Fuzzy Logic means for Intelligent Diagnosis of Obstetrics Fistula Disease

International Journal of Electrical, Electronics and Computers (EEC Journal) [Vol-2, Issue-5, Sep-Oct 2017]
https://dx.doi.org/10.24001/eec.2.6.1 ISSN: 2456-2319
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Fuzzy Logic means for Intelligent Diagnosis of
Obstetrics Fistula Disease.
Amosa Babalola1
, Hameed Aderemi2
, Kawonise Kayode2
, Ekuewa Jacob2
1
Department of Computer Science, San Juan de la Cruz University, San Jose, Costa Rica
2
Department of Computer Science, Federal Polytechnic, Ede, Nigeria
Abstract - Obstetrics fistula is one of the most serious and
tragic childbirth injuries. It is a hole between the birth canal
and bladder or rectum caused by prolonged, obstructed
labour, without access to timely, high-quality medical
treatment. It leaves women leaking urine, faeces or both and
often leads to chronic medical problems, depression, social
isolation and deepening poverty. The goal of this research is
to develop a Fuzzy logic means for intelligent diagnosis of
Obstetrics fistula disease. In the study we presented the
architecture of the FCM system for the diagnosis of
Obstetrics Fistula. It comprises of knowledge base system,
fuzzy c-means inference engine and decision support system.
The knowledge base system holds the symptoms for
Obstetrics Fistula. The expert system is developed in an
environment characterized by Microsoft XP Professional
operating system, Microsoft Access Database Management
System, Visual BASIC Application Language and Microsoft
Excel.
Keywords-fuzzy Logic, intelligent diagnosis, childbirth
injuries, obstetrics fistula.
I. INTRODUCTION
Obstetrics fistula is one of the most serious and tragic
childbirth injuries. It is a hole between the birth canal and
bladder or rectum caused by prolonged, obstructed labour,
without access to timely, high-quality medical treatment. It
leaves women leaking urine, faeces or both and often leads
to chronic medical problems, depression, social isolation and
deepening poverty. Obstetric fistula is a condition that most
frequently affects women living in resource poor countries
where, for a variety of reasons, access to emergency obstetric
care (EmOC) is difficult. In such settings, women living in
rural areas and those from low socioeconomic households
have fewer opportunities to obtain EmOC (specifically, a
cesareansection) and are therefore more vulnerable to fistula.
When not repaired, vaginal fistula causes incontinence, and
for some women it can result in an inability to carry and bear
children. Because of the physical consequences, fistula
stigmatizes women, often forcing them to isolate themselves
and remain silent about their condition [1]. The World
Health Organization has estimated that more than 2 million
women have untreated obstetric fistula and some 50,000 TO
100000 new cases develop annually. Globally, there were an
estimated 289,000 maternal deaths in 2013[2]. Further
statistical figures on obstetric fistula mortality are presented
in [3-4]. However, this figure is thought to be an
underestimate, because many women with fistula do not seek
treatment. The overall rate of obstetric fistula in Africa is
three to five cases per 1,000 deliveries; in rural Africa,
however, the rate is five to 10 cases per 1,000 deliveries. The
United Nations Population Fund estimates that, worldwide,
fistulas occur in one or two of every 1,000 deliveries. The
actual prevalence of fistula, however, is not known. Fistula
from prolonged or obstructed labour can strike any pregnant
woman, regardless of her age or gravidity. However,
adolescents who marry early have unique characteristics that
put them at increased risk for obstetric fistula. Most of these
adolescents become pregnant before the pelvis is fully
developed for childbearing[5].
