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

Authors

  • Devon Madelyn Rupley Columbia University Medical Center, Department of Obstetrics and Gynecology, 161 Fort Washington Ave, New York, NY 10034, USA
  • Deepa Dongarwar Center of Excellence in Health Equity, Training and Research, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030 USA
  • Hamisu M. Salihu Baylor College of Medicine, Department of Family and Community Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA
  • Allison M. Janda University of Michigan Hospital System, Department of Anesthesia, 1301 Catherine St, Ann Arbor, MI 48109, USA
  • Rachel Pope Baylor College of Medicine, Department of Obstetrics and Gynecology, 1 Baylor Plaza, Houston, TX, 77030, USA

DOI:

https://doi.org/10.21106/ijma.292

Keywords:

  • Health care index,
  • Obstetric complications,
  • Vesicovaginal fistula,
  • Poverty,
  • Malawi,
  • Malawi Healthcare Access Index

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.

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Published

2019-12-10
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How to Cite

Madelyn Rupley, D., Dongarwar, D., M. Salihu, H., M. Janda, A., & Pope, R. (2019). Healthcare Access as a Risk-Marker for Obstetric Vesicovaginal Fistula in Malawi. International Journal of Maternal and Child Health and AIDS, 9(1), 4–13. https://doi.org/10.21106/ijma.292

Issue

Vol. 9 No. 1 (2020): International Journal of Maternal and Child Health and AIDS

Section

ORIGINAL ARTICLE

License


Copyright © 2019 Devon Madelyn Rupley, Deepa Dongarwar, Hamisu M. Salihu, Allison M. Janda, Rachel Pope. Published by Global Health and Education Projects, Inc., USA.

Creative Commons License

This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License , which permits others to remix, transform, and build upon the work non-commercially, provided the original author is credited and the new creations are licensed under the same terms.