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

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.