The prevalence and management of obstetric fistula among women of reproductive age in a low-resource setting

Olaniyi Felix Sanni; Michael Olugbamila Dada; Abimbola Oluseyi Ariyo; Aisha Oluwakemi Salami; Olaide Lateef Afelumo; Oluwasola Stephen Ayosanmi; Olaiya Paul Abiodun; Elizabeth Abike Sanni

doi:10.4081/hls.2023.11566

Authors

Olaniyi Felix Sanni
fescosofanalysis@gmail.com
Research and Development Department, Fescosof Data Solutions, Ogun State, Nigeria. https://orcid.org/0000-0001-7761-3604
Michael Olugbamila Dada Department of Medical Laboratory Science Babcock University, Ogun State, Nigeria.
Abimbola Oluseyi Ariyo Clinical Services, AIDS Prevention Initiative, Public Health Initiatives, Abuja, Nigeria.
Aisha Oluwakemi Salami Department of Public Health, Texila America University, Guyana.
Olaide Lateef Afelumo Department of Public Health, Texila America University, Nigeria.
Oluwasola Stephen Ayosanmi Department of Pharmacy, University of Saskatchewan, Saskatoon, Canada.
Olaiya Paul Abiodun Department of Public Health, Texila America University, Nigeria.
Elizabeth Abike Sanni Research and Development Department, Fescosof Data Solutions, Ogun State, Nigeria.

Obstetric fistula is one of the most significant obstetrical concerns and apparent indications of maternal morbidity in low-resource nations. Therefore, the study assessed the prevalence and management of fistula among women of reproductive age (15-49) in low-resource settings. This population-based cross-sectional study was conducted in three local government areas (Jere, Konduga and Maiduguri Municipal City) in Borno State. A structured questionnaire was used to collect data from 484 respondents, and the data were analysed using SPSS version 25.0. The overall prevalence of obstetric fistula was 10.7%. Over 13% of women with seven or more vagina deliveries had a fistula. Likewise, 19% of respondents knew about fistula prevention and treatment services available, and 13.7% of those did not participate in antenatal care services. Furthermore, 48.1% of respondents with a fistula during labour were treated successfully. Almost half (47.9%) who were aware of health facilities around them were successfully treated, same with 46.2% of those living within 1 to 2 km of a health facility, and almost half (49.0%) of those who got married within age 20. The study emphasizes the importance of effective community-level interventions to address obstetric fistula. To achieve this, a comprehensive action plan should be developed, ensuring pregnant women have access to necessary obstetric care services at all healthcare levels. The plan should include preventive measures, timely management of labour complications, and increased awareness of fistula prevention and treatment services. Prioritizing maternal healthcare and empowering women with knowledge and access to services are essential in preventing and managing obstetric fistula.

Swain D, Parida SP, Jena SK, Das M, Das H. Prevalence and risk factors of obstetric fistula: Implementation of a need-based preventive action plan in a South-eastern rural community of India. BMC Womens Health 2020;20:1–10. DOI: https://doi.org/10.1186/s12905-020-00906-w

Yismaw L, Alemu K, Addis A, Alene M. Time to recovery from obstetric fistula and determinants in Gondar University Teaching and referral hospital, northwest Ethiopia. BMC Womens Health 2019;19:5. DOI: https://doi.org/10.1186/s12905-018-0700-3

Chauhan S, Kulkarni R, Agarwal D. Prevalence & factors associated with chronic obstetric morbidities in Nashik district, Maharashtra, India. Indian J Med Res 2015;142:479–88. DOI: https://doi.org/10.4103/0971-5916.169219

Jungari S, Govind Chauhan B. Obstetric fistula in Assam, India: a neglected cause of maternal morbidities and mortality. Healthc Low-Resource Settings 2015;3:4663. DOI: https://doi.org/10.4081/hls.2015.4663

Wall LL. Obstetric vesicovaginal fistula as an international public-health problem. Lancet 2006;368:1201–9. DOI: https://doi.org/10.1016/S0140-6736(06)69476-2

Mallick L, Tripathi V. The association between female genital fistula symptoms and gender-based violence: A multicountry secondary analysis of household survey data. Trop Med Int Heal 2018;23:106–19. DOI: https://doi.org/10.1111/tmi.13008

Adler AJ. Estimating the prevalence of obstetric fistula: a systematic review and meta-analysis. Obstet Gynecol Surv 2013;13:246. DOI: https://doi.org/10.1186/1471-2393-13-246

Ramphal S. Vesicovaginal fistula: obstetric causes. Curr Opin Obs Gynecol 2006;18147–51.

