Obstetric fistulas in Uganda: scoping review using a determinant of health approach to provide a framework for health policy improvement.

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Autor/Urheber	Geerte C. den Hollander; Erica W. M. Janszen
Institution	BMC
Titel	Obstetric fistulas in Uganda: scoping review using a determinant of health approach to provide a framework for health policy improvement.
Quelle	In: doi:10.1186/s12884-020-02951-7; 1471-2393; BMC Pregnancy and Childbirth, Vol 20, Iss 1, Pp 1-8 (2020)(2020) PDF als Volltext kostenfreie Datei
Sprache	englisch
Dokumenttyp	online; Zeitschriftenaufsatz
DOI	10.1186/s12884-020-02951-7
Schlagwörter	Obstetric fistula; Maternal health; Determinants of health; Health policy; Inequity; Poverty; Gynecology and obstetrics
Abstract	Abstract Background The uneven global and national distribution of obstetric fistulas suggests a complex network of determinants contributing to fistula development. This study aims to create an understanding of the determinants of obstetric fistula in Uganda and to give a framework for health policy improvement. Methods A scoping review of existing literature was performed, searching the PubMed/MEDLINE database, Ugandan Demographic and Health Surveys, and official sources of Ugandan statistics. Data was analysed using the model for the determinants of health by Dahlgren and Whitehead. Results Obstetric fistulas are associated with different personal lifestyle factors, certain social and community networks, as well as poor working and living conditions. Malnutrition, early childbearing, limited female empowerment, lack of awareness of childbearing risks, low socioeconomic status, and long distances to emergency obstetric care play a part. Certain regions of Uganda are in particular associated with obstetric fistula, where an accumulation of determinants is notable. Conclusion Analysis using the model of Dahlgren and Whitehead shows that obstetric fistulas are associated with determinants at different levels of society. Poverty and low education link these in a web that is disproportionately hard to escape from for the poorest women. This inequity asks for co-operation between ministries to dismantle the environment for obstetric fistula.
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