Table 3

Sources of risk of bias in included studies
Selection Comparability Outcome
Study: What is the case definition? (Condition of interest) Representativeness of the study population Selection of non cases Comparability of cases and non-cases Assessment of outcome Was study long enough to ensure cases would be found Differential follow up?
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

Adler et al.

Adler et al. BMC Pregnancy and Childbirth 2013 13:246   doi:10.1186/1471-2393-13-246

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