Pattern and Outcome of Iatrogenic Genitourinary Fistula from Obstetric and Gynaecological Surgeries in a Tertiary Institution, North-Western Nigeria

Genitourinary fistulas experience in a tertiary hospital in North-Western Nigeria

“…It is therefore not surprising that almost all the patients in this study had no formal education (94.2%), and were full-time house-wives (98.1%). Studies conducted in other hospitals in Nigeria, 11,17,19,20 and other sub-Saharan African countries including Zambia, 21 Ethiopia, 22 and Uganda, 23 majorly reported similarly young population of obstetric fistula patients, with little or no formal education and unemployed. A meta-analysis of national household surveys that included data for 262,100 women of reproductive age (15-49 years) in 19 sub-Saharan African countries reported a very high prevalence of symptoms of vaginal fistula, with a lifetime prevalence of 3.0 cases (95% Confidence Interval [CI]: 1.3-5.5) per 1000 women.…”

“…On the contrary, studies conducted in designated fistula hospitals (where treatment is offered to patients free of charge) in the neighboring Kano and Katsina States reported large turnout of patients (despite the fact that there were fewer numbers of trained fistula surgeons in these fistula hospitals as compared to the teaching hospitals). 11,20 While 288 of 343 patients that presented with genital tract fistula (within a year) at the Laure Fistula Center, Murtala Mohammed Specialist Hospital, Kano, Nigeria, were operated successfully, 20 728 genitourinary surgeries were carried out at the National Obstetric Fistula Centre, Babbar-Ruga, Katsina, Nigeria, within a 2-year period. 11 It is therefore evident that the snail-pace at which the backlog of patients awaiting fistula treatment is cleared in Nigeria is principally due to financial inaccessibility, and it underscores the need for the Federal Government of Nigeria to establish a designated fistula centre in all the 36 States of the Federation, including the Federal Capital Territory, instead of the paltry 16 designated fistula centres that are currently available in the country.…”

“…11,20 While 288 of 343 patients that presented with genital tract fistula (within a year) at the Laure Fistula Center, Murtala Mohammed Specialist Hospital, Kano, Nigeria, were operated successfully, 20 728 genitourinary surgeries were carried out at the National Obstetric Fistula Centre, Babbar-Ruga, Katsina, Nigeria, within a 2-year period. 11 It is therefore evident that the snail-pace at which the backlog of patients awaiting fistula treatment is cleared in Nigeria is principally due to financial inaccessibility, and it underscores the need for the Federal Government of Nigeria to establish a designated fistula centre in all the 36 States of the Federation, including the Federal Capital Territory, instead of the paltry 16 designated fistula centres that are currently available in the country. The relatively young age of the patients in this study with a mean age of 28.25 ± 10.0 years, close to a fifth of them (17.3%) being aged less than 20 years, and majority of them (65.4%) being aged less than 30 years, reflects the cultural practice of early marriage for the girl child in Northern Nigeria; their education is disrupted, they become pregnant early in life when their pelvis is not fully mature, lack access to appropriate obstetric care and inevitably develop obstetric fistula together with its dire consequences.…”

“…Mairo Hassan 1 , Kehinde Joseph Awosan 2 in sub-Saharan Africa including Tanzania, 9 Uganda, 10 Nigeria, 11 and Cameroon, 12 as this could worsen the situation, considering the shortage of trained surgeon and facilities for fistula repair, the very low proportion of cases that are operated yearly, and the huge backlog of patents awaiting fistula repair across the continent.…”