Time-to-recovery from obstetric fistula and associated factors: The case of Harar Hamlin Fistula Center

Background: Obstetric fistula has caused a significant number of morbidity and mortality throughout the world especially in developing countries. Objective: The purpose of this study is to determine mean time to recovery from obstetric fistula and identify the potential risk factors associated with time to recovery of patients from obstetric fistula. Methods: An institutional-based retrospective cohort study was conducted among 433 patients that were selected by simple random sampling. Data were collected by using structured check list. Epi Data, Statistical Package for Social Science (SPSS) version 20 and R version 3.0.2 software's were used for data entry and processing. Descriptive nature of data was examined using frequency tables and Kaplan-Meier curve. Furthermore, bi-variable and multivariable Cox proportional hazard regression analyses were used to identify predictors. The crude and adjusted hazard ratios together with their corresponding 95% confidence intervals were computed and interpreted accordingly. To ensure the proportional hazards assumption is valid, the numerical and graphical methods of Goodness of fit test method that contains p-value and schoenfeld plot were used in this study. Result: The mean survival time of obstetric fistula patients to become recovered in this study is 18.71 days with standard deviation of 6.68 days. The standard Cox proportional hazard analysis shows that being having complete bladder neck distraction (AHR=0.1324, CI: 0.0360, 0.4867), partial urethral damage (AHR=0.6929, CI: 0.4812, 0.9976) and severe vaginal scaring (AHR=0.269, CI: 0.1399, 0.5174) have significant effect on mean time to recovery from obstetric fistula. Conclusion: In this study, a substantial proportion of obstetric fistula patients had recovered from the obstetric fistula and nearly one third of patients were censored observations. This study provides further evidence on the role of vaginal scarring, urethral and bladder neck involvement in predicting the time to recovery from obstetric fistula.