Vesico Vaginal Fistula In Birnin Health And Social Care Essay

Approximately, environing 7 darling women were restraintced from confusion of pregnancy and offshoot race earthwide. Quenched of the deems, 6.5darling women are from the clearing enumerateries. (WHO Global doom of sickness 1998).

According to the grounds from West African Register of Remedy (WAJM 2004; 23 1) the influence of obstetric fistula in West Africa is environing 1-3 per 1000 deliveries season, in other African deposit-of-land is 5-10 per 1000 deliveries.

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Fame shows that, kind morbidity and non-creature is floating the elder example restraint women in Nigeria. Kind non-creature narration of 800 demises per 100,000 speed races which is too scoldd floating the chief in the earth. The fame raise customary that restraint each demise that happenred 20 or excite women conciliate be restraintced by offshootrace injuries and most of this is obstetric fistula (UNFPA/Nigeria 2005).

Obstetric fistula is individual of the kind morbidities and non-creature example in Nigeria which is an effect of institution to Public Bloom (WAJM 2010; 29 (5); 293-298. The exhibition is substance excite attrrenewal in the Northern bisect of the empire, influence nature ranges from as inaudible as 400,000 to as ample as 800,000 contingencys, 5% of these contingencys are from the Northern deposit-of-land. There could probably be an impingement of 20,000 innovating contingencys a year, with plugly 2,000-4,000 fistula restore surgeries substance carried quenched annually. Too Nigeria enumescold restraint 40% of the earthwide fistula influence (Empire rate UNFPA/Nigeria 2009). Life expectancy of dowagerly population at race is 52 yrs, with a wcavity of 5.5 fertility scold (Unicef 2010).

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Statistic fame from (UNFPA /Nigeria 2005) customary that, elderity of fistula unrepining visited the Bloom centers are beinaudible 20 years. Nigeria is confrontment a powerful challenges of Bloom regard arrangers, with an deemd of 58-39% trained trained carrisenility restraint Ante-Natal and introduction (Midwives) sturdy to the Bloom facilities (NDHS 2008). Efforts by the Empire to arrange them halt unfortunate.

In Nigeria, future matrimonys give 23% of the kind demise that are account by extreme hemorrhage, amenable and continue operation which may conclusion to obstetric fistula and repeatedly season tranquil race. 69% of women in the bucolic areas exhibition intricateies in accessing medical regard that made them to keep home deliveries by ungoverned race adherent. (Lindros and Inaudiblekkainen 2004).

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Kebbi Aver with an deemd population of 3.8darling quenched of it 836,000 are women of offshoot behavior senility is located in the North West bisect of Nigeria. It has a bisecticularly inaudible socio -economic indicators. Kind non-creature scolds restraint the deposit-of-land are deemd at 1,000/100,000 speed races (NDHS 2008) Wcavity fertility scold is 8 which are aloft the exoteric medium. According to Conveyership Innovatings word 19 April 2012, customary that, kebbi aver dispose floating the chief scold of kind demise in the empire. Most of the plain accounts of kind demise are hemorrhage, sepsis, eclamsia and anemia. Season crave and amenable operation has been obligatory restraint twain kind morbidity and non-creature such as vesico-vaginal fistula. According to a contemplate, the aver exhibitions thoughtful kind challenges.

Senility at marrisenility in the aver is 12-13 years and most of them became fruitful by 13-14 years. VVF victims can be build in wcavity bisect of the aver with influence scold of 5,000-8,000, Birnin Kebbi National Empire has the chief scold of 2,500 contingencys. (Khalid & Zango 1996). Elements accounts restraint haughty morbidity in women in the aver apprehend collective, cultural, economic accessibility and bloom pliancy associated examples.

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Obstetric fistula is can be treated excluding, indigence, smattering and noncommunication of referableification are the most contributing element restraint women to search restraint medical vigilance. These haughty influence shows heedlessness restraint the empire to discourse the exhibition.

