Prevalence and risk factors associated with obstetric fistula among women of reproductive age in Bungoma, Kilifi and Kiambu Counties, Kenya

Henry Kilonzo; Karen Basiye; Gilbert Ebole; Sophie Onyango; Anne Gitimu; John Kutna; Happiness Oruko; Herbert Barasa; Vayonda Ongaya; Tanya Nduati; John P. Oyore

doi:10.18203/2394-6040.ijcmph20262680

Authors

Henry Kilonzo Safaricom and MPESA Foundation Safaricom House, Nairobi, Kenya
Karen Basiye Safaricom and MPESA Foundation Safaricom House, Nairobi, Kenya
Gilbert Ebole Safaricom and MPESA Foundation Safaricom House, Nairobi, Kenya
Sophie Onyango Safaricom and MPESA Foundation Safaricom House, Nairobi, Kenya
Anne Gitimu Amref Health Africa in Kenya, Nairobi, Kenya
John Kutna Amref Health Africa in Kenya, Nairobi, Kenya
Happiness Oruko Amref Health Africa in Kenya, Nairobi, Kenya
Herbert Barasa Amref Health Africa in Kenya, Nairobi, Kenya
Vayonda Ongaya Amref Health Africa in Kenya, Nairobi, Kenya
Tanya Nduati Flying Doctors’ Society of Africa, AMREF Kenya, Langata Rd, Nairobi, Kenya
John P. Oyore Department of Family Medicine, Community Health and Epidemiology, Nairobi, Kenya

DOI:

https://doi.org/10.18203/2394-6040.ijcmph20262680

Keywords:

Coping mechanisms, Female genital fistula, Healthcare-seeking behaviour, Kenya, Psychosocial effects

Abstract

Background: Female genital fistula (FGF) is a debilitating childbirth-related condition affecting an estimated 50,000-100,000 women globally each year. In Kenya, the incidence is estimated at 17.4 cases per 100,000 deliveries, yet only about 8% of new cases receive surgical treatment annually. This study explored the risk factors, psychosocial experiences, healthcare-seeking behaviour, and coping mechanisms among women living with FGF in Bungoma, Kiambu, and Kilifi counties.

Methods: A cross-sectional study was conducted among 113 purposively selected female genital fistula survivors. Quantitative data were collected using structured interviewer-administered questionnaires and analysed using descriptive statistics.

Results: Severe depression was reported by 66.2% of participants, while 51.3% experienced anxiety associated with stigma and social exclusion. Suicidal thoughts were reported by 22.1% of respondents. Regarding childbirth, 59.3% delivered their youngest child in a health facility, whereas 40.7% delivered at home. Among home deliveries, the leading reason was the long distance to a health facility (40.0%). Social isolation was the most common coping strategy, reported by 59.3% of participants.

Conclusions: Female genital fistula continues to have profound psychosocial consequences and remains closely linked to barriers in accessing skilled maternal healthcare. Strengthening maternal health services, promoting community awareness, and providing comprehensive post-repair care that integrates psychosocial and economic support are essential. Increased county investment in fistula prevention, treatment, rehabilitation, and reintegration programmes is recommended.

References

World Health Organization. Obstetric Fistula, 2018. Available at: https://www.who.int/news-room/facts-in-pictures/detail/10-facts-on-obstetric-fistula. Accessed 01 January 2026.

Wilson SM, Sikkema KJ, Watt MH, Masenga GG. Psychological symptoms among obstetric fistula patients compared to gynecology outpatients in Tanzania. Int J Behavior Medi. 2015;22(5):605-13.

Kebede MA, Tor DS, Aklilu T, Petros A, Ifeanyichi M, Aderaw E, et al. Identifying critical gaps in research to advance global surgery by 2030: a systematic mapping review. BMC Heal Servi Res. 2023;23(1):946.

Vervoort D. The road to 2030: introduction to the global surgery focused issue. J Publ Heal Emerg. 2021;5:1.

Khisa AM, Omoni GM, Nyamongo IK, Spitzer RF. 'I stayed with my illness': a grounded theory study of health seeking behaviour and treatment pathways of patients with obstetric fistula in Kenya. BMC Wom Heal. 2017;17(1):92.

Kenya National Bureau of Statistics. Kenya Demographic and Health Survey 2014, 2014. Available at: https://dhsprogram.com/pubs/pdf/fr308/fr308.pdf. Accessed 01 January 2026.