Cowgill KD, Bishop J, Norgaard AK, et al. Obstetric fistula in low-resource countries: An under-valued and under-studied problem - systematic review of its incidence, prevalence, and association with stillbirth. BMC Pregnancy Childbirth 2015;15:1–7.

Roush KM. Social Implications of Obstetric Fistula: An Integrative Review. J Midwifery Women’s Heal 2009;54:e21-33. DOI: https://doi.org/10.1016/j.jmwh.2008.09.005

Creanga AA, Ahmed S, Genadry RR, Stanton C. Prevention and treatment of obstetric fistula: Identifying research needs and public health priorities. Int J Gynecol Obstet 2007;99:151-4. DOI: https://doi.org/10.1016/j.ijgo.2007.06.037

Kayla McGowan. MHTF Blog [Part 1] Obstetric Fistula: A Global Maternal Health Challenge 2017;115.

Wall LL. Preventing obstetric fistulas in low-resource countries: Insights from a Haddon matrix. Obstet Gynecol Surv 2012;67:111–21. DOI: https://doi.org/10.1097/OGX.0b013e3182438788

Maheu-Giroux M, Filippi V, Samadoulougou S, et al. Prevalence of symptoms of vaginal fistula in 19 sub-Saharan Africa countries: A meta-analysis of national household survey data. Lancet Glob Heal 2015;3:e271–8. DOI: https://doi.org/10.1016/S2214-109X(14)70348-1

Bello OO, Morhason-Bello IO, Ojengbede OA. Nigeria, a high burden state of obstetric fistula: a contextual analysis of key drivers. Pan African Med J 2020;36. DOI: https://doi.org/10.11604/pamj.2020.36.22.22204

UNFPA. National Strategic Framework For The Elimination Of Obstetric Fistula In Nigeria 2019-2023. UNFPA, New York 2019.

Hodin S, Initiative H. More Women in Nigeria Are Using Maternal Health Services – But Gaps Persist. But Gaps Persist 2018:1–7.

Daniel mfonobong. Borno State: List of Local Government Areas & Towns 2020:1–4. https://nigerianinfopedia.com.ng/borno-state-local-government-areas-towns/ accessed December 21, 2021.

Britannica. Borno state, Nigeria. Britannica 2021:1–5. Accessed December 16, 2021. Available from: https://www.britannica.com/place/Borno

City population. Borno (State, Nigeria) - Population Statistics, Charts, Map and Location 2020:1–3. Accessed December 16, 2021. Available from: https://www.citypopulation.de/php/nigeria-admin.php?adm1id=NGA008

NPC. Nigeria Demographic Health Survey 2018. Natl Popul Comm [Nigeria] ICF 2019:748.

Questionpro. Multi-stage Sampling - Definition, steps, applications, and advantages with example. QuestionPro 2021:1–4. Accessed December 16, 2021. Available from: https://www.questionpro.com/blog/multistage-sampling-advantages-and-application/

BRM. Multi-stage sampling 2021:1–4. Accessed December 16, 2021. Available from: https://research-methodology.net/sampling-in-primary-data-collection/multi-stage-sampling/

Naru T, Rizi JH, Talati J. Surgical Repair of Genital Fistulae. J Obs Gynaecol Res 2004;30:293-6. DOI: https://doi.org/10.1111/j.1447-0756.2004.00196.x

Hayet S, Sujan KM, Mustari A, Miah MA. Hemato-biochemical profile of turkey birds selected from Sherpur district of Bangladesh. Int J Adv Res Biol Sci 2021;8:1–5. DOI: https://doi.org/10.5455/javar.2021.h556

Johnson K. Incontinence in Malawi: Analysis of a proxy measure of vaginal fistula in a national survey. Int J Gynecol Obstet 2007;99:S122-9. DOI: https://doi.org/10.1016/j.ijgo.2007.06.033

Muleta M, Fantahun M, Tafesse B, et al. Obstetric fistula in rural Ethiopia. East Afr Med J 2007;84:525–33.