The five types of obstetric fistula are: Vesicovaginal (VVF)
fistula: Between the bladder and vagina,Rectovaginal fistula
(RVF): Between the rectum and vagina, Urethrovaginal
fistula: Between the urethra and the vagina, Ureterovaginal
fistula: Between the distal ureter and vagina, Vesicouterine
fistula: Between the uterus and the bladder, Vesicovaginal
(VVF) is the most common type of obstetric fistula, A client
may have both vesicovaginal and rectovaginal fistula at the
same time—the combination of VVF and RVF is the second
most commonly encountered type of obstetric fistula.The
most common cause of obstetric fistula in developing
countries is prolonged or obstructedlabour. Other physical
causes of fistula include: Trauma caused by sexual violence,
Accidental surgical injury, Unsafe abortions, Harmful
traditional practices, Diseases or radiotherapy treatments,
Most women who develop obstetric fistula during childbirth
do so because they did not receive the health care they
needed.
The problems in accessing timely obstetric care, which can
lead to maternal death or complications (including fistula),
are commonly referred to as the “Three Delays”: Delay in

deciding to seek care, Delay in reaching a health care
facility, and Delay in receiving adequate care/attention at the
facility. Other societal factors that contribute to obstetric
fistula include: Poverty, Early marriage and childbirth,
Gender discrimination, Poor nutrition and compromised
development and Inadequate family planning information.
Symptoms of Obstetrics fistula are; Flatulence, Foul-
smelling, Repeated virginal/urinary infections, Irritation or
pains in vagina areas and Pains during sexual activity [6-8].
1.1 Consequence of Obstetric fistula
Obstetric fistula, in conjunction with prolonged or obstructed
labour, can lead to a range of physicaland mental health
complications,[9-11]including: Gynecologic sequelae, Nerve
damage, Dermatologic injuries, Bone abnormalities, Anxiety
and Depression, Ancillary medical conditions (such as
dehydration, bladder stones, malnutrition, anemia, urinary,
tract infections, and kidney disease), The social
consequences for women living with obstetric fistula
include: Stigma related to stillbirth, Subjection to myths and
misconceptions about fistula, Social isolation (Because of the
unpleasant odour, women with fistula may be perceived as
unclean and are often excluded, or exclude themselves, from
participating in communityactivities), Marital
breakdown/divorce, Shame, Self-esteem issues, and other
psychological problems, Inability to make a living (Many
women with fistula live for years without any financial or
socialsupport and fall into extreme poverty),Suicide, “The
understanding that one must treat the ‘whole person’ with the
fistula—not just her injuredbladder or rectum—is the single
most important concept in fistula care”[9]. The record of
high mortality presented by WHO, coupled with the
aforementioned consequences of Obstetrics fistula beckons
for an intelligence system for early diagnosis of obstetrics
fistula. The goal of this research is to develop a Fuzzy logic
means for intelligent diagnosis of Obstetrics fistula disease.
II. RELATED WORKS
Studies on obstetric fistula closely follows maternal
mortality; a recent longitudinal study of 230 parturient
women in Nigeria found a cumulative prevalence rate of 12.2
%, 13.5% and 3% for urinary, anal and combined urinary
and anal incontinence respectively [12].
Risk factors associated with Epidemiology of Obstetric
Fistula in [13] can be caused by delay.Once a woman arrives
at the facility, she may not have access to adequate care, due
to a lack of staff or unfriendly staff, supplies, or electricity.
Furthermore, insufficiently skilled staff may mean that the
woman may not get the care that is needed or when provided,
and which results in complications [14].
Factors that can lead to Obstetric fistula arepresented in [15].
A condition exclusive to women and gender has a big role in
its genesis. Gender inequality and oppression of women are
known to persist in regions where obstetric fistula occurs. In
these regions, forced adolescent and teen marriages, low
education levels for girls, male control of money, and the
need for women in obstructed labor to get the permission of
their husband or mother-in-law to seek care are common
findings
Obstetric Fistula Community Based Assessment Tool (OF-
COMBAT) is an enhanced verbal screening tool presented
in[16]. The tool was designed to minimize the number of
clients referred to treatment centres with conditions other
than obstetric fistula. OF-COMBAT helps health facilities to
minimize the screening of resources required and improvethe
efficiency and cost-effectiveness of fistula programs by
limiting transport and logistics costs for ineligible clients.
