Abstract

Background: Fistula is a global problem that appears to be particularly common in Sub-Saharan Africa. Women affected by fistula who have been shunned and isolated typically experience intense feelings of shame, self-loathing, and depression.

Objective: Pooled prevalence of depression among fistula patients and the effect of factors affecting depression were the outcome interest of the current systematic review and meta-analysis.

Methods: Electronic data bases of SCOPUS, PubMed, EMBASE, and Psych INFO were searched up to November 06, 2019 for observational studies, and other data sources like Hinari, advanced Google scholar and Google were used to search studies. Screening of titles abstracts and full text which is a three-stage was conducted independently by two review authors on the bases of these criteria.  A disagreements were resolved by consensus and third reviewer’s decision. Data were entered in to excel 2013 and exported to Stata version 14 for meta-analysis. In the presence of between  study heterogeneity, the pooled prevalence estimates of depression, odds ratio, and corresponding 95% confidence intervals (CIs) were calculated using random-effects meta-analyses. Potential influences on prevalence estimates was investigated using subgroup analyses and a leave-one-out sensitivity test. To test the small study effect funnel plot and egger's test were applied in the Meta-analysis.

Result: Twelve cross sectional studies with a total 2102 participants were included .The prevalence of the studies ranges between 36% and 91% and based on random effect model analysis, the pooled prevalence of depression among fistula patients reported by 12 studies was 62% (95%CI (49, 75%)). The overall prevalence of depression among fistula patients was higher in Africa (62% (95% CI: 49, 76 %)) compared to   other worlds (Asia and Europe) (51 % (95% CI: 46, 56 %)). According to spectrum of fistula , the pooled prevalence was 72% (95% CI:60,83;I²=95.49%; p<0.001 ) among  obstetric fistula patients and 49%(95% CI: 35,63;I2=94.33;p<0.001) among  vesicovaginal  patients. For factors associated with depression among fistula patients , residency (rural) (OR:2.4,95% CI:1.3-2.5), history of still birth  (OR:3.1, 95% CI:1.2-7.7) and  no social support (OR:3.9, 95% CI:1.2-9.9) were significant  variables.

Conclusion: In our review the overall depression among fistula patients was higher. In addition to this, occupation, duration of fistula and educational level of the participants were insignificant and residency, history of still birth and social support were statistically significant with depression.

Key words: depression, fistula, and meta-analysis