Walraven G, Scherf C, West B, et al. The burden of reproductive-organ disease in rural women in The Gambia, West Africa. Lancet 2001;357:1161–7. DOI: https://doi.org/10.1016/S0140-6736(00)04333-6

Kalilani-Phiri LV, Umar E, Lazaro D, et al. Prevalence of obstetric fistula in Malawi. Int J Gynecol Obstet 2010;109:204–8. DOI: https://doi.org/10.1016/j.ijgo.2009.12.019

Biadgilign S. A population-based survey in Ethiopia using questionnaire as proxy to estimate obstetric fistula prevalence: results from demographic and health survey. Reprod Heal 2013;10:1–8. DOI: https://doi.org/10.1186/1742-4755-10-14

Cowgill KD, Bishop J, Norgaard AK, et al. Obstetric fistula in low-resource countries: An under-valued and under-studied problem - systematic review of its incidence, prevalence, and association with stillbirth. BMC Pregnancy Childbirth 2015;15:193. DOI: https://doi.org/10.1186/s12884-015-0592-2

Roka ZG, Akech M, Wanzala P, et al. Factors associated with obstetric fistulae occurrence among patients attending selected hospitals in Kenya, 2010: a case-control study. BMC Pregnancy Childbirth 2013;13:56. DOI: https://doi.org/10.1186/1471-2393-13-56

Dolea C, Abouzahr C. Global burden of obstructed labour in the year 2000: Evidence and Information for Policy (EIP), World Health Organization, Geneva. Geneva World Heal Organ 2000:1–17.

Amzat A. Despite decades of funding, literacy level in the northern states remains low. The Guardian Nigeria News - Nigeria and World News 2017:1–4. Accessed December 21, 2021. Available from: https://guardian.ng/news/despite-decades-of-funding-literacy-level-in-the-northern-states-remains-low/

Muleta M, Hamlin EC, Fantahun M, Kennedy RC, Tafesse B. Health and Social Problems Encountered by Treated and Untreated Obstetric Fistula Patients in Rural Ethiopia. J Obstet Gynaecol Canada 2008;30:44–50. DOI: https://doi.org/10.1016/S1701-2163(16)32712-8

Itebiye BO. Forced And Early Marriages: Moral Failures Vs Religious Nuances. Eur Sci J 2016;12:305. DOI: https://doi.org/10.19044/esj.2016.v12n17p305

Baker Z, Bellows B, Bach R, Warren C. Barriers to obstetric fistula treatment in low-income countries: a systematic review. Trop Med Int Heal 2017;22:938–59. DOI: https://doi.org/10.1111/tmi.12893

Wall LL, Arrowsmith SD, Briggs ND, Browning A, Lassey A. The obstetric vesicovaginal fistula in the developing world. Obstet Gynecol Surv 2005;60:S3-S51. DOI: https://doi.org/10.1097/00006254-200507001-00002

Dai Y, Zhou Y, Zhang X, Xue M, Sun P, Leng J, et al. Factors associated with deep infiltrating endometriosis versus ovarian endometrioma in China: A subgroup analysis from the FEELING study. BMC Womens Health 2018;18:205. DOI: https://doi.org/10.1186/s12905-018-0697-7

Muleta MM, Fantahun B, Tafesse EC. Hamlin, R.C. Kennedy. Obstetric fistula in rural Ethiopia. East African Med J 2007;84:525–533. DOI: https://doi.org/10.4314/eamj.v84i11.9572

Kapoor R, Ansari MS, Singh P, et al. Management of vesicovaginal fistula: An experience of 52 cases with a rationalized algorithm for choosing the transvaginal or transabdominal approach. Indian J Urol 2007;23:372–6. DOI: https://doi.org/10.4103/0970-1591.36709

Biswas A. Genital Fistula- our experience. J Indian Med Assoc 2007;105:123-6.

Khan RM, Raza N, Jehanzaib M, Sultana R. Vesicovaginal fistula: an experience of 30 cases at Ayub Teaching Hospital Abbottabad. J Ayub Med Coll Abbottabad 2005;17:48–50.

Banke-Thomas AO, Wilton-Waddell OE, Kouraogo SF, Mueller E. Current evidence supporting obstetric fistula prevention strategies in sub-Saharan Africa: a systematic review of the literature. Afr J Reprod Health 2014;18:118–27.

Sanni, O. F., Dada, M. O., Ariyo , A. O., Salami , A. O., Afelumo , O. L., Ayosanmi , O. S., Abiodun , O. P., & Sanni, E. A. (2023). The prevalence and management of obstetric fistula among women of reproductive age in a low-resource setting. Healthcare in Low-Resource Settings, 11(1). https://doi.org/10.4081/hls.2023.11566