This con-aggravate in-fact is going to behold in to the Proof environing the vesico vaginal fistula and the nationality towards it. The con-aggravate conciliate too be directed floating women with and withquenched vesico vaginal fistula. The conclusion conciliate arrange referableification as to proof contemplatione concerning vesico vaginal fistula and as to how the women withquenched fistula behold at vesico vaginal fistula as a sickness and their nationality towards fistula women.

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1.2. Lore questions con-over

1.2.1 What is the influence of stubborn fameed contingencys of Vesico Vaginal Fistula floating married women?

1.2.2. What are the proof, nationality and proof of destructive metes of women towards vesico vaginal fistula in Birnin -Kebbi LGA of Kebbi- Aver, Nigeria?

1.3. Lore Hypothesis

Knowledge, nationality and destructive metes of women towards vesico vaginal fistula food in Birnin Kebbi National Empire of Kebbi Aver, Nigeria.


1.4. Objectives

1.4.1. Public Objective

To assess the proof and nationality towards vesico vaginal fistula in Birnin Kebbi LGA of Kebbi Aver, Nigeria.

1.4.2. Specific Objectives

To con-aggravate the influence of vesico vaginal fistula in Birnin Kebbi LGA.

To assess the contemplatione of proof of married women on the contributing elements of vesico vaginal fistula.

To invent quenched if married women knows environing destructive metes of vesico vaginal fistula.

To mention the nationality towards women with vesico vaginal fistula.

To mention the practicable lavishs elements kindred to foothold of vesico vaginal fistula.

To awaken the union of proof and nationality with the foothold of vesico vaginal fistula.


1.5. Conceptual Framework

Socio -demographic




Socio-cultural elements

Senility of Matrimony


Gender violence



Foothold of Vesico vaginal fistula

Access to bloom regard:

Antenatal visit

Ungoverned race


Aid natal

Place of introduction


Proof environing the

Lavish elements, proof and concomitants and destructive metes of vesico vaginal fistula

Locality of women towards vesico vaginal fistula and women with recto vaginal fistula

1.6. Influenceal Definitions:-


1.6. Influenceal Definitions:-

Senility of Matrimony: – refers to getting marrisenility beinaudible 18 yrs.

Poor race usages: – Home introduction by un- aptitude adherent.

Parity: – Multiple race with inaudible spacing.

Patriarchy: – Head of the stock sentence is definite.

Ungoverned race adherents: – Ungoverned or stubborn reasonra in introduction.

Knowledge: – Proof in this con-aggravate concerning to proof and concomitant of VVF.

Attitude: – In this con-aggravate refers to the availability of bloom utilitys and the barriers to searching.

Destructive Metes: – Proof environing steps to tackle the VVF.

Foothold of vesico vaginal fistula:- The foothold of vesico vaginal fistula in this con-aggravate is women keep obstetric fistula or vesico vaginal fistula




The paragraph 11 deals with the:

History Vesico Vaginal Fistula

Global exhibition of vesico vaginal fistula

Exhibition of Fistula in Nigeria

Causes of vesico vaginal fistula

Collective Consequences of vesico vaginal fistula

Tenor of vesico vaginal fistul

2.1. History of vesico vaginal fistula

Vesico vagianal fistula or obstetric fistula has been attested to be a elder effect or women of offshoot behavior senility since decades. In 1935 bigot Derry from Cairo customary that, the halts of Queen Henhenit (2050 BC) were the oldest to descry fistula. Environing 1845 james marion sims was the pristine surgeon to endmenteasily restore VVF from a 3 dowagerly slaves in Montgonery Albana. Later, in 1852 he recognized a VVF restore capital where sundry unrepinings from America and Europe came restraint surgery (Robert F. Zacharin 2008).

A descryy during 1550 BC in the obsolete Egypt, Aveicenna was a far-famed Arabian physician to specify VVF and obstetric (Derry DE 1935; 42:490). Another reversal came up in 1836 from Peter Mettnauer from Virginia who was attested to be the pristine surgeon to plug fistula in United Aver (Aust N.Z.J. surg (2000) 70, 851-854.)

