We read the recent report by Mathieu Maheu-Giroux and colleagues (May, 2015) of a meta-analysis of Demographic and Health Survey data on fistula prevalence in sub-Saharan Africa. This study can only provide an estimate of urinary incontinence symptoms, and since there was no confirmation of fistula diagnosis, the data cannot be used to represent fistula prevalence. Indeed, Maheu-Giroux and colleagues report that women with fistula are older and of greater parity than women without fistula. This finding should have alerted them to an obvious error in the data because women classically experience fistula during their first delivery (at a young age) and frequently have no further pregnancies, whereas women with other causes of incontinence, such as uterine prolapse and stress incontinence, are older and multigravid.
Moreover, the data on Ethiopia’s fistula prevalence are in profound contrast to our experience and the results of two studies we have recently undertaken in Ethiopia, both of which are currently being considered for publication. The first is a community-based study of 23 023 women surveyed for fistula and uterine prolapse, with suspected fistula cases being followed up for diagnostic confirmation. The second is of surgical fistula treatment in three Ethiopian fistula hospitals, where around 70% of the country’s treatments are provided. Both studies reveal a significant decline in fistula prevalence and illustrate that Ethiopia is far from having “deficiencies in national treatment planning”, and it has been successful in improving maternal health care and delivering an effective patient identification programme and high-quality fistula.
- Maheu-Giroux, M, Fillipi, V, Samadoulougou, S et al. Prevalence of vaginal fistula symptoms in 19 sub-Saharan African countries: a meta-analysis of national household survey data. Lancet Glob Health. 2015; 3: e271–e278
- Ahmed, S and Tuncalp, O. Burden of obstetric fistula: from measurement to action. Lancet Glob Health. 2015; 3: e243
- THE LANCET Global World, fistula in sub-saharan Africa,vol. 3, no_8, e441, August 2015