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Medico-Social Problems of Patients with Vesico- Vaginal Fistula in Murtala Mohammed Specialist Hospital, Kano

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Medico-Social Problems of Patients with Vesico- Vaginal Fistula in Murtala Mohammed Specialist Hospital, Kano Annals of African Medicine Vol. 2, No. 2; 2003: 54 - 57 MEDICO-SOCIAL PROBLEMS OF PATIENTS WITH VESICO- VAGINAL FISTULA IN MURTALA MOHAMMED SPECIALIST HOSPITAL, KANO M. Kabir, Z. Iliyasu, I. S. Abubakar and U. I. Umar Department Of Community Medicine, Aminu Kano Teaching Hospital, Kano, and Department of Community Medicine and Primary Care, Bayero University Kano, Nigeria Reprint requests to: Dr. Mohammed Kabir, Department of Community Medicine, Aminu Kano Teaching Hospital, P.M.B. 3452, Kano, Nigeria. E-mail: [email protected] Abstract Background: Vesico-vaginal fistula is still a persisting scourge in the developing countries with devastating medical and social consequences. These consequences were studied among patients presenting with VVF at a large referral center in Kano, Northern Nigeria. Methods: A total of 120 patients with Vesico-vaginal fistula admitted at the VVF centre of the Murtala Mohammed Specialist Hospital, Kano were investigated using structured questionnaires to determine their medical and social problems. Additional information on clinical features was obtained from patients’ case notes. Results: Their ages ranged between 10 and 36 years with a median of 16 years. A majority of the patients 87 (72.5%) were between 10-20 years. Most of the patients 98(81.6%) had their first marriage between the ages of 10 – 15 years. Patients were found to suffer from vulval dermatitis, foot drop, amenorrhoea, recurrent urinary tract infections and dysmenorrhoea as main medical problems. Economically they cannot work because they are shunned by the society. They are considered to have brought shame and dishonour to themselves and their families, and where they manage to avoid not being divorced by their husbands they quite often lose any form of support from the husbands. Conclusion: Special counselling and enlightenment programme on VVF, the need to train more traditional birth attendants and the need to improve referral of women likely to have VVF to facilities that offer emergency obstetric services were recommended. Key words: Medico-social problems, vesicovaginal fistula Introduction trauma during operative delivery, infections and irradiation necrosis from treatment of cervical Vesico-vaginal fistula (VVF) is a direct pathological carcinoma. The problem of VVF in Northern Nigeria communication between the urinary bladder and the has been found to be associated with young girls who vagina resulting in the uncontrolled leakage of urine are denied skilled maternity care despite their high- into the vagina from the bladder. 1 Actual risk pregnancies. Other factors contributing to the incidence/prevalence rates from community-based high incidence of VVF include illiteracy, poverty, studies are difficult to come by because the condition ignorance, home delivery, non-utilisation of antenatal is under reported due to stigma associated with it. and intrapartum medical facilities and the habit of However, in many parts of Africa especially in the performing traditional episiotomy - “Gishiri cut” by more remote rural areas, it is one of the commonest untrained traditional birth attendants, husband distressing conditions that bring women to hospital. 2 dominance and severe deprivation and neglect. 3 The condition has many causes with variation Vesico-vaginal fistula is a disease with depending on the social and educational status of tremendous socio-economic and health implications people. Notable among the causes are pressure and consequences. The uncontrolled urine leakage necrosis following prolonged obstructed labour, causing bad odour in gatherings result in social stigma 55 Medico-social problems of patients with vesico-vaginal fistula. Kabir M. et al and consequent neglect. Other problems include that a majority 98(81.6%) of the patients had their childlessness from loss of viable foetus from first marriage between the ages of 10-15 years. pregnancy associated with VVF, secondary infertility, Most of the patients 93(77.5%) did not book for vaginal stenosis by fibrosis and bands, amenorrhoea, antenatal care during the index pregnancy preceding high and unaffordable costs of repair and elective development of the vesicovaginal fistula. Table 3 caesarean section among those who get pregnant later. shows that the commonest associated medical Psychosocial problems of the patients include problem among the patients is vulval dermatitis (31%) depression, loss of husband’s affection, divorce and followed by foot drop (23%) and 17.5% had rejection by the society. amenorrhoea. There was an associated rectovaginal fistula in 7 (6%) of the patients. Up to half of the patients were bitter about the Materials and Methods condition they found themselves in and a third were psychologically depressed. Only a minority (7.5%) The Laure fistula centre of Murtala Mohammed were indifferent. This is