Burden of Obstetric Fistulas in Zambia: A Bayesian Modelling Approach

Background Obstetric fistula, a severe but preventable complication of childbirth, disproportionately affects women in low-resource settings, but its true burden in Zambia remains uncertain owing to inconsistent routine health data collection and limited surveillance. This study aimed to estimate the national and subnational burden of obstetric fistula in Zambia using Bayesian modelling. Methods The records of women who underwent obstetric fistula repair from nine national Fistula Repair Facilities in Zambia were reviewed from 2018 to 2023 to obtain district-specific and country wide data. District-level birth data was obtained from the national Health Management Information System (HMIS). A Bayesian hierarchical model was implemented to estimate fistula burden, accounting for variation in the number of births and uncertainty in observed case counts. Posterior burden estimates were reported per 1,000 births with 95% credible intervals (CrIs). Results A total of 928 fistula cases were reported across 4,964,598 births between 2018 and 2023 with an estimated national burden of 0.28 per 1,000 births (95% CrI: 0.25-0.35). Provincial burden ranged from 0.07 per 1,000 births (95% CrI: 0.04-0.13) in Southern Province to 0.61 per 1,000 births (95% CrI: 0.46-0.95) in Northern Province. The highest district-level burden was observed in Chama at 2.48 per 1,000 births (95% CrI: 1.24-4.89). Conclusion The estimated national burden of obstetric fistula in Zambia is lower than reported from many high burden countries in sub-Saharan Africa, however, considerable district and provincial disparities persist. Strengthening maternal health services and expanding fistula prevention and treatment programs in high-burden areas should be prioritized.