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Toward a complete estimate of physical and psychosocial morbidity from prolonged obstructed labour: a modelling study based on clinician survey
  1. Lina Roa1,2,
  2. Luke Caddell1,3,
  3. Gabriel Ganyaglo4,
  4. Vandana Tripathi5,
  5. Nazmul Huda6,
  6. Lauri Romanzi1,5,
  7. Blake C Alkire1,7,8
  1. 1Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States
  2. 2Department of Obstetrics & Gynecology, University of Alberta, Edmonton, Alberta, Canada
  3. 3Miller School of Medicine, University of Miami, Miami, Florida, USA
  4. 4Department of Obstetrics and Gynecology, Korle Bu Teaching Hospital, Accra, Greater Accra, Ghana
  5. 5Fistula Care Plus, EngenderHealth, Washington, District of Columbia, USA
  6. 6EngenderHealth Inc, Dhaka, Bangladesh
  7. 7Center for Global Surgery Evaluation, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
  8. 8Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States
  1. Correspondence to Dr Lina Roa; lroa123{at}


Introduction Prolonged obstructed labour often results from lack of access to timely obstetrical care and affects millions of women. Current burden of disease estimates do not include all the physical and psychosocial sequelae from prolonged obstructed labour. This study aimed to estimate the prevalence of the full spectrum of maternal and newborn comorbidities, and create a more comprehensive burden of disease model.

Methods This is a cross-sectional survey of clinicians and epidemiological modelling of the burden of disease. A survey to estimate prevalence of prolonged obstructed labour comorbidities was developed for prevalence estimates of 27 comorbidities across seven categories associated with prolonged obstructed labour. The survey was electronically distributed to clinicians caring for women who have suffered from prolonged obstructed labour in Asia and Africa. Prevalence estimates of the sequelae were used to calculate years lost to disability for reproductive age women (15 to 49 years) in 54 low- and middle-income countries that report any prevalence of obstetric fistula.

Results Prevalence estimates were obtained from 132 participants. The median prevalence of reported sequelae within each category were: fistula (6.67% to 23.98%), pelvic floor (6.53% to 8.60%), genitourinary (5.74% to 9.57%), musculoskeletal (6.04% to 11.28%), infectious/inflammatory (5.33% to 9.62%), psychological (7.25% to 24.10%), neonatal (13.63% to 66.41%) and social (38.54% to 59.88%). The expanded methodology calculated a burden of morbidity associated with prolonged obstructed labour among women of reproductive age (15 to 49 years old) in 2017 that is 38% more than the previous estimates.

Conclusions This analysis provides estimates on the prevalence of physical and psychosocial consequences of prolonged obstructed labour. Our study suggests that the burden of disease resulting from prolonged obstructed labour is currently underestimated. Notably, women who suffer from prolonged obstructed labour have a high prevalence of psychosocial sequelae but these are often not included in burden of disease estimates. In addition to preventative and public health measures, high quality surgical and anaesthesia care are urgently needed to prevent prolonged obstructed labour and its sequelae.

  • maternal health
  • obstetrics
  • surgery

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  • LR and BCA are joint senior authors.

  • Handling editor Sanni Yaya

  • Twitter @LinaRoaS

  • Contributors LR, LC and BCA conceived the study. LR, GG, VT and LR developed the survey. LC, NH and GG collected data. LR, LC and BCA conducted the analysis. LR and BCA drafted the manuscript. All authors made significant contributions to the manuscript and meet authorship criteria.

  • Funding Lina Roa received support from the Ronda Stryker and William Johnston Global Surgery Fellowship Fund. This study was partly supported by the American people through the United States Agency for International Development (USAID) associate cooperative agreement AID-OAA-A14-00013. The opinions expressed are those of the authors and do not necessarily reflect the views of USAID or the United States Government.

  • Disclaimer Blake Alkire reports grants from Mercy Ships. No other disclosures were reported.

  • Competing interests BCA reports grants from Mercy Ships, these did not influence the submitted work.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data from the survey results are available upon request. Data used for burden of disease modelling is available at the Global Burden of Disease Study website from the Institute for Health Metrics and Evaluation and is available open access.

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