(86.6)

  Yes 1(3.4) 13(13.4)

Height(Cm)      

  Less than 150 10(14.3%) 25(11.9)

  Equal or greater than 150 60(85.7) 185(88.1)

Preceding birth interval(months)      

  <24 15(31.3) 25(23.6)

Equal or greater than 24 33(68.8) 81(76.4)

Ever had a terminated pregnancy      

  No 56(80.0) 190(90.5)

  Yes 14(20.0) 20(9.5)

Page 11/15
 

Table 3: Factors associated with anemia using bivariate and multivariable logistic regression model (n = 280)

Page 12/15
Variables Experienced Obstetric COR p- AOR p-
Fistula value value
(95% CI) (95% CI)
Yes No
n (%) n (%)

Age at rst  <18 62(88.6) 163(77.6) 3.717 0.01 3.294 0.01*

marriage (3.123,5.671) (2.832,4.601)
(Years) ≥18 8(11.4) 47(22.4) 1      

Height(Cm) <150 10(14.3) 25(11.9) 1.982(1.321,2.211) 0.039    

>150 60(85.7) 185(88.1) 1      

Wealth Poorest 21(30) 51(24.3) 4.621(2.998,6.123) 0.01 3.34(2,238,5.015) 0.01*

index
Poorer 10(14.3) 26(12.4) 0.871 (0.745,1.017 0.090    

Middle 14(20.0) 26(12.4) 1.037 0.562    

(0.881,1.221)

Richer 10(14.3) 27(12.9) 1.124 0.330    

(0.889,1.421)

Richest 15(21.4) 80(38.1) 1      

Residence Urban 11(15.7) 74(35.2) 1      

Rural 59(84.3) 136(64.8) 6.123(4.981,8.413) 0.01 5.141(4.262,7.521) 0.01*

Has No 61(87.1) 150(71.4%) 2.323(1.721,2.986) 0.04    

television
Yes 9(12.9) 60(28.6) 1      

Literacy Literate 24(34.3) 102(48.6)        

Illiterate 46(65.7) 108(51.4%)        

               

Number of              
house hold
members

  1 7(10.0) 29(13.8) 1      

  2-4 22(31.4) 48(22.9) 1.258 0.076    

(0.890,1.395)

  >4 41(58.6%) 133(63.3) 2.912(1.631,3.211) 0.046    

Ever had a No 56(80) 190(90.5%)        

terminated
pregnancy Yes 14(20) 20(9.5)        

Mainly 3(4.8) 12(25) 1.258 0.057    

respondent (0.994,1.592)

  Mainly 16(25) 3(6.3) 1.554 0.02 1.308 0.032*

husband, (1.248,1.693) (1.124,1.670)
partner

Joint 44(69.3) 33(68.8) 1      

decision

Page 13/15
 

Figures

Figure 1

Flow chart of sample selection technique EDHS 2016 (n = 280).

Page 14/15
Figure 2

Number of operation to x obstetric stula cases, EDHS (n=70)

Page 15/15