Obstetric Fistula in Zambia: A Population-Based Cross-Sectional Analysis of Associated Factors Using the 2018 DHS...

Obstetric fistula remains an understudied severe maternal health outcome in Zambia. This study examines the socioeconomic, reproductive, and healthcare access factors associated with obstetric fistula among women in Zambia.

We conducted a cross-sectional analysis of 10 296 women using data from the 2018 Zambia Demographic and Health Survey (ZDHS). The outcome variable was self-reported lifetime experience of continuous leakage of urine or stool from the vagina. Survey-weighted proportions were used to describe the prevalence and distribution of obstetric fistula. Associations were assessed using Firth logistic and survey-weighted regression in both unadjusted and adjusted models, accounting for the rarity of the outcome and the complex sampling design, respectively.

The weighted prevalence of obstetric fistula was 0.24%. Among the 32 women who reported a history of obstetric fistula, 77% (n = 24) initiated sexual activity between the ages of 15 and 19. Women who were no longer in union had higher odds of reporting a history of obstetric fistula in both the Firth model (AOR: 4.81; 95% CI: 1.80-12.86) and survey-weighted model (AOR: 3.55; 95% CI: 1.25-10.05). Similarly, women in polygynous unions had higher odds of reporting a history of obstetric fistula (Firth AOR: 4.82; 95% CI: 1.58-14.69, survey-weighted AOR: 5.65; 95% CI: 2.50-12.76). Women in the poor wealth group showed higher odds only in the survey-weighted model (AOR: 9.38; 95% CI: 1.63-54.16). Finally, women with no antenatal care had higher odds of reporting obstetric fistula than those with four or more visits in the Firth model (AOR: 5.62; 95% CI: 1.29-24.42), but this association was not present in the survey-weighted model.

The findings suggest that marital structure, low socioeconomic status, and the lack of antenatal care are important underlying factors that may be associated with experiencing obstetric fistula in Zambia. Therefore, improving access to antenatal care and addressing women's social and structural vulnerabilities may contribute to reducing the burden of obstetric fistula.