# Obstetric fistula awareness in The Gambia, Côte d’Ivoire, Madagascar and Sierra Leone: A cross-sectional analysis of Demographic and Health Surveys data

## TL;DR

This study examines obstetric fistula awareness in four African countries and finds that education, media access, and health knowledge significantly influence awareness levels.

## Contribution

The study identifies socioeconomic factors influencing fistula awareness and proposes targeted strategies to improve it in sub-Saharan Africa.

## Key findings

- Only 0.01% of respondents reported having a fistula, with awareness ranging from 13% to 57% across countries.
- Education, media use, and health knowledge were significant predictors of fistula awareness.
- Improving women's education and media access could enhance awareness and reduce fistula rates.

## Abstract

Obstetric fistulas represent a frequently overlooked consequence of inadequate maternal health care and are largely preventable and treatable, with fistula awareness playing a key role in these efforts. This article aimed to understand the levels of fistula awareness and socioeconomic factors that aid or hinder that awareness in four African countries.

The intent was to increase knowledge of the importance of fistula awareness and propose possible pathways to further increase this awareness in the region.

This research used cross-sectional data from the 2019–2021 Demographic and Health Surveys (DHS) in The Gambia, Côte d’Ivoire, Madagascar and Sierra Leone.

We noted the prevalence of fistulas in these populations and used weighted logistic regression (n = 60 128) to examine the relationships between key factors and fistula awareness overall and by country.

Overall, 0.01% of respondents report having a fistula, and 33% of women are aware of fistulas, ranging from a low of 13% to a high of 57% in The Gambia and Sierra Leone, respectively. Marital status, age, media and internet use, level of education, sexual activity, employment and health knowledge were all discovered to be significant factors in shaping a woman’s awareness of obstetric fistulas.

Increasing efforts to improve educational attainment, media access, workplace opportunities for women and health knowledge may have the potential to further increase fistula awareness in these and neighbouring countries. Addressing inadequate maternal health care and increasing women’s rights in these countries can reduce the rates of childbirth injuries like obstetric fistulas.

This article provides insights to the importance of targeting awareness initiatives through education, media, and community engagement, particularly among women who are younger, less educated, or socially marginalised.