Prevalence of obstetric fistula: a population-based study in rural Pakistan.

OBJECTIVE: To estimate the prevalence of obstetric fistula, its duration and impact on women's daily life using robust data collection methods in a population-based sample in rural Pakistan. DESIGN: A population-based, cross-sectional study. SETTING: A rural community in Sindh Province, Pakistan. POPULATION: Randomly selected women aged 15 years or older. METHODS: A multistage random sampling strategy was used to recruit the women. Lady Health Workers interviewed women in their own homes using a structured questionnaire to obtain symptom data. Women with symptoms of incontinence were then examined by female gynaecologists in their local health facilities to confirm obstetric fistula. MAIN OUTCOME MEASURE: Obstetric fistula confirmed by gynaecological examination. RESULTS: Among the 5064 women interviewed (96% response rate), 20 women with obstetric fistula were identified, showing a prevalence of 0.39% of all women (95% confidence interval [95% CI] 0.22-0.57%) and 0.45% of parous women (95% CI 0.25-0.65%). Significantly more of the women with obstetric fistula compared with parous women without fistula were primiparae and aged <20 years. Of the women with obstetric fistula, 40% had had this for >5 years and 90% reported a major impact on their lives, yet only four had consulted a doctor, three of whom had failed repairs. CONCLUSIONS: The prevalence of obstetric fistula is high in rural Pakistan. Appropriate provision is needed for fistula repair to reduce the burden of the condition. Alongside this, the improvement of maternity care services is urgently needed to prevent its continued occurrence.

Urinary incontinence in women in rural Pakistan: prevalence, severity, associated factors and impact on life.

OBJECTIVE: To estimate the prevalence of urinary incontinence (UI) and its subtypes in women in rural Pakistan, associated factors, severity and impact on daily life. DESIGN: Population-based, cross-sectional study. SETTING: A rural community in Sindh Province, Pakistan. POPULATION: Randomly selected women aged 15 years or older. METHODS: A three-level random sampling strategy was used to select women: a random sample of health centres; a random sample of Lady Health Workers (LHWs) from each health centre; and a random sample of women in the LHW catchment areas. The LHWs used an interview-based structured questionnaire to collect data from women. MAIN OUTCOME MEASURE: Urinary incontinence reported by women. RESULTS: Among the 5064 participants (response rate 95.8%) the prevalence of any UI was 11.5% (581/5064; 95% CI 10.6-12.3). The most common subtype was stress incontinence, with a prevalence of 4.7% (95% CI 4.1-5.3), followed by urge incontinence, with a prevalence of 3.2% (95% CI 2.7-3.7), mixed incontinence, with a prevalence of 2.8% (95% CI 2.3-3.2), other incontinence, with a prevalence of 0.4% (95% CI 0.2-0.5) and continuous incontinence, with a prevalence of 0.5% (95% CI 0.3-0.6). Older age, higher parity and marriage at an early age were independently associated with UI. We found that 52% of women with UI reported leakage at least daily, and 45% reported a great or moderate impact on their daily life. Only 15.7% of women with UI had consulted a doctor. CONCLUSIONS: The prevalence of UI reported in rural Pakistan was lower than is generally found in studies from the developed world, but among the women affected it commonly occurred on a daily basis and impacted on their everyday lives, yet few had obtained medical advice.