Predictors of Time to Recovery from a Surgical Repair of Obstetric Fistula at Mekelle Hamlin Fistula Center, Tigray, Ethiopia

Abstract

Background: Ethiopia is one of the high fistula burdened countries in the world with an annual occurrence of 3,500 new and existence of 37,500 untreated obstetric fistula cases. Studies conducted in this area focus on determinants of obstetric fistula before surgical repair and researches addressing the associated factors are limited. Objective: To estimate time to recovery from a surgical repair of obstetric fistula and its associated factors among patients treated at Mekelle Hamlin Fistula Center. Methods: The data represent random samples of 306 fistula patients treated at Mekelle Hamlin Fistula Center from February 2006 to December 2014. Patients’ background characteristics, obstetric and perioperative information was collected. Comparison of survival time and selection of candidates among categorical variables were done using Kaplan-Meier curve and log rank test. Variables with p-value ≤ 0.25 in bivariate analysis were included in multivariable analysis. Cox proportional hazard assumption, Confounding, Interaction, Multicollinearity and Model fitness were tested: Tables, figures, hazard ratios and 95% confidence intervals were used to present results. Results: The patients were followed for 6657 person days at risk, the median recovery time was 20 days. The overall recovery rate was 2.5 cases per 100 person days. Multivariable Cox proportional hazard model result showed labor duration of two or more days (AHR=0.73, 95% CI=0.53, 0.99) and post-operative bladder catheterization longer than 14 or more days (AHR=0.45, 95% CI=0.32, 0.62) were factors negatively associated with recovery time from obstetric fistula surgery. Conclusion and recommendations: women who experienced labor of two or more days and post-operative bladder drainage for more than two or more weeks took longer time to recover after the repair. Therefore, Decision makers, Health care professionals, Stakeholders and Researchers should give emphasis on activities that reduce delays’ in decision making, delays’ in giving urgent intervention and delays’ in reaching health institutions that contributes in reducing complications of prolonged labor ultimately obstetric fistula.