International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2026
Spatial disparities and determinants of obstetric fistula among childbearing women in sub-Saharan Africa: A geospatial regression approach.
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Adane Kassaw Chekole, Abuhay Habtamu Wagnew, Abate Belayneh Jejaw, Nigatu Solomon Gedlu
Аннотация
OBJECTIVE: Obstetric fistula is a leading cause of maternal mortality and morbidity and continues to pose a significant public health challenge in sub-Saharan Africa (SSA). Despite its serious and devastating effects, there are a few studies that describe the spatial distribution, pooled prevalence, and factors associated with obstetric fistula in SSA. Understanding the burden and geographic variation is important for targeted interventions, efficient resource allocation, and progress toward Sustainable Development Goal 3. The aim of the present study was to assess geospatial variations, pooled prevalence, and factors associated with obstetric fistula in SSA using Demographic and Health Survey (DHS) data from 2015 and 2024.
METHODS: This study utilized a community-based cross-sectional design, which drew from DHS data collected from 14 SSA countries over a nine-year range (2015-2024). The sample consisted of 146 023 weighted women ages 15-49 with a childbirth history, sampled from a two-stage stratified cluster sampling framework. The data were processed using STATA 17. Spatial analysis included Global Moran's I for clustering, Getis-Ord Gi* for hotspot detection, and Kriging interpolation to predict prevalence in the unsampled areas using ArcGIS. Both global (ordinary least squares [OLS], spatial lag, spatial error) and local (geographically weighted regression, multiscale geographically weighted regression) spatial regression models were used to identify predictors, with model fit assessed by Akaike information criterion (AICc) and adjusted R.2 Significant predictors (P < 0.05) were mapped to illustrate spatial distribution.
RESULTS: The pooled prevalence of obstetric fistula in SSA was seven per 1000 women (95% CI: 0.5, 10.00), and its spatial distribution was found to be clustered (Global Moran's I = 0.07, P < 0.01). Hotspot areas were located in Sierra Leone, Chad, Uganda, Côte d'Ivoire, Ethiopia, Cameroon, and Mozambique; cold spot areas were Burkina Faso, Gambia, Zambia, and Senegal. The multiscale geographically weighted regression model explained 86% of the spatial variation of obstetric fistula in SSA. Adolescent childbearing, unskilled birth attendants, women undergoing cesarean section delivery, rural residency, and living in areas where distance to health facilities is a big problem were significant spatial predictors of obstetric fistula in SSA.
CONCLUSION: The study showed that the prevalence of obstetric fistula varies significantly across SSA countries. Due to the spatial clustering of obstetric fistula, a geographically targeted intervention is crucial, especially in hotspot areas. To address this issue, policymakers and health planners should implement focused strategies that improve access to skilled maternity care, prevent adolescent pregnancies, strengthen rural healthcare infrastructure, and ensure timely access to emergency obstetric services.
METHODS: This study utilized a community-based cross-sectional design, which drew from DHS data collected from 14 SSA countries over a nine-year range (2015-2024). The sample consisted of 146 023 weighted women ages 15-49 with a childbirth history, sampled from a two-stage stratified cluster sampling framework. The data were processed using STATA 17. Spatial analysis included Global Moran's I for clustering, Getis-Ord Gi* for hotspot detection, and Kriging interpolation to predict prevalence in the unsampled areas using ArcGIS. Both global (ordinary least squares [OLS], spatial lag, spatial error) and local (geographically weighted regression, multiscale geographically weighted regression) spatial regression models were used to identify predictors, with model fit assessed by Akaike information criterion (AICc) and adjusted R.2 Significant predictors (P < 0.05) were mapped to illustrate spatial distribution.
RESULTS: The pooled prevalence of obstetric fistula in SSA was seven per 1000 women (95% CI: 0.5, 10.00), and its spatial distribution was found to be clustered (Global Moran's I = 0.07, P < 0.01). Hotspot areas were located in Sierra Leone, Chad, Uganda, Côte d'Ivoire, Ethiopia, Cameroon, and Mozambique; cold spot areas were Burkina Faso, Gambia, Zambia, and Senegal. The multiscale geographically weighted regression model explained 86% of the spatial variation of obstetric fistula in SSA. Adolescent childbearing, unskilled birth attendants, women undergoing cesarean section delivery, rural residency, and living in areas where distance to health facilities is a big problem were significant spatial predictors of obstetric fistula in SSA.
CONCLUSION: The study showed that the prevalence of obstetric fistula varies significantly across SSA countries. Due to the spatial clustering of obstetric fistula, a geographically targeted intervention is crucial, especially in hotspot areas. To address this issue, policymakers and health planners should implement focused strategies that improve access to skilled maternity care, prevent adolescent pregnancies, strengthen rural healthcare infrastructure, and ensure timely access to emergency obstetric services.