Incontinence in Malawi: Analysis of a proxy measure of vaginal fistula in a national survey

Abstract Objective To document the first effort to collect national lifetime prevalence data on vaginal fistulas and discern the usefulness of the measure. Methods The 11,698 women successfully interviewed in the 2005 Malawi Demographic and Health Survey were asked whether they had ever experienced leakage of urine or stool from their vagina. Multivariate techniques were then used to determine factors associated with fistula symptoms. Results The relationships between fistula symptoms and wealth and fistula symptoms and education were negative and monotonic. Rural women were 40% more likely than urban women to report fistula symptoms. Women who had experienced a stillbirth were 66% more likely to report the symptoms, and those who had experienced sexual violence were 71% more likely to report the symptoms. A crude fistula rate of 15.6 per 1000 live births was found for Malawi. Conclusions Survey methods may be used to capture the prevalence of vaginal fistula cases in a given country, but further work is needed to improve the sensitivity and specificity of the questions asked.