2nd Edition of Public Health World Conference (PHWC) 2026

Abstract

Background

EDHS data estimated that in 2016 there were almost 32 thousand historic obstetric fistula (OF) cases across Ethiopia, and approximately 948 new injuries per year. Given national average treatment numbers per year of circa 1,500, it is estimated there are still likely to be just under 30,000 historic OF cases across Ethiopia in 2024. The national strategic plan for eliminating obstetric fistula notes that women's awareness of OF is only 39%, hindering efforts in preventing it.

Objectives

One of the objectives of Hamlin Fistula Ethiopia’s (HFE) Project Zero (PZ) Woreda-by-Woreda (Eradication of Fistula) strategy is to understand the number of historic fistula cases in Ethiopia, as a support to patient identification and to inform Hamlin Fistula Ethiopia’s prevention strategy for the future eradication of Obstetric Fistula in Ethiopia while the other objective is to raise awareness. Data and research obtained will also be shared with the Ministry of Health National Fistula Task force to support MoH’s country wide strategy.

Methods

Project Zero piloted in Ale Woreda, Ethiopia in 2023 and the first intervention was in Didesa Woreda in 2024. Although it would be legitimate to employ a sample methodology and visit a selection of households, it was decided that the only way to be sure of finding all OF cases would be to carry out a survey - House to House - across Ale’s 24 Kebeles with around 16,400 households and around 54,000 households in 33 kebeles of Didesa woreda.

The Survey was carried out after a week of awareness raising in each Kebele. The PZ team were supported by 620 people of which; 509 Health Development Army (HDA) and 111 Health Extension Workers (HEW) across both woredas. HEWs helped with their knowledge of the Kebele (where households were located, numbers to expect) and in communicating with and organizing the HDAs.

HDAs were given specific areas to cover and used standard questionnaires for each household, which they returned to the PZ team each day. The PZ team checked each completed questionnaire with each HDA, ensuring that questions were answered in a consistent way, and checking the completeness of forms which were transcribed onto an excel database with a sample of entries double checked by PZ team.

After doing the base line assessment, a Woreda wide community awareness campaign is undertaken through into education sessions and public woreda wide communication. These sessions include; definition, cause, risk factors, prevention and treatment of the OF and the utilization of maternal health care services. Power points, leaflets, t-shirts, banners, pre-recorded voice on speakers were used to raise awareness in market places, schools, community gatherings and health facilities.

Results / Conclusions

Obstetric Fistula and 217 Pelvic Organ Prolapse cases were found. Attendance at ante-natal clinics increased substantially during phase 1 at Ale and Didesa.

The findings in Ale Woreda are not statistically significant enough to change the national estimate. However, with 8 cases found in a Woreda only 18km from a Hamlin Treatment Centre it’s unlikely that cases elsewhere are less than the national estimate.

The awareness level was raised from an average of 11% to 78% in Ale woreda and from 17% to 79% in Didesa woreda.

Following the Ale PZ intervention, HFE launched PZ in Didessa Woreda in February 2024. HFE has launched a further 2 interventions in 2025 and plans to launch 6 more in 2026 then increase PZ interventions to up to 50 interventions a year by 2030. It is hoped that over time, other institutions working in maternal health, and the Ministry of Health will become involved until every Woreda has been reached.