RESEARCH ARTICLE e m h

7HT, UKparticularly in low income countries where women have less geographical and financial access to appropriate sur-gical care for repair. In high income countries they are also devastating, but they are very rare and surgery to repair them occurs more rapidly. Women with fistulae often experience horrific or diffi-cult associated conditions which stem either from the fistulae itself or from the prolonged or obstructed labour which caused it [3]. The most obvious consequences are incontinence, either urinary [3], faecal or both. The con-stant leakage of urine and faeces can also lead to damage to the vulva and thighs [2]. Fistulae are linked with social * Correspondence: alma.adler@lshtm.ac.ukcluding vesicovaginal fistula (VVF) and rectovaginal fis-broader maternal and reproductive morbidities. Studies including estimates of incidence and prevalence of fistula at the population level were included. We conducted meta-analyses of prevalence of fistula among women of reproductive age and the incidence of fistula among recently pregnant women. Results: Nineteen studies were included in this review. The pooled prevalence in population-based studies was 0.29 (95 % CI 0.00, 1.07) fistula per 1000 women of reproductive age in all regions. Separated by region we found 1.57 (95 % CI 1.16, 2.06) in sub Saharan Africa and South Asia, 1.60 (95 % CI 1.16, 2.10) per 1000 women of reproductive age in sub Saharan Africa and 1.20 (95 % CI 0.10, 3.54) per 1000 in South Asia. The pooled incidence was 0.09 (95% CI 0.01, 0.25) per 1000 recently pregnant women. Conclusions: Our study is the most comprehensive study of the burden of fistula to date. Our findings suggest that the prevalence of fistula is lower than previously reported. The low burden of fistula should not detract from their public health importance, however, given the preventability of the condition, and the devastating consequences of fistula