PERCEIVED CAUSES, PREVALENCEAND EFFECTS OF VESICO VAGINA FISTULA AMONG WOMEN IN KANO STATE
ABSTRACT
This study investigated the perceived causes, prevalence and effect of VVF among Hausa/Fulani women in Kano State. The study looked into the stigmatization effects as well as the treatment facilities of Vesico Vagina Fistula in Kano State. An ex-post facto research design was used and the population was the victims of the disease, and health Personnel. Stratified and Purposive sampling techniques were used and three hundred (300) questionnaires were used to collect data for the study, of which 242 responded to the questionnaire. Descriptive statistic of frequency means and percentages were used to analyze the demographic characteristics of the respondents. The hypotheses of the study were tested using one way Analysis of Variance (ANOVA) and two sample t-test was used to analyze the data at 0.05 level of significance.
The results of the study revealed that:
1. Prolonged obstetric labour and the use of traditional birth attendants were the major causes of VVF.
2. It was discovered that the victims suffered divorce and social restrictions by their husbands as a result of VVF and RVF.
3. Facilities/equipment for treating VVF was available and adequate within the state. The researcher, therefore, recommended public enlightenment programmes and proper education of tradition birth attendants in conducting labour.
4. Most of them have been rendered destitute, begging in the streets, motor parks and market to make ends meet.
5. Based on the above findings, it was recommended that female education up to secondary level should be encouraged. Any father that withdraws his daughter from school should be dealt with by the law through the local chief of Mai Angwa.
6. Advocacy and community mobilization should be used to sensitize people on the issues of VVF or RVF, to inform people that services are available and were to get them, dispelling negative rumors and generating favorable attitudes towards responsible parenthood.
Based on the results of the study, the following conclusions were drawn:
1. Prolonged labour, early marriage, traditional birth attendants and home delivery are the major causes of VVF among the victims in Kano State.
2. Ignorance, lack of knowledge and rural dwelling are among the factors responsible for the prevalence of VVF in Kano State.
3. VVF victims suffer considerable divorce and discrimination in Kano State.
4. It was discovered that VVF treatment facilities and equipments are adequately available and utilized in Kano State.
On the basis of results and conclusion, it was recommended that:
1. Future cases of VVF should be prevented and controlled through a legislation preventing early of marriage.
2. There is need for awareness creation and public enlightenment on the dangers of early marriage, child hawking, the importance of ante natal services, as well as, hospital delivery.
3. Micro-Credit Scheme should be put in place to empower the women economically. This will enable them have access to medical care, and control the issue of non patronage resulting from the high level of poverty, as well as the dependency of women on their husbands and other relations.
4. Government of Kano State should discourage a total withdrawal of girl-child from for the purpose of giving them out in marriage by their parents. This is because of the popular saying that “he who educates a woman educates a nation”.
CHAPTER ONE: INTRODUCTION
1.0 Introduction
Vesico vaginal fistula has been a health problem of women worldwide. This abnormality is mostly as a result of childbirth, home delivery, early marriage, obstructed labor, unskilled birth attendant, economic and socio-cultural factors to mention but a few (Kees, 1994). To meet one of these mothers is to be profoundly moved into mourning the still birth of their baby, incontinence of urine, shame of their offensiveness, often spurned by their husbands, homelessness, unemployment, trauma, stigmatization and rejection in the society.
An obstetric fistula is the breakdown of tissue in the vaginal wall extending into the bladder (Vesico Vaginal Fistula V.V.F.) or to the rectum (Recto Vaginal Fistula R.V.F.) or both. It is one of the most degrading morbidities resulting from pregnancy and childbirth. Maternal morbidity as a result of V.V.F. or R.V.F. is particularly high in Nigeria. Out of an estimated 200 case, 70 percentage occur in Northern Nigeria (Kuti, 2001).
The profile of Vesico Vaginal Fistula victims according to Ward, (1945) and Amiru (2004) is that of a destitute, illiterate, unemployed, divorced and smelly teenager, who has lost control of her bladder functions, and is constantly wearing rag in between her legs during the day and wetting her bed at night. Therefore, all efforts must be put on ground to eliminate this condition in women – especially in the light of the recognition advocated for women in the present dispensation. Vesico Vaginal Fistula occurs all over Nigeria, but more worse in some areas. There are areas that caught public attention especially the far northern area.
The true incidence of Vesico Vaginal Fistula in Nigeria is unknown because most of the victims are not registered in hospitals, clinics and maternity centers, due to fear of stigmatization and rejection. VVF has physical, physiological, social and economic effect on the victim. According to United Nations Population Fund (UNFPA, 2005), obstetric fistula is the most devastating of all pregnancy disabilities, while Njoku (2006), stressed that more than two million women in developing nations of the world are suffering from this conditions in the world and about fifty thousand to one hundred thousand new cases are recorded yearly.
