Current Evidence Supporting Obstetric Fistula Prevention Strategies in Sub Saharan Africa: A Systematic Review of the Literature.

Aduragbemi O. Banke-Thomas, Oluwasola E. Wilton-Waddell, Salam F. Kouraogo, Judith E. Mueller


Obstetric fistula has been eliminated in developed countries, but remains highly prevalent in sub-Saharan Africa. The End fistula campaign is the first concerted effort to eradicate the disease. The objective of this review is to retrieve and link available evidence to obstetric fistula prevention strategies in sub-Saharan Africa, since the campaign began. We searched databases for original research on obstetric fistula prevention. Fifteen articles meeting inclusion criteria were assessed for quality, and data extraction was performed. Grey literature provided context. Evidences from the articles were linked to prevention strategies retrieved from grey literature. The strategies were classified using an innovative target-focused method. Gaps in the literature show the need for fistula prevention research to aim at systematically measuring incidence and prevalence of the disease, identify the most effective and cost-effective strategies for fistula prevention and utilise innovative tools to measure impact of strategies in order to ensure eradication of fistula. (Afr J Reprod Health 2014; 18[3]: 118-127)


Keywords: Obstetric fistula; Fistula prevention; Prevention strategies; Sub-Saharan Africa



La fistule obstétricale a été éliminée dans les pays développés, mais reste très répandue en Afrique sub-saharienne. La Campagne pour mettre fin à la fistule est le premier effort concerté pour éradiquer la maladie. L'objectif de ce compte rendu est de récupérer et de lier l’évidence disponible aux stratégies de la prévention de la fistule obstétricale en Afrique sub-saharienne, depuis le commencement  de la campagne. Nous avons cherché des bases de données pour la recherche originale sur la prévention de la fistule obstétricale. 15 articles ont satisfait  aux critères d'inclusion et ont été évalués pour vérifier leur qualité et l'extraction des données et a été réalisée. La documentation grise a fourni un contexte. Les évidences tirées ont été liés à des stratégies de prévention extraites de la documentation grise.  Les stratégies ont été classées à l'aide d'une méthode de cible axé innovante. Les lacunes dans la documentation montrent la nécessité pour la recherche sur la prévention de la fistule pour viser systématiquement la mesure de l'incidence et de la prévalence de la maladie, identifier les stratégies les plus efficaces et rentables pour la prévention de la fistule et d'utiliser des outils innovants pour mesurer l'impact des stratégies afin de garantir l'éradication de la fistule. (Afr J Reprod Health 2014; 18[3]: 118-127) 

Full Text:



Mselle LT, Kohi TW, Mvungi A, Evjen-Olsen B, Moland KM. Waiting for attention and care: birthing accounts of women in rural Tanzania who developed obstetric fistula as an outcome of labour. BMC Pregnancy Childbirth. 2011;11:75.

Wall LL. Preventing obstetric fistulas in low-resource countries: insights from a Haddon matrix. Obstet. Gynecol. Surv. 2012;67(2):111–21.

Tebeu PM, Fomulu, Joseph Nelson Khaddaj S, Rochat L de B, Delvaux T, Henry C. Risk factors for obstetric fistula: a clinical review. Int Urogynecol J. 2012;23(4):387–94.

Vangeenderhuysen C, Prual A, Ould el Joud D. Obstetric fistulae: Incidence estimates for sub-Saharan Africa. Int. J. Gynecol. Obstet. 2001;73(1):65–6.

Kalembo F, Zgambo M. Obstetric Fistula: A Hidden Public Health Problem In Sub-Saharan Africa. Arts Soc. Sci. J. 2012;Vol. 2012:(ASSJ-41).

Stanton C, Holtz SA, Ahmed S. Challenges in measuring obstetric fistula. Int. J. Gynaecol. Obstet. 2007;99 Suppl 1(null):S4–9.

