Obstetric fistula prevalence
The number of females (girls and women) age 10 and older who are living with obstetric fistula (OF) in a defined area per 1,000 females age 10 and older.
This indicator is calculated as:
(An estimate of the number of females age 10 and older who are living with an OF in a defined area/ Total number of females age 10 and older who live in the same area) x 100
To calculate the prevalence of OF, one needs an estimate of the number of females in a defined area who are living with OF and the number of females age 10 and older who live in the same area.
Data should be disaggregated by young women/girls under age 18, and women age 18 and above.
Facility-based medical records provide data on women who have presented at the facility with OF. However, women who do not access facilities are excluded from this data. These are usually women in remote and rural areas with home births unattended by a skilled provider – i.e., those at most risk for OF (Tuncalp et al., 2015).
Community-based surveys generally provide wider coverage and better representation of a regional or national population. However, such surveys can be expensive or time-consuming.
Population-based special studies or surveys, such as the DHS, gather information on OF, however, there are limitations with self-reporting and restricted age limitations.
To obtain data for the numerator, a survey such as DHS or RHS with well-developed and -tested questions specifically about OF can be used to estimate the number of women of reproductive age (15-49 years old) in an area living with OF. The only way to obtain information on females younger than age 15 or older than age 49 is to conduct a special survey.
A survey using the direct sisterhood method can be used to calculate the denominator. However, it is better to obtain information about the number of females age 10 and older from census data or from intra-censal projections.
The prevalence of OF provides a sense of the magnitude of the problem of OF, including how adequate/accessible maternity services were in the past and the current need for surgical care and reintegration services. Understanding the overall burden of morbidity that exists in the country from this medical condition can have positive implications for policy development and advocacy efforts.
It is difficult to obtain an accurate estimate of the number of OF cases for several reasons. Because OF is believed to be a statistically rare event, a large sample size is required, which is often prohibitively expensive. Still, all community based studies of reproductive health should explicitly ascertain and report the clinical presence or absence of fistula, even when the sample size is small (Adler, Ronsmans, Calvert and Filippi, 2013).
Women with OF are less likely to live in the mainstream of society and may be difficult to locate. Identifying women with OF using questions can be problematic, as women without OF can have a history of symptoms similar to those with OF, such as occasionally leaking urine, caused by other conditions. Others may be too embarrassed to report incontinence. This can lead to overestimation and underestimation of the burden of OF, respectively (Tuncalp, et al., 2015). Thus, it is important to use questions that have been pilot-tested and found to have high predictive value. Ideally, these questions should have been validated with a clinical examination.
Although the DHS questionnaires for some countries include standard modules with OF questions, not all DHS questionnaires ask about OF. Furthermore, the DHS captures only women of reproductive age and excludes young adolescent girls as well as older women.
safe motherhood (SM), obstetric fistula (OF)
Adler A. J., Ronsmans C., Calvert C., and Filippi V. 2013. Estimating the prevalence of obstetric fistula: a systematic review and meta-analysis. BMC Pregnancy and Childbirth 2013, 13:246.
Tuncalp O, Tripathi V, Landry E, Stanton CK, and Ahmed S. 2015. Measuring the incidence of obstetric fistula: approaches, needs and recommendations. Bulletin of the World Health Organization. Jan 1, 2015; 93(1): 60-62.