Universal Journal of Public Health Vol. 14(5), pp. 875 - 885
DOI: 10.13189/ujph.2026.140505
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Socioeconomic Determinants and Impacts of Healthcare Utilization on Obstetric Fistula Morbidity in Madagascar

Abayomi Samuel Oyekale ^*
Department of Agricultural Economics and Extension, North-West University Mafikeng Campus, South Africa

ABSTRACT

Background: Obstetric fistula is an emerging health problem in Sub-Saharan Africa (SSA). However, very little is known about the correlates of the average duration of fistula morbidity and the impact of healthcare service utilization. This study therefore explored the impacts of healthcare service utilization, along with other variables, on fistula morbidity. Methods: The data were from 47720 recorded births among Madagascan women of reproductive age as presented in the 2021 Demographic and Health Survey (DHS). The data were analysed with Poisson regression with logit zero-inflation. The regression adjustment inverse probability weighting estimator was used for treatment impact assessment. Results: The results showed that average obstetric fistula incidence was 0.44% with an average morbidity day of 13.97. The zero-inflated Poisson results showed that the expected number of fistula morbidity decreased significantly (p<0.05) with mother's age, urban residence, education levels (except higher education), non-smoking, health insurance, and health distance concern. It, however, increased with age at first birth, male household headship, and age of household head. The inflation model showed that always being unaffected by fistula significantly increased (p<0.05) with mother's age, urban residence, household size and age at first birth, but decreased with wealth index. The average treatment effects (ATEs) were significant (p<0.05) with -0.05731 and -0.05997 for consulting doctors and nurses during prenatal medical care, respectively, while the average treatment effects on the treated (ATETs) for doctor prenatal care was -0.14928 (p<0.05). Conclusions: It was concluded that access to professional healthcare consultations holds some promise in ending obstetric fistula morbidity in Madagascar, while emphasis should be placed on prevention of child marriage or pregnancy and development of women-targeted education programmes on obstetric fistula prevention.

KEYWORDS
Socioeconomic Determinants, Healthcare, Indicators, Obstetric Fistula, Madagascar

Cite This Paper in IEEE or APA Citation Styles
(a). IEEE Format:
[1] Abayomi Samuel Oyekale , "Socioeconomic Determinants and Impacts of Healthcare Utilization on Obstetric Fistula Morbidity in Madagascar," Universal Journal of Public Health, Vol. 14, No. 5, pp. 875 - 885, 2026. DOI: 10.13189/ujph.2026.140505.

(b). APA Format:
Abayomi Samuel Oyekale (2026). Socioeconomic Determinants and Impacts of Healthcare Utilization on Obstetric Fistula Morbidity in Madagascar. Universal Journal of Public Health, 14(5), 875 - 885. DOI: 10.13189/ujph.2026.140505.