Con-aggravate point-outs that, during the 19th Generation, women with fistula in United Aver and Europe were accountd by dystocia (Russell). In the future 20th generation, excite trials and techniques came up to reform the tendency of VVF restore. Again, in 1942 Latzko published a innovating act in restoreing aid -hysterctomy of VVF which narrative 95-100% endment (VVF MedScape).

Sundry unadorned reversals and recent technique by surgeons has been narrative season, excite lorees and trial are tranquil ongoing restraint the reformment and reform elucidation towards VVF.


2.2. Global Exhibition of Vesico Vaginal Fistula

Vesico Vaginal fistula (VVF) which is too designated obstetric fistula is an unnatural chink betwixt the urinary bladder and the vagina or betwixt the vagina and the rectum (RVF).This is accountd as a conclusion of continue operation where the offshoot presses despite the recognized fashion thereby clearing the cavity betwixt the vagina and the urinary bladder (WHO def).

Globally, 529,000 women were deemd to keep died full year attributable to pregnancy and offshootrace kindred confusion. Almost 90 percent of this demise is from Africa and Asia. Publicly, 5 percent of this demise is expected to keep proof from amenable operation (UNFPA/Nigeria 2005).

According to M.J Metro fame in 2006 involved as VVF is referable innovating sickness it has been in creature restraint decades. He raise haughtylighted that, in the third earth enumerateries mainly in the west 90% of VVF contingencys are accountd by bladder trauma during hysterectomy surgery. Nowadays, recent technologies from patent clear enumerateries such as Europe and bisect of North America keep eliminated the sickness (VVF) in there deposit-of-land (M.J.Metro 2006).

In the selfselfselfsame fame of metro 2006, he customary that, VVF is an troubled sickness the victims should be excite thoughtful towards their multiplyicular hygiene.

In a WHO fame of 2006 point-outs that, environing 2 darling women food with untreated VVF, season 50,000 to 100,000 innovating contingencys are fameed full year (WHO 2006).The acception on figures could be attributable to stain that associated with the exhibition. Too in another fame from WHO con-aggravate on global doom of sickness, customary that, if 2% of the amenable operation are accountd by VVF, then 130,000 women are going to be restraintced with the circumstances (WHO 1998 243-66).

A con-aggravate fame published from UK involved that, quenched of 166 contingencys treated unformed 18 year, singly 21 contingencys are accountd by obstetric confusions. Another fame from Nigeria customary that, quenched of 377 contingencys of VVF 369 contingencys are accountd by offshootrace (Lawson J. 1998, 83; 454-456).


2.3. Exhibition of vesico vaginal fistula in Nigeria

The millennium Clearment Goals (MDGs) targeted at reducing the relation of women latter in offshootrace by three nationality by 2015 behove unrealistic in Nigeria. (Adeyemi Ezekiel). The debate rearwards it is that, the empire has made short advancement in reducing kind and non-creature than any other sub-Saharan African enumerateries. The kind non-creature scold in Nigeria deemd as 800nto 1,500 per 100,000 speed race (WHO 2006).

The Northern bisect of the empire has publicly worse indicators with an deemd kind non-creature scold of 1,500/100,000 speed race. The haughty kind non-creature scold influences the basic bloom utilitys in the empire (NDHS 2003).

According to UNFPA fame, Nigeria plugly to keep an deem of 400,000 and 800,000 women restraintced with VVF circumstances season, 20,000 innovating contingencys are narrative full year. Most of these unrepinings are from the northern bisect that speeds in the bucolic areas where they invent it intricateies in accessing suited medical regard. (UNFPA/Fistula Nigeria 2005). Too statistics shows that, most of the VVF victims are beinaudible 20years.

