{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T15:08:48Z","timestamp":1784300928486,"version":"3.55.0"},"reference-count":62,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T00:00:00Z","timestamp":1771977600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T00:00:00Z","timestamp":1771977600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Gynecology &amp; Obste"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Obstetric fistula is a leading cause of maternal mortality and morbidity and continues to pose a significant public health challenge in sub\u2010Saharan Africa (SSA). Despite its serious and devastating effects, there are a few studies that describe the spatial distribution, pooled prevalence, and factors associated with obstetric fistula in SSA. Understanding the burden and geographic variation is important for targeted interventions, efficient resource allocation, and progress toward Sustainable Development Goal 3. The aim of the present study was to assess geospatial variations, pooled prevalence, and factors associated with obstetric fistula in SSA using Demographic and Health Survey (DHS) data from 2015 and 2024.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This study utilized a community\u2010based cross\u2010sectional design, which drew from DHS data collected from 14 SSA countries over a nine\u2010year range (2015\u20132024). The sample consisted of 146\u2009023 weighted women ages 15\u201349 with a childbirth history, sampled from a two\u2010stage stratified cluster sampling framework. The data were processed using STATA 17. Spatial analysis included Global Moran's I for clustering, Getis\u2010Ord Gi* for hotspot detection, and Kriging interpolation to predict prevalence in the unsampled areas using ArcGIS. Both global (ordinary least squares [OLS], spatial lag, spatial error) and local (geographically weighted regression, multiscale geographically weighted regression) spatial regression models were used to identify predictors, with model fit assessed by Akaike information criterion (AICc) and adjusted R.\n                      <jats:sup>2<\/jats:sup>\n                      Significant predictors (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.05) were mapped to illustrate spatial distribution.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The pooled prevalence of obstetric fistula in SSA was seven per 1000 women (95% CI: 0.5, 10.00), and its spatial distribution was found to be clustered (Global Moran's I\u2009=\u20090.07,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.01). Hotspot areas were located in Sierra Leone, Chad, Uganda, C\u00f4te d'Ivoire, Ethiopia, Cameroon, and Mozambique; cold spot areas were Burkina Faso, Gambia, Zambia, and Senegal. The multiscale geographically weighted regression model explained 86% of the spatial variation of obstetric fistula in SSA. Adolescent childbearing, unskilled birth attendants, women undergoing cesarean section delivery, rural residency, and living in areas where distance to health facilities is a big problem were significant spatial predictors of obstetric fistula in SSA.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The study showed that the prevalence of obstetric fistula varies significantly across SSA countries. Due to the spatial clustering of obstetric fistula, a geographically targeted intervention is crucial, especially in hotspot areas. To address this issue, policymakers and health planners should implement focused strategies that improve access to skilled maternity care, prevent adolescent pregnancies, strengthen rural healthcare infrastructure, and ensure timely access to emergency obstetric services.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ijgo.70881","type":"journal-article","created":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T16:55:05Z","timestamp":1772988905000},"page":"930-952","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Spatial disparities and determinants of obstetric fistula among childbearing women in sub\u2010Saharan Africa: A geospatial regression approach"],"prefix":"10.1002","volume":"174","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-3846-8774","authenticated-orcid":false,"given":"Kassaw Chekole","family":"Adane","sequence":"first","affiliation":[{"name":"Department of Occupational Health and Safety, College of Medicine and Health Sciences Wollo University  Dessie Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Habtamu Wagnew","family":"Abuhay","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar  Gondar Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-7649-2830","authenticated-orcid":false,"given":"Belayneh jejaw","family":"Abate","sequence":"additional","affiliation":[{"name":"University of Gondar Comprehensive Specialized Hospital  Gondar Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Solomon Gedlu","family":"Nigatu","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar  Gondar Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,2,25]]},"reference":[{"key":"e_1_2_11_2_1","unstructured":"WHO.Obstetric fistula.2018[cited January 25 2025; Available from:https:\/\/www.who.int\/news\u2010room\/facts\u2010in\u2010pictures\/detail\/10\u2010facts\u2010on\u2010obstetric\u2010fistula"},{"key":"e_1_2_11_3_1","unstructured":"UNFPA.The Campaign to End Fistula.2022[cited January 25 2025 Available from:https:\/\/www.unfpa.org\/sites\/default\/files\/pubpdf\/UNFPA_Fistula_10th_Anniv_Report_FINAL.pdf"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/s41182-022-00443-2"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.3126\/njog.v8i2.9759"},{"issue":"3","key":"e_1_2_11_6_1","first-page":"57","article-title":"Translation and validation of Bahasa Malaysia version of urogenital distress inventory (UDI\u20106) and incontinence impact quality of life questionnaires (IIQ\u20107), a cross sectional study","volume":"23","author":"Nusee Z","year":"2016","journal-title":"Malays J Med Sci"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12905-015-0267-1"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.15546"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.aogh.2017.07.003"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.2147\/IJWH.S306221"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1155\/2020\/7306108"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(14)70348-1"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-016-0871-6"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.11606\/s1518-8787.2017051007076"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0036-1594004"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.puhe.2012.12.009"},{"key":"e_1_2_11_17_1","volume-title":"Guide