Though Vesico Vaginal Fistula (VVF) is a preventable and treatable condition, LEADERSHIP Weekend’s checks reveal that about 12,000 Nigerian women come down with the condition every year.
Sadly, due to very limited capacity for treatment, only a half of this number – about 6,000 – of these new cases receive treatment, leaving the rest to swell the 150,000 women living with the condition in Nigeria.
A vesicovaginal fistula is described an opening that develops between the bladder and the wall of the vagina which causes urine to leak out of the vagina, sometimes lightly but it can be steady if the fistula is large.
A sufferer of the condition will have urine constantly leaking from the bladder into the genitals and vagina, and can cause incontinence – inability to control urination. Other symptoms include fever, belly pain, diarrhoea, weight loss, nausea, and vomiting.
This medical problem is seriously embarrassing to sufferers because of the bad smell that can ooze from the condition.
According to the Federal Ministry of Health, there are 22 VVF centres with three designated as National Obstetric Fistula Centres for Prevention, Training VVF Repair/Research Centres, with four more national centres in the making.
The centres are in Uyo in Akwa Ibom State, Ilorin in Kwara State, Ibadan in Oyo State, Jahun in Jigawa State, Kano in Kano State, Damaturu in Yobe State, Yola in Adamawa State, Kontagora in Niger State, Sawaba Gambo, Zaria in Kaduna State, Gusau in Zamfara State, and Jos in Plateau State. Also in Cross River, Sokoto, Kebbi and Gombe states.
However, a report shows that only about 6,000 fistula clients undergo surgical repairs across the country annually, meaning there are 6,000 women with the condition being added to the backlog of 150,000 clients awaiting repairs every year.
Also, available statistics show that Nigeria accounts for 40 per cent of fistula cases worldwide and one of the top 10 most dangerous countries in the world for a woman to give birth.
Meanwhile, public health experts have linked the huge backlog of unrepaired cases to inadequacy of specialists in fistula surgery; there are only about 30 of them available in the country.
Senior medical officer, Reproductive Health Division, Federal Ministry of Health, Dr. Henry Jumbo, said obstetrics and gynecologists are the ones meant to handle fistula surgery, but that they have to undergo further training to be able carry out the surgery.
“This is where the problem is; that is why we are not having enough surgeons to carry out operations. There are only about 30 experts now that are carrying out the operation, even though the Federal Ministry of Health has trained about 60 of them and other organisations like UNFPA and USAID have also trained some others,” he said.
The two acronyms stand for United Nations Population Fund and United States Agency for International Development.
Experts have expressed concern that even though VVF is preventable and treatable, it has high prevalence with a large number of untreated cases in the country. The condition, which is often associated with childbirth complications, has left many women depressed as they suffer several physical, psychosocial and economic problems.
LEADERSHIP Sunday learnt that for each woman who dies during child birth, an estimated 18 to 30 women survive with avoidable complications, and obstetric fistula stands out as the most tragic of preventable childbirth complications.
According to a public health physician, Dr. Amodu Abiodun, genital fistula is a medical condition, often an obstetric complication, with vast majority of the cases being the result of unrelieved prolonged obstructed labour.
In Nigeria, the most common cause of fistula (obstetric fistula) is childbirth and obstructed labour that is left unrelieved, while Iatrogenic fistula results as complications of medical care like Cesarean Section, episiotomy, instrumental deliveries, destructive deliveries, myomectomies, radiotherapy etc, the expert explained.
Available statistics show that 80-95 per cent of the causes of obstetric fistula occurs when a woman experiences prolonged obstructed labour.
Abiodun further explained that this obstruction can occur when a woman’s pelvis is too small, the baby’s head is too big, or the baby is not rightly positioned. Either of these can cause the women to be in labour for several days. Even if the baby eventually dies and the mother survives, she is at risk of obstetric fistula.
He, however, noted that there are other causes of fistula, including traumatic fistula which results from sexual violence such as rape, harmful traditional practices, advanced cervical cancer, accident and infections.
“Root causes of fistula are poverty, ignorance, cultural or religious beliefs and practices resulting in poor health seeking behaviour.
“Also, early marriage, teenage pregnancy, poor health seeking behaviour, delays in reaching health facility, cost, poor maternal health and emergency obstetric care services are some of the root causes of fistula,” said Abiodun.
On preventing fistula, he said it is important for every pregnant woman to have complete antenatal care and develop a birth plan.
He added that early diagnosis of prolonged labour and timely delivery usually by Cesarean Section is recommended to avoid complications, in addition to the promotion of girl-child education and avoidance of girl-child marriage or pregnancy.
He said good health seeking behavior – regular, attendance of antenatal care, birth preparedness and delivering in standard health facilities will help to prevent fistula.
On treatment, he said fistula is treated usually with surgery. If performed by a skilled surgeon, the patient can have a good chance of returning to a normal life.
Meanwhile, the federal government has envisioned a Nigeria free of obstetric fistula through sustainable collaborative efforts with partners and stakeholders at all levels.
To achieve this, the federal government initiated the National Framework for the Elimination of Obstetric Fistula in Nigeria (2019-2033)
The aim is to strengthen the health care system so that women will have access to quality, effective and affordable maternal health care services.
It hopes to address human rights issues affecting women and girls: poverty, gender inequality, lack of education and early childbearing, as well as eliminating the incidence of obstetric fistula through ensuring universal access to sexual and reproductive health services and maternal health services for women in the reproductive age group.
LEADERSHIP Sunday learnt that the federal government through the framework is planning to promote the reduction of the incidence of obstetric fistula by 30 per cent, to reduce the backlog of untreated obstetric fistula cases by 30 per cent and to promote and facilitate the rehabilitation and reintegration of 30 per cent of needy treated fistula patients into their communities.
However, experts in the health sector have expressed worry that with the backlog of unrepaired VVF cases in the country, it is obviously going to take several years to achieve a VVF-free Nigeria.