Importantly, the tool enables the woman to receive a
tentative diagnosis within the comfort of her home or
community before she travels a very long distance, only to at
times be turned back because her condition may not be
covered through charitable fistula programs. OF-COMBAT
is best used by a community outreach worker who has
received basic training on verbal screening for fistula. The
outreach worker is encouraged to listen to the client’s story
before he/she takes the client through the set of up to 27
questions, depending on the type of injury described by the
client. The responses are then tallied and rated on the given
scale to provide a tentative diagnosis. The OF-COMBAT is
unique in that in utilizes a set of confirmatory questions in
order to improve the rates of correctly diagnosing a fistula
case. The limitation of the tool is that, it is a verbal screening
tool.
Medical diagnosis involves identifying illness or disorder in
a patient through physical examination, medical tests or
other procedures while therapy is the treatment of physical,
mental or behavioral problems and it is meant to cure or
rehabilitate the sick [17-18]. However, the system lacks the
capabilityfor global access due to its offline nature and could
not handle vague (imprecise) data which are inherent in
medical records.
The authors in [19] proposed a Fuzzy Expert System for the
Management of Malaria which has been identified as a
predominant environmental health problem in several parts
of the world. While the authors in [20]presented a model for
the diagnosis of Liver problems, both systemswere suitable
to act as a decision support platform to researchers,
physicians and other healthcare practitioners in malaria
endemic and liver diseases respectively. The limitations of
the conventional methods for the diagnosis of diseases call
for the development of expert systems which will aid
medical practitioners in delivering effective and efficient
medical services to patients at affordable prices (cost)

irrespective of their geographical location. Due to the
strength of Fuzzy Logic (FL) in the provision of accurate
solutions to difficult real life problems and the advancement
in Internet technology, there has been an increasing need to
incorporate FL concept into medical diagnosis for a
successful development of Internet-based expert system that
will have a human-like reasoning capability[21].
III. RESEARCH METHODS
The process for the medical diagnosis of Obstetrics Fistula
begins when an individual consults a medical expert (doctor)
and presents a set of complaints (symptoms). The medical
expert thenrequests further information that will further aid
in the proper diagnosis of the disease. Data collected include
patient’s previous state of health, living condition and other
medical conditions. During the diagnosis of Obstetrics
Fistula, the medical expert looks at the patient’s symptoms
after which he conducts a physical examination. From the
symptoms presented by the patient, the Medical expert
narrows down the possibilities of the illness that corresponds
to the apparent symptoms and make a list of the conditions
that could account for what is wrong withthe patient. These
are usually ranked in possibility order (Low, Moderate and
High). When the list has been narrowed down to a single
condition, it is called differential diagnosis and provides the
basis for a hypothesis of what is ailing the patient. The
examining physician accounts for possibilities of having
Obstetrics Fistula through physical examination, interview,
or laparoscopic test.
The expert system is developed in an environment
characterized by Microsoft XP Professional operating
system, Microsoft Access Database Management System,
Visual BASIC Application Language and Microsoft Excel.
The research was carried out at the University Teaching
hospital (UCH), Ibadan, Nigeria. Verbal informed consent
was administered to all respondents before they participated
in the study. International ethical standards were followed to
ensure the confidentiality of the information collected and
the anonymity of the respondents. Our dataset is made up of
5 clinical symptoms and 5 types of Obstetrics fistula
diseases. We also performed training, testing and validation.
The correct classified records are stored in the knowledge
base. Rule extraction with the correct classified data was also
performed.
3.1 Fuzzy C-Means Clustering (FCM)
The FCM algorithm is one of the most widely used fuzzy
clustering algorithms. The FCM algorithm
attempts to partition a finite collection of elements X={X1,
X2,...,Xn} into a collection of c fuzzy clusters withrespect to
some given criterion. Given a finite set of data, the algorithm
returns a list of c cluster centers V, such that;
V =Vi, i=1, 2,..., c
and a partition matrix U such that
U = Uij , i =1,..., c , j =1,..., n
whereUij is a numerical value in [0, 1] that tells the degree to
which the element Xj belongs to the i-th cluster.
