Background: Vaginal fistula is a devastating maternal complication characterized by an abnormal opening between the vagina and the bladder or rectum, which results in continuous leakage of urine or stool. We aimed to comprehensively assess district-level geographical disparities, lifetime and point prevalence of symptoms of vaginal fistula using national household surveys based on self-report of symptoms.

Methods: We used data from 2005 and 2016 Ethiopia Demographic Health Surveys, which included self-reported signs of vaginal fistula for 14,070 and 15,683 women of childbearing age (15-49 years) respectively. We estimated the lifetime prevalence and point prevalence of vaginal fistula in all districts of Ethiopia using a binomial mixed model. We then fitted a binomial mixed model combining the site-level vaginal fistula prevalence with continuous environmental covariates to estimate prevalence at unsampled locations. Finally, we produced estimates of cases by district combining our mean predicted prevalence and a contemporary gridded map of estimated population density.

Results: In 2016 we estimated the number of women of reproductive age who had ever had vaginal fistula symptoms to be 72,533 (95% CI: 38,235–124,103) and the point prevalence (untreated cases) 31,961(95% CI: 11,596–70,309) in Ethiopia, with reduction from the 2005 estimates of 98,098 (95% CI: 49,819–170,737) life time fistula and 59,114 (95% CI 26,580–118,158) point estimates.  Relatively high prevalence of vaginal fistula were predicted in some part of Amhara, Oromia, SNNP and Tigray regions. With regards to the prevalence of vaginal fistula symptoms indicators in districts in Ethiopia, lifetime prevalence of vaginal fistula symptoms ranged from 2.3 to 6.7 per 1000 women of reproductive age. District level point prevalence ranged from 0.6 to 3.9 per 1000 women of reproductive age. Looking at the number of cases of vaginal fistula in 2005 the number of districts with >200 cases of untreated virginal fistula was 54 districts in Ethiopia and this reduced to 6 districts in 2016.

Conclusion: We noted large geographical inequalities in symptoms of vaginal fistula, masked by national and regional averages. Novel evidence from our study can be used to understand and to identify granular disparities for local level tracking, planning, and implementation of vaginal fistula interventions.