The effects of VVF are life shattering, while women with fistula are perceived as unclean and thus shunned by their husband, family and the community, they are frequently blamed for their conditions and forced to live in isolation (Ejembi & Kees, 2001).
The health status of Nigerians is very low compared to other developing countries and their improvement are taking place at a slow rate. The determinants of health status are still bio-medical in nature. However, there is an increasing recognition of the underling effect of socio-economic factors on ill-health. Lack of education and high rate of illiteracy result in existence of ignorance and resistance to the use of health facilities particularly to women of child bearing age. Other cultural and religious practices such as early marriage and superstitious beliefs, have continued to remain major obstacles to the attainment of higher health status. There have continued to be major differences in health status between the north and south, rural versus urban, poor versus rich, educated versus uneducated. The lower status of women in Nigeria is said to be the major reason for the differences in the health status of females compared to males. Women are exposed more to harmful traditional practices and are uneducated and they generally have limited access to health facilities which results in the restriction in the decisions in matters affecting their family life and welfare. These coupled with
existing high fertility rate, with little or no use of family planning further reduces the health status of women (Masha, 1994; Kuti, 2001, Kees, 2001, Kabir, 2004).
A National Workshop on V.V.F. organized by the national task force on Vesico Vaginal Fistula in collaboration with grass root health organization in Nigeria in 1993, noted that there is no true survey of Vesico Vaginal Fistula in Nigeria particularly as regards the extent on areas of concentration, but is estimated that 200,000 cases are presently in existence and 10,000 new cases are seen annually (Njoku, 2006).
Chuike (1994) submitted that from the present knowledge, the areas of high prevalence are Kano, Katsina, Sokoto, Bauchi, Maiduguri, Zaria, Kaduna, Malumfashi, Funtua and Daura. In light of the above, the choice of Kano State as seat for this study is quite appropriate as this study intends to establish a reliable base data in reference to women in Kano State.
Vesico Vaginal Fistula is a preventable condition and hence, the problem of VVF should not be allowed on a large proportion especially among women of Kano State. Also considering the fact that most of the women affected are teenagers, that shows the danger it constitute to the future mothers of this our great nation, Nigeria.
Government and its citizens cannot afford the wastage of these groups of (young women). Our young women who are mostly affected must be alive and healthy to meet the challenging perception of women and the important roles they play within the society. The new millennium has bright opportunities for the feminine gender and any health problem which tends to stay in their way to accomplishing these opportunities must be amply tackled from medical point of view.
Most of the causes of Vesico-Vaginal-Fistula are the end result of a prolong obstructed labor at child bearing during which the bladder, the anterior vaginal wall and the urethra are compressed between the foetal head and the maternal pubis; thus causing the tear (Kees, 2001). Labor usually becomes obstructed, when the pelvis is too small for the passage of the baby. It is pathetic to observe that some women especially in the rural areas are left to labor for days without medical intervention; the implication of this is that an atmosphere conducive for the development of Vesico-Vaginal-Fistula is created. Those social conditions require Government intervention through public enlightenment and campaigns as it needs to be treated with the utmost urgency it requires, because of its socio-economic, psychological and physiological consequences. It has achieved this status not only because of the high death or diseases rate of these women living with the condition they suffered from but because of the trauma these victims undergo (Kuti, 2001).
It is indeed a social calamity to mankind, in spite of this knowledge especially the knowledge that Vesico-vaginal fistula is a preventable condition; yet, it continues to remain a public health menace with its prevalence. Apparently intervention strategies have failed to make any appreciable impact on the incidence of the disease. This may not be unconnected to the fact that no community based studies has been conducted to ascertain the causes and prevalence of VVF among Hausa/Fulani women in Kano State (Kees, 1992).
It is in the light of the above that there is urgent need for studies of this nature with proper understanding; to the factors which all together contribute to the occurrence of vesico- vaginal-fistula among women in Kano State. Probably, besides, Ethiopia, there is no other country in Africa, where V.V.F. is of such public health importance as in Nigeria. According to Bandipo (1994) there are no community data based, but from hospital records and studies at
Kano, and Kaduna states the incidence rate has been estimated at a minimum of 2 per-1000 deliveries.
Bandipo (1995) also observed that the victims of Vesico-vaginal-fistula in Northern Nigeria are usually in their mid-teens that had been married at 12 - 13 years of age. The women with Vesico-vaginal-fistula are often rejected by their families and communities impoverished and divorced. The consequence of this condition is that the Vesico-vaginal-fistula victims are stigmatized. The society most often develops negative attitudes in response to Vesico fistula conditions.
There is the need for victims to struggle with these negative attitudes and develop strategies for handling the V.V.F. condition. On the other hand, if a victim fails to do this, they may not be able to function adequately in the society. These and other factors have prompted the researcher to carry out the present study to assess the causes and prevalence of VVF among Hausa / Fulani women in Kano State.