The fuzzy logic linguistic description of the typical FCM
algorithm is presented below:
Start
Step 1: Select the number of clusters c (2≤c≤n),
exponential weight μ (1<μ<∞), initialpartition matrix U0,
and the termination criterion ε. Also, set the iteration index i
to 0.
Step 2: Calculate the fuzzy cluster centers
{Vi 1| i=1, 2,..., c} by usi n g U1 .
Step 3: Calculate the new partition matrix U1+1 by using
{Vi 1| i=1, 2,. .., c}.
Step 4: Calculate the new partition matrix = || U1+1 - U1|| = |
Uij 1+1 – Uij 1 |. If >ε, then set l = l+ 1 and go to step 2. If
≤ε, then stop.
Stop
IV. MODEL OF FCM FOR OBSTETRICS
FISTULA DISEASES
In this work, we present an architecture model of the fuzzy
C-means expert system for the diagnosis of obstetrics fistula
diseases as shown in Fig. 1. It consists of a Knowledge base
system, Fuzzy C-means inference engine and decision
support module. The knowledge base is made of the
demographic details of the patients, the observed clinical
symptoms and data. The values of the clinical symptoms are
vague and imprecise hence the adoption of fuzzy logic as a
means of analyzing these information. These values therefore
constitute the fuzzy parameters of the knowledge base. The
fuzzy set of the clinical symptoms characteristics is
represented by ‘P’ which is defined as: P = {p1, p2… pn}
where pi represents the jth parameter and n is the total
number of parameters (in this study, n= 5).Neural network
provides the structured intelligent learning for all forms of
the symptoms of obstetrics fistula diseases, which serves as a
platform for the inference engine. The inference engine
consists of reasoning algorithms, driven by production rules.
These production rules are evaluated by using the forward
chaining approach of reasoning. The fuzzy logic and Fuzzy
C-means algorithm provides the rules for the partitioning of
patients into a number of homogenous clusters with respect
to a suitable similarity measure. The patients were classified
according to 5 types of obstetrics fistula diseases as given by
a gynecologist (medical expert).
Fuzzy logic is a superset of the conventional Boolean logic
with capability for handling imprecise (vague) and
incomplete data that are commonly found in medical records.

It resembles human decision making with its ability to work
from approximate reasoning and ultimately find a precise
solution to a given problem. The process of diagnosing
obstetrics fistula by the fuzzy logic involves the following
stages:
a) Fuzzification of input variables (values of signs,
symptoms, and laboratory test results).
b) Establishment of the fuzzy rule base.
c) Building the decision making logic of the fuzzy
logic component (inference engine).
d) Defuzzification of the output of the inference engine
into crisp values.
A fuzzy set of healthy, mild, moderate, severe, very severe
for the input variables (signs, symptoms, and laboratory test
results) are defined.The input variables are fuzzified and the
membership functions defined for them are applied to their
actual values to determine the degree of truth for each rule
antecedent.
Fig 1: Architecture of Fuzzy Logic for Diagnosis of Obstetrics Fistula
V. RESULTS AND DISCUSSIONS
To design the FCM Knowledge Base System for diagnosis of
Obstetrics Fistula, we design a system which consists of a set
of parameters needed for diagnosis presented in Table 1,
while types of Obstetrics Fistula is in Table 2.
Table.1: Clinical Symptoms of Obstetrics Fistula
SN Input Field Code
1 Flatulence FT
2 Foul-smelling FS
3 Repeated virginal/urinary
infections
RF
4 Irritation or pains in
vagina areas
IV
5 Pains during sexual
activity
PS
In Figure 1 we presented the architecture of the FCM system
for the diagnosis of Obstetrics Fistula. It comprises of
knowledge base system, fuzzy c-means inference engine and
decision support system. The knowledge base system holds
the symptoms for Obstetrics Fistula. The values of the
parameters are vague and imprecise hence the adoption of
fuzzy logic as a means of analyzing these information. Those
parameters therefore constitute the fuzzy parameter of the
knowledge base.
