The trend of iatrogenic genitourinary fistula and its risk factors among genitourinary fistula patients at Hamlin fistula hospital from 2005 to 2019.

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Addis Abeba University


Background: Genitourinary fistula is public health importance in low and middle income countries though it has been neglected. It has multiple health adversities to women. It is mainly caused after lack of timely and appropriate intervention mainly cesarean section. But genitourinary fistula can be Iatrogenic because of medical error during obstetric and gynecological surgery like cesarean section and hysterectomy. Objectives: This study assessed the trend, major surgical procedures resulted in iatrogenic genitourinary fistula and its risk factors. Methods: a facility based cross sectional study design was deployed. A mixed method that involved both quantitative and qualitative study was done. The study included respondents retrospectively using their medical history from January 2005 to December 2019 at Addis Ababa fistula hospital, Addis Ababa, Ethiopia. All Iatrogenic genitourinary fistula patients who fulfill the inclusion criteria and registered by the Addis Ababa fistula hospital over the study period were included in the quantitative study while clinicians and care providers who were providing service in the facility during the study period considered for the qualitative study. Data was cleaned and analyzed using SPSS version 20.0 software. Descriptive statistics such as frequencies and graphs were used. Results were shown using frequency tables to show Sociodemographic characteristics of fistula patients and frequency of iatrogenic genitourinary fistula by type and by cause. Bar graphs and pie chart was also used. Time trends in incidence of iatrogenic genitourinary fistula were analyzed using linear regression analysis. Annual percent change and average annual percent change were calculated using joinpoint regression analysis on joinpoint regression program version Binary logistic regression model applied to identify risk factors associated with iatrogenic genitourinary fistula. Crude odds ratio and adjusted odds ratio with 95% CI reported. Analysis of qualitative data was done using open code software version 4.02 to code and categorize data. Result: Total 9229 fistula patients treated at Addis Ababa fistula hospital, of which 643(6.96%) and 8,586(93.03%) were iatrogenic genitourinary fistula and obstetric fistula cases respectively. The mean age of iatrogenic genitourinary fistula patients was 30.02 ± 4.625 years (Range, 17-45 years) and the mean age of obstetric fistula patients was 26.65 ± 6.534 years (Range, 14-42 years). 341(53%) had iatrogenic genitourinary fistula after cesarean section while, 131(20.4), 78(12.1%), 93(14.5%) were after repair for ruptured uterus, hysterectomy for ruptured uterus and gynecological hysterectomy respectively. A significant rising trend in iatrogenic genitourinary fistula was found from 2005 to 2019 (1.55% to 52.9%; p<0.001) but the trend significantly declined in obstetric fistula (98.45% to 47.1%; p<0.001).average annual percent change throughout the year 2005-2019 is 13.2% (95% CI 7.7-18.9). Binary Logistic Regression analysis shows Previous history of obstetric or gynecologic surgery, type of institution at which the surgery is performed; height and parity were found to be factors significantly associated with iatrogenic genitourinary fistula. Conclusion: Iatrogenic genitourinary fistula has increased over the last 15 years and an urgent action for improved and safe operation and surgical procedure on abdominal and pelvic surgeries is important.



Iatrogenic, obstetric fistula, cesarean section, hysterectomy