Healthcare-seeking behavior for obstetrical fistula and its determinant factors in sub-Saharan Africa: systematic...

An obstetrical fistula is an abnormal communication between the vagina and adjacent tubular structures, usually the bladder and rectum. If timely and effective treatment is not given, women with a fistula face lifetime embarrassment, isolation, social stigmatization, and marital separation. Although early detection and management of obstetrical fistula often result in improved treatment outcomes, most women do not have access to care due to either the cost, stigma, or lack of awareness. This study aimed to determine the pooled prevalence and predictors of healthcare seeking for obstetrical fistula in sub-Saharan Africa.

As this is a systematic review and meta-analysis protocol, the primary data sources will be electronic databases and grey literature. We will systematically search PubMed, Cochrane Library, and Google Scholar to retrieve eligible primary studies.

Per our protocol, we apply the CoCoPop (Condition, Context, and Population) mnemonic framework:•Inclusion Criteria: Observational studies (cross-sectional, case-control, cohort) investigating healthcare seeking for obstetric fistula and its determinants; conducted in sub-Saharan Africa (SSA) countries; published in the English language between 2015 and 2025.•Exclusion Criteria: Studies conducted outside of SSA, studies lacking an abstract or full text, qualitative studies, conference summaries, and studies where the primary outcome variable is not formal clinical healthcare-seeking behavior.

This systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Cochrane Library, Google Scholar, and gray literature were used to search for eligible articles. The quality of the studies was assessed using the Joanna Briggs Institute critical appraisal checklist. All studies on obstetrical fistula care seeking conducted in English from 2015 to 2025 and in sub-Saharan Africa were included. The required data were extracted from each article using Microsoft Excel 2016 (Microsoft, Redmond, WA) and exported to Stata (version 16; StataCorp LLC, College Station, TX). Forest plot and I² statistics were performed for heterogeneity. A funnel plot and Egger regression test were performed to check for publication bias. Subgroup analysis and meta-regression analysis were performed to identify potential sources of bias.

Because this manuscript is a systematic review and meta-analysis protocol, there are no empirical results to report at this stage. The protocol establishes our plan to extract, transform, and pool data using STATA version 17 to determine the pooled magnitude and effect sizes (OR/RR) of predictors once the full review is completed.

As a protocol, final study conclusions are not yet available. However, this upcoming systematic review and meta-analysis is designed to provide a comprehensive, pooled magnitude of healthcare-seeking behavior and its multi-level socio-ecological predictors. The final findings will provide robust empirical evidence intended to guide policy makers, program implementers, and healthcare providers in optimizing maternal health interventions across sub-Saharan Africa.