Table 3 Sources of risk of bias in included studies

Muleta et al., 2008 [18]

Obstetric fistula treated and untreated

Population based sample of seven administrative regions of rural Ethiopia

Only women reporting leaking examined, therefore it is possible that some women may have been counted as non cases

All from same population

Sufficient physical exam

As sample was women of reproductive age, some women will have only just given birth and it is possible they may have not yet developed fistula

Do not state

Walraven et al., 2001 [24]

Obstetric morbidities including fistula

Population based rural region

All women invited for a physical examination

All from same population

Sufficient physical exam

As sample was women of reproductive age, some women will have only just given birth and it is possible they may have not yet developed fistula

28% of sample did not have examination

Kulkarni, 2007 [35]

Obstetric morbidities including fistula

Population based

Included all women examined

All from same population

Sufficient physical exam

Women with children at least six months examined so assumption is that it would be six months postpartum

25% of sample women did not have examination

Bhatia et al., 1997 [19]

Gynecological morbidity including fistula

Population based

Included all women examined

All from same population

Sufficient physical exam

Women had exam after one year so long enough for fistula to develop

5% lost to follow up, 6% not examined

Younis et al., 1993 [29]

Gynaecological and related morbidities, but do not state that they looked for fistula

Population based

Included all women examined

No cases

Sufficient physical exam

Women who were ever married and not pregnant, so it is possible they may have not yet developed fistula

Do not state

Deeb et al., 2003 [27]

Gynaecological and related morbidities, but do not state that they looked for fistula

Population based

Included all women examined

No cases

Sufficient physical exam

Women who were ever married and not pregnant, so it is possible they may have not yet developed fistula

9% did not have examination

Al-Riyami et al., 2007 [28]

Gynaecological and related morbidities, but do not state that they looked for fistula

Population based from national survey

Included all women examined

No cases

Sufficient physical exam

As sample was women of reproductive age, it is possible they may have not yet developed fistula

Do not state

Al-Qutob, 2001 [26]

Gynaecological and related morbidities, but do not state that they looked for fistula

Population based

Included all women examined

No cases

Sufficient physical exam

Women who were ever married and not pregnant, so it is possible they may have not yet developed fistula

10.7% did not have examination

Bulut et al., 1995 [25]

Gynaecological and related morbidities, but do not state that they looked for fistula

Population based, but in Istanbul which may not be representative of Turkey as a whole. Additionally only included women who had ever used contraception

Included all women examined

No cases

Sufficient physical exam

Unclear how long women were followed up for after pregnancy

5% did not have examination

Tehrani et al., 2011 [34]

Gynaecological and related morbidities, but do not state that they looked for fistula

Population based

Included all women examined

No cases

Sufficient physical exam

All women from 18-45 who were not pregnant, so it is possible some may not have had time for fistula to form

119 dropped out

Ijaiya and Aboyeji, 2004 [23]

Obstetric fistula

Hospital record review of fistula repairs with details about reference population

Case series of repairs

No non cases

Physical exam and treatment

All women already had fistula. Possible that women missed who did not present for treatment

N/A

Kalilani-Phiri et al., 2010 [21]

Obstetric fistula

Hospital record review with details of population it came from, however researchers eliminated all cases not originating in the region.

Case series of repairs

No non cases

Physical exam and treatment

All women already had fistula. Possible that women missed who did not present for treatment

N/A

Mabeya, 2004 [36]

Obstetric fistula

Hospital record review of fistula repairs with details about reference population

Case series of repairs

No non cases

Physical exam and treatment

All women already had fistula. Possible that women missed who did not present for treatment

N/A

Vangeenderhuysen et al., 2001 [22]

Obstetric morbidities including fistula

Population based

Included all women examined

All from same population

Sufficient physical exam

Followed up to 60 days after birth

5.7% loss to follow up

Ferdous et al., 2012 [33]

All short and long term postpartum morbidities including fistula

Women with morbidities and random sample of all women

Included all women examined

All from same population

Sufficient physical exam

Examined 6-9 weeks postpartum

4.1% lost to follow up and 6.1% did not have examination

Fronczak et al., 2005 [20]

Obstetric morbidities including fistula

Population based

All women examined, but women who may have had fistula followed up longer

All from same population

Sufficient physical exam

Women feared to have fistula followed up one month postpartum

63% did not have examination

Filippi et al., 2007 [30]

Severe obstetric complications including fistula

Women with complications over-represented but also had follow up of women with uncomplicated birth

All women examined

All from same population

Sufficient physical exam

Women had follow up at six months

11% only had either interview or physical exam at six months

Filippi et al., 2010 [31]

Severe obstetric complications including fistula

Women with complications over-represented but also had follow up of women with uncomplicated birth

All women examined

All from same population

Sufficient physical exam

Women had follow up at six months

32% of women did not have follow up at six months

Prual et al., 1998 [32]

Severe obstetric complications including fistula

Women with complications over-represented but also had follow up of women with uncomplicated birth

All women examined

All from same population

Sufficient physical exam

Unclear how long women were followed up for after pregnancy so it is possible they may have not yet developed fistula

Do not state