KNOWLEDGE OF RISK FACTORS ASSOCIATED WITH VESICOVAGINAL FISTULA AMONG WOMEN OF REPRODUCTIVE AGE ADMITTED TO NATIONAL OBSTERIC FISTULA CENTER NINGI, BAUCHI STATE

CHAPTER ONE

INTRODUCTION

Background of the study

The issue of maternal morbidity continues to be a critical worldwide health concern, especially in underdeveloped nations where women in their reproductive years encounter substantial health hazards associated with giving birth. Onyinye and Margret (2023) argue that parenthood is a significant achievement for any woman throughout her reproductive years. However, this stage of life, which should be a source of immense delight and joy, is frequently tainted by the uncertainties and challenges associated with giving birth. While many women may experience problems during pregnancy and delivery, resulting in the death of either the child or the mother, others may live with underlying health conditions that may need a significant amount of time before their systems are restored . Apparently, of all the complications, obstetric fistula is particularly a catastrophic disease that significantly affects the lives of women who are affected. Obstetric Fistula (OBF) is a medical disorder characterized by an anomalous link between a woman's genitals and the urinary tract or rectum. It is often a result of prolonged and blocked labour, exacerbated by the lack of timely medical intervention. According to Habtamu & Sisay (2023), Obstetric fistulas are commonly classified as vesico-uterine (positioned between the bladder and uterus), rectovaginal (located between the rectum or colon and the vagina), ureterovaginal (located between the ureter and the vagina), or vesicovaginal (located between the anterior vaginal wall and posterior bladder).

More precisely, Vesicovaginal fistula (VVF) is a prevalent kind of obstetric fistula that arises when extended blocked labour causes a gap between the bladder and the vagina, leading to persistent and unmanageable urine leaking (Tebeu & Winifred 2022). The disorder not only induces bodily pain but also gives rise to significant psychological and social ramifications, frequently culminating in stigmatisation and the experience of isolation. VVF-afflicted women are often marginalised, having their lives significantly changed by a disease that may be avoided with prompt and sufficient obstetric treatment. Wall (2012) defines vaginal vesicositis (VVF) as an anomalous connection between the bladder and the vagina, resulting in persistent and unmanageable urine leaking mostly through the vaginal canal. This syndrome is mostly attributed to extended obstructed labour, which is widespread in areas with poor availability of timely and sufficient obstetric treatment. Adler et al. (2013) state that prolonged labour frequently occurs due to cephalopelvic disproportion, malpresentation, or other factors that impede the normal course of birthing, resulting in ischaemic necrosis of the vesicovaginal septum.

Prevalently, vaginal vesicositis (VVF) affects both low- and middle-income nations as well as high-income countries. However, the highest prevalence of VVF is observed in low- and middle-income countries. According to the World Health Organisation (WHO, 2018), there are an estimated 50,000 to 100,000 documented cases of OBF globally each year. The data for sub-Saharan Africa (SSA) are astonishing, with an incidence rate of vesicoerectile dysfunction (VVF) reaching 10 instances per 1000 natal births. According to a study conducted by Habatamu et’al (2023), fistula impacts around 2-3 million women globally, with a greatest prevalence in South Asia and Sub-Saharan Africa. Each year, some 30,000 to 130,000 women in Sub-Saharan Africa alone experience the development of obstetric fistulas during childbirth. The prevalence of VVF in Nigeria is notably high in women of reproductive age residing in rural regions with restricted availability of healthcare facilities. Factors such as early marriage, poverty, and poor levels of education in Nigeria worsen the occurrence of vertical uterine fibroids (VVF) by causing delays in seeking and obtaining suitable obstetric treatment (UNFPA, 2017). In addition, cultural customs and gender disparity exacerbate the risk, since women frequently cannot exercise autonomy in making decisions about their own health and reproductive options (Tebeu et al., 2012). Therefore, emphasizing the necessity to eradicate VVF. 

