Objective

To validate a symptom-based, fistula screening questionnaire and estimate obstetric fistula (OF) prevalence in rural Nepal.

Design

Cross-sectional and nested case-control study.

Setting

Sarlahi District, Nepal.

Population

Parous, reproductive-age women.

Methods

The questionnaire assessed symptoms of vesicovaginal (VVF) and rectovaginal (RVF) fistula, stress (SUI) and urge urinary (UUI) incontinence, fecal incontinence (FI), and included interviewer observations on the smell and presence of urine and/or stool. All women who screened positive for OF and a randomly-selected group of women who screened negative for OF were included in a nested case-control study (one case: four normal controls: four incontinent controls) and underwent confirmatory clinical examinations.

Main outcome measure

Clinically-confirmed OF, questionnaire sensitivity (Se) and specificity (Sp).

Results

Of the 16,893 women who completed cross-sectional screening, 68 were “screened-positive cases.” Of these, 55 (82%) “screened-positive cases,” 203 “screened-negative normal controls,” and 203 “screened-incontinent controls” participated in the case control study, which confirmed one case of VVF and one case of both VVF and RVF without any false negative cases. For VVF, the screening tool demonstrated Se 100% (95%CI: 34.2, 100), Sp 86.9% (95%CI; 83.3, 89.9), and estimated VVF prevalence as 12 per 100,000 (95%CI: 3, 43); for RVF, it demonstrated Se 100% (95%CI: 20.7, 100), Sp 99.8% (95%CI: 98.6, 100) and estimated RVF prevalence as 6 per 100,000 (95%CI: 1, 34).

Conclusions

The OF screening questionnaire demonstrated high sensitivity and specificity in this low-prevalence setting.