Fistula: An Overlooked Preventable and Treatable Tragedy of Women

Abstract

Background: Although fistula is a preventable and treatable condition, in Bangladesh it is a curse for at least 71,000 women. Therefore, it is important to understand the factors hindering successful treatment of fistula in women.

Purpose: The aim of the study was to describe the characteristics of the fistula patients and identify the socio-demographic determinants associated with successful treatment of the fistula. Methods: In this cross-sectional study, 140 fistula patients were interviewed from six different hospitals of Bangladesh: Dhaka Medical College, Sir Salimullah Medical College, Dr.Muttalib Community Hospital, Chittagong Medical College, Hope Hospital in Cox’s Bazar and Ad-din Hospital. Data was collected from September 2014 to February 2015. A subgroup of women (N=98) with available information on first time of seeking treatment after development of fistula was analyzed to investigate the association between early care seeking and successful outcome of surgery utilizing bivariate and multivariate logistic regression. Result: The sample comprised 96% (N=135) of vesico-vaginal fistula, 0.7% (N=1) rectovaginal fistula, and 2.9% (N=4) of combination of vesico-vaginal and rectovaginal fistula patients. Obstetric labor was considered the major cause of fistula in 108 (77%) of the women and 32 (23%) had iatrogenic fistula. The subgroup analysis showed that women who sought care within 2 years of their fistula development were 4.92 times more likely to be cured earlier than women who sought for treatment longer than 2 years of their fistula development (p=0.023). Interestingly, access to health facilities, and who they live with were significantly associated with seeking care earlier (P<.005).

3 Conclusion: Early care seeking was associated with the successful treatment of fistula. Patients need to be encouraged to seek care as early as possible.