Social reintegration of women after obstetric fistula surgery: Evidence from a longitudinal multilevel mixed‐effects study in Zambia

INTRODUCTION: Obstetric fistula remains a persistent maternal health challenge in sub-Saharan Africa, severely impairing women's physical, social, and psychological well-being. Although surgical repair restores continence, less is known about the factors influencing women's social reintegration after treatment. This study examined the association of continence status and follow-up time on social reintegration among women who underwent obstetric fistula repair in Zambia. MATERIAL AND METHODS: This prospective cohort study included 2172 women who underwent fistula repair between 2017 and 2023 at eight hospitals across Zambia. Multilevel mixed-effects models were used to assess the effects of continence and follow-up time on a composite social reintegration score (0-100), derived from the five domains using principal component factor analysis (eigenvalue = 4.02) and demonstrating internal consistency (Cronbach's α = 0.94), while adjusting for baseline covariates. RESULTS: Among all participants, 86.3% achieved continence, whereas 13.7% remained incontinent at discharge. The null model yielded negligible between-patient variance (intraclass correlation coefficient, ICC