Fistula: Succour As NHIA Launches Intervention Programme

Despite being a preventable and treatable condition, obstetric fistula has high prevalence with a large number of unrepaired cases in Nigeria.

Sadly, additional 13,000 new cases are added to the backlog every year.

Report shows that Nigeria accounts for 7.5 percent of the two million people living with unrepaired obstetric fistula globally.

Obstetric fistula is a  complication that causes an abnormal hole between the bladder and vagina, resulting in uncontrolled, continuous leakage of urine through the vagina.

The condition, which is often associated with childbirth complications, has left many woman depressed as they suffer several physical, psychosocial and economical problems.

A public health physician, Dr. Amodu Abiodun, told LEADERSHIP that for each woman who dies  during child birth, estimated 18 to 30 women survive avoidable complications, and obstetric fistula standout as the most tragic of preventable childbirth complications.

He said  in Nigeria, the most common cause of obstetric fistula is childbirth and obstructed labour that is left unrelieved.

It is estimated that 80-95 percent of the causes of obstetric fistula occur when a woman experiences prolonged obstructed labour.

According to Abiodun, 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. They said either of these can cause the women to labour for several days, adding that even if the baby eventually dies and  the mother survives, she may have 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 behavior.

“Also, early marriage, teenage pregnancy, poor health seeking behavior, delays in reaching health facility-transportation barriers, 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 labor and timely delivery usually by Cesarean Section is recommended to  avoid complications.

According to Abiodun, promotion of girl child education and  avoidance of girl-child marriage or pregnancy is vital.

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, through the National Health Insurance Authority (NHIA), has launched an intervention programme for fistula.

The drector-general of NHIA, Dr. Kelechi Ohiri, said the intervention falls within the pillar of equity, which is among the NHIA four pillars of focus and of coverage of equity and efficiency.

Ohiri stated this during the flag off of the NHIA Fistula Free Intervention and inauguration of Steering Committee for the programme by the coordinating minister of Health and Social Welfare, Prof.Mohammed Ali Pate, on Tuesday in Abuja.

He said “And within the pillar of equity is where this is situated, where we’re looking at the design of the vulnerable fund to prioritise equity and enhance safety nets for the poor and vulnerable.

“The first phase we intend to start with the National obstetric fistula centres. There are four of them in the country: Katsina, Bauchi, Ebonyi and Edo. And in the second phase of this, we hope to expand it to other hospitals that provide fistula care but are not necessarily designated for fistula care only.

“Beyond the treatments, the plan is also to ensured that they are enrolled into a social health insurance program that will cater to them so that we can build sustainability to the outcomes that we have achieved.”

The DG said that about 13,000 women in Nigeria come down with obstetric fistula each year.

He also said that there is a huge backlog of unrepaired obstetric fistula cases in the country, and it might take up to 83 years to close the backlog.

“Globally, roughly two million people live with unrepaired obstetric fistula. roughly one million are in developing countries and about 100,000 affected by offsetting slavery. Here in Nigeria, we account for about 7.5 percent of that number. We have roughly 13,000 new cases each year and given the backlog because of lack of financial access. At the current rate if we do not intervene, it might take up to 83 years to actually close the backlog,” he said.

According to him, the role of  the NHIA through the vulnerable group fund is to ensure that the definitive care treatments for these women are affordable, adding that the aim is to reduce physical and financial pain.

Earlier, the coordinating minister of Health and Social Welfare, Prof. Ali Pate, commended the NHIA for the programme which is about affordability of care for women who suffer from the consequences of childbirth, leading to fistula.

The minister noted that the country has a burden of maternal morbidity and mortality, saying “When you go all over the country, you see a lot of young woman, adolescents, woman who for one reason or the other, had intensive care or sometimes general care, come to deliver and have complications. But when they have fistula, they tend to be left behind.”