Miteku Andualem Limenih ^1* Destaye Shiferaw ¹ Alemakef Wagnew Melesse ¹ Chernet Baye ² Beletew Shewabere ³ Getie Mekonnen ⁴ Hamid Y. Hassen ⁴ Aster Berhe ⁵ Wagaye Fentahun Chanie ⁶

• ¹ Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia, Gondar, Ethiopia
• ² Department Obstetrics and Gynecology, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
• ³ Family Health International-360, Addis Ababa, Ethiopia
• ⁴ Department Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Antwerp, Belgium
• ⁵ United Nations Population Fund (Ethiopia), Addis Ababa, Addis Ababa, Ethiopia
• ⁶ University of Gondar, Gondar, Ethiopia

Background: Obstetric fistula causes a significant maternal morbidity in resource-limited settings, where women often suffer without prompt access to skilled obstetric services. It is imperative to comprehend and pinpoint the factors that shape community knowledge about obstetric fistula to enhance prevention strategies, enable early detection, and providing support and treatment to affected women. However, there is a substantial gap in the available evidence concerning the level of community knowledge regarding obstetric fistula and its influencing factors within the Ethiopian context.Objective: To investigate the level of knowledge regarding obstetric fistula and identifying influencing factors within the communities in Gondar, Ethiopia.A community-based cross-sectional study was conducted among 663 households. Households selected using systematic random sampling technique. Descriptive statistics and exact binomial confidence interval (CI) are reported. Mann-Whitney U test or the Kruskal-Wallis test wereas done for group comparisons. Parameters with p-value ≤ 0.2 in the bunivariable ordinal regression wereas selected to the multivariable ordinal regression model. The proportion odds assumption was checked through parallel lines test. A multivariable proportional ordinal regression analysis was done. P-values <5% wereas considered as statistically significant. Data were analysed using R version 4.3.1.Result: Of 663 households, 265 (39.9%; (95%CI: 36.2-43.8), 375 (56.6%; (95%CI: 52.7-60.4), and 23 (3.5%; (95%CI: 2.2-5.2) had low-level, medium-level, and high-level of knowledge about obstetric fistula, respectively. Self-employment (AOR:0.33; 95%CI: 0.219-0.54), unemployment (AOR: 0.435; 95%CI: 0.215-0.879), income $50-$200 USD (AOR:5.216; 95%CI: 2.01-16.11), income > $200 USD (AOR:7.01; 95%CI: 2.56-22.91), distance from health facility (AOR:1.765; 95%CI: 1.01-2.769), not participated in women conference (AOR:0.766; 95%CI: 0.45-0.98), and heard of obstetric fistula (AOR:4.44; 95%CI: 2.82-7.109) showed statistically significant association with the likelihood of having a high level of knowledge regarding obstetric fistula versus medium or low level.The study reveals an alarmingly low level of knowledge on obstetric fistula. Higher income and prior awareness increased knowledge of obstetric fistula, while self-employment, unemployment, and non-participation in women's conferences decreased it. Enhancing community knowledge requires a holistic strategy involving cooperation from all stakeholders and tackling wider socioeconomic disparities.