The fuzzy set of parameters is represented by ‘P’ which is
defined as P= P1, P2,…,Pn Where Pi represents the jth
parameter and n is the total number of parameter (in
this case n = 5). The set of linguistic values which is
modeled as a linker scale denoted by ‘L’ is given as L =
(Low, Average and High).
Table.2: Types of Obstetrics Fistula
No
Types of
Obstetrics
Fistula
Description
Cluster
code
1 Vesicovaginal
Between
the bladder
and vagina
VV
2 Rectovaginal
Between
the rectum
and vagina
RV

3 Urethrovaginal
Between
the urethra
and the
vagina
HV
4 Ureterovaginal
Between
the distal
ureter and
vagina
TV
5 Vesicouterine
Between
the uterus
and the
bladder
VT
The clustering of the data is achieved using the typical FCM
algorithm presented in Fig. 2. Neural networks provide the
structure for the parameters which serves as a platform for
the inference engine. The inference engine consists of
reasoning algorithms driven by production rules. These
production rules are evaluated by using the forward chaining
approach of reasoning. The inference mechanism is fuzzy
logic driven. The cognitive filter of the decision support
engine takes as input the output report of the inference
engine and applies the objective rules to rank the individual
on the presence or absence of Obstetrics Fistula disease. The
emotional filter takes as input the output report of the
cognitive filter and applies the subjective rules in the domain
of Obstetrics Fistula studies in order to rank individuals on
the extent of the Obstetrics Fistula disease.
Table.3: FCM membership grade of all patients in all
clusters
PNO
C1
(VV)
C2
(RV)
C3
(HV)
C4
(TV)
C5
(VT)
P1 0.10 0.35 0.25 0.47 0.08
P2 0.63 0.40 0.17 0.57 0.71
P3 0.09 0.27 0.46 0.62 0.78
P4 0.51 0.44 0.00 0.88 0.05
P5 0.70 0.21 0.82 0.14 0.12
A typical FCM membership grade table (Table3) using 5
parameters and 5 clusters which shows thedegree of
membership of each parameter of Obstetrics Fistula is
represented in Figure 3. From Table3, it could be observed
that from the various degrees of membership there are no
unitary (crisp) coefficients, indicating that each data point
belongs to more than one cluster. For example P3 = (0.10/c1
+0.03/c2+0.30/c3+0.52/c4+0.05/c5) where c1, c2, …, c5 are
clusters, and in this study represents Vesicovaginal fistula
(VV), Rectovaginal fistula (RV), Ureterovaginal fistula
(TV),Urethrovaginal fistula (HV) and Vesicouterine
fistula(VT) respectively. Each of the symptoms highlighted
in Table1 is represented with P (starting from 1 – 5, i.e., P1-
P5).
Fig. 2: Membership Clusters of Obstetrics fistula Disease
Finally, Table 3 presents membership grades of parameters
in all clusters and the degree of membership of the clusters is
presented in Figure 2.Cluster 1 has the highest degree (0.78)
for symptom P3, Cluster 2 has the highest degree (0.88) for
symptom P4, Cluster 3 has the highest degree (0.82) for
symptom P5,and Cluster 4 has the highest degree (0.44) for
symptom P4 while Cluster 5 has the highest degree (0.70) for
symptom P5.
VI. CONCLUSIONS
The end to the problems associated with the medical
diagnosis of Obstetrics fistula diseases is in view, with this
research work where the application of fuzzy logic concept
to medical diagnosis of Obstetrics fistula disease has been
explored. The paper presents a diagnostic fuzzy cluster
platform to help in diagnosis of Obstetrics fistula diseases
using a set of symptoms and demonstrates the practical
application of soft computing in the domain of diagnostic
pattern appraisal by determining the extent of membership of
individual symptoms. The classification, verification and
matching of symptoms to the five groups of clusters was
necessary especially in some complex scenarios. The
proposed model as experimented can assist the medical
experts in the diagnosis of Obstetrics fistula.
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