Prevalence, profile and obstetric experience of fistula patients in Abakaliki, Southeast Nigeria

Abstract

<em>Objective</em>. Fistula has always been thought to be a scourge of the Northern region of Nigeria only. This study was aimed at providing data on the prevalence, profile and obstetric experience of fistula patients in Abakaliki, Southeast Nigeria and to demonstrate that fistula is also a burden in the southern parts of Nigeria. <em>Materials and Methods</em>. This was a prospective descriptive study conducted between 2003 and 2009. Sample size and sampling method. Four hundred and sixty-two fistula patients who were operated at the Fistula Unit of the Teaching Hospital and later at the Southeast Fistula Centre was consecutively recruited and interviewed during the study period. <em>Results</em>. The prevalence of fistula was 4.3%, the mean age was 35±9.5 years and 8.4% was less than 20 years, majority of them had no formal education. A quarter had no occupation and majority had no regular monthly income. Twenty percent were married by the age of 14 years and majority were multiparous. In about 40%, the fistula occurred during the first child birth. About 34% were still sexually active and 30% of the married clients had achieved childbirth after development of fistula. The average height and weight were 1.47m±0.08 and 46.4kg±7.2 respectively. Majority had fistula following prolonged obstructed labour, though 42.6% eventually had caesarean section for prolonged obstructed labour. Majority of the patients were older, had a longer urine leakage and presented latter for corrective surgery than those reported from other parts of Nigeria. <em>Conclusions</em>. There is a high prevalence (43.6/1000 deliveries) of obstetric fistula in this Centre, and majority of the vesico-vaginal fistula (VVF) was due to prolonged obstructed labour. Majority of the patients were older, had a longer urine leakage and presented latter for corrective surgery than those reported from other parts of Nigeria. However, 30% of the married patients achieved a pregnancy and delivered vaginally even in the presence of the fistula

The Burden of vesico-vaginal fistula in ILE-IFE, south western Nigeria

“…The average duration of fistula before presentation for care in this study was 6.2 yrs. This is similar to mean duration reported by Sunday-Adeoye (13).…”

“…Many women in developing countries have contracted pelvis, most often as a result of malnutrition and increased infection rate in adolescent leading to growth stunting and poor development. This is compounded by early marriage and childbearing and female genital mutilation (12,13,14).…”

Prevalence of anaemia in obstetric fistula patients in Abakaliki

“…12 The mean age in this study was 32.96±9.0 which is similar to the mean age of 35±9.5 found earlier at the study site. 13 This is however different from the mean age of 23.9 years reported by Ijaiya et al in Ilorin, Nigeria. 12 About three-quarters of women studied were married while about 16% were divorced or separated.…”

“…This is similar to what was found in previous studies in which it was noticed that over a quarter of the patients had no palpable means of livelihood and came from economically marginalised regions of the world. 13,14 About two-thirds of the patients in this study were anaemic based on WHO's cut off value of 36% packed cell volume in non-pregnant women (15-years and above). 11 About 14% had values of 30% and below.…”

Obstetric fistula policy in Nigeria: a critical discourse analysis

“…Our findings demonstrate that there is overt silencing of the issue of forced marriage and early childbearing which is a strong determinant of obstetric fistula in Nigeria. Although women of all ages are affected by obstetric fistula, underdeveloped pelvises which is the case when girls are young or malnourished, is a major biological predisposing factor to obstetric fistula [ 16 , 31 ]. In other words, the federal government is constitutionally detached from the responsibility of protecting the rights of minors, which complicates its role in the elimination of obstetric fistula, despite the downstream approach of the NSFEOF that gives primary authority to the federal government.…”