Vesico Vaginal Fistula In Birnin Health And Social Care Essay

Vesico vaginal Fistula In Birnin health And Social Cargon EssayApproximately, ab unwrap 7 million women were affected from complication of pregnancy and child have a bun in the oven oecumenic. Out of the estimates, 6.5million women argon from the underdeveloped countries. (WHO Global burden of infirmity 1998).According to the data from western Afri abide Journal of Medicine (WAJM 2004 23 1) the prevalence of obstetric venous sinus in West Africa is around 1-3 per 1000 deliveries while, in new(prenominal) African vicinity is 5-10 per 1000 deliveries.Report shows that, maternal(p) morbidity and mortality is among the major problem for women in Nigeria. Maternal mortality ratio of 800 expirations per 100,000 live births which is also rated among the superiorest in the world. The name further democracyd that for each death that occurred 20 or much women will be affected by childbirth injuries and most of this is obstetric venous sinus (UNFPA/Nigeria 2005).Obstetric fistul ous withers is one of the maternal morbidities and mortality problem in Nigeria which is an edit of concern to Public Health (WAJM 2010 29 (5) 293-298. The situation is being more evidence in the Yankee part of the country, prevalence estimation ranges from as low as 400,000 to as much as 800,000 cases, 5% of these cases atomic number 18 from the Northern region. There could probably be an incidence of 20,000 new cases a year, with approximately 2,000-4,000 sinus repair surgeries being carried out yearly. Also Nigeria count for 40% of the worldwide venous sinus prevalence (Country assessment UNFPA/Nigeria 2009). Life expectancy of female population at birth is 52 yrs, with a total of 5.5 fertility rate (Unicef 2010).1Statistic report from (UNFPA /Nigeria 2005) stated that, majority of fistula patient visited the Health centers atomic number 18 below 20 years. Nigeria is facing a great challenges of Health care providers, with an estimated of 58-39% dexterous skilled attendan ce for Ante-Natal and delivery (Midwives) attached to the Health facilities (NDHS 2008). Efforts by the Government to provide them remain unsuccessful.In Nigeria, early couplings contribute 23% of the maternal death that are cause by severe hemorrh shape up, obstructed and pro eagle-eyed labor which may result to obstetric fistula and often date still birth. 69% of women in the rural areas face difficulties in accessing medical care that made them to get under ones skin home deliveries by unskilled birth attendant. (Lindros and Lowkkainen 2004).Kebbi State with an estimated population of 3.8million out of it 836,000 are women of child bearing jump on is located in the North West part of Nigeria. It has a particularly low socio -economic indicators. Maternal mortality place for the region are estimated at 1,000/100,000 live births (NDHS 2008) Total fertility rate is 8 which are above the national average. According to Leadership News write up 19 April 2012, stated that, kebbi s tate rank among the highest rate of maternal death in the country. Most of the direct causes of maternal death are hemorrhage, sepsis, eclamsia and anemia. While long and obstructed labor has been responsible for both maternal morbidity and mortality such as vesico-vaginal fistula. According to a survey, the state faces serious maternal challenges. historic period at marriage in the state is 12-13 years and most of them became meaning(a) by 13-14 years. VVF victims can be found in all part of the state with prevalence rate of 5,000-8,000, Birnin Kebbi Local Government has the highest rate of 2,500 cases. (Khalid Zango 1996). Factors accounts for high morbidity in women in the state include social, cultural, economic accessibility and health rapidness associated problems.2Obstetric fistula is can be treated but, beggary, ignorance and lack of information are the most contributing factor for women to seek for medical attention. These high prevalence shows negligence for the governm ent to address the situation.This try out actually is going to look in to the Knowledge just nigh the vesico vaginal fistula and the attitude towards it. The interpret will also be conducted among women with and without vesico vaginal fistula. The result will provide