Typically, women who suffer from OBF are subjected to social disapproval and compelled to lead a life marked by suffering, isolation, and material destitution. Eniola & Kadijat (2023) have noted that vesico-vaginal fistula is a clinical condition that has significant socio-economic and health ramifications. Uncontrolled urine leakage leading to unpleasant odours at social gatherings leads to social shame and subsequent neglect. Other issues include infertility resulting from the loss of a viable foetus during pregnancy due to vaginal vesicles (VVF), secondary infertility, vaginal stenosis caused by fibrosis and bands, amenorrhoea, exorbitant and prohibitive expenses for repair and elective caesarean section among those who conceive later. The patients report experiencing psychosocial issues such as despair, loss of marital intimacy, divorce, and social rejection. Therefore, emphasising the necessity to eradicate VVF. 

1.2 Statement of the problem

In recent times, the problem of VVF in Northern Nigeria has been found to be associated with young girls who are denied skilled maternity care despite their high risk pregnancies. As pointed by Adeoluwa & Huseni (2023) factors contributing to the high incidence of VVF in Northern Nigeria includes illiteracy, poverty, ignorance, home delivery, non-utilisation of antenatal and intrapartum medical facilities and the habit of performing traditional episiotomy - “Gishiri cut” by untrained traditional birth attendants, husband dominance and severe deprivation and neglect. Despite the devastating physical, emotional, and social consequences of VVF, awareness of the risk factors associated with the condition remains low among women of reproductive age in Nigeria.  Bizzarely, many women are unaware of the signs and symptoms of obstructed labor or the importance of seeking immediate medical intervention during childbirth (Wada et al., 2013). This lack of knowledge contributes to the high incidence of VVF, as women are less likely to take preventive measures or recognize the need for timely obstetric care.

According to  Kabir, Iliyasu, & Abubakar (2022) the Nigerian government, in collaboration with international organizations, has made efforts to reduce the incidence of VVF through various interventions, including the establishment of National Obstetric Fistula Centers, where women can receive free surgical repair and rehabilitation services. However, the effectiveness of these interventions is limited by the persistent low levels of awareness and knowledge about VVF among the target population. For instance, studies have shown that even in areas where fistula repair services are available, many women are unaware of the existence of these facilities or the services they offer (Bangser, 2023). Contextually, The National Obstetric Fistula Center in Ningi, Bauchi State, has been at the forefront of efforts to address the issue of VVF in Nigeria, providing free surgical repair and rehabilitation services to affected women. Despite these efforts, the incidence of VVF in the region remains alarmingly high, particularly among women of reproductive age. This suggests that there may be significant gaps in the knowledge and awareness of women regarding the risk factors associated with VVF, which may contribute to the persistence of the condition (Muleta 2020).

Existing studies have highlighted the importance of knowledge and awareness in the prevention of VVF. For example, a study by Wada & Adebisi (2013) found that women who were aware of the signs of obstructed labor and the need for timely medical intervention were less likely to develop VVF. However, in Bauchi State, many women still lack basic knowledge about the condition, its causes, and the importance of seeking prompt medical care during childbirth. This lack of awareness may be due to various factors, including low levels of education, cultural beliefs, and limited access to healthcare information (UNFPA, 2017). More so, the literature on VVF in Nigeria has primarily focused on large urban centers, with limited attention given to rural and semi-urban areas like Ningi, Bauchi State. This gap in the literature highlights the need for targeted research to understand the specific challenges and opportunities for improving knowledge and awareness of VVF among women of reproductive age in Ningi, Bauchi State. Upon this premise, the current study seeks to fill this gap by assessing the knowledge of risk factors associated with VVF among women of reproductive age admitted to the National Obstetric Fistula Center in Ningi, Bauchi State.

1.3 Objectives of the Study

The aim of this this study is focused on knowledge of risk factors associated with VVF among women of reproductive age admitted to the National Obstetric Fistula Center in Ningi, Bauchi State. Specifically, the study seeks:

To assess the awareness level of women of reproductive age regarding vesicovaginal fistula (VVF).

