article · Universal Journal of Public Health
Obstetric fistula represents an ongoing public health challenge across Sub-Saharan Africa. Using survey records from 47,720 births gathered during the 2021 Demographic and Health Survey in Madagascar, this investigation examines how healthcare utilisation and socioeconomic conditions relate to the duration and incidence of fistula morbidity. Statistical analysis revealed an average obstetric fistula incidence of 0.44 percent, with patients experiencing an average morbidity duration of approximately 14 days. Factors such as maternal age, living in urban areas, formal schooling, non-smoking status, and possession of health insurance correlated with significant reductions in expected morbidity. Conversely, characteristics including male-headed households and older household heads correlated with higher morbidity. Crucially, receiving prenatal consultations from doctors or nurses demonstrated measurable protective impacts that significantly lowered the duration of fistula-related illness.
Obstetric fistula causes prolonged physical suffering and social complications for affected women. By identifying the socioeconomic determinants and demonstrating that professional prenatal medical consultations significantly decrease morbidity, this work provides concrete evidence to help public health authorities and maternal health programmes target resources, improve clinical access, and design preventative educational policies across Madagascar.
The findings can inform public health agencies, maternal care organisations, and healthcare policymakers seeking evidence to design prenatal service pathways and targeted educational programmes. As an epidemiological analysis of survey data, the research is at a policy-informing stage rather than offering a commercial product or technical tool.
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Background: Obstetric fistula is an emerging health problem in Sub-Saharan Africa (SSA). However, very little is known about the correlates of the average duration of fistula morbidity and the impact of healthcare service utilization. This study therefore explored the impacts of healthcare service utilization, along with other variables, on fistula morbidity. Methods: The data were from 47720 recorded births among Madagascan women of reproductive age as presented in the 2021 Demographic and Health Survey (DHS). The data were analysed with Poisson regression with logit zero-inflation. The regression adjustment inverse probability weighting estimator was used for treatment impact assessment. Results: The results showed that average obstetric fistula incidence was 0.44% with an average morbidity day of 13.97. The zero-inflated Poisson results showed that the expected number of fistula morbidity decreased significantly (p<0.05) with mother’s age, urban residence, education levels (except higher education), non-smoking, health insurance, and health distance concern. It, however, increased with age at first birth, male household headship, age of household head, and age at first birth. The inflation model showed that always being unaffected by fistula significantly increased (p<0.05) with mother’s age, urban residence, household size and age at first birth, but decreased with wealth index. The average treatment effects (ATEs) were significant (p<0.05) with -0.05731 and -0.05997 for consulting doctors and nurses during prenatal medical care, respectively, while the average treatment effects on the treated (ATETs) for doctor prenatal care was -0.14928 (p<0.05). Conclusions: It was concluded that access to professional healthcare consultations holds some promise in ending obstetric fistula morbidity in Madagascar, while emphasis should be placed on prevention of child marriage or pregnancy and development of women-targeted education programmes on obstetric fistula prevention.
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DOI: 10.13189/ujph.2026.140505
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