ArticleTropical medicine and health2025
Barriers and facilitators for treatment-seeking among women with genital fistula: a facility-based qualitative study in Bangladesh.
Article in Tropical medicine and health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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Who cites it
3 citing papers in PubMed.
- Prevalence of obstetric fistula: a systematic review and meta-analysis of available evidence from 38 countries.Irish journal of medical science · 2026Review
- Perceptions of facilitators, barriers and adaptations for provision of obstetric fistula surgery and care: a qualitative descriptive study of service providers in selected hospitals in Busoga sub-region, eastern Uganda.Frontiers in global women's health · 2026Article
- Geographic Access Barrier as a Critical Mediator in Obstetric Fistula Treatment Cascade in Nigeria: Evidence from a Causal Mediation Analysis of 5,496 Cases.International journal of women's health · 2026Article
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Abstract
backgroundWomen living with genital fistula often endure prolonged suffering and face multiple barriers to accessing treatment. Bangladesh's government has enhanced referral mechanisms, enabling case detection in communities and facilitating surgical interventions at medical college hospitals through nationwide initiatives. However, research on barriers and facilitators for fistula treatment in Bangladesh remains limited. Detailed insights into treatment-seeking paths with time sequences are scarce. This study aimed to explore facilitators and barriers to completing fistula treatment with the description of treatment-seeking paths. This study is important to assist with future policy and program strategies for fistula treatment.
methodsA facility-based qualitative study was conducted at Dhaka Medical College Hospital, Dhaka, Bangladesh. Data were collected from February to May 2024 through 18 in-depth interviews (IDIs) with in-patients, five IDIs with families, and 11 key informant interviews with health service providers. Participants' treatment-seeking paths were described chronologically and identified patterns of treatment-seeking paths. Thematic analysis, guided by the Partners for Applied Social Sciences model for health-seeking behavior and access to care, was used to analyze case histories.
resultsThe average duration of treatment-seeking by the women was 39 months, with a maximum of 22 years. Women with fistula often sought care at multiple facilities (up to eight), suspended treatment, and encountered systemic obstacles that delayed treatment. Key barriers included scarce information on illness and treatment in the community, less decision-making power, failure of medical communication, and systemic failures in cost, treatment, and referral systems. Facilitators that motivated women to complete treatment included informal peer support through shared treatment experiences and emotional, physical, and financial support.
conclusionsAnalysis of treatment-seeking paths revealed the absence of standardized treatment routes for women with fistula. To ensure effective care, raising societal awareness about fistula, improving treatment and referral systems, enhancing medical communication, and providing peer and emotional support are strongly recommended.
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