Awareness towards obstetric fistula and associated factors among reproductive age group women in Bibugn district, East Gojjam, Amhara, Northwest Ethiopia; Cross sectional study

doi:10.21203/rs.3.rs-5273952/v1

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Research Article

Awareness towards obstetric fistula and associated factors among reproductive age group women in Bibugn district, East Gojjam, Amhara, Northwest Ethiopia; Cross sectional study

https://doi.org/10.21203/rs.3.rs-5273952/v1

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Background

Obstetric fistula is a hole which develops between female private organs and leaves a woman incontinent of urine or faeces or both. It is a devastating public health problem usually caused by obstructed labour. Its occurrence is correlated with lack of awareness. The key to eliminate obstetric fistula is raising awareness of it and the factors that contribute to it.

Objective

To assess awareness towards obstetric fistula and associated factors among reproductive age women in Bibugn district, East Gojjam zone, Amhara, Ethiopia, 2022.

Methods

A community based cross-sectional study was employed to collect data from 612 reproductive age women from May20-June20/2022. A systematic sampling technique was used to select study participants. Data were collected using a pretested structured face to face interviewer- administered questionnaire. Bivariable and multivariable analysis were used to identify factors associated with the dependant variable.

Result

From total sampled participants, of them 608(99.3%) were interviewed, from those 37.8%[95%CI (34, 42%)]study participants had good awareness towards obstetrics fistula. Primary andsecondaryeducation(AOR = 4.91,CI = 3.10,7.99), and (AOR = 6.37, CI = 3.70,10.91) respectively, being urban resident (AOR = 1.71,CI = 1.09,2.67), contraceptive use (AOR = 1.70,CI = 1.04, 2.79), and distance < 30minute on foot from health facility(AOR = 0.42,CI = 0.34,0.79) weresignificantly associated with awareness towards obstetric fistula.

Conclusion and Recommendation

This study reported that awareness of obstetrics fistula was low compared to previous studies in Ethiopia. Urban residency, education (primary and above), having a history of using contraceptives and proximity to a health facility were significantly associated with awareness towards obstetric fistula. Measures to improve educational level and contraceptive utilization of reproductive age women should be considered.

Awareness level

Obstetric fistula

Reproductive age women

Bibugn

Ethiopia

Obstetric fistula (OF) is a medical disorder in which a hole or fistula forms between the rectum and vagina (rectovaginal fistula) or between the bladder and vagina (vesico-vaginal fistula), through which urine and faeces continuously leaks. It causes a woman to become incontinent of faeces, urine or both(1, 2).

Obstetric fistula is caused by prolonged obstructed labor in which the soft tissues of the birth canal are compressed for an extended period of time between the baby's head and the mother's pelvis leading to ischemia and necrosis. Risk factors for obstetric fistula include low levels of education, early marriage and childbirth, the status and role of women in developing nations, and harmful traditional practices(3).

Even if fistula is treatable, the success rate of surgery is only between 70–90% if performed by an experienced surgeon, 10–30% victims obligated to live with these disabilities. So prevention through awareness creation has less cost and more effective key intervention than its treatment(4).

Due to this WHO developed guidelines for the establishment of a national or sub-national strategy for the prevention and treatment of obstetric fistula, including the long-term objectives of a strategy. This demonstrates promoting health; raising awareness of the causes of the condition; and providing basic and comprehensive emergency obstetric care services of sufficient quality(5).

Obstetric fistula prevention strategies can be primary prevention strategies (focused delaying the age of first marriage and birth, cessation of harmful traditional procedures, and using contraception), secondary prevention strategies (ensuring women can access skilled care for delivery) and tertiary prevention strategies (early screening for fistula for most at risk women).Women must be properly informed about obstetric fistula and where to get treatment because it is thought that once people are aware of the problem, they will reject its existence(6, 7).

Awareness of obstetric fistula about the risk factors, prevention and treatment fistula helps women to take appropriate steps to prevent obstetric fistula(8). Creating awareness about obstetric fistula by addressing the contributing factors through promoting women’s education, encouraging targeted behavioural change, spreading information via multiple media, and supporting community health-seeking behaviour are all necessary ways to address the underlying factors of obstetric fistula(9, 10)

In some groups, fistula is thought to be a punishment from God, therefore women who have it and others of their community may be misinformed about its causes. So raising public awareness about obstetric fistulas is essential to lowering morbidity, death, and social stigma. Since raising awareness is one of the preventable strategies, women may be better able to take the necessary precautions to prevent obstetric fistula if they are adequately informed of the risk factors, prevention methods, and treatment options, social factors such as young age at marriage, malnutrition of girl children, and use of family planning(11, 12).

Globally as World Health Organization (WHO) estimates that about 50,000–100,000 women develop obstetric fistula annually with at least 33,000 of these located in Sub-Saharan Africa (SSA).Obstetric fistula(OF) almost eradicated in the developed world since the end of the 19th century when caesarean section but it continues to affect women throughout the developing world(13).

In low-income countries, between 15 and 20 million girls and women develop this disabilities following obstructed labour every year. These could have been prevented if adequate, quality emergency obstetric care services had been accessible(1, 14).

In Ethiopia obstetric fistula is remained a major public health problem. The national prevalence of obstetric fistula is 0.42%(15).And the highest prevalence of untreated fistula in 2016 was found in Amhara region with 2.3 cases per 1000 women in reproductive age(16).

Occurrence of obstetric fistula is highly related with lack of awareness (misperception) on risk factors of obstetric fistula. Lack of awareness is the condition usually affects the most marginalized group, that is, the poor, young women who are often illiterates and who live in rural areas(17).

There contributing factors that affects the awareness of obstetric fistula are maternal level of education, place of birth, antenatal care attendance, maternal age, distance to a health facility, residency, low economic status, gender inequality, and lack information to prevent obstetric fistula and physical, psychological, social and economic consequences which affects the awareness of obstetric fistula to seek care (9, 18–20).

Therefore in recent decades there have been concerted global efforts geared towards reducing and/or eradicating fistula, but the progress has been slow. United Nation Fund for Population Agency (UNFPA)in collaboration with other stakeholders, launched the global campaign to end fistula with the aim of reducing fistula cases, by focusing on prevention through awareness creation, treatment and social reintegration. Recently, the international fistula day (23rd May) was created to draw global attention to obstetric fistula and mobilize support for on-going initiatives (21). In line with this global commitment, Ethiopia have also launched a five-year fistula elimination programme in 2014 with a theme of ending fistula and transforming lives by 2020 by ensuring prevention trough awareness creation(11) .

In actual fact, awareness of obstetric fistula appears to be such an understudied area that a recent explanation described it as neglected. It is an area that is frequently hidden under the broad documentation of maternal health and is therefore not sufficiently prioritised. But it is well documented that obstetric fistula is entirely preventable through awareness creation(22).

In Ethiopia study revealed that lack of awareness is a major factor about the meaning, causes, effects and treatment hindered early seeking fistula treatment; many women do not know what fistula is, that the condition is treatable, or where to get treatment due to lack of adequate and comprehensive reproductive health education and low literacy of the population in the country(23).

Consequences of lack of awareness on cause, symptoms, prevention and presence of treatment options of obstetric fistula hinder seeking treatment. Many of women are not aware of how to prevent obstetric fistula. If such women develop obstetric fistula during the process of childbirth, it is also difficult for them to get treatment since they may not even be aware that it can be treated(24).

Awareness on Obstetric Fistula in Ethiopia appear inadequate (about 38% according to the result of the national study on EDHS 2016) (19).Based on my search, there are limited research on awareness of obstetric fistula and no study conducted on reproductive age group women in Amhara region. To end obstetric fistula raising awareness and intensify actions towards eradicating obstetric fistula is mandatory. Therefore this study aimed to assess awareness towards obstetric fistula and its associated factors in Bibugn district, East Gojjam Amhara Ethiopia.

Study area and Study period

The study was conducted from May 20- June 20/2022 in Bibugn which is one of the districts in East Gojjam zone, and bordered on the south by Sinan wereda, on the west by Dega Damot, on the northwest by Goncha, and on the east by Hulet EjEnese. The district is 381km far from Addis Ababa, the capital of the country, 145km from Bahir Dar, capital of the region and 81km from Debre Markos capital of the zone. It has a total of 19 kebeles The district has one government primary hospital, four health centres, nineteen health posts and three private clinics. According to 2007 survey projection and 2014 health services plan the total population is 98834, from these population 48167 are males and 59667 are females. The reproductive age group women are estimated to be around 21959and the total households are 16692.

Study design

Community based cross sectional study was conducted

Population

The study’s source population included all reproductive age women in Bibugn district were source population. The Study included all reproductive age group women who are available during data collection and resident for at least 6 months before the data collection. Reproductive age group women who were critically ill and unable to communicate were excluded from the study.

Sample size determination

The sample size was determined by using a single population proportion formula based on the following assumption in 95% CI and 5% of Margin error with a proportion of 39.5% of study participant had good awareness as obtained from the previous study done at Injibara(25).

n = (Z_α/2)²p (1-P)

d²n = (1.96)² (0.395) (0.605)

(0.05)² n = 368

So, with adjustment for non-response rate (10%) nf = ni*1/1-NR, nf = 368*1/1-0.1, nf = 368*1.11 = 408.45 ~ 409

n = 409. Since study participants were selected by going stages a design effect of (1.5) was used to get a final sample size of 614.

Sampling technique and Data collection procedure

Among total of nineteen kebeles in Bibugn, five kebeles were selected randomly .There were total of 4450 households in the five kebeles, from these the number of participants in each kebele were allocated proportionally. (The sample size for each kebeles was calculated by multiplying the house hold in the specific kebeles by total sample size (614) and dividing the product to the total household of selected kebeles (4450)). A list of household was obtained from kebeles registration was used as a sampling frame. A systematic sampling technique was used to recruit households. The first household was selected by lottery method and the next households were selected by systematic sampling every K^th). K = total number of household in all selected kebeles/total sample size.

Data collection instrument

A structured interviewer administered questionnaire was first prepared in English and then translated in to Amharic and again translated to English to maintain consistency. The tool was adapted from structured questionnaire(25, 26). The questionnaire has 3 sections: the first section was socio demographic based (13) questionnaire, the second section obstetric history and reproductive based (9) questionnaire and the third were awareness (21) about OF based questionnaire.

Data quality control

Training was given for the data collectors (3 diplomas and2 BSC midwives) and supervisors (2 public health officers) by the principal investigator on the objective of the study and how to fill the questioners. The instrument was pretested before the actual period of data collection at Sekela Wereda (Gish Abay kebele 01(which out of the study area) by 5% (31 participants) of the sample population. Any ambiguity and missed points were incorporated to the tool based on the findings of the pre-test in the final version of the questionnaire. The questioners were checked for its completeness and consistency. Close supervision was carried out by the investigator and supervisors during data collection. Any difficulty occurs during data collection was explained and a correction was made accordingly.

Data processing and analysis

The collected data were entered into Epi data 4.6for data and exported to SPSS version 25 for analysis. The descriptive analysis such as frequency, percentages and mean were used to describe the data. The statistical analysis was being conducted in two steps, namely: Bivariate and multivariable Logistic regression analysis was employed. Fitness of the final model was checked by using the Hosmer and Lemishow goodness of fit test. Multi-co linearity was checked by using variance inflation factor. The association between specific independent variable and the dependant variable on bivariate analysis with crude odds ratio (COR) and p-value of </=0.25 was used for multivariable logistic regression. Then the variables which show significant association on multivariable logistic regression with p-value of < 0.05 were considered Statistical significant. The strength of the association with adjusted odds ratio (AOR) between independent variables and dependent variable was determined by a multivariate logistic regression analysis with 95% confidence intervals.

Variables

Dependent variable

Awareness towards obstetric fistula.

Independent variables

A. Socio-Demographic characteristics

Age, Monthly income, Age at first marriage and at first pregnancy, marital status, Educational status, Occupational, Educational status of the partner, Occupation of the partner, Women’s decision-making power and Availability of media at home

B. Obstetric and reproductive factors

History of pregnancy, Number of pregnancy, Place of delivery, history of contraceptive use, History of induced abortion ,ANC follow up, pregnant women conference and history of delivery complications

C. Health services and household related factors

Availability of health facility and distance from health facility

Operational definitions

Awareness

Being conscious or informed about obstetric fistula cause, symptoms, prevention and treatment.

Good Awareness

From awareness questions participants who scored above mean score are assigned as they have good awareness,

Poor Awareness

Participants who scored less or equal to mean score is considered as having poor awareness(26, 27)

Socio-demographic character and health service related issues of the study participants

From total of 614 calculated samples, 608study participants had interviewed,with response rate was 99%. Among these 28.1%participants were in the age between 25–29 years with mean age of 29.45 years (SD 7.6) and (58.1) were above the mean age. About one third 208 (34.2%) participants reported that they were not attend formal education and 287(47.2%) were farmers in occupation( Table 1).

Table 1

;Socio-demographic and health related characteristics of the study participants in Bibugn district, East Gojjam, Amhara, Ethiopia 2022,(N = 608).
Category	Variables	Frequency	Percentage
Age group Age at first marraige Educational status Occupational Statu Residence Marital status Partner educational Status(n = 414) Partner Occupational Status(n = 414) Average family monthly income Who is responsible for you in deciding related issues? Any type of media at home Is there health institution in your kebele? How far the health facility from your home?	15–19 20–24 25–29 30–34 35–39 40–49 < 18 >=18 No formal education Primary education Secondary and above Farmer Housewife Student Merchant Unemployed Government employee House made Urban Rural Married Single Divorced Separated Widowed No formal education Primary education Secondary and above Farmer Merchant government employee Daily labourer Privately employed < 1500 1500–3000 > 3000 Parents or hasband Participant her self Yes No Yes No > 30min <=30min	61 120 171 109 73 74 293 171 208 202 198 287 81 76 59 23 63 19 229 379 394 144 34 20 16 181 91 142 257 74 60 15 8 403 29 176 353 255 233 375 450 158 458 150	10.0 19.8 28.1 17.9 12.0 12.2 61.1 38.9 34.2 33.2 32.6 47.2 13.3 12.5 9.7 3.8 10.4 3.1 37.7 62.3 64.8 23.7 5.6 3.3 2.6 43.7 21.9 34.4 62.9 17.1 16.5 3.6 1.9 66.3 4.8.0 28.9 58.0 42.0 38.3 61.7 74.0 26.0 75.3 24.7

Obstetrics and reproductive characteristics of the study participants

Above two third 413(67.9) had history of pregnancy of which 221 (53.6%) of them were < 18 years of age at first pregnancy. The majority of the participants 341 (82.8%) and 332(81.0%) had ANC follow up and had institutional delivery for their last pregnancy and last delivery. Concerning family planning 469(77.1%) women had ever used modern contraceptives (Table 2).

Awarenessof the study participants towards obstetric fistula

Nearly two third 364 (59.9%) of the participants had ever heard about obstetric fistula(. Figure 2)

Table 2

Reproductive and obstetrics characteristics of reproductive age women in Bibugn district, East Gojjam zone, Amhara, Ethiopia 2022 (n = 608).
Variable	Catagory	Frequency	Percent
Have you ever been pregnant? What was your age when you were pregnant for the first time?(n = 413) Have you exprience induced abortion? How many times you experienced pregnancies?(n = 413) Did you have ANC follow up for the last pregnancy? (n = 413) Did you attained pregnant women conference for the last pregnancy? (n = 413) Place of your last delivery(n = 410) Have you ever exprenced delivery complication(n = 410) Have you ever used modern contraceptive?	Yes No < 18 >=18 Yes No < 5 >=5 Yes No Yes No health Center/ hospital home Yes No Yes No	413 195 221 192 23 390 337 76 341 72 143 270 332 78 108 302 469 139	67.9 32.1 53.6 46.4 5.6 94.4 81.6 18.4 82.8 17.2 34.6 65.4 81.0 19.0 26.3 73.7 77.1 22.9

Nearly two fivth 230(37.8%) of the study participants had good awareness towards obstetric fistula among reproductive age women. About three fourth240(72.5%) of participants identified early marriage and early pregnancy as risk factor,On the other hand there are misconceptions 18(4.5%)participants identified evil sprites as a risk factor for obstetric fistula.(Table3)

Table 3

Participants' characteristics of awareness towards obstetric fistula among reproductive age women in Bibugn district, East Gojjam zone, Amhara, Ethiopia 2022 (Multiple response).
Variables	Catagories	Frequency	Percent
Which one is/are predispose to obstetric fistula	Early marriage Home delivery Early pregnancy Prolonged labor Unsafe abortion malnutrietion Evil sprite	240 154 103 103 82 23 18	72.5 46.5 31.1 31.1 24.8 6.9 5.4
Which one is/are symptoms of obstetrics Fistula	Unable to control urine Unable to control feces Unable to control urine and feces Unable to control flatuce Maloduor vaginal discharge Vulval irritation	256 193 76 63 50 24	70.7 53.3 21.0 17.4 13.8 6.6
Which one is/are prevention method of obstetrics fistula(n = 364)	Avoid early marriage Avoid early pregnancy Giving birth at health facility Using family planing Safe abortion Proper nutrietion	238 172 88 82 80 15	72.6 52.4 26.8 25.0 24.4 4.6
Source of Information	Health professional Family/friend/relative Media School Other(specify)	202 141 30 102 5*	42.1 29.4 21.2 6.3 1.0
*fistula victims

Factors associated with awareness status on obstetric fistula

In bivariate logestic regression eight variables such as educational status of women,residence, decision to seek health care,distance to health facility, modern contraceptive use,income,avaliablity of media at homeand avaliablity of heath facility in the kebele were found to had significant association with awareness of reproductive age women towards OF. But only educational status, urban residence, distance < 30min by foot from health facility and modern contraceptive use were ramined significantly associated in mutilvarable logestic regression.

The odds of good awareness about OF is 4.9 times higher among women who have primary level of education as compared to women who have no formal education. (AOR = 4.91. CI = 3.10–7.99) Likewise, the odds of good awareness about OF is 6.3 times higher among women who have secondary and above level of education as compared to women who have no formal education. (AOR = 6.37, CI = 3.70-10.91).

Women who are living in urban area were 71% more likely to have good awareness than women who are living in rural areas (AOR = 1.71, CI = 1.09–2.67), and Women who are using modern contraceptives were 70% more likely to have good awareness than their counter parts(AOR = 1.70, CI = 1.04–2.79).The odds of good awareness about obstetric fistula 2.3 times higher among women living in areas where health facility is found at a distance less than half an hour, as compared to those living in areas where found at greater than half an hour(on foot) from the home they are living (AOR = 2.3,CI = 1.47–3.72)( Table4).

Table 4

Multivariable logistic regression analysis showing the impact of selected associated factors of obstetric fistula awareness among reproductive age women in Bibugn district, East Gojjam zone,Amhara, Ethiopia 2022 (n = 608).
Variables	Catago ries	Awareness			COR [95%CI]	AOR[95% CI]	p-value
Variables	Catago ries	Good		Poor	COR [95%CI]	AOR[95% CI]	p-value
Educational Status	No formal education	35(5.7%)	174(28.6%)		1	1
	Primary School	53(8.7%)	148(24.3%)		1.78(7.410-19.099)	4.9 (3.102–7.99)	0.000**
	Secondary and above	142(23.4%)	56(9.2%)		12.606(4.253–10.195)	6.3(3.700-10.912)	0.000**
Media	Yes	125(20.6%)	108(17.7%)		2.98(2.114–4.191)	1.289(0.902–5.113	0.55
Media	No	105(17.3%)	270(44.4%)		1	1
Avialablity health facility in the kebele	Yes	192(31.6%)	258(42.4%)		2.35(1.56–3.54)	1,329(0.774–2.23)	0.32
Avialablity health facility in the kebele	No	38(6.3%)	120(19.7%)		1	1
Distance	<=30min	149(24.5%)	81(13.3%)		4.26(2.995–6.014)	2.342(1.474–3.72)	0.003*
Distance	> 30min	114(18.7%)	264(43.4%)		1	1
Income	< 1500	117(19.2%)	286(47.0%)		1	1
	1500–3000	12(2%)	19(3.1%)		1.54(2.34–4.289)	0.76(0.44–1.33)	0.34
	> 3000	101(16.6%)	73(12%)		3,38(1.001–4.190)	1.22(0.47–3.15)	0.6
Residence	Urban	132(21.7%)	97(15.9%)		3.902(12.753–5.53)	1.7 (1.097–2.670)	0.018*
Residence	Rular	98(14.6%)	281(46.2%)		1	1
Family planing use	Yes	192(31.5%)	277(45.6%)		1.842(1.213–2793)	1.7 (1.036–2.787)	0.036*
Family planing use	No	38(6.3%)	101(16.6%)		1	1
Decision to seek care	Participant her self	125(20.6)	130(21.4)		2.27(0.32–0.62)	1.62(0.17–1.06)	0.066
Decision to seek care	Parents $husband	105(17.3)	248(40.8)		1	1
*Note:=significant at p-value < 0.05, =significant at p < 0.001 ,1 = reference CI = confidence interval,AOR = ajusted odds ratio,COR = crude odds ratio

In this study, nearly two fifth (37.8%) with (CI = 34% − 42%) of the participants had good awareness towards obstetric fistula.

This result is in line with result of studies conducted in Awi39.5%(25), Bench 40.8(26), EDHS 201638%(19),Burkina Faso 36.4%(28) and Nigeria 39.2%(9).

But this result is lower than studies conducted in Ilubabur(51.1%(27),Tigray(42,15%(29)),Tanzania(60.1%(30)) and Nigeria 57.8%(9)).The difference might be the difference in the study population(in Ilubabur reproductive age women who visit health institutions, in Nigeria study populations were pregnant women at ANC attendees and the difference in socio-demographic characteristics(in Tanzania most of participants (76.7%) educated and (67%) lived in urban) ,study settings and simple size.

This result is higher than the study in conducted in Ghana showed that 29% were aware of about obstetric fistula(18). This difference might be the difference in the study population, study setting and socio-demographic characteristic, sample size and study period.

Educational status of the women is found to be one of the predictors variable for the outcome variable, Participants who were attend primary and secondary education were 4.9 times and 6.3 times respectively more likely to have good awareness as compared to women who didn’t attend formal education.

The finding is consistent with studies conducted in Awi, Bench, EDHS2016, Nigeria, Burkina Faso and sub Saharan Africa (19, 25, 26, 28, 31, 32).This might be attending formal education have greater opportunity to asking and getting information about maternal health services and also due the fact that better educational status is believed to be an important factor for good awareness and positive attitude related to maternal health. In addition to this women with higher educational levels might have a better socioeconomic status, which allowed them to media exposure to be informed than those who had not attended formal education. Furthermore this is due to the fact that when education level is improved the awareness comes more improved.

This result reported that there is a significant association between residence and women’s awareness towards obstetric fistula. Women who are living in urban area were 70% more likely to have good awareness than women who are living in rural areas. This result is consistent with studies in Awi, Tigray, Nigeria and Burkina Faso(25, 28, 29, 31). This urban – rural awareness gap signifies lack of focus on rural women with targeted messages on maternal health generally, and on the risks and consequences of fistula and ways of preventing it specifically.

This might be due to the fact that urban women with more availability of information access, easily accessibility of facility, and accessibility of education than rural women.

This result reported that there is a significant association between women’s awareness towards obstetric fistula and distance to the nearby health facility. Women who are living in areas where health facility is found at a distance less than half an hour from the home they are living were 2.3 times more likely to have good awareness than those who are walking greater than half an hour to reach the nearest health facility(on foot).

The finding is consistent with study conducted in Ilubabur Zone, EDHS 2016,in Tanzania and sub Saharan Africa possible explanation for this might belong distance from health facility brings poor health seeking behaviour which is associated with poor awareness about obstetric fistula. This might be due to the fact that as the women lived near the health facilities have chance to access health related information easily. This means as their home becomes near to the health facility women are willing to visit the facility because they don’t need transportation, accompany and transport cost to go to a health facility this helps the women to have access to health related issues including obstetric fistula.

The result showed that there is a significant association between women’s awareness towards obstetric fistula and women’s history of use of modern contraceptives. Women had used modern contraceptive were70% more likely to have good awareness than those who had not used any type of modern contraceptive. The finding is consistent with the study done at Ilubabur and Tigray, Nigeria demographic health servey2018 (27, 29, 31). This might be due to the fact that using modern contraceptive brings knowledge about obstetric fistula because of women who had used modern contraceptives had a chance of visiting health facility frequently this helps them to acquire knowledge about reproductive and sexual health issues including obstetric fistula. And women who have used contraceptives are preventing obstetric fistula by preventing pregnancy. This helps them to participate in different social works which can make them aware of health related issues.

Conclusion

This study reported that awareness of obstetrics fistula was low compared to previous studies conducted in Ethiopia. Urban residency, education (primary and above), having a history of using contraceptives and proximity to a health facility were significantly associated with awareness towards obstetric fistula.

Recommendation

Based on the findings of this study, the following recommendations are forwarded for the followings concerned bodies:

The regional government it is better to ensure that roads to health facilities so as to available transportation at all times especially for women in deprived settings (rural and far from health facility).The district health office better to raise awareness by creating different strategies for distant and rural community. The health care providers better to focus on using contraceptives. The community need to strengthen education for girls and also the study participants (reproductive age women) better to attend formal education and use contraceptives

Limitations

Due to the cross-sectional nature of the design, the study limits the cause and effect determination variables.The study was also prone to social desirability and recall bias (Age related and income questions).

EDHS: Ethiopian Demographic Health Survey; OF: Obstetric fistula; RVF: Recto vaginal fistula SPSS: Statical product and service solutions; UNFPA: United Nation Fund for Population Agency VVF: Vesico-vaginal Fistula, WHO: World Health Organization.

ACKNOWLEDGEMENTS

We have heartfelt thank to Genet Degu(assistant professor) and Mr Asmare Talie(assistant professor) for their unreserved and constructive feedback and guidance to this research paper.

We also had heartfelt thank to Debre Markos University and Amhara regional health bureau for giving their financial support.

Availability of data and supporting materials

Please contact the author for data requests

Funding

This research was funded by Debre Markos University College of medicine and Health Sciences till data collection. Whereas data analysis, interpretation and writing of manuscript was covered by the authors.

Authors’ contributions

AT and GD were giving scientific advices starting title, proposal preparation, data collection and interpretation until this manuscript preparation stage. BK and LC were involved in study design, data collection, analysis and manuscript writing.

Ethical approval and consent to participate

Ethical approval was given from Debre Markos University College of medicine and health sciences ethical review board. First permission letter was sent to Zonal health Department then to Bubugn Woreda Health office. Finally, consent letter was sent to each public health institutions of the district.

Consent for publication

Not applicable

Competing interests

The author(s) declare that they have no competing interests

Publisher’s interest

Springer nature remains neutral with regard to judicial claims in published maps and institutional affiliations.

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No competing interests reported.

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Awareness towards obstetric fistula and associated factors among reproductive age group women in Bibugn district, East Gojjam, Amhara, Northwest Ethiopia; Cross sectional study

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Abstract

Figures

INTRODUCTION

METHODS AND MATERIALS

Study area and Study period

Study design

Population

Sample size determination

Sampling technique and Data collection procedure

Data collection instrument

Data quality control

Data processing and analysis

Variables

Operational definitions

RESULT

Socio-demographic character and health service related issues of the study participants

Obstetrics and reproductive characteristics of the study participants

Factors associated with awareness status on obstetric fistula

DISCUSSION

CONCLUSION AND RECOMMENDATION

Conclusion

Recommendation

Limitations

Abbreviations

Declarations

ACKNOWLEDGEMENTS

References

Additional Declarations

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