1.2 Statement of the Problem
Vesico Vaginal fistula is one of the most disturbing health problems of women of child bearing age in our communities today. It is fast becoming one of the most debilitating factors hindering the development of the womenfolk. The disease incapacitates victims for months and sometimes for years, causing untold hardships to the victims, their families and the community at large. This terrible health condition often leads to isolation of the victim in a way that may cause social and psychological consequences.
The menace of Vesico vaginal Fistula could be arrested or tackled if proper care is taken to understand the nature, causes and consequences of the disease. It is pathetic to observe that some women especially in the rural areas are left to labor for days without medical intervention, thereby creating a conducive atmosphere for the development of Vesico vaginal fistula. Efforts should be made to eliminate this dehumanizing health condition of women in our society, since it is preventable.
Because of the physiological, social and psychological consequences of the disease among the Hausa/Fulani women in Kano State, there is the need to find out the causes and prevalence of the disease in Kano State with a view to curbing the menace.
1.3 Research Questions
This study sought answers to the following research questions.
1) What are the causes of VVF among Hausa/Fulani women as perceived by the respondents of different status in Kano State?
2) Are there differences in the prevalence of VVF among Hausa/Fulani women as perceived by the respondents of different status in Kano state?
3) What are the effects of VVF among Hausa/Fulani women as perceived by the respondents of different status in Kano state?
4) Are there differences in adequacy of facilities / equipment for VVF treatment as perceived by the respondents of different status in Kano State?
1.4 Purpose of the Study
The purpose of this study was to:
1) Identify causes of Vesico Vaginal Fistula among Hausa/Fulani women in Kano state.
2) Identify factors responsible for the prevalence of Vesico vaginal fistula among Hausa/Fulani women in Kano State.
3) Identify the stigmatizations that Hausa/Fulani Women victims of Vesico Vaginal Fistula suffer in Kano State.
4) Determine the availability and adequacy of facilities and equipment for the treatment of Vesico Vaginal Fistula in Kano State.
1.5 Basic Assumption
This study was based on the following assumptions:
1) The causes of Vesico Vaginal Fistula among Hausa/Fulani women in Kano State are related to early marriage, prolonged labor and cultural beliefs of the patient.
2) The prevalence of Vesico vaginal fistula among Hausa/Fulani women in Kano State are related to place of residence and knowledge of the patients.
3) Hausa/Fulani women victims of Vesico vaginal Fistula suffer stigmatization.
4) Facilities and equipment for treatment of Vesico vaginal fistula are not adequately available in Kano State.
1.6 Hypotheses
Based on the research questions and assumptions, the following hypotheses were raised for this study.
Major Hypothesis
There is no significant difference between the respondents of different status in their perception on the causes, prevalent, effect and adequacy of facilities on VVF among Hausa/Fulani women in Kano State.
Sub-Hypotheses
1) There is no significant difference among the respondents of different status in their perception of the causes of Vesico vaginal fistula among Hausa/Fulani women in Kano State.
2) There is no significant difference among the respondents of different status in their perception on the prevalence of vesico vaginal fistula among Hausa/Fulani women in Kano State.
3) There is no significant difference among the respondents of different status in their perception on the effect of vesico vaginal fistula among Hausa/Fulani women in Kano State.
4) There is no significant difference among the respondents of different status in their perception on the adequacy of facilities / equipment for the treatment of vesico vaginal fistula patients in the health care centers in Kano State.
1.7 Significance of the Study
The outcome of this study would be significant in the following respects:
1. The findings of this study would provide information on the causes and prevalence of VVF among Hausa / Fulani women in Kano State, with a view to curbing the menace.
2. The findings of the study would motivate government and non-governmental organization that are interested in women and child development to formulate health
policies that will help rehabilitate VVF patients as well as eradicate the disease in Kano State as well as other states were the disease is prevalent.
3. The study will motivate the enactment and enforcement of legislation on age at first marriage for girls to prevent the effect of early marriage in the development of VVF among women.
1.8 Delimitation of the Study
This study was delimited to the causes and prevalence of Vesico Vaginal Fistula among Hausa/Fulani women in two VVF centers in KANO. It was also delimited to the availability of facilities and equipment for the treatment of Vesico vaginal Fistula in the sampled local government areas.
1.9 Limitation of the Study
This study had the following limitations:
1. Some of the Vesico-vaginal fistula patients could not be reached due to leaking urine and stool.
2. Some of the respondents were not willing to give accurate information on the statements in the questionnaire. However, these limitations were taking care of through the research assistants who helped in translating the intention of the research to the respondents in their own native language. Also, the limitations were given adequate consideration during the analysis and interpretation of the results of the study.
.