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Objective: To determine the incidence of and risk factors for perioperative blood transfusions after urogenital fistula repairs in Uganda., Design: A retrospective cohort study., Setting: A community hospital in Masaka, Uganda., Population: Women who underwent fistula repair at the Kitovu Hospital between 2013 and 2019., Methods: Retrospective review of demographics and clinical perioperative characteristics of patients surgically treated for urogenital fistula. Patient characteristics were compared between those who did and those who did not require a blood transfusion., Main Outcome Measures: Need for perioperative blood transfusion and risk factors., Results: A total of 546 patients treated for urogenital fistulas were included in this study. The median age was 31.1 ± 13.2 years. A vaginal surgical approach was used in the majority of patients (84.6%). Complications occurred in 3.5% of surgical repairs, and the incidence of blood transfusions was 6.2%. In multivariable analyses, for each gram per deciliter (g/dl) increase in preoperative haemoglobin, the odds of blood transfusion decreased by approximately 28% (adjusted OR 0.72, 95% CI 0.59-0.86). Women who had their fistula repaired abdominally were 3.4 times more likely to require transfusions (95% CI 1.40-8.08)., Conclusions: The incidence of blood transfusions among urogenital fistula repairs in our population is twice that of developed nations. An abdominal surgical approach to urogenital fistula is a significant risk factor for perioperative blood transfusions. The timing of the repair may warrant further study., Tweetable Abstract: One of the first studies to look at blood transfusion risk factors after fistula repair in a low-resource setting., (© 2021 John Wiley & Sons Ltd.)