Time to recovery from Obstetric Fistula and its predictors among patients admitted to Hamlin Fistula Center, Addis Ababa, Ethiopia: A survival analysis

Obstetric Fistula (OBF) remains a devastating maternal condition in Ethiopia, causing significant physical suffering, social isolation and psychological traumas among affected women. Despite its burden, only a limited number of healthcare facilities in Ethiopia provide surgical interventions. Furthermore, there is a scarcity of evidence regarding the time to recovery from OBF and its predictors in treatment centers. Therefore, this study aimed to determine the time to recovery from OBF and its predictors among patients admitted to Hamlin Fistula Hospital Addis Ababa, Ethiopia. A Hospital based retrospective cohort study was conducted among 513 women treated for OBF from January 2017 to June 2023. The Kaplan-Meier method was employed to estimate the distribution of recovery time, and the log-rank test was utilized to assess the experience of recovery time among different levels of categorical variables. Bivariate and multivariable Cox proportional regression analyses were conducted. The overall recovery rate was 74.7%, (95%CI: 71.1, 78.2), with a median recovery-time from OBF was 5.9 weeks (95%CI: 5.1, 6.6). Receiving physiotherapy after surgery (AHR: 1.85, 95%CI: 1.13–3.02) and having a fistula length of 2.2–4 cm (AHR: 5.23, 95%CI: 1.17–12.33) were found to be predictors of faster recovery for OBF. Conversely, women with urethral damage (AHR: 0.43, 95%CI: 0.25–0.76) or severe vaginal scarring (AHR: 0.60, 95%CI: 0.40–0.89) experienced delayed recovery from OBF. Only 7.3% of OBF patients received physiotherapy despite 85% faster recovery. Based on the findings, the median recovery time from OBF was 5.9 weeks. Therefore, scaling-up postoperative physiotherapy for all OBF patients, early identification, and providing counselling and specialized care for women with urethral injury or severe vaginal scarring could improve recovery time from OBF. These findings also highlighted the critical importance of individualized rehabilitation services in fistula treatment centers to optimize patient recovery and overall quality of life.