Khisa W, Wakasiaka S, McGowan L, Campbell M, Lavender T. Understanding the lived experience of women before and after fistula repair: a qualitative study in Kenya. BJOG: Int J Obstetr Gynaecol. 2017;124(3):503-10.

Weston K, Mutiso S, Mwangi JW, Qureshi Z, Beard J, Venkat P. Depression among women with obstetric fistula in Kenya. Int J Gynecol Obstetr. 2011;115(1):31-3.

Raassen TJ, Ngongo CJ, Mahendeka MM. Iatrogenic genitourinary fistula: an 18-year retrospective review of 805 injuries. Int Urogynecol J. 2014;25(12):1699-706.

Sripad P, Arnoff E, Warren C, Tripathi V. Measuring barriers to fistula care: investigating composite measures for targeted fistula programming in Nigeria and Uganda. BMC Wom Heal. 2021;21(1):142.

United Nations Population Fund. Obstetric Fistula and Other Forms of Female Genital Fistula, 2021. Available at: https://www.unfpa.org/sites/default/files/pub-pdf/027%20UF%20ObstetricFistulaManual_ILLUSTRATED_34-online%20%281%29.pdf. Accessed 01 January 2026.

Ngongo CJ, Raassen TJ, Mahendeka M, Bisanzio D, Lombard L, Bann C. Living with obstetric fistula: learnings from nine African countries. BMJ Glob Heal. 2023;8(5):e012509.

Muleta M, Hamlin C, Fantahun M, Kennedy R, Tafesse B. Health and social problems encoun tered by treated and untreated obstetric fistula patients in rural Ethiopia, Addis Ababa Fistula Hospital, Addis Ababa, Ethiopia. J Obstet Gynaecol. 2008;30(1):44-50.

Asmare L, Bayou FD, Arefaynie M, Tsega Y, Endawkie A, Kebede SD, et al. A systematic review and meta-analysis on the recovery time of obstetric fistula in Ethiopia, 2023. BMC Wom Heal. 2024;24(1):547.

Baba SB. Birth and sorrow: the psycho-social and medical consequences of obstetric fistula. Int J Medical Sociol Anthropol. 2014;2(2):055-65.

Hurissa BF, Koricha ZB, Dadi LS. Understanding healthcare-seeking pathways and dilemmas among women with obstetric fistulas in Ethiopia: a qualitative inquiry. Int J Wom Heal. 2023;15:135-50.

Barone MA, Widmer M, Arrowsmith S, Ruminjo J, Seuc A, Landry E, et al. Breakdown of simple female genital fistula repair after 7 day versus 14 day postoperative bladder catheterisation: a randomised, controlled, open-label, non-inferiority trial. Lancet. 2015;386(9988):56-62.

Kumara, M.G, Debelew GT, Ademe BW. Lived experiences of women with uterine rupture who were managed at Nekemte specialized hospital: a qualitative study. BMC Pregn Childb. 2024;24(1):697.

Khisa AM. An exploratory study of reintegration of women following obstetric fistula surgery in West Pokot, Kenya. SAGE Open. 2015;5(4):2158244015621112.

Molzan Turan J, Johnson K, Lake Polan M. Experiences of women seeking medical care for obstetric fistula in Eritrea: implications for prevention, treatment, and social reintegration. Glob Publ Heal. 2007;2(1):64-77.

Browning A, Menber B. Women with obstetric fistula in Ethiopia: a 6‐month follow up after surgical treatment. BJOG: Int J Obstetr Gynaecol. 2008;115(12):1564-9.

Nielsen HS, Lindberg L, Nygaard U, Aytenfisu H, Johnston OL, Sørensen B, et al. A community‐based long‐term follow up of women undergoing obstetric fistula repair in rural Ethiopia. BJOG: Int J Obstetr Gynaecol. 2009;116(9):1258-64.

Pope R, Bangser M, Requejo JH. Restoring dignity: Social reintegration after obstetric fistula repair in Ukerewe, Tanzania. Global Public Health. 2011;6(8):859-73.

Khisa AM, Nyamongo IK, Omoni GM, Spitzer RF. A grounded theory of regaining normalcy and reintegration of women with obstetric fistula in Kenya. Reproduct Heal. 2019;16(1):29.