To examine the knowledge of risk factors associated with VVF among women of reproductive age admitted to the National Obstetric Fistula Center, Ningi, Bauchi State

To identify the sources of information through which women of reproductive age learn about the risk factors associated with VVF.

To ascertain variables influencing knowledge of risk factors associated with VVF among women of reproductive age admitted to the National Obstetric Fistula Center, Ningi, Bauchi State

1.4 Research Questions

What is awareness level of women of reproductive age regarding vesicovaginal fistula (VVF) in National Obstetric Fistula Center, Ningi, Bauchi State

What is the level of knowledge on risk factors associated with VVF among women of reproductive age admitted to the National Obstetric Fistula Center, Ningi, Bauchi State?

What are the primary sources of information through which women of reproductive age learn about the risk factors associated with VVF?

What are the variables influencing knowledge on risk factors associated with VVF among women of reproductive age admitted to the National Obstetric Fistula Center, Ningi, Bauchi State?

1.5 Research Hypotheses

Ho: The level of knowledge on risk factors associated with VVF among women of reproductive age admitted to the National Obstetric Fistula Center, Ningi, Bauchi State is low.

Hi: The level of knowledge on risk factors associated with VVF among women of reproductive age admitted to the National Obstetric Fistula Center, Ningi, Bauchi State is high.

1.6 Significance of the Study

Practically, the findings will provide valuable insights into the current level of knowledge of VVF risk factors among women of reproductive age in Bauchi State. This information will be crucial for healthcare providers, policymakers, and non-governmental organizations (NGOs) working in the region, as it will inform the development of more effective awareness campaigns and educational programs aimed at preventing VVF. By improving knowledge and awareness, these interventions can help reduce the incidence of VVF and improve the overall reproductive health of women in the region.

Theoretically, the study will contribute to the existing body of literature on VVF by providing new data on the knowledge and awareness of the condition among women in a rural and semi-urban setting in Nigeria. The findings will also help to fill the gap in the literature regarding the specific challenges and opportunities for VVF prevention in Bauchi State. Furthermore, the study will offer a basis for future research on the factors influencing the knowledge of VVF risk factors, which can inform the design of more targeted and effective interventions.

1.7 Scope of the Study

The study will focus on assessing the knowledge of risk factors associated with VVF among women of reproductive age admitted to the National Obstetric Fistula Center in Ningi, Bauchi State. The study will cover the content related to the awareness and understanding of VVF risk factors, sources of information, and the effectiveness of existing awareness programs.

Geographically, the study is limited to the National Obstetric Fistula Center in Ningi, Bauchi State.

1.8 Limitations of the Study

Like every human endeavor, the study is assuming will not be void of limitations. One of the limitations of this study is the potential for bias in self-reported data. Since the study relies on information provided by the participants, there may be a tendency for respondents to overestimate their knowledge or provide socially desirable responses. To minimize this bias, the study will employ strategies such as ensuring anonymity and confidentiality and using a standardized questionnaire with objective measures of knowledge.

Another limitation is the geographical restriction of the study to the National Obstetric Fistula Center in Ningi, Bauchi State. While this focus allows for an in-depth analysis of the knowledge of VVF risk factors in this specific context, it may limit the generalizability of the findings to other regions in Nigeria. Future studies may consider expanding the geographical scope to include multiple centers across different states for a more comprehensive understanding of the issue.

1.9 Definition of Terms

Vesicovaginal Fistula (VVF): An abnormal communication between the bladder and the vagina, leading to continuous and uncontrollable leakage of urine through the vaginal route.

Risk Factors: Conditions or behaviors that increase the likelihood of developing VVF, such as prolonged obstructed labor, early marriage, and limited access to obstetric care.

Awareness: The state of conscious state of  fistula and noticing when there is abnormal communication between the bladder and the vagina, 

Knowledge:  A basic idea on the causes, consequences Vesicovaginal Fistula (VVF) and care options available,

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