to DHS Statistics","author":"Croft TN","year":"2018"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/aji.70012"},{"key":"e_1_2_11_19_1","doi-asserted-by":"crossref","unstructured":"GebrerufaelGG HagosBT.Predictors of mortality among under\u2010five children in rural Ethiopia: a cross sectional study.2023;23(1):633.","DOI":"10.1186\/s12887-023-04440-0"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12939-017-0602-2"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-021-03669-w"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1177\/2158244019851551"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2393-14-161"},{"key":"e_1_2_11_24_1","first-page":"1","article-title":"Individual\u2010and community\u2010level determinants of neonatal mortality in the emerging regions of Ethiopia: a multilevel mixed\u2010effect analysis","volume":"21","author":"Tesema GA","year":"2021","journal-title":"BMC Pregnancy Childbirth"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1201\/9780203739051-8"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40808-016-0122-x"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1080\/15230406.2013.762138"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1038\/s43856-024-00699-1"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2025.103137"},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.1111\/tmi.12469"},{"key":"e_1_2_11_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.childyouth.2020.105453"},{"key":"e_1_2_11_32_1","doi-asserted-by":"publisher","DOI":"10.11113\/mjfas.v16n2.1387"},{"key":"e_1_2_11_33_1","doi-asserted-by":"publisher","DOI":"10.1186\/s41043-022-00309-7"},{"key":"e_1_2_11_34_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2393-13-246"},{"key":"e_1_2_11_35_1","doi-asserted-by":"publisher","DOI":"10.1002\/ijgo.13031"},{"issue":"1","key":"e_1_2_11_36_1","first-page":"8","article-title":"Clinical and psychosocial outcomes of obstetrics fistulae in sub\u2010Saharan","volume":"9","author":"Oluwasolaa TA","year":"2020","journal-title":"J Basic Clin Reprod Sci"},{"key":"e_1_2_11_37_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12905-023-02220-7"},{"issue":"1","key":"e_1_2_11_38_1","first-page":"2","article-title":"Nigeria, a high burden state of obstetric fistula: a contextual analysis of key drivers","volume":"36","author":"Bello OO","year":"2020","journal-title":"Pan Afr Med J"},{"key":"e_1_2_11_39_1","doi-asserted-by":"publisher","DOI":"10.1111\/tmi.12893"},{"key":"e_1_2_11_40_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12978-023-01622-y"},{"key":"e_1_2_11_41_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12905-022-02001-8"},{"key":"e_1_2_11_42_1","doi-asserted-by":"publisher","DOI":"10.4314\/ahs.v17i3.9"},{"key":"e_1_2_11_43_1","first-page":"953","article-title":"The teenage pregnancy on obstetric fistula among women in fistula center at Malalai hospital, Kabul Afghanistan: a cross\u2010sectional study","volume":"20","author":"Mahbooba S","year":"2021","journal-title":"Technium Soc Sci J"},{"key":"e_1_2_11_44_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-021-04280-9"},{"key":"e_1_2_11_45_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2021-007954"},{"key":"e_1_2_11_46_1","unstructured":"Assembly U.G.Intensifying efforts to end fistula within a generation. Report of the Secretary General."},{"key":"e_1_2_11_47_1","doi-asserted-by":"publisher","DOI":"10.4236\/arsci.2017.53005"},{"key":"e_1_2_11_48_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.13901"},{"key":"e_1_2_11_49_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-017-3368-6"},{"key":"e_1_2_11_50_1","doi-asserted-by":"publisher","DOI":"10.4314\/ahs.v22i2.59"},{"key":"e_1_2_11_51_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-011-1622-x"},{"key":"e_1_2_11_52_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.16047"},{"key":"e_1_2_11_53_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0302529"},{"key":"e_1_2_11_54_1","doi-asserted-by":"publisher","DOI":"10.1080\/21645515.2023.2217076"},{"key":"e_1_2_11_55_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-022-04774-0"},{"key":"e_1_2_11_56_1","doi-asserted-by":"publisher","DOI":"10.1093\/inthealth\/ihab074"},{"key":"e_1_2_11_57_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph17010372"},{"key":"e_1_2_11_58_1","doi-asserted-by":"publisher","DOI":"10.1155\/2024\/5582151"},{"key":"e_1_2_11_59_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-018-1787-0"},{"issue":"2","key":"e_1_2_11_60_1","first-page":"149","article-title":"Socio\u2010demographic factors influencing utilization of obstetric fistula services among women of reproductive age in Makueni County, Kenya","volume":"34","author":"Mbinya MM","year":"2021","journal-title":"Afr J Health Sci"},{"key":"e_1_2_11_61_1","doi-asserted-by":"publisher","DOI":"10.29063\/ajrh2016\/v20i3.16"},{"key":"e_1_2_11_62_1","doi-asserted-by":"publisher","DOI":"10.1002\/hsr2.70141"},{"key":"e_1_2_11_63_1","doi-asserted-by":"publisher","DOI":"10.3389\/fgwh.2024.1426578"}],"container-title":["International Journal of Gynecology &amp; Obstetrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ijgo.70881","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ijgo.70881","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ijgo.70881","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T14:52:55Z","timestamp":1784299975000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1002\/ijgo.70881"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,25]]},"references-count":62,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1002\/ijgo.70881"],"URL":"https:\/\/doi.org\/10.1002\/ijgo.70881","archive":["Portico"],"relation":{},"ISSN":["0020-7292","1879-3479"],"issn-type":[{"value":"0020-7292","type":"print"},{"value":"1879-3479","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,25]]},"assertion":[{"value":"2025-07-29","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-02-02","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-02-25","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}