Does Uganda register 1,900 new fistula cases annually?

Has the number of new fistula cases registered annually in the country changed since 2011?

Obstetric fistula is a a major public health problem in Uganda, with an article in the New Vision claiming that over 140,000 women are living with the condition, with 1,900 new cases reported every year.

On the 2016 Obstetric Fistula Day, Uganda’s Ministry of Health noted, that the country ranked third in the world in terms of the number of obstetric fistula cases.

Hon. Sarah Opendi, the then Minister of State for Primary Health Care, noted that while there are a growing number of surgeons who carry out fistula repairs in the country, the burden posed by fistula still remains a challenge.

There is a surgeon in each of the 13 regional referral hospitals to carry out fistula repairs. In addition, there are surgeons in seven private not for-profit hospitals which is a great improvement. But we have a backlog of 200,000 fistula cases and 1,900 new cases recorded every year; these surgeons alone are not enough to deal with these many cases — Hon. Sarah Opendi

Majority of Uganda’s fistula victims are teenage mothers and girls who have undergone early marriage.

The relative rarity of obstetric fistula and the geographical remoteness of the areas where most cases occur mean that there are few reliable estimates of the number of women affected.

The estimate of 1,900 new cases of fistula registered annually first appeared in Uganda’s Draft National Obstetric Fistula Strategy 2011–2015, as well as the 2011 Uganda Demographic and Health Survey. Since then, the figure has been repeated in articles in 2014, 2016 and most recently in March 2018. Does this mean that fistula prevalence has remained the same in the seven years since this number first emerged?

So, the question is, how many new cases of fistula are registered in Uganda every year?

PesaCheck has researched the issue and finds the claim that there are 1,900 new cases of fistula registered every year in Uganda to be INCONCLUSIVE for the following reasons:

Obstetric fistula is a serious and traumatic injury caused by prolonged, obstructed labour, without access to timely, high-quality medical treatment.

It results in a hole between the birth canal and bladder or rectum, leaving women leaking urine, faeces or both, and often leads to chronic medical problems, depression, social isolation and deepening poverty.

According to the United Nations Population Fund, more than 2 million women in sub-Saharan Africa, Asia, the Arab region, and Latin America and the Caribbean are estimated to be living with fistula, and the World Health Organization estimates that 50 to 100,000 women worldwide develop the condition each year.

Uganda’s Ministry of Health first noted that there were 1,900 new cases of fistula reported annually in 2011, estimating that 200,000 women suffering from the condition in the country.

These numbers have been extensively repeated verbatim, and they either indicate that there has been no new research into the problem, or government efforts to improve maternal and child health services have largely failed.

The 2016 Uganda Demographic and Health Survey notes that 64% of women age 15–49 have heard of obstetric fistula, while 1% of women, or about 200,000 individuals report ever having experienced leakage of urine or stool from the vagina after childbirth.

Among women who reported leakage, 62% had sought treatment, 12% felt embarrassed and did not seek treatment, 9% did not know where to go for treatment, 7% did not know that fistula can be repaired, and 3% felt that treatment was too expensive.

Incidence and prevalence estimates of obstetric fistula are generally based on self-reporting, personal communication with surgeons, studies by advocacy groups and reviews of hospital services.

That means that the claim that 1,900 new cases of fistula are reported in Uganda is INCONCLUSIVE, based on data from a 2011 report that needs to be updated with new research.

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This report was written by PesaCheck Fellow Emma Laura N. Kisa, a Ugandan data journalist and multimedia specialist, and edited by PesaCheck managing editor Eric Mugendi. The infographics are by Eunice Magwambo, a Kenyan graphic designer, visual artist and digital content producer.

PesaCheck, co-founded by Catherine Gicheru and Justin Arenstein, is East Africa’s first public finance fact-checking initiative. It seeks to help the public separate fact from fiction in public pronouncements about the numbers that shape our world, with a special emphasis on pronouncements about public finances that shape government’s delivery of so-called ‘Sustainable Development Goals’ or SDG public services, such as healthcare, rural development and access to water / sanitation. PesaCheck also tests the accuracy of media reportage. To find out more about the project, visit pesacheck.org.

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PesaCheck is an initiative of Code for Africa, through its local Code for Uganda chapter, with additional support from the International Center for Journalists (ICFJ).

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