American Journal of Public Health Research
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American Journal of Public Health Research. 2018, 6(5), 215-221
DOI: 10.12691/ajphr-6-5-2
Open AccessArticle

Prevalence of Depression and Associated Factors among Patients with Obstetric Fistula at Hamlin Fistula Treatment Centers, Ethiopia: A Facility Based Cross-sectional Study

Melsew Getinet Tsegaw1,

1Department of public health, Kea-Med Medical College, Addis Ababa, Ethiopia

Pub. Date: September 03, 2018

Cite this paper:
Melsew Getinet Tsegaw. Prevalence of Depression and Associated Factors among Patients with Obstetric Fistula at Hamlin Fistula Treatment Centers, Ethiopia: A Facility Based Cross-sectional Study. American Journal of Public Health Research. 2018; 6(5):215-221. doi: 10.12691/ajphr-6-5-2


Objective: The aim of this research was to assess the prevalence of depression and associated factors among patients with obstetric fistula in Hamlin Fistula treatment centers in Ethiopia. Methods: A cross-sectional study design was employed. Study participants of the project were patients with obstetric fistula from the treatment centers of Hamlin fistula Ethiopia. Participants were interviewed using validated structured Amharic version patient health questionnaire for depression (PHQ-9). As many women were illiterate, the questionnaires were completed by a nurse. During a 2-month period, from July to August 2016, all women presenting with only obstetric fistula to Addis Ababa Fistula Hospital, Bahir-Dar Hamlin Fistula Center, Yirgalem Hamlin Fistula Center and Harara Hamlin Fistula center participated. Logistic regression analysis was used. Odds ratios with 95% confidence intervals were calculated to identify associated factors. Results: 167 women with obstetric fistula were screened for probable depressive disorder. The prevalence of depression was 73.7%. After adjusting for possible confounders, depression (PHQ-9 score of > 5) was significantly associated with perceived lack of social support (P=0.014), history of stillbirth (P=0.017), primi-parous (P=0.008), separation/divorce (P=0.02) and stay length at home with fistula for over 3 months (P=0.002). Conclusion and Recommendation: The study revealed a high prevalence of depression in patients with obstetric. A stillbirth history, perceived lack of social support, Separation/divorce with a husband, Parity history of one, living with fistula for over 3 months before reporting to a hospital were found to be the factors associated with depression among patients with obstetric fistula . Integrating psychiatric care and treatment including family support with the routine medical care is strongly recommended.

depression obstetric fistula psycho-social consequences medical consequences hamlin fistula Ethiopia

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[1]  Lewis G. Bernis L. d: Guiding principles for clinical management and program development Editors: WHO, department of making pregnancy safer: NLM classification: WP 180.
[2]  Hancock B, Browning A. Practical Obstetric fistula surgery: cause and nature. The Royal Society of Medicine Press Limited 2009.
[3]  Ijaiya MA, Rahman AG, Aboyeji AP, Olatinwo AW, Esuga SA, Ogah OK, Raji HO, Adebara IO, Akintobi AO, Adeniran AS, Adewole AA. Vesicovaginal fistula: a review of Nigerian experience. West African journal of medicine. 2010; 29 (5).
[4]  Muleta M, Fantahun M, Tafesse B, Hamlin EC, Kennedy RC: Obstetric fistula in rural Ethiopia. East Afr Med J 2007, 84: 525-533.
[5]  Goh JT, Sloane KM, Krause HG, Browning A, Akhter S. Short communication: mental health screening in women with genital tract fistulae. BJOG: An International Journal of Obstetrics & Gynaecology. 2005 Sep 1; 112(9): 1328-30.
[6]  Zeleke M, Awoke T, Adefris M, Azale T, Awoke A: Depression among women with obstetric fistula, and pelvic organ prolapse in northwest Ethiopia. BMC Psychiatry 2013 13:236.
[7]  Samaila B. Birth and sorrow: The psycho-social and medical consequences of Obstetric fistula. International journal of medical sociology and Anthropology Vol.2 (2). Pp. 055-065, February, 2014.
[8]  Goh J, Krause H, Sloane K, Akhter S:MENTAL HEALTH SCREENING IN FISTULA WOMEN IN A DEVELOPING COUNTRY. Royal Women's Hospital and Dhaka Medical College Hospital, Bangladesh, 2004.
[9]  James U. Clinical Features Of Patients Diagnosed With Vesico Vaginal Fistula (VVF) In South East Nigeria. Nature and Science 2013; 11(12).
[10]  Gelaye B, Williams MA, Lemma S, Deyessa N, Bahretibeb Y, Shibre T, et al. Validity of the Patient Health Questionnaire-9 for depression screening and diagnosis in East Africa. Psychiatry Res. 2013 Dec 15; 210(2):653-61.
[11]  Ather M, Fareed A, Asad Tamiz-ud-Din N, Faiza M and Asma T.U: Frequency and Associated Factors for Postnatal Depression. Journal of the College of Physicians and Surgeons Pakistan 2009, Vol. 19 (4): 236-239.
[12]  Rich-Edwards JW, Kleinman K, Abrams A, Harlow BL, McLaughlin TJ, Joffe H, Gillman MW. Sociodemographic predictors of antenatal and postpartum depressive symptoms among women in a medical group practice. Journal of epidemiology and community health. 2006 Mar 1: 60 (3):221-7.
[13]  Al Dallal FH, Grant IN. Postnatal depression among Bahraini women: prevalence of symptoms and psychosocial risk factors/Depression postnatale chez des femmes bahreinies: prevalence des symptomes et des facteurs de risque psychosociaux. Eastern Mediterranean Health Journal. 2012 May 1; 18 (5): 432.
[14]  ELEONARD E. EGEDE. Effect of Comorbid Chronic Diseases on Prevalence and Odds of Depression in Adults With Diabetes. Psychosomatic Medicine 67:46-51 (2005)
[15]  Weston K, Mutiso S, Mwangi JW, Qureshi Z, Beard J, Venkat P. Depression among women with obstetric fistula in Kenya. Int J Gynaecol Obstet.2011Oct; 115(1): 31-33.
[16]  Muleta M, Hamlin EC, Fentahun M, Kennedy RC, Tafesse B: Health and Social Problems Encountered by Treated and Untreated Obstetric Fistula Patients in Rural Ethiopia. J ObstetGynaecol Can 2008; 30 (1): 44-50.
[17]  Browning A, Fentahun W, Goh J. The impact of surgical treatment on the mental health of women with obstetric fistula. BJOG 2007; 114:1439-1441.
[18]  Ahmed S, Holtz SA. Social and economic consequences of obstetric fistula: life changed forever?. International Journal of Gynecology & Obstetrics. 2007 Nov 1; 99 (S1).
[19]  Hsiung J, Savbäck S. Long-time Suffering from Psychosocial Consequences: A problem for Women with Vaginal Fistula in Moshi, Tanzania. Medical students’ paper, Sahlgrenska Academy, Gothenburg University.
[20]  Fiona D, John H: Joint AusAID and USAID Review of Support to Hamlin Fistula Ethiopia. Final report 2013, Services Order: 230.
[21]  UNFPA: when child birth harms obstetric fistula: updated with technical feedback, December 2012.
[22]  WHO: Every mother counts: common and heartbreaking “morbidities”: Module on direct result of poor maternal health care. Fistula study guide, final report. 2011.
[23]  Sachdev PS, Hassan N, Abbasi RM, Das CM. Genito-urinary fistula: a major morbidity in developing countries. J Ayub Med Coll Abbottabad. 2009; 21(2): 8-11.
[24]  Hardee K, Gay J, Blanc AK. Maternal morbidity: neglected dimension of safe motherhood in the developing world. Global public health. 2012 Jul 1; 7(6): 603-17.
[25]  Ridder DD, Badani GH, Browning A, Singh P, Sombie I, Wall LL: Fistula in the developing world. Committee 18.
[26]  WAHA International and the University of Gondar: Press Briefing Obstetric Fistula in Gondar. July, 2011.
[27]  Raassen TJ, Verdaasdonk EG, Vierhout ME. Prospective results after first-time surgery for obstetric fistulas in East African women. International Urogynecology Journal. 2008 Jan 1; 19(1): 73-9.
[28]  Assil SM, Zeidan ZA. Prevalence of depression and associated factors among elderly Sudanese: a household survey in Khartoum State/Prevalence de la depression et des facteurs associes chez des Soudanais ages: enquete aupres des menages dans l'Etat de Khartoum. Eastern Mediterranean Health Journal. 2013 May 1; 19(5): 435.
[29]  Kroenke K, Spitzer R, Williams W. The PHQ-9: validity of depression severity measure. JGIM, 2001, 16: 6006-6016.