Time to recovery of Obstetric fistula patients at Bahirdar Hamlin fistula center: Application of Bayesian Approach Using Intergrated Nested Laplace Approximation Method

Abstract

Introduction: fistula is a medical term that refers to an abnormal connection between two organs in the body. Obstetric fistula specifically occurs when the pressure exerted by the baby’s head during obstructed labor disrupts the blood flow to nearby tissues in the mother’s pelvis. Ethiopia has poor maternal healthcare, and it has a high prevalence of obstetric fistula, over 100,000 girls live with a f istula, and approximately 9,000 new cases develop each year. The Amhara Region has the highest prevalence rate of obstetric fistula (7 per 1000 women) in Ethiopia, followed by the Tigray Region, contributing to the higher number of obstetric fistula cases. Objective: This study aims to analyze the time to recovery of obstetric fistula patients at Bahirdar Hamlin Fistula Centre using Bayesian INLA methods. Method: A retrospective study was conducted at Bahirdar Hamlin Fistula Center from March 2018 to April 2023 to identify the significant predictor of time to recovery in obstetric fistula. Bayesian para metric AFT survival models were applied in this study, and the Bayesian parametric AFT Log-normal survival model were fitted using the Integrated Nested Laplace Approximation methodology. Result: Among 501 obstetric fistula patients 393 (78.44%) of them were recovered while the rest 108 (22.56%) were censored. The median recovery time which measures how long patients have been re covered is 4.29 weeks. The Bayesian log-normal AFT model was found to be the best model for time to recovery of obstetric fistula data set. The results of Bayesian log-normal AFT model revealed that aged 21 to 30 (ˆ γ=1.30, 95% Crl:1.231, 1.373), Age > 30 (ˆ γ=1.481, 95%:1.369, 1.605), duration of bladder catheterization > 14 days (ˆ γ=1.178, 95% Crl:1.121,1.239), duration of labor ≥ 2 days (ˆ γ=1.088, 95% Crl:1.451,1.718), place of delivery Health centre (ˆ γ=0.979, 95% Crl:0.576,0.866), status of urethra completely destructed (ˆ γ=1.029, 95% Crl:1.005,1.124), status of vagina sever scarring (ˆ γ=1.077, 95%Crl:1.009,1.150) and incontinence of urine above 4 month (ˆ γ= 1.260, 95% Crl:1.379,1.584) were statistically significant predictor time to recovery of obstetric fistula patients. Conclusions: The results revealed that age group of 21-30 and > 30, duration of bladder catheteriza tion > 14 days, duration of labor 2 days, delivery place of health centre, length of fistula 3-5 cm and >5cm, width of fistula > 5 cm, status of urethra completely destructed, status of vagina sever scarring and incontinence of urine > 4 month were found significant predictors. The researcher recommends that the people should aware of the burden of those risk factors and well informed about the fistula.