THE BURDEN OF VESICO-VAGINAL FISTULA IN NORTHERN NIGERIA
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By Comfort Joseph, Lagos.
Vesico-vaginal fistula is still a major cause for concern in many developing countries.it represents a significant morbidity in female urology. continual wetness,odor,and discomfort which cause serious social problems .VVF an opening that develops between the bladder and the wall of the vagina.the result is that urine leaks out of the vagina,sometimes lightly but it can be steady if the fistula is large.in addition to being a serious medical problem,this condition is very upsetting. VVF from prolonged obstructed labour occurs as a result of ischaemic necrosis of entrapped soft tissues between the fetal skull and the maternal pelvis which subsequently sloughs off leaving a defect between the epithelial surface of the urinary bladder and that of the vagina and occasionally involving the rectum as well. Vesico-vaginal fistula of obstetric aetiology was first reported in the literature by the physician of ancient Egypt about 2050 BC. This dehumanizing condition has continued to inflict high morbidity in young mothers in the rural populations in the developing countries of the world even till date.
Many women with VVF are regarded as social outcasts and marriages have been dissolved as a result of this.Many girls between the ages of 11 and 15 in the country become mothers either through early marriage or unwanted pregnancy .they experience obstructed labor even as some unskilled birth attendants simply cut through the vagina to create passage for the baby, that eventually results VVF, the leakage of urine and feces through the vagina.
Before the 19th century,women who suffered from VVF were judged harshly and rejected by society.throughout the 19th century,treatment for VVF was limited because the practice of gynecology was perceived as taboo.Doctors were almost entirely male at the time and looking at a nude female,even for medical purposes,was seen as divergent.Black enslaved women were particularly prone to VVF because they were denied proper nutrient sand medical care,they were also subjected to childbearing at tender age as a result of rape.
The exact magnitude of VVF worldwide is unknown,however, the World Health Organization(WHO) estimated that over 20 million women are living with this condition,with 50,000 to 100,000 new cases per annum. The incidence in West Africa is estimated to be 3 to 4 per 1000 deliveries. this is attributed to poverty,illiteracy,ignorance and poor obstetric services."in an unequal world,women with fistula are the most unequal among the unequal".
The situation in the developed world is now different .Advances in
obstetric care have made the various sequelae of obstructed labor
nearly obsolete.
In July 2013,the Minister of women Affairs and social Develoment, Hajiya Zainab Mainasaid "Nigeria has the highest prevalence of VVF in the world, with between 400,000and 800,000 women living with the problem and about 20,000 new cases occurring annually; 90 percent of the cases go untreated" Ibrahim et al emphasize,as have others working in the largely Muslim culture of Northern Nigeria,the high prevalence of early marriage and childbearing,low literacy rate, and the poor uptake of conventional antenatal care among the fistula patients, probably the most important factors contributing to the problem.
The plague of VVF is one that must be addressed with all the seriousness it deserves. The Federal Government has to engage all stakeholders; the National Assembly,traditional rulers,community leaders,health workers, women rights groups and others to ensure that child marriage is drastically reduced and eventually eliminated in Nigeria.
there is no doubt that the prevalence of VVF is still high. it has been estimated that it will take over 30years to clear the back log of existing fistula in Nigeria if the repair continuous at the the present rate. Hence there is need to aggressively train appropriate health personnel, and establish more centers in the country where VVF can be repaired successfully.Rehabilitation and psychotherapy with skills acquisition will go a long way in addressing some of the patients socioeconomic challenges,which are contributory to causing the fistulae
Prevention should be the ultimate goal if this disability and dehumanizing condition is to be eliminated. this could be achieved through education of the girl child,as well as the provision of available, accessible, and affordable quality obstetric care in every part of this country to prevent prolonged obstructed labor.
some other ways to prevent VVF are:
Adequate antenatal care should be extended to at risk mothers who are likely to develop obstructed labor.
A cesarean section should be planned for those who need it.