ABUJA, Nigeria – Nigeria has the highest prevalence of Vesico Vaginal Fistula (VVF) in the world, with between 400,000 and 800,000 women living with the problem and about 20,000 new cases occurring annually; 90 percent of the cases go untreated.
This implies that about 55 women are infected by Vesico Vaginal Fistula and 18,000 cases are untreated daily. It is estimated that two million women suffer from obstetric fistula globally.
Vesico Vaginal Fistula is a direct communication between the bladder and vagina is resulting in leakage of urine into the vagina. This is a major gynecological problem in the country. It also occurs when the blood supply to the tissues of the vagina and the bladder is restricted during prolonged obstructed labor, the tissues die between these organs, forming holes through which urine can pass uncontrollably.
In July 2013, the Minister of Women Affairs and Social Development, Hajiya Zainab Maina, said that Nigeria has been identified as the country with the highest number of Vesico Vaginal Fistula, accounting for about 0.4 million to 0.8 million out of the 2 million cases recorded globally.
But, why is this problem prevalent in Nigeria?
Dr. Rahmat Hassan Mohammad of the Foundation for Women’s Health, Research and Development has attributed the cause of VVF to unrelieved obstructed labor, accidental surgical injury related to pregnancy as well as to crude attempts at induced abortion. Lack of education coupled with low socio-economic status and powerlessness of young wives, mean that 87 percent of rural childbirths take place at home.
Similarly, Ijaiya, M. A., identified other common causes included Cesarean section, advanced cervical cancer and uterine rupture. The identified predisposing factors were early marriage and pregnancy, which were rampant in northern Nigeria. While unskilled birth attendance and late presentation to the health facilities was common nationwide, among the significant contributory factors to the high rate of unskilled birth attendance were poverty, illiteracy, ignorance, restriction of women’s movement, non-permission from husband and transportation.
According to Toyin Adebayo, in Nigeria, Vesico Vaginal Fistula has social, economic, and religious implications.
Many women with VVF are regarded as social outcasts and marriages have been dissolved as a result of this. Many girls between the ages of 11 and 15 in the country become mothers either through early marriage or through unwanted pregnancy. They experience obstructed labor even as some unskilled birth attendants simply cut through the vagina to create passage for the baby, that eventually results in VVF, the leakage of urine and feces through the vagina.
The malodorous nature of the condition makes women with Vesico Vaginal Fistula become outcast in the society.
There are hundreds of thousands of such cases throughout the federation. Senior Special Assistant to the President on Millennium Development Goals (MDGs), Dr. Precious Gbeneol, lamented the rising incidence of VVF in the country, adding that Nigeria has one of the worst incidences in the world.
What action has the Nigerian Government been taking?
According to Chief Iyeme Efem, Programme Manager at USAID Fistula Care Project in Nigeria, the disturbing magnitude of Vesico Vaginal Fistula prevalence in the country had forced the Federal Government to order care of 66,000 patients in 2013.
“The prevalence of the scourge in Nigeria is worrisome and President Goodluck Jonathan has ordered that 66,000 persons living with Vesico Vaginal Fistula conditions should be given free repair surgery in 2013,’’ he said.
Efem said a National Strategic Framework for the Elimination of Obstetric Fistula in Nigeria, covering 2011 to 2015 was currently in place — adding, however, that the President’s target might not be attained in 2013. He attributed his fear to lack of funds, saying that due to inadequate funding, USAID was only able to carry out repair surgeries on not more than 8, 000 patients in its centers across the country in 2012.
“Federal Government’s budgetary provision for the care of VVF patients in 2011 and 2012 were N300 million and N250 million, respectively; but the money was not released and no one could account for it,’’ he said.
He said the cost of repair surgery on a Vesico Vaginal Fistula patient was $250 (about N39,000), adding that an additional N50,000 was required for the rehabilitation of the patient after surgery. He urged the relevant authorities to release all approved funds for the handling of the scourge.
“It took us a lot of time and energy to convince the Federal Ministry of Health to provide and pursue budget for VVF treatment in the country.’’ The USAID program manager also said dearth of professionals in the field was another drawback to meeting the target.
If Vesico Vaginal Fistula problem is not resolved in Nigeria, author Gbola Jonathan Fasakin feared that the increasing victims would be abandoned or divorced by their husbands and become ostracized by families and societies because of their repulsive smell and inability to engage in sexual activity and bear children.
– Dickson Salami Adama