Aiming to investigate the epidemiological factors of obstetric fistula, structured questionnaires were used to gather data from women admitted to Kassala hospital, eastern Sudan (2010-2012) with obstetric fistula. Two consecutive women with birth complications and who were discharged from the postnatal ward in the hospital were used to act as controls. During the study period there were 34 cases of obstetric fistula yielding a prevalence rate of 7.7 per100.000 women of reproductive age. Their mean (SD) of age, age at marriage, age at last delivery and parity was 26.5 (6.5) years 18.7(5.1), 24.4 (7) and 2.8 (2.6), respectively. All of the patients were illiterate and majority of them belonged to rural residence (97.1%) and had no use of antenatal care in the last delivery (94.1%). Women with obstetric fistula were those who had less education [34 (100%) vs. 14 (20.6%), P < 0.001], delivered at home [19 (55.9%) vs.18 (26.5%), P = <0.004] of rural residence [33 (97.1%) vs. 28 (41.2%), P < 0.001] and had no antenatal care coverage [2(5.9%) vs. 53 (77.9%), P < 0.001]. Likewise, while use of contraception was not associated with obstetric fistula, primipara [20(58.8%) vs. 17 (25%), P < 0.001] young age at delivery (<20 years) [12(35.3%) vs. 4 (5.9%), P < 0.001], and age at marriage [18.7(5.1) vs. 23.7 (6.7), P < 0.001] were the predictors for obstetric fistula. Thus, effort to prevent obstetric fistula in eastern Sudan should be encouraged by health education, training programmes for the birth attendants and encouragement of institutional delivery.