The underlying account of VVF in Nigeria is attributable to continue amenable operation and mainly the immature senilitys are at lavish attributable to future marrisenility and future offshootrace where there mass is tranquil in the stsenility of clearing (WHO2006). In 2002, a multi-sectorial committee was setup by the Federal Minisprobe of Bloom to invent the elucidation to the example. At the selfselfselfsame season the committee identifies Engender Bloom acrave with UNFPA/Nigeria to direct a nationwide needs rate in direct to clear a frameoperation and renewal contemplation restraint the ejection of fistula in Nigeria.

Although Nigeria has been initiative mete to discourse reproductive bloom and kind bloom examples, the implemented interventions keep referable end optimum coversenility to end the desired application. (NDHS 2008).



Sundry surgeons keep feeling fistula according to their proof during restore. In 1852 Sims too classified fistula by its subsidence in the vagina. According to (Cater, Palumbo et al. 1952) customary that, it is intricate to draw the fameed contingencys of fistula excluding, the flag habit is to fulfill it during the real influence and the conclusion.

Mayor clinic schoolman has little classified six types of vaginal fistula

Vesico vaginal fistula- is unnatural chink betwixt the vagina and urinary bladder

Ureterovaginal fistula- is unnatural chink that associate the vagina and the ducts which raise the urine from the kinsfolk to the bladder.

Urethrovaginal fistula- is an chink betwixt the vagina and the tube that carries the urine quenched.

Rectovaginal fistula- an chink betwixt the vagin and the chink anus.

Colovaginal fistula- the chink betwixt the vagina and the vast civil.

Enterovaginal fistula- an chink betwixt the smwcavity civil and the vagina.



Sundry promulgations and registers keep their incongruous statements on the accounts of vesico vaginal fistula. According to remedy restraint African register classified the elements that gived to the account of vesico vaginal fistula as: – (MfA- VVF)

Primary element

Childbirth: – 8% of the VVF contingencys are continue and amenable operation where the deliveries are directed by ungoverned trained race adherent or as a conclusion of malpresentation of baby in the uterus which account a doom of damsenility to the dowager’s urinary deposit.

Hysterectomy or other gynecological example:- This can be accountd by vital surgery that happen unformed the pelvic and may conclusion to VVF.

Gishiri slice or Salt slice:- It is a transmitted fashion of tenor by a transmitted healers mainly reasonra in Nigeria and some bisect of west Africa. When a dowager exhibit Gishiri sickness concomitants such as vulva hankering, neglect of menstruation, waste or amenable operation. As a conclusion of these concomitants a national surgical slice in the earlier vagina wwcavity of a dowager was dindividual restraint wcavity re-establish.

During disunion of clitoris in a process of dowagerly Genital mutilation or dowagerly circumcision the vaginal tissues and its extreme conciliate be scrapped thereby accounts VVF.

Unimportant element

Sexual transmission sickness or anterior pelvic exasperating sickness.

Bladder stindividual or restrain restrainteign mass unformed the vagina


2.5.3. Socio-cultural accounts

The most underlying socio-cultural accounts in Nigeria are: – Future matrimony; injurious transmitted race usages; indigence and illiteracy.


2.5.4. Future matrimony

Future marrisenility can be eliminate as substance marrisenility at the senility of 15-24 years when the reproductive organs are referable easily developed restraint initiative once as dindividual by the adult. This conciliate conclusion t damsenility of the race canal that conciliate convey to vaginal fistula (John Zang). According to WHO/UNICEF, the recommended senility of marrisenility is 25 to 26 years.

In word 16, of the session on the ejection of wcavity restraintms of nicety despite women, certain the proper to vpoint-extinguished offshoot matrimony.

I n a promulgation from unicef lore capital on future marrisenility 2001 customary the guidelines on changing nationalitys of families and societies towards offshoot matrimony.

According to global rate of offshoot marrisenility it is deemd that, South Asia and Africa has the chief reckon of immature women/immature girls who are consecrated quenched into marrisenility at the senility of 15-24years. These conciliate influence their nutritional foothold which conciliate convey to so sundry pregnancy- kindred confusions and most of the season she has no utter in making sentence restraint herself.

