Abstract:
Vesicovaginal Fistula (VVF), an uncontrollable leakage of urine through the vaginal, is a global
public health problem associated with maternal death. In Nigeria, it is a common gynaecological
issue associated with marital disruption and social exclusion. Studies on VVF have mainly focused
on its biomedical aspects with scant attention given to the social factors associated with the
condition, especially in Ebonyi and Plateau states where there are availability of well-established
VVF Centres for patient referrals. This study therefore, examined the determinants, community
perception, prevalence, treatment pathways and factors influencing care and support for VVF in
Ebonyi and Plateau states.
The Ecological Model of Health provided the framework. A mixed-methods approach comprising
a comparative cross-sectional survey design was adopted. A sample of 695 respondents: Ebonyi
(324) and Plateau (371) states were drawn using Cochran’s (1977) formula. A multi-stage sampling
technique was used to administer semi-structured questionnaire to community members to elicit
information on community perception and socio-economic consequences of VVF. Hospital Records
(Ebonyi (136) and Plateau (381) states) were used to generate information on the prevalence and
determinants of VVF. Key Informant interviews were conducted with four gynaecologists and four
nurses. In-depth interviews (20 from each state) and case studies (4 from each state) were conducted
with VVF patients to elicit information on treatment pathways, and care and support. Quantitative
data were analysed using descriptive statistics, Chi-square and Logistic Regression at p≤0.05, while
the qualitative data were content-analysed.
The respondents’ age was 34.22±10.27 years; 78.6% were married and 40.7% attained secondary
education. The major determinants of VVF included obstetrics complications (86.1%), congenital
(1.0%) and prolonged labour (0.6%). Eight per cent had negative perception about VVF patients,
but those in Plateau were six times (OR=5.56) more likely to hold negative perceptions of VVF
patients than those in Ebonyi State. Prevalence of VVF was 12.2 (Ebonyi) and 23.7 (Plateau) per
100,000 women; and these were significantly related to age at child delivery (x2=20.19), parity
(x2=27.02) and education (x2=102.34). The common treatment pathways for VVF among patients
started from simple home remedies and herbs with few visiting modern healthcare facilities before
referrals to VVF Centres. Ignorance and the belief that the traditional therapy was more effective
were factors that influenced VVF patients’ decision to utilise home remedies and herbs at the
beginning of the condition. Perceived severity of the condition and referrals made by the healthcare
providers influenced the choice of subsequent treatment options. Delay to visit modern healthcare
facilities aggravated the VVF condition. In Ebonyi State, care and support for VVF patients was
influenced by marital status and level of spousal affection, while the number of times VVF repairs
were done as well as relatives’ decisions influenced care and support for VVF patients in Plateau
State. The burden of odour from VVF patients and the cost of treatment resulted in stigmatisation,
divorce, job loss and economic disempowerment among these patients.
Social and demographic factors influenced the determinants and treatment pathways for
Vesicovaginal Fistula in Ebonyi and Plateau states, Nigeria. There is a need for government and
healthcare providers to further sensitise women about the best practices leading to the prevention of
the condition.