Determinants of fistula awareness among adolescent girls and young women in Zambia

Abstract Background Improving reproductive healthcare for adolescent girls and young women (AGYW) requires raising awareness of obstetric fistula (OBF), which affects over two million AGYW globally. Despite being preventable, OBF persists as one of the causes of maternal morbidity and mortality in low- and middle-income countries like Zambia. This study examined the factors influencing OBF awareness among AGYW aged 15–24 years in Zambia. Methods This analytical cross-sectional study used secondary data from the 2024 Zambia Demographic and Health Survey (ZDHS) women’s file (IR). The outcome variable was ‘knowledge of fistula’ assessing OBF awareness. We included 5,882 AGYW with complete cases of the variable of interest in multivariable binary logistic regression analysis. Adjusted odds ratios (AOR) with a 95% confidence interval (CI) determined statistical significance. Results Overall OBF awareness among AGYW in Zambia was 22.5% (95% CI: 21.0–24.0). Significant individual factors included age (20–24 years) (aOR = 1.58, 95%CI = 1.35–1.86), secondary (aOR = 1.52, 95%CI = 1.05–2.20) or higher education (aOR = 3.64, 95%CI = 2.16–6.12), employment (aOR = 1.27, 95%CI = 1.09–1.48), parity (one (aOR = 1.75, 95%CI = 1.46–2.09) and two or more (aOR = 1.67, 95%CI = 1.30–2.14)), currently pregnant (aOR = 1.39, 95%CI = 1.10–1.75), insurance cover (aOR = 1.39, 95%CI = 1.01–1.92), exposed to media family planning messages (aOR = 1.49, 95%CI = 1.28–1.74) and read newspapers/ magazines (aOR = 1.42, 95%CI = 1.18–1.69). At the community level, rural residence (aOR = 0.73, 95%CI = 0.57–0.94), high community employment (aOR = 1.23, 95%CI = 1.04–1.45) and high community wealth (aOR = 0.73, 95%CI = 0.65–1.11) were statistically significant with OBF awareness. Conclusion OBF awareness among AGYW in Zambia remains low, driven by individual (demographic and obstetric) and community factors. Low levels of OBF awareness limits symptom recognition and timely treatment seeking. Integrating OBF education into routine sexual and reproductive healthcare services accessed by AGYW is essential.