{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T07:22:04Z","timestamp":1789111324515,"version":"build-2803163510"},"reference-count":30,"publisher":"BMJ","issue":"5","license":[{"start":{"date-parts":[[2022,5,24]],"date-time":"2022-05-24T00:00:00Z","timestamp":1653350400000},"content-version":"unspecified","delay-in-days":23,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100008199","name":"RTI International","doi-asserted-by":"publisher","award":["0291013.201.102"],"award-info":[{"award-number":["0291013.201.102"]}],"id":[{"id":"10.13039\/100008199","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2022,4,27]]},"published-print":{"date-parts":[[2022,5]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To examine characteristics associated with remaining married with fistula.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Retrospective record review and logistic regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Tanzania, Uganda, Kenya, Malawi, Zambia, Rwanda, Ethiopia, Somalia and South Sudan.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Women who developed fistula during childbirth (1975\u20132017) and sought treatment (1994\u20132017).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome measure<\/jats:title>\n                    <jats:p>Self-reported status of living with original husband at time of presentation for fistula repair.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Over half of the women lived with their husbands at the time of fistula treatment (57.2%, 3375\/5903). The strongest predictor of remaining married with fistula was either parity at fistula development (adjusted odds ratio [AOR] 1.4\u20134.4) or living kids at fistula repair (among women who had not given birth between fistula development and repair) (AOR 1.7\u20134.9). Predicted probability of remaining married declined sharply over the first 2\u2009years of incontinence, levelling out thereafter. Predicted probability of remaining married was lower for women with both urinary and faecal incontinence (AOR 0.68) as compared with women with urinary incontinence alone. Probability of remaining married with fistula declined over time (AOR 1.03\u20130.57). The woman\u2019s education was not a statistically significant predictor, but the odds of remaining married were 26% higher if the husband had any formal schooling.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Most husbands do not abandon wives with fistula following childbirth. Treatment, counselling, social support and rehabilitation must consider the circumstances of each woman, engaging men as partners where appropriate. Communities and facilities offering fistula repair services should stress the importance of early intervention.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2021-055961","type":"journal-article","created":{"date-parts":[[2022,5,25]],"date-time":"2022-05-25T13:10:15Z","timestamp":1653484215000},"page":"e055961","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Factors associated with marital status of women with genital fistula after childbirth: a retrospective review in nine African countries"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6501-5532","authenticated-orcid":false,"given":"Carrie J","family":"Ngongo","sequence":"first","affiliation":[{"name":"Global Health Division, RTI International, Research Triangle Park, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas J I P","family":"Raassen","sequence":"additional","affiliation":[{"name":"Independent Consultant, Nairobi, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marietta","family":"Mahendeka","sequence":"additional","affiliation":[{"name":"Obstetrics\/Gynecology, Bugando Medical Centre, Mwanza, United Republic of Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donal","family":"Bisanzio","sequence":"additional","affiliation":[{"name":"Global Health Division, RTI International, Research Triangle Park, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ladeisha","family":"Lombard","sequence":"additional","affiliation":[{"name":"Independent Consultant, Cape Town, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carla","family":"Bann","sequence":"additional","affiliation":[{"name":"Division for Statistical and Data Sciences, RTI International, Research Triangle Park, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,5,25]]},"reference":[{"key":"2025121410355204000_12.5.e055961.1","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1016\/j.ijgo.2008.09.011","article-title":"Obstetric fistula in low-income countries","volume":"104","author":"Zheng","year":"2009","journal-title":"Int J Gynaecol Obstet"},{"key":"2025121410355204000_12.5.e055961.2","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1080\/17441692.2012.668919","article-title":"Maternal morbidity: neglected dimension of safe motherhood in the developing world","volume":"7","author":"Hardee","year":"2012","journal-title":"Glob Public Health"},{"key":"2025121410355204000_12.5.e055961.3","doi-asserted-by":"publisher","DOI":"10.1016\/S0968-8080(12)40661-9"},{"key":"2025121410355204000_12.5.e055961.4","doi-asserted-by":"crossref","first-page":"702","DOI":"10.1111\/1471-0528.16047","article-title":"Delivery mode for prolonged, obstructed labour resulting in obstetric fistula: a retrospective review of 4396 women in East and Central Africa","volume":"127","author":"Ngongo","year":"2020","journal-title":"BJOG"},{"key":"2025121410355204000_12.5.e055961.5","doi-asserted-by":"crossref","DOI":"10.1186\/s12884-017-1604-1","article-title":"\u2018I am a person but I am not a person\u2019: experiences of women living with obstetric fistula in the central region of Malawi","volume":"17","author":"Changole","year":"2017","journal-title":"BMC Preg Child"},{"key":"2025121410355204000_12.5.e055961.6","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2008.01900.x"},{"key":"2025121410355204000_12.5.e055961.7","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1007\/s00192-010-1236-8","article-title":"Childbirth experiences of women with obstetric fistula in Tanzania and Uganda and their implications for fistula program development","volume":"22","author":"Bangser","year":"2011","journal-title":"Int Urogynecol J"},{"key":"2025121410355204000_12.5.e055961.8","doi-asserted-by":"crossref","first-page":"S10","DOI":"10.1016\/j.ijgo.2007.06.011","article-title":"Social and economic consequences of obstetric fistula: life changed forever?","volume":"99","author":"Ahmed","year":"2007","journal-title":"Int J Gynaecol Obstet"},{"key":"2025121410355204000_12.5.e055961.9","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1002\/ijgo.12945","article-title":"Persistent depression after obstetric fistula repair","volume":"147","author":"Stokes","year":"2019","journal-title":"Int J Gynaecol Obstet"},{"key":"2025121410355204000_12.5.e055961.10","doi-asserted-by":"crossref","DOI":"10.1186\/s12884-015-0755-1","article-title":"Long-term outcomes for women after obstetric fistula repair in Lilongwe, Malawi: a qualitative study","volume":"16","author":"Drew","year":"2016","journal-title":"BMC Pregnancy Childbirth"},{"key":"2025121410355204000_12.5.e055961.11","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1016\/j.ijgo.2011.01.006","article-title":"Fertility and pregnancy outcomes among women with obstetric fistula in rural Malawi","volume":"113","author":"Wilson","year":"2011","journal-title":"Int J Gynaecol Obstet"},{"key":"2025121410355204000_12.5.e055961.12","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1111\/tmi.13008","article-title":"The association between female genital fistula symptoms and gender-based violence: a multicountry secondary analysis of household survey data","volume":"23","author":"Mallick","year":"2018","journal-title":"Trop Med Int Health"},{"key":"2025121410355204000_12.5.e055961.13","unstructured":"Hub GF , 2018. Available: https:\/\/www.directrelief.org\/product\/fistula-map\/ [Accessed 11 Jun 2021]."},{"key":"2025121410355204000_12.5.e055961.14","doi-asserted-by":"publisher","DOI":"10.1186\/-1471-2393-13-246"},{"key":"2025121410355204000_12.5.e055961.15","doi-asserted-by":"crossref","first-page":"e271","DOI":"10.1016\/S2214-109X(14)70348-1","article-title":"Prevalence of symptoms of vaginal fistula in 19 sub-Saharan Africa countries: a meta-analysis of national household survey data","volume":"3","author":"Maheu-Giroux","year":"2015","journal-title":"Lancet Glob Health"},{"key":"2025121410355204000_12.5.e055961.16","doi-asserted-by":"crossref","DOI":"10.1155\/2018\/5250843","article-title":"The experience of women with obstetric fistula following corrective surgery: a qualitative study in Benadir and Mudug regions, Somalia","volume":"2018","author":"Mohamed","year":"2018","journal-title":"Obstet Gynecol Int"},{"key":"2025121410355204000_12.5.e055961.17","unstructured":"Ending obstetric fistula: devastating and preventable childbirth injury continues to haunt women. Available: https:\/\/www.unfpa.org\/news\/ending-obstetric-fistula-devastating-and-preventable-childbirth-injury-continues-haunt-women [Accessed 6 Jan 2021]."},{"key":"2025121410355204000_12.5.e055961.18","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1007\/s00192-018-3729-9","article-title":"Marital disruption among women with genital fistula in Nigeria: who is at greatest risk?","volume":"30","author":"Shephard","year":"2019","journal-title":"Int Urogynecol J"},{"key":"2025121410355204000_12.5.e055961.19","doi-asserted-by":"crossref","first-page":"945","DOI":"10.3109\/00016341003801698","article-title":"Obstetric fistula in 14,928 Ethiopian women","volume":"89","author":"Muleta","year":"2010","journal-title":"Acta Obstet Gynecol Scand"},{"key":"2025121410355204000_12.5.e055961.20","doi-asserted-by":"crossref","first-page":"1699","DOI":"10.1007\/s00192-014-2445-3","article-title":"Iatrogenic genitourinary fistula: an 18-year retrospective review of 805 injuries","volume":"25","author":"Raassen","year":"2014","journal-title":"Int Urogynecol J"},{"key":"2025121410355204000_12.5.e055961.21","unstructured":"Rosling H , Rosling O , Ronnlund AR . Factfulness: ten reasons we\u2019re wrong about the world \u2013 and why things are better than you think. Flatiron Books, 2018."},{"key":"2025121410355204000_12.5.e055961.22","unstructured":"Adichie CN . The danger of a single story. Available: https:\/\/www.ted.com\/talks\/chimamanda_ngozi_adichie_the_danger_of_a_single_story\/transcript?language=en [Accessed 11 Jun 2021]."},{"key":"2025121410355204000_12.5.e055961.23","doi-asserted-by":"crossref","first-page":"e21","DOI":"10.1016\/j.jmwh.2008.09.005","article-title":"Social implications of obstetric fistula: an integrative review","volume":"54","author":"Roush","year":"2009","journal-title":"J Midwifery Womens Health"},{"key":"2025121410355204000_12.5.e055961.24","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1017\/S0021932000013304","article-title":"Social consequences of vesico-vaginal fistula in northern Nigeria","volume":"13","author":"Murphy","year":"1981","journal-title":"J Biosoc Sci"},{"key":"2025121410355204000_12.5.e055961.25","first-page":"205","article-title":"Repair of obstetric fistulae: review from an overseas perspective","volume":"4","author":"Kelly","year":"2002","journal-title":"Obstet Gynaecol"},{"key":"2025121410355204000_12.5.e055961.26","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1016\/j.ajog.2004.02.020","article-title":"The immediate management of fresh obstetric fistulas","volume":"191","author":"Waaldijk","year":"2004","journal-title":"Am J Obstet Gynecol"},{"key":"2025121410355204000_12.5.e055961.27","unstructured":"Girls' education. Available: https:\/\/www.worldbank.org\/en\/topic\/girlseducation [Accessed 10 Jun 2021]."},{"key":"2025121410355204000_12.5.e055961.28","doi-asserted-by":"publisher","DOI":"10.1111\/j.1728-4457.2015.00086.x"},{"key":"2025121410355204000_12.5.e055961.29","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0060694"},{"key":"2025121410355204000_12.5.e055961.30","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1111\/1471-0528.13902","article-title":"Understanding the lived experience of women before and after fistula repair: a qualitative study in Kenya","volume":"124","author":"Khisa","year":"2017","journal-title":"BJOG"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2021-055961","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,14]],"date-time":"2025-12-14T18:36:01Z","timestamp":1765737361000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2021-055961"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,5]]},"references-count":30,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2022,5,25]]},"published-print":{"date-parts":[[2022,5]]}},"alternative-id":["10.1136\/bmjopen-2021-055961"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2021-055961","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,5]]}}}