{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T08:13:08Z","timestamp":1777277588272,"version":"3.51.4"},"reference-count":24,"publisher":"BMJ","issue":"11","license":[{"start":{"date-parts":[[2020,11,12]],"date-time":"2020-11-12T00:00:00Z","timestamp":1605139200000},"content-version":"unspecified","delay-in-days":11,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2020,10,16]]},"published-print":{"date-parts":[[2020,11]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Involuntary leakage of urine and or stool per vaginam (vaginal fistula) after childbirth remains a public health challenge in Africa and South East Asia. To the best of our knowledge, there is no previous national data that examined the awareness of vaginal fistula among women in Nigeria.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To determine the prevalence of awareness of urinary\/faecal incontinence due to vaginal fistula, and the associated risk factors among women with no previous experience of incontinence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We used a cross-sectional study, the 2018 Nigerian Demographic Health Survey, to analyse awareness of vaginal fistula among women with no previous leakage of urine or stool. The primary outcome was childbirth experience, and other variables were demographics, access to information and reproductive or sexual history. The descriptive, univariate and multivariable models were presented.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 26 585 women interviewed, 50 (0.2%) who had experienced fistula were excluded from the risk factor analysis. The mean age of women with childbirth experience was 32.8\u00b18.6 years, while that of women without childbirth experience was 20.3\u00b16.2 years. The prevalence of vaginal fistula awareness was 52.0%. Factors associated with the awareness include the following: childbirth experience (adjusted OR (AOR)=1.14; 95% CI, 1.01 to 1.30); age of 20\u201324 years (AOR=1.36; 95% CI, 1.18 to 1.56) and older; currently working (AOR=1.35; 95% CI, 1.22 to 1.49) and ownership of a mobile phone (AOR=1.16; 95% CI, 1.05 to 1.27). Other associated factors include the following: having at least secondary education; wealth quintiles, ethnicity, regional location, religion, access to radio, newspaper and internet; age up to 17 years at first sex; history of previous termination of pregnancy and use of contraception.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>A significant number of young women with no childbirth experience had low level of awareness. We recommend vaginal fistula awareness programmes that will target women at risk of vaginal fistula and the inclusion of other useful questions to improve the quality of information in future surveys.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2020-040078","type":"journal-article","created":{"date-parts":[[2020,11,12]],"date-time":"2020-11-12T16:10:52Z","timestamp":1605197452000},"page":"e040078","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":15,"title":["Factors associated with the awareness of vaginal fistula among women of reproductive age: findings from the 2018 Nigerian demographic health cross-sectional survey"],"prefix":"10.1136","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7448-4824","authenticated-orcid":false,"given":"Imran O","family":"Morhason-Bello","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, University of Ibadan College of Medicine, Ibadan, Oyo, Nigeria"},{"name":"Institute of Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria"},{"name":"Centre for Population and Reproductive Health, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yusuf Olushola","family":"Kareem","sequence":"additional","affiliation":[{"name":"Institute of Advanced Medical Research and Training, University of Ibadan College of Medicine, Ibadan, Oyo, Nigeria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rukiyat A","family":"Abdus-Salam","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, University of Ibadan College of Medicine, Ibadan, Oyo, Nigeria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oluwasomidoyin O","family":"Bello","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, University of Ibadan College of Medicine, Ibadan, Oyo, Nigeria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Olatunji O","family":"Lawal","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, University of Ibadan College of Medicine, Ibadan, Oyo, Nigeria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fatimat Motunrayo","family":"Akinlusi","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Lagos State University College of Medicine, Ikeja, Lagos State, Nigeria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Linda O","family":"Abegunde","sequence":"additional","affiliation":[{"name":"Cooperative Information Network (COPINE), National Space Research and Development Agency, Obafemi Awolowo University, Ile-Ife, Osun, Nigeria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oladosu","family":"Ojengbede","sequence":"additional","affiliation":[{"name":"Centre for Population and Reproductive Health, University of Ibadan College of Medicine, Ibadan, Oyo, Nigeria"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2020,11,12]]},"reference":[{"key":"2025120518361795000_10.11.e040078.1","doi-asserted-by":"crossref","DOI":"10.1186\/s12884-018-1787-0","article-title":"Barriers and facilitators to preventive interventions for the development of obstetric fistulas among women in sub-Saharan Africa: a systematic review","volume":"18","author":"Lufumpa","year":"2018","journal-title":"BMC Pregnancy Childbirth"},{"key":"2025120518361795000_10.11.e040078.2","first-page":"22","article-title":"Too far to walk: maternal mortality in context","volume":"36","author":"Thaddeus","year":"1991","journal-title":"Newsl Womens Glob Netw Reprod Rights"},{"key":"2025120518361795000_10.11.e040078.3","doi-asserted-by":"crossref","DOI":"10.1186\/s12884-018-1881-3","article-title":"The fourth delay and community-driven solutions to reduce maternal mortality in rural Haiti: a community-based action research study","volume":"18","author":"MacDonald","year":"2018","journal-title":"BMC Pregnancy Childbirth"},{"key":"2025120518361795000_10.11.e040078.4","doi-asserted-by":"crossref","first-page":"73","DOI":"10.4103\/ijph.IJPH_2_18","article-title":"Obstetric fistula: a challenge to public health","volume":"63","author":"Swain","year":"2019","journal-title":"Indian J Public Health"},{"key":"2025120518361795000_10.11.e040078.5","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1080\/2090598X.2019.1590033","article-title":"Update on vesicovaginal fistula: a systematic review","volume":"17","author":"El-Azab","year":"2019","journal-title":"Arab J Urol"},{"key":"2025120518361795000_10.11.e040078.6","doi-asserted-by":"crossref","first-page":"60","DOI":"10.2471\/BLT.14.141473","article-title":"Measuring the incidence and prevalence of obstetric fistula: approaches, needs and recommendations","volume":"93","author":"Tun\u00e7alp","year":"2015","journal-title":"Bull World Health Organ"},{"key":"2025120518361795000_10.11.e040078.7","first-page":"S4","article-title":"Challenges in measuring obstetric fistula","volume":"99 Suppl 1","author":"Stanton","year":"2007","journal-title":"Int J Gynaecol Obstet"},{"key":"2025120518361795000_10.11.e040078.8","doi-asserted-by":"crossref","first-page":"1039","DOI":"10.1111\/1471-0528.12739","article-title":"Prevalence of obstetric fistula: a population-based study in rural Pakistan","volume":"121","author":"Jokhio","year":"2014","journal-title":"BJOG"},{"key":"2025120518361795000_10.11.e040078.9","unstructured":"National Population Commission (NPC) [Nigeria] and ICF . Nigeria demographic and health survey 2008. Abuja, Nigeria, and Rockville, Maryland, USA: NPC and ICF, 2009."},{"key":"2025120518361795000_10.11.e040078.10","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(06)69476-2"},{"key":"2025120518361795000_10.11.e040078.11","first-page":"93","article-title":"Knowledge, attitude and maternal health care utilization among married women of reproductive age towards vesicovaginal fistula in Kebbi state, Nigeria","volume":"29","author":"Basheer","year":"2015","journal-title":"J Health Res"},{"key":"2025120518361795000_10.11.e040078.12","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1002\/ijgo.13034","article-title":"Knowledge of obstetric fistula among prenatal clinic Attendees and midwives in Mfantsiman municipality, Ghana","volume":"148 Suppl 1","author":"Azanu","year":"2020","journal-title":"Int J Gynaecol Obstet"},{"key":"2025120518361795000_10.11.e040078.13","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2393-13-229","article-title":"Community awareness about risk factors, presentation and prevention and obstetric fistula in Nabitovu village, Iganga district, Uganda","volume":"13","author":"Kasamba","year":"2013","journal-title":"BMC Pregnancy Childbirth"},{"key":"2025120518361795000_10.11.e040078.14","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0085921"},{"key":"2025120518361795000_10.11.e040078.15","first-page":"377","article-title":"Perceived causes of obstetric fistulae from rural southern Tanzania","volume":"11","author":"Kazaura","year":"2011","journal-title":"Afr Health Sci"},{"key":"2025120518361795000_10.11.e040078.16","unstructured":"National Population Commission (NPC) [Nigeria] and ICF . Nigeria demographic and health survey 2018. Abuja, Nigeria, and Rockville, Maryland, USA: NPC and ICF, 2019."},{"key":"2025120518361795000_10.11.e040078.17","first-page":"1","article-title":"Multicollinearity diagnostic in statistical modelling and remedies to deal with it using SAS","volume":"1","author":"Joshi","year":"2012","journal-title":"Pharm Users Softw Exch"},{"key":"2025120518361795000_10.11.e040078.18","doi-asserted-by":"crossref","DOI":"10.1186\/s12978-020-0860-0","article-title":"Obstetric fistula in southern Mozambique: a qualitative study on women's experiences of care pregnancy, delivery and post-partum","volume":"17","author":"Boene","year":"2020","journal-title":"Reprod Health"},{"key":"2025120518361795000_10.11.e040078.19","doi-asserted-by":"crossref","DOI":"10.1186\/s12884-018-1907-x","article-title":"Obstetric fistula policy in Nigeria: a critical discourse analysis","volume":"18","author":"Amodu","year":"2018","journal-title":"BMC Pregnancy Childbirth"},{"key":"2025120518361795000_10.11.e040078.20","first-page":"178","article-title":"A survey on obstetric fistula awareness in northern Ghana","volume":"4","author":"Saeed","year":"2014","journal-title":"Eur J Exp Biol"},{"key":"2025120518361795000_10.11.e040078.21","doi-asserted-by":"publisher","DOI":"10.1016\/j.pec.2009.11.010"},{"key":"2025120518361795000_10.11.e040078.22","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1080\/13691058.2018.1497813","article-title":"Community perceptions of obstetric fistula in Malawi","volume":"21","author":"Changole","year":"2019","journal-title":"Cult Health Sex"},{"key":"2025120518361795000_10.11.e040078.23","doi-asserted-by":"crossref","DOI":"10.1186\/s12905-019-0732-3","article-title":"\"The sun keeps rising but darkness surrounds us\": a qualitative exploration of the lived experiences of women with obstetric fistula in Ethiopia","volume":"19","author":"Animut","year":"2019","journal-title":"BMC Womens Health"},{"key":"2025120518361795000_10.11.e040078.24","doi-asserted-by":"crossref","DOI":"10.2147\/IJWH.S68382","article-title":"A qualitative study of the experience of obstetric fistula survivors in Addis Ababa, Ethiopia","volume":"6","author":"Gebresilase","year":"2014","journal-title":"Int J Womens Health"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2020-040078","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,6]],"date-time":"2025-12-06T02:36:38Z","timestamp":1764988598000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2020-040078"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,11]]},"references-count":24,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2020,11,12]]},"published-print":{"date-parts":[[2020,11]]}},"alternative-id":["10.1136\/bmjopen-2020-040078"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2020-040078","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,11]]}}}