Too in another fame from WHO 2006 point-extinguished that: excite than 25% of women with fistula from Ethiopia and Nigeria are fruitful precedently the senility of 15years season aggravate 80% of them too behove fruitful at 18years of senility.


Almost wcavity the fame from the medical authoritative point-outs the psychical consequences of women with VVF that bears. This is attributed attributable to lacj of aid from the families and societies as a integral. Elderity of these women exhibitions powerful challenges in the communion beaccount of the odour from the dissoluteness of urine.


According to WHO fame point-extinguished that, women with VVF are confrontment intricateies to mansenility the urinary dissoluteness that accounts odour from urine. The fame too haughtylighted that, attributable to deterioration to the vaginal wwcavity sundry confusions may inaugurate uniform following obstetric restore of the VVF. These confusions are narrowing of the vagina, unimportant amenorrhea inability to raise the offshoot.

However, (Murphy 1981 and Harrison 1983) customary that, the most traumatic exhibition of VVF conclusioning to urinary dissoluteness and lost of offshoot who someseason may convey to matrimonial separation/divorce and too collective excommunication.

In another fame from (WHO 2006), VVF unrepinings are to be sympathized attributable to the inaudibleer collective foothold of women in Nigeria. The most disheartening is that, they are surrendering by their mate and they keep scant role unformed the origin.

2.7. Tenor

Women with fistula exhibition a doom of challenges which most of the season invent intricate to displug their exhibition. The singly elucidation restraint their survivor is surgery and multiplyicular hygiene.

A averment from WHO Kind Bloom and Safe Motherhood program point-extinguished that, the endemic VVF area should capital interruption exhibition through potent collective changes that conciliate reform the foothold of women.




3.1. Lore Design

Cross- sectional contemplate con-aggravate floating the married women of reproductive senility in Birnin Kebbi LGA in Kebbi Aver, Nigeria.

Capital assemblsenility path to assess the proof and nationality towards vesico vaginal fistula floating persons who speed in Birnin Kebbi LGA, in Kebbi Aver, Nigeria.

3.2 Con-aggravate Area

Birnin- Kebbi LGA which lies in the capital of Kebbi Aver of Nigeria. A wcavity of 45 wards :- Nasarawa 1, Nasarawa 11, Dangaldima, Marafa, Gwadangwaji, Zauro, Ambursa, Gulumbe, Ujario, Kardi, Gawasu, ,Makera, Kola, Tarasa, Fadama,

3.3. Con-aggravate Population

The con-aggravate conciliate be floating the married women of reproductive senility 15-49yrs of senility.

3.4. Contingency Technique

Selection of Contingency sites: – Systematic Randomly sampling conciliate be dindividual restraint the assemblsenility of grounds in 45 settlements from 15 wards

3.4.1 Exclusion criteria are

The contingency who are referable Birnin Kebbi contingencys

The contingencys keep never followed up schoolman or refilled medical vigilance during 3 months anterior to con-over

The contingency who are weak to tell verbally and orally to colloquyer appropriately


3.5. Contingency extent

Yamane contingency extent Restraintmula

n=z2p (1-p)

(e) 2

n= (1.96)2 X 0.22 (1-0.22) = 264


Where ,

n = contingency extent

p = relation of women of reproductive senility in B/Kebbi LGA that are expected to keep proof environing vesico viginal fistula.

e = Marginal blunder or original blunder

z = Flag compute of 95% self-reliance period of 1.96

Contingency extent is 264 + 10% to supplement up in contingency of any privation compute/data, the wcavity contingency extent conciliate be 264 + 26.4 (10%)= 290

3.6. Measuring Cat's-paws

Contemplate questionnaires are to be admitted on proof and nationality of married women towards vesico vaginal fistula.

Exhibition to Exhibition colloquy conciliate be carried quenched during the capital assemblsenility discourse

3.7. Power and Reliability ordeal

Power ordeal

3 Expert power are to be separated from B/K LGA.

Questionnaire conciliate be checked and reviewed by these 3 experts.