UNFPA. Campaign to End Fistula. 2013. Available from:

UNFPA. International Day to End Obstetric Fistula 23 May. 2013. Available from: en/ events/endfistuladay/

Shefren JM. The tragedy of obstetric fistula and strategies for prevention. Am. J. Obstet. Gynecol.


Wall LL. Obstetric fistula is a “neglected tropical disease”. PLoS Negl. Trop. Dis. Public Library of Science; 2012;6(8):e1769.

Miller S, Lester F, Webster M, Cowan B. Obstetric fistula: a preventable tragedy. J. Midwifery Womens Health. 2005;50(4):286–94.

Lewis Wall L, Karshima JA, Kirschner C, Arrowsmith SD. The obstetric vesicovaginal fistula:

Characteristics of 899 patients from Jos, Nigeria. Am. J. Obstet. Gynecol. 2004;190(4):1011–6.

Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and metaanalyses: the PRISMA statement. PLoS Med/Public Library of Science; 2009;6(7):e1000097.

De Bernis L. Obstetric fistula: guiding principles for clinical management and programme development, a new WHO guideline. Int. J. Gynaecol. Obstet. 2007;99 Suppl 1(null):S117–21.

Tebeu PM, de Bernis L, Doh AS, Rochat CH, Delvaux T. Risk factors for obstetric fistula in the Far North Province of Cameroon. Int. J. Gynaecol. Obstet. 2009;107(1):12–5.

Melah GS, Massa AA, Yahaya UR, Bukar M, Kizaya DD, El-Nafaty AU. Risk factors for obstetric fistulae in north-eastern Nigeria. J. Obstet. Gynaecol. 2007;27(8):819–23.

Gerten KA, Venkatesh S, Norman AM, Shu’aibu J, Richter HE. Pilot study utilizing a patient educational brochure at a vesicovaginal fistula hospital in Nigeria, Africa. Int. Urogynecol. J. Pelvic Floor Dysfunct; 2009;20(1):33–7.

Turan JM, Johnson K, Polan ML. Experiences of women seeking medical care for obstetric fistula in Eritrea: implications for prevention, treatment, and social reintegration. Glob. Public Health. 2007;2(1):64–77.

Hassan M, Ekele B. Vesicovaginal fistula: Do the patients know the cause? Ann. Afr. Med. 2009;8(2):122–6.

Umoiyoho A., Inyang-Etoh E. Community misconception about the aetiopathogenesis and treatment of vesicovaginal fistula in northern Nigeria. Int. J. Med. Biomed. Res 2013;1(3):193–198.

Tsui AO, Creanga AA, Ahmed S. The role of delayed childbearing in the prevention of obstetric fistulas. Int. J. Gynaecol. Obstet.. 2007;99 Suppl 1:S98–107.

Muleta M, Fantahun M, Tafesse B, Hamlin EC, Kennedy RC. Obstetric fistula in rural Ethiopia. East Afr. Med. J. 2007;84(11):525–33.

Meyer L, Ascher-Walsh CJ, Norman R, Idrissa A, Herbert H, Kimso O, et al. Commonalities among women who experienced vesicovaginal fistulae as a result of obstetric trauma in Niger: results from a survey given at the National Hospital Fistula Center, Niamey, Niger. Am. J. Obstet. Gynecol. 2007;197(1):90.e1–4.

Roka ZG, Akech M, Wanzala P, Omolo J, Gitta S, Waiswa P. Factors associated with obstetric fistulae occurrence among patients attending selected hospitals in Kenya, 2010: a case control study. BMC Pregnancy Childbirth. 2013;13:56.

Nathan LM, Rochat CH, Grigorescu B, Banks E. Obstetric fistulae in West Africa: patient perspectives. Am. J. Obstet. Gynecol. 2009;200(5):e40–2.

Yisma E, Dessalegn B, Astatkie A, Fesseha N. Knowledge and utilization of partograph among obstetric care givers in public health institutions of Addis Ababa, Ethiopia. BMC Pregnancy Childbirth. 2013;13(1):17.

