Rare causes of genital fistula in nine African countries: a retrospective review

Carrie J. Ngongo, Thomas J.I.P. Raassen, Marietta Mahendeka, Ladeisha Lombard, Jos van Roosmalen, Marleen Temmerman

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)


Background: Most genital fistulas result from prolonged, obstructed labor or surgical complications. Other causes include trauma (from accidents, traditional healers, or sexual violence), radiation, carcinoma, infection, unsafe abortion, and congenital malformation. Methods: This retrospective records review focuses on rare fistula causes among 6,787 women who developed fistula after 1980 and sought treatment between 1994 and 2017 in Tanzania, Uganda, Kenya, Malawi, Zambia, Rwanda, Ethiopia, Somalia, and South Sudan. We compare fistula etiologies across countries and assess associations between rare causes and type of incontinence (urine, feces, or both). Results: Rare fistula accounted for 1.12% (76/6,787) of all fistulas, including traumatic accidents (19/6,787, 0.28%), traumatic sexual violence (15/6,787, 0.22%), traumatic injuries caused by traditional healers (13/6,787, 0.19%), unsafe abortion (10/6,791, 0.15%), radiation (8/6,787, 0.12%), complications of HIV infection (6/6,787, 0.09%), and congenital abnormality (5/6,787, 0.07%). Trauma caused by traditional healers was a particular problem among Somali women. Conclusion: Fistulas attributable to rare causes illuminate a variety of risks confronting women. Fistula repair training materials should distinguish trauma caused by traditional healers as a distinct fistula etiology. Diverse causes of fistula call for multi-pronged strategies to reduce fistula incidence.

Original languageEnglish
Article number497
JournalBMC Women's Health
Issue number1
Publication statusPublished - Dec 2022


  • Fistula
  • Injury
  • Traditional healer
  • Trauma


Dive into the research topics of 'Rare causes of genital fistula in nine African countries: a retrospective review'. Together they form a unique fingerprint.

Cite this