DETERMINING THE PREVALENCE OF VESICO VAGINA FISTULA AND THE OUTCOME OF THE REPAIR AMONG PATIENTS ATTENDING CLINIC IN GAMBA SAWABA IN ZARIA LOCAL GOVERNMENT AREA OF KADUNA STATE

DETERMINING THE PREVALENCE OF VESICO VAGINA FISTULA AND THE OUTCOME OF THE REPAIR AMONG PATIENTS ATTENDING CLINIC IN GAMBA SAWABA IN ZARIA LOCAL GOVERNMENT AREA OF KADUNA STATE

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CHAPTER ONE

INTRODUCTION

1.1     Background of the Study

Vesico Vaginal Fistula (VVF) is an abnormal opening between the bladder and the vagina that results in continuous and unremitting urinary incontinence. The entity is one among the most distressing complications of gynecologic and obstetric procedures. The existence of VVF is believed to have been known to the physicians of ancient Egypt, with examples present in mummies before 2,000 years bc (WHO, 2015).

It is a very old entity, the earliest case was reported in 1923 in a mummified body that was dated 2050 BC (1). The reported incidence of vesico vaginal fistula in developed countries is 0.3-2% (WHO, 2015).

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 cause serious social problems (Combs, 2016).

Although the incidence of VVFs has become rare in the industrialized world, they still commonly occur in developing countries. Estimates suggest that at least three million women in poor countries have unrepaired VVFs, and that 30,000–130,000 new cases develop each year in Africa alone. The general public and the world medical community remain largely unaware of this problem (UNICEF, 2015).

Philips (2016) emphasized, as have others working in the largely Muslim culture of northern Nigeria, the high prevalence of early marriage and childbearing, the low literacy rate, and the poor uptake of conventional antenatal care among the fistula patients. Probably the most important factors contributing to the high incidence and prevalence of obstetric fistulas in Africa are socio-economic. Early marriage, low social status for women, malnutrition, and inadequately developed social and economic infrastructures are all more common in the poor areas.

Most importantly, lack of access to emergency obstetric services is ubiquitous in the poor regions. In parts of the world where obstructed labor is a major contributor to maternal mortality, the rate of VVF might even approach the maternal death rate (WHO, 2015).

However, the exact incidence in the developing world is not known, probably due to the underreporting of cases. A study estimated the prevalence of VVF in the reproductive age group as 1.60 per 1000 women in South Asia. The burden can be estimated by the fact that according to an estimation in Ethiopia alone, 9000 women develop fistula annually, and only 1200  of those were being treated (UNICEF, 2015).

Vesico Vaginal Fistula (VVF) is the most common fistula between the female genital tract and the urinary tract, and it is characterized by drainage of urine through the vagina, with a significant reduction in patients’ quality of life. It is presented by urinary flow through the vagina, unrelated to urination, and the volume of loss is directly related to the diameter of the fistula (Combs, 2016).

In low-resourced countries, it often occurs as a result of prolonged obstructed labour due to the ischemia, as the bladder becomes compressed between the foetus and the pubic symphysis (WHO, 2015). Meanwhile, the VVFs that are seen in well-resourced countries commonly develop following iatrogenic injury, with over 60% following a hysterectomy. In a study of the English National Health Service, one in every 788 hysterectomies is associated with urogenital fistulae, occurring about 1 to 6 weeks after hysterectomy, and when recurrent, about 3 months after the first repair.

1.2     Statement of the Problem

Urinary fistula is one of the most distressing complications after difficult vaginal deliveries, obstetric, and gynecologic surgeries. It has great impact on social, psychological, and sexual life of affected patients.

In addition, other risk factors also favour the appearance of genitourinary fistulas, such as pelvic surgeries, radiation, infection, and neoplasias affecting the pelvic floor. The most common location of the fistulas is supratrigonal, with fewer cases of trigonal and infratrigonal fistulas (Philips, 2014).

Article 3 of the sustainable development goals requires all nations to improve maternal health by reducing the maternal mortality ratio to 70 per 100,000 births and to achieve universal access to reproductive healthcare services (WHO, 2016). One of the common causes of maternal mortality is obstructed labor, which is mainly due to a lack of access to professional birth attendants and emergency obstetric services. The consequences of obstetric or prolonged labor can include an obstetric fistula that develops as a result of the prolonged pressure of the presenting fetal part on the pelvis over days of labor, leading to a vesicovaginal fistula, a rectovaginal fistula, or both. Studies on women affected by fistula in Africa found that socio-cultural and health system factors contribute to occurrences of obstetric fistula. Early marriage, female genital mutilation, teenage pregnancies, and lack of access to emergency obstetric care are also some of the major risk factors. It is on this basis that the researcher has decided to choose the topic the prevalence of vesico vagina fistula and the outcome of the repair among patients attending clinic in Gamba Sawaba in Zaria Local Government Area of Kaduna state.

1,3    Objectives of the Study

The objective of this study is to determine the prevalence of vesico vagina fistula and the outcome of the repair among patients attending clinic in Gamba Sawaba in Zaria Local Government Area of Kaduna state. These include:

1.     To determine the causes of vesico vagina fistula among patients attending clinic in Gamba Sawaba in Zaria Local Government Area of Kaduna state.

2.     To assess the effects of vesico vagina fistula among patients in the study area.

3.     To ascertain the strategies that could be adopted to minimize the problems of vesico vagina fistula and the outcome of the repair among patients attending clinic in Gamba Sawaba in Zaria Local Government Area of Kaduna state.

1.4   Research Questions

1.     What are the causes of vesico vagina fistula among patients attending clinic in Gamba Sawaba in Zaria Local Government Area of Kaduna state?

2.     What are the effects of vesico vagina fistula among patients in the study area?

3.     What are the strategies that could be adopted to minimize the problems of vesico vagina fistula and the outcome of the repair among patients attending clinic in Gamba Sawaba in Zaria Local Government Area of Kaduna state?

1.5       Significance of the Study

The findings of this study would assist the women in Gamba Sawaba

community to adopt proper measures to curb the menace of vesico vagina

 fistula.

The findings would also assist the local government, state and the country as a whole to adopt appropriate steps to reduce the prevalence of vesico vagina fistula.

Information from this study will serve as baseline data for policy makers who may wish to confront this menace vigorously .

The findings would assist a number of students and other educationists in           many fields.

1.6  Scope and Limitation of the Study

This study works covers the Prevalence of vesico vagina fistula and the outcome of the repair among patients attending clinic in Gamba Sawaba in Zaria Local Government Area of Kaduna state. It is limited to the women only as a result of financial constraints and lack of time. It is hope of the researcher that this research work would provide foundation for further research.

1.7   Operational Definition of Terms

Vesico Vagina Fostula (VVF): Is an abnormal opening between the bladder and the vagina that results in continuous and unremitting urinary incontinence.

          Prevalence:

          Outcome:

          Repair:

          Patients:


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