Reliability ordeal

Questionnaire conciliate be pr-tested by the respondents who are resembling to the targeted respondents. The reliability of questionnaire conciliate be statistically ordealed with the Crobach’s Alpha, which its satisfactory coefficient is excite than


3.8. Grounds Assemblage

Constructed questionnaires to be reasond on the followings:–


Public and stockhold referableification,

Proof towards the proof and concomitant of Vesico Vaginal Fistula.

Locality towards the

Destructive Metes on the vesico vaginal fistula

Access to the bloom pliancy- referableification and utility.

Capital assemblsenility discourse – women with and withquenched VVF

3.9. Grounds Analysis (Statistics)

Questionnaire conciliate be coded precedently entering into the computer.

SPSS statement 17 conciliate be reasond

Descriptive statistic is to be reasond to awaken grounds which conciliate draw the quantity, percentage, medium and flag deviation

3.10. Ethical Consideration

Under the control of College of Public Bloom Sciences, and national authorities

Interviewees conciliate be cognizant and explained

Cognizant proofed consent


Keep immunity to withdrawal



Can access to definite fame or conclusions

Referable reason restraint other purpose

3.11. Limitation

The con-aggravate conciliate referable reexhibit the public population of Birnin Kebbi LGA.

Incongruous socio-demographic assemblsenility may keep incongruous usage

The con-aggravate conciliate referable reexhibit restraint other types.



Margaret Murphy (1981). Collective Consequences of Vesico-Vaginal Fistula in Northern Nigeria. Register of Biocollective Science, 13 , pp 139-150 doi:10.1017/S0021932000013304

Vesicovaginal fistula. Retrieved from the web


Wall, L. L (1988) “Dead Mothers and injured wives: The Collective Context of

kind morbidity and non-creature floating the Hausa of Northern Nigeria.” Studies in origin contemplationning 29: 341-359

WHO (2006) Obstetric Fistula: Guiding principles restraint clinical manipulatement and notice clearment. WHP Press: Geneva Zacharin, R F. 1998. Obstetric Fistula. Innovating York: Springer-Verlag Wien.

COMPASS 2006 – FMOH bisectnership operations to end Millennium Clearment Goal of suitable kind bloom regard Abuja, Nigeria September

Haddad S, Fourier P: “Quality, Cost and Utilization of Bloom Utilitys in Clearing Enumerateries: A Craveitudinal Con-aggravate in Zaire”. Soc Science Remedy 1995, 40: 743-753.

Metro (2006) Modification of O’Connor’s technique restraint the tenor of VVF

restore feeling.

Abu- Zahr C. Continueed and amenable labour, In: Murray C. Lopez A. Ed

Bloom compass of sex and reproduction: the global doom of sextually transmitted sicknesss, HIV, kind circumstancess, perinatal disorders and coeval anomalities, Cambridge: Havard University Press restraint WHO. 1998; 243-66

Ijaiya MA, Aboyeji PA. Obstetric urogenital fistula: the Ilorin proof, Nigeria. West Afr J Med 2004; 23(1):7-9.

Word Source:

Lawson J. Vesico -Vaginal fistula y’ a typical sickness. Trans R Soc. Trop. Med Hyg 1998; 83: 454-456


11. MfA – VVF – Vesicovaginal Fistula…/VesicoVaginal_Fistula_en.html

12. Environing Vaginal Fistulas – Mayo Clinic


Season Schedule





Jun- Aug













Preparation and word review




Detail and cat's-paw clearment




Ethical consideration




Lore cat's-paw probe quenched

– ordeal power and reliability



Revise the cat's-paw



Recruitment of colloquyer team


Field operation and grounds assemblage



Grounds analysis



Fame match and Exhibitation








Printing questionnaire




Grounds assemblage

-Photocopies Quest

-Souvenir restraint respondent


-Transportation cost

-Grounds processing


Air fare




Wcavity Thesis instrument process


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