Hareru Habtamu Endashaw, Wtsadik Daniel Sisay, Ashenafi Eden, Debela Berhanu Gidisa, Lerango Temesgen Leka, Ewunie Temesgen Muche, Abebe Mesfin
School of Public Health, College of Health Sciences and Medicine, Dilla University, Dilla, Ethiopia.
Department of Reproductive Health, College of Health Sciences and Medicine, Dilla University, Dilla, Ethiopia.
Heliyon. 2023 Jul 22;9(8):e18126. doi: 10.1016/j.heliyon.2023.e18126. eCollection 2023 Aug.
Obstetric fistula among women of reproductive age is a significant public health issue in developing countries, including Sub-Saharan Africa. However, the pooled awareness of obstetric fistula among women of reproductive age in Sub-Saharan Africa and its variation between countries have not yet been studied. Hence, the review aims to assess variability and awareness of obstetric fistula among women of reproductive age in Sub-Saharan African Countries.
Articles were searched using different electronic databases, such as PubMed, Web of science, science direct (Scopus), Google scholar, and HINARI and manual search without regard to publication date. A random-effects model was used to ascertain the pooled prevalence of obstetric fistula awareness among women of reproductive age in Sub-Saharan Africa. Publication bias was checked by using funnel plot and Egger's test at a 5% level of significance. I test statistics was performed to evaluate heterogeneity among included studies. In addition, to identify the possible reason for the potential heterogeneity between the studies, sub-group and meta-regression analyses were conducted. A sensitivity analysis was performed to determine the impact of individual research on the overall results. The data were extracted by using Microsoft excel and analyzed using statistical software STATA/SE version 17.
A total of 22 studies with 79,693 women of reproductive age were included in this systematic review and meta-analyses. In Sub-Saharan Africa, the pooled prevalence of awareness towards obstetric fistula among women of reproductive age was 40.85% (95% CI: 33.48, 48.22%). Analysis of the subgroups by specific countries revealed significant variation. The highest awareness of obstetric fistula was found among Tanzanian women of reproductive age (61.10%, 95% CI: 55.87-66.33%), whereas the lowest awareness was found in research from the Gambia (12.80%, 95% CI: 12.20-13.40%).The likelihood of obstetric fistula awareness were lower by a factor of 0.424 among studies with sample sizes greater than 3542 (β = -0.424 (95% CI: -0.767 to 0.081), p -value <0.05).
According to the current review, there is a low level of awareness about obstetric fistula among women of reproductive age in sub-Saharan Africa, and the results of the sub-group analysis by country showed wide variations. Therefore, we emphasize the need for country-specific public health initiatives to raise awareness about obstetric fistula among women of reproductive age, which could reduce the risk of delayed treatment.
育龄妇女的产科瘘是包括撒哈拉以南非洲在内的发展中国家的一个重大公共卫生问题。然而，尚未对撒哈拉以南非洲育龄妇女对产科瘘的综合认知及其在不同国家之间的差异进行研究。因此，本综述旨在评估撒哈拉以南非洲国家育龄妇女对产科瘘的认知差异。
使用不同的电子数据库进行文献检索，如PubMed、科学网、科学直连（Scopus）、谷歌学术和HINARI，并进行手工检索，不考虑出版日期。采用随机效应模型确定撒哈拉以南非洲育龄妇女对产科瘘认知的综合患病率。通过漏斗图和Egger检验在5%的显著性水平上检查发表偏倚。进行I检验统计以评估纳入研究之间的异质性。此外，为了确定研究之间潜在异质性的可能原因，进行了亚组分析和元回归分析。进行敏感性分析以确定个别研究对总体结果的影响。数据使用Microsoft excel提取，并使用统计软件STATA/SE 17版进行分析。
本系统综述和荟萃分析共纳入了22项研究，涉及79,693名育龄妇女。在撒哈拉以南非洲，育龄妇女对产科瘘的综合认知患病率为40.85%（95%置信区间：33.48，48.22%）。按具体国家进行的亚组分析显示存在显著差异。坦桑尼亚育龄妇女对产科瘘的认知率最高（61.10%，95%置信区间：55.87 - 66.33%），而冈比亚的研究中认知率最低（12.80%，95%置信区间：12.20 - 13.40%）。样本量大于3542的研究中，产科瘘认知的可能性降低了0.424倍（β = -0.424（95%置信区间：-0.767至0.081），p值<0.05）。
根据当前综述，撒哈拉以南非洲育龄妇女对产科瘘的认知水平较低，按国家进行的亚组分析结果显示差异很大。因此，我们强调需要针对特定国家开展公共卫生倡议，以提高育龄妇女对产科瘘的认知，这可以降低延迟治疗的风险。