Bangser M. Strengthening public health priority-setting through research on fistula, maternal health, and health inequities. Int. J. Gynaecol. Obstet. 2007;99 Suppl 1:S16–20.

Stekelenburg J, Kyanamina S, Mukelabai M, Wolffers I, Roosmalen J. Waiting too long: low use of maternal health services in Kalabo, Zambia. Trop. Med. Int. Heal. 2004;9(3):390–8.

Capes T, Ascher-Walsh C, Abdoulaye I, Brodman M. Obstetric fistula in low and middle income countries. Mt. Sinai J. Med. 2011;78(3):352–61.

Banke-Thomas AO, Kouraogo SF, Siribie A, Taddese HB, Mueller JE. Knowledge of Obstetric Fistula Prevention amongst Young Women in Urban and Rural Burkina Faso: A Cross-Sectional Study. PLoS One. 2013;8(12):e85921.

Tostan. Promoting Health and Positive Practices. Health (Irvine. Calif). 2013. Available from: http://www.

Wegner MN, Ruminjo J, Sinclair E, Pesso L, Mehta M. Improving community knowledge of obstetric fistula prevention and treatment. Int. J. Gynaecol. Obstet. 2007;99 Suppl 1:S108–11.

Kwawukume EY, Ghosh TS, Wilson JB. Maternal height as a predictor of vaginal delivery. Int. J. Gynecol. Obstet. 1993;41(1):27–30.

Wall LL. A framework for analyzing the determinants of obstetric fistula formation. Stud. Fam. Plann. 2012;43(4):255–72.

Casterline JB, Sinding SW. Unmet Need for Family Planning in Developing Countries and Implications for Population Policy. Popul. Dev. Rev.


Fulton BD, Scheffler RM, Sparkes SP, Auh EY, Vujicic M, Soucat A. Health workforce skill mix and task shifting in low income countries: a review of recent evidence. Hum. Resour. Health. 2011;9(1):1.

Ronsmans C, Etard JF, Walraven G, Hoj L, Dumont A, Bernis L, et al. Maternal mortality and access to obstetric services in West Africa. Trop. Med. Int. Heal. 2003;8(10):940–8.

Ameh C, Msuya S, Hofman J, Raven J, Mathai M, van den Broek N. Status of emergency obstetric care in six developing countries five years before the MDG targets for maternal and newborn health. PLoS One/Public Library of Science; 2012;7(12):e49938.

Lim SS, Dandona L, Hoisington JA, James SL, Hogan MC, Gakidou E. India’s Janani Suraksha Yojana, a conditional cash transfer programme to increase births in health facilities: An impact evaluation. Lancet. 2010;375(9730):2009–23.

Waaldjik K. Evaluation report XIV on VVF projects in northern Nigeria and Niger. Katsina (Nigeria); 1998 p. 27.

Elneil S, Browning A. Obstetric fistula-a new way forward. Br. Journal of Obst. & Gynae.. 2009;116 Suppl:30–2.

Feasey N, Wansbrough-Jones M, Mabey DCW, Solomon AW. Neglected tropical diseases. British Med. Bulletin. 2010;93(1):179–200.

Molyneux DH, Hotez PJ, Fenwick A. “Rapid-impact interventions”: how a policy of integrated control for

Africa’s neglected tropical diseases could benefit the poor. PLoS Med./Public Library of Science; 2005;2(11):e336.

Millar R, Hall K. Social Return on Investment (SROI) and Performance Measurement. Public Manag. Rev. 2013;15(6):923–41.

Velez A, Ramsey K, Tell K. The Campaign to End Fistula: what have we learned? Findings of facility and community needs assessments. Int. J. Gynaecol.

Obstet. 2007;99 Suppl1:S143–50.


  • There are currently no refbacks.