information as to friendship level regarding vesico vaginal fistula and as to how the women without fistula look at vesico vaginal fistula as a disease and their attitude towards fistula women.1.2. Research questions battlefield1.2.1 What is the prevalence of self reported cases of Vesico Vaginal Fistula among married women?1.2.2. What are the knowledge, attitude and knowledge of preventive measures of women towards vesico vaginal fistula in Birnin -Kebbi LGA of Kebbi- State, Nigeria?1.3. Research HypothesisKnowledge, attitude and preventive measures of women towards vesico vaginal fistula living in Birnin Kebbi Local Government of Kebbi State, Nigeria.31.4. Objectives1.4.1. General ObjectiveTo assess the knowledg e and attitude towards vesico vaginal fistula in Birnin Kebbi LGA of Kebbi State, Nigeria.1.4.2. Specific ObjectivesTo study the prevalence of vesico vaginal fistula in Birnin Kebbi LGA.To assess the level of knowledge of married women on the contributing factors of vesico vaginal fistula.To find out if married women knows about preventive measures of vesico vaginal fistula.To determine the attitude towards women with vesico vaginal fistula.To determine the possible risks factors related to consideration of vesico vaginal fistula.To analyze the association of knowledge and attitude with the status of vesico vaginal fistula.41.5. Conceptual FrameworkSocio -demographicAgeOccupationEducationSocio-cultural factorsAge of weddingpatriarchateGender violenceWorkloadParity positioning of Vesico vaginal fistulaAccess to health careAntenatal visitUntrained birthAttendantsPost natalPlace of deliveryAaaaaa111111Knowledge about theRisk factors, pledge and symptoms and preventive measures of ve sico vaginal fistula stead of women towards vesico vaginal fistula and women with recto vaginal fistula1.6. Operational Definitions-51.6. Operational Definitions-Age of Marriage refers to getting marriage below 18 yrs.Poor birth practices Home delivery by un- skill attendant.Parity Multiple birth with low spacing.Patriarchy Head of the house decision is final.Untrained birth attendants Untrained or self practice in delivery.Knowledge Knowledge in this study regarding to sign and symptom of VVF.Attitude In this study refers to the availability of health services and the barriers to seeking.Preventive Measures Knowledge about steps to tackle the VVF.Status of vesico vaginal fistula- The status of vesico vaginal fistula in this study is women have obstetric fistula or vesico vaginal fistula6CHAPTER 11LITERATURE surveyThe chapter 11 deals with theHistory Vesico Vaginal FistulaGlobal situation of vesico vaginal fistula stance of Fistula in NigeriaCauses of vesico vaginal fistula Social Consequences of vesico vaginal fistulaTreatment of vesico vaginal fistul2.1. History of vesico vaginal fistulaVesico vagianal fistula or obstetric fistula has been identified to be a major issue or women of child bearing age since decades. In 1935 professor Derry from Cairo stated that, the remains of Queen Henhenit (2050 BC) were the oldest to discover fistula. Around 1845 james marion sims was the first operating surgeon to successfully repair VVF from a 3 female slaves in Montgonery Albana. Later, in 1852 he established a VVF repair centre where many patients from America and europium came for surgery (Robert F. Zacharin 2008).A discovery during 1550 BC in the ancient Egypt, Aveicenna was a famous Arabian physician to differentiate VVF and obstetric (Derry DE 1935 42490). A nonher insane asylum came up in 1836 from Peter Mettnauer from Virginia who was identified to be the first surgeon to close fistula in United State (Aust N.Z.J. surg (2000) 70, 851-854.) write up re points that, during the 19th Century, women with fistula in United State and Europe were caused by dystocia (Russell). In the early 20th century, more experiments and techniques came up to improve the quality of VVF repair. Again, in 1942 Latzko published a new procedure in repairing post -hysterctomy of VVF which recorded 95-100% success (VVF MedScape).Many historical innovations and advanced technique by surgeons has been recorded while, more researches and experiment are still ongoing for the improvement and better solution towards VVF.72.2. Global Situation of Vesico Vaginal FistