Impact of health education on knowledge and behaviours toward obstetric fistula among women of reproductive age in Uganda

Obstetric fistula is among the most severe maternal morbidities. It is caused directly by obstructed labour, and indirectly by social, political, and economic factors. Effects of obstetric fistula include chronic urinary incontinence. Urinary incontinence often leads to isolation and death if left untreated. Death of women during childbirth is detrimental to both social economic transformation and shift of poor economies to middle income status. In this study, we estimate the burden of obstetric fistula on Ugandan women, and the effect of educating these women on its causes. We hypothesise that symptomatic women seek treatment after interactions with a treated woman. We consider one cycle of fistula and seek to determine how many women will eventually seek treatment, when one woman is treated in a population. We further assume that each treated woman becomes the educational resource for more symptomatic women. We then invest in getting women into treatment, providing treatment, or educating them about prevention and treatment of obstetric fistula. Results show that for each investment strategy, there exists a unique maximal solution that remains bounded. It is also shown from the model that high investment rates leads to high treatments rates. However, the highest treatment output is obtained when the level of investment is 44.9%. We also see from the results that for every one woman treated, 17 more seek treatment. However, as investment increases, the number of women that are eventually treated reduces due to lack of further investment into treatment and therefore no more women to treat. Results also show that educating women reduced fistula prevalence although the magnitude of reduction depended on the level of education coverage. These results show that an optimal strategy to reduce fistula prevalence would require achieving a balance between the two desirable but incompatible health outcomes. This will help maximise the total return or effectiveness under given circumstances such as continued women that develop fistula due to lack of skilled healthcare or lifetime incontinence due to lack of treatment. From this study we conclude that improving access to quality health education will contribute to the elimination of obstetric fistula in Uganda. (C) 2019 Elsevier Inc. All rights reserved.