Background: Pregnant women in the Democratic Republic of Congo (DRC) are at\nincreased risk for developing obstetric fistulas (OFs) as a result of obstructed labor,\nin conditions similar to many other African countries. No case-control study of biological\nand social risk factors for OF has been reported from the DRC. This study\naimed to identify factors that would aid in prevention and early identification of\nwomen who are at risk of developing OF. Methods: Participants were enrolled in a\ncase-control study at four obstetric clinics in the central DRC. Cases of OF were evaluated\nas they presented, then a control participant was enrolled among women presenting\nsubsequently to the same clinic, seeking to match parity at the time of the\nfistula and tribe of the case. A questionnaire was administered to elicit physical, obstetric,\ndemographic, socioeconomic, religion, geographic, and delivery attributes of\nthe participants. Case-control comparisons sought to identify independent risk factors\nfor OF in the total case-control pairs and in subgroups of the participants. Logistic regression\nwas utilized to identify independent risk factors for OF in the total case-control\nstudy group and in selected subgroups of the participants, and linear regression\nwas utilized to estimate the variation explained between case and control outcomes\nfrom the variables independently significant in the logistic regression models. Results:\nA total of 177 case-control pairs were enrolled. Among all pairs, shorter height of the\ncase (odds ratio = 1.06, 95% Confidence Limits 1.02 - 1.12); more kilometers travelled\nto the delivery site (1.02, 1.01 - 1.02); her village, not town, residence (OR = 5.52, 2.72 -\n11.2), and her lower professional status (2.95, 1.53 - 5.72) were statistically independent\nfactors associated with OF development. When applied in linear regression\ncomparison of the pairs, these variables yielded an r2 = 0.48, imputing 48% of the dif-ference in delivery outcome between the pairs was explained by these variables. Among\nthe 38 pairs who were primigravida, the independent variables were more kilometers\ntravelled to the delivery site (1.02, 1.00 - 1.05), village, not town, residence (50.0, 10.2 -\n248.7), and facility intended for lower patient acuity (3.7 s, 1.01 - 13.6, r2 = 0.66) patients\nwho were matched on parity and tribe, the significant risk factors were professional\nstatus (OR = 0.29), greater distance travelled to the clinic (OR = 1.02, 1.01 -\n1.02), village, not town, residence (5.52, 2.72 - 11.2), and mother�s lower professional\nstatus (2.95, 1.53 - 5.72) when the OF occurred. Conclusions: Our study showed biological\nand social factors associated with the development of OF. Shorter height was the\nonly biological risk factor found to be statistically significant in the study population.\nOther factors were related to limited resources and limited access to medical care.
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