shown in table 4. In addition, specialist hospital and a patients’ waiting hostel in more than half of the patients (53%) suffered from Kwalli became operational in January 1990. A Dutch societal negative reactions as shown in table 5. surgeon,Dr. Waaldijk comes from Katsina twice a week to operate on these patients. The centre attracts patients from all over northern Nigeria and Niger Table 1: Age distribution of VVF patients in Murtala republic. The total number of repairs carried out at Mohammed specialist hospital, Kano 10 this centre from 1990 to 2001 was 4,261. This centre serves as a national training centre for doctors and Age (years) No. (%) nurses. Consent was obtained from the Murtala 10-15 42(35) Mohammed specialist hospital authorities as well as 16-20 45(37.5) each patient before commencement of the study. 21-25 23(19.2) Between November and December 2001, 120 26-30 7(5.8) women with vesico-vaginal fistula who were admitted 31+ 3(2.5) into the hospital were studied. Using a structured Total 120(100) questionnaire, data on personal particulars of the patients including their marital status were recorded. Data collected on their health and medical conditions Table 2: Distribution of VVF patients by age at first include gynaecological problems such as marriage amenorrhoea, dysmenorrhoea, dyspereunia and infertility. Additional information about findings on physical examination was obtained from the patient’s Age (years) No. (%) case notes. Social problems elicited include how the 10-15 98(81.5) patients felt about the fact that they have the 16-20 18(15.5) condition, as well as the societal reaction towards 20-25 4(3.5) them. Total 120(100) Results were analysed using MINITAB 12.21(U.S.A) statistical software package. Median, range and percentages were used to describe Table 3: Distribution of medical complications among quantitative and qualitative data respectively. VVF patients in Kano Microsoft Excel and Word in windows 98 were used for graphics and tables in that order. Complications No. (%) Amenorrhoea 21(17.5) Vulval dermatitis 37(31.0) Results Dysmenorrhoea 9(8) Foot drop 28(23.3) The patient’s age ranged between 10 and 36 years Infertility 2(1.7) with a median age of 16 years. A majority of the Recto-vaginal fistula 7(5.8) patients 87 (72.5%) were between 10-20 years of age Recurrent UTI 11(9.2) as shown in table 1. A majority of these patients Dyspereunia 5(4.2) 94(78.3%) were illiterate. Even among the literate Total 120(100) ones none had tertiary education. Table 2 indicates UTI = urinary tract infection Medico-social problems of patients with vesico-vaginal fistula. Kabir M. et al. 56 Table 4: VVF patient’s reaction to their condition vesico-vaginal fistula could be prevented in the developing countries. Patient’s reaction No. (%) The findings of a larger proportion of VVF Bitter 61 (51.0) patients being unbooked for antenatal care in this 6,11,13 Resigned to fate 10 (8.0) study are consistent with other studies. Reasons Depressed 40 (33.0) as to why most of the cases did not receive any form Indifferent 9 (8.0) of antenatal care possibly include the fact that most Total 120 (100) were rural dwellers and had poor access to health services and facilities. It is a well-known fact that VVF is associated with Table 5: VVF patients’ perception of societal reaction medical and psychosocial complications. Thus, VVF towards them could be responsible for many serious problems, which can cripple the patient especially with respect to inability to bear any more children despite the Societal reaction No. (%) young age of these patients. The significance of this Sympathetic 34(28.0) will be better appreciated when one considers that Rejected 64(53.0) bearing children is highly valued in this society. The Indifferent 22(18.0) plight of these unfortunate victims can be so Total 120(100) devastating and dehumanising that even when cured after surgery some of them never regain their self esteem and as such shun social life. The low level of Discussion dyspereunia observed in this study could be as a result of separation, divorce or low self-esteem common The highest frequency of VVF was recorded in the among these patients. Economically they cannot 10– 15 years age brackets accounting for 78.5% of the work because they cannot stay in the public and will patients. Thus, the age of acquisition of the disease not be employed. The patient thus becomes an could generally be said to be in the early teenage economic burden to others. These social problems period. These findings agree with those of similar were also observed by Murphy among VVF patients studies conducted in Zaria (Northern Nigeria) where in Zaria. 12 the condition was found to be commoner among These problems highlight the need to design and teenagers fifteen years or younger but very rare after 4, 9 implement an effective health education programme the age of twenty-five years. on female education, family life education and Among the patients studied 78.3% were illiterate utilization of maternity services especially in rural and none of those who were literate had read up to communities.
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