Landry E, Frajzyngier V, Ruminjo J, Asiimwe F, Barry TH, Bello A, et al. Profiles and experiences of women undergoing genital fistula repair: findings from five countries. Glob Publ Heal. 2013;8(8):926-42.

Bashah DT, Worku AG, Mengistu MY. Consequences of obstetric fistula in sub Sahara African countries, from patients’ perspective: a systematic review of qualitative studies. BMC Wom Heal. 2018;18(1):106.

Andargie AA, Debu A. Determinants of obstetric fistula in Ethiopia. Afr Heal Sci. 2017;17(3):671-80.

Asiedua E, Maya E, Ganle JK, Eliason S, Ansah-Ofei AM, Senkyire EK, et al. Health-seeking experiences of women with obstetric fistula: a qualitative study at two fistula centres in Ghana. BMJ open. 2023;13(8):e064830.

Changole J, Thorsen V, Trovik J, Kafulafula U, Sundby J. Coping with a disruptive life caused by obstetric fistula: perspectives from Malawian women. Int J Environ Res Publ Heal. 2019;16(17):3092.

Dev S, Luitel P, Sah B, Yadav BK, Dev B, Thapaliya I, et al. Knowledge, attitude, and practice on arteriovenous fistula care among end‐stage kidney disease patients receiving maintenance hemodialysis: a single‐center, prospective cohort study in Nepal. Heal Sci Rep. 2025;8(5):e70823.

Fekecha HB, Birhamu KZ, Dadi S. Self-Esteem and its predictive fcators among women with obstetric fistula in Ehtiopia: a facility-based study. J Midwife Reporduct Heal. 2022;10(3):3309-16.

Hurissa BF, Koricha ZB, Dadi LS. Challenges and coping mechanisms among women living with unrepaired obstetric fistula in Ethiopia: A phenomenological study. Plos one. 2022;17(9):e0275318.

Kabayambi J, Barageine JK, Matovu JK, Beyeza J, Ekirapa E, Wanyenze RK. Living with obstetric fistula: Perceived causes, challenges and coping strategies among women attending the fistula clinic at Mulago Hospital, Uganda. Int J Trop Dis Heal. 2014;4(3):352-61.

Kamel FR, Ramadan S, Elbana H, Kamal F. Pregnant womens knowledge and attitude regarding obstetric fistula. Benha J Appl Sci. 2023;8(4):309-19.

Lewis M. Prevalence and factors associated with obstetrics fistula among women admitted at Kitwe Teaching Hospital for obstetrics related conditions between 2021-2022. J Clin Res. 2023;7(5):1-12.

Maroyi R, Moureau MK, Brown HW, Ajay R, Byabene G, Mukwege DM. Etiology and factors associated with urogenital fistula among women who have undergone cesarean section: a cross-sectional study. BMC Pregnan Childb. 2023;23(1):54.

Mutola S, Chomba BM, Ng N, Menda DM, Louis VR, Michael LW. Surgical success in obstetric fistula repair and associated factors: findings from a retrospective cohort study in Zambia. BMC Surg. 2025;25(1):163.

Nalubwama H, Ayadi AM, Barageine JK, Byamugisha J, Kakaire O, Obore S, et al. Perceived causes of obstetric fistula and predictors of treatment seeking among Ugandan Women: insights from qualitative research. Afr J Reproduct Heal. 2020;24(2):129-40.

Nduka IR, Ali N, Kabasinguzi I, Abdy D. The psycho-social impact of obstetric fistula and available support for women residing in Nigeria: a systematic review. BMC Wom Heal. 2023;23(1):87.

Ngongo CJ, Raassen TJ, Mahendeka M, Bisanzio D, Lombard L, Bann C. Factors associated with marital status of women with genital fistula after childbirth: a retrospective review in nine African countries. BMJ open. 2022;12(5):e055961.

Odonkor ST, Yeboah TN. Challenges of rural women living with obstetric fistula: a phenomenological study. Women Birth. 2023;36(1):e1-9.

Tsega Dejen M, Assebe Yadeta T, Gedefaw Azeze G, Demis Bizuneh A, Tiruye G, Semahegn A. Knowledge of obstetric fistula and its associated factors among women of reproductive age in Northwestern Ethiopia: a community-based cross-sectional study. BMC Wom Heal. 2022;22(1):467.