SOCIAL CONTEXT OF VESICOVAGINAL FISTULA IN EBONYI AND PLATEAU STATES, NIGERIA

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.