Healthcare Access as a Risk-Marker for Obstetric Vesicovaginal Fistula in Malawi

Abstract

Objectives: To determine the association between access to health care among pregnant women in Malawi and occurrence of obstetric vesicovaginal fistula (VVF).

Methods: This was a case-control study using data obtained from patients’ records documented by the ‘Fistula Care Center-Bwaila Hospital’ in Malawi. Socio-demographic characteristics of women with VVF (study arm, n=1046) and perineal tear (control arm, n=37) were examined. A composite variable called “Malawi Healthcare Access Index” (MHAI) was created through summation of scores related to three factors of access to care: (1) walking distance to closest health center; (2) presence of trained provider at  delivery; and (3) receipt of antenatal care. Binomial logistic regression models were built to determine the association between the MHAI and presence of VVF.

Results: Obstetric VVF was more common in women from rural areas, mothers delivering at extremes of age, those with less education, and patients with long labor (>12 hours). In adjusted models, women with “insufficient” health access based on the MHAI were at greater risk (OR = 2.64, 95%CI = 1.07 – 6.03) of obstetric VVF than women with “sufficient” score on the MHAI.

Conclusion and Global Health Implications: Inadequate access to essential obstetric care increases the risk of VVF.

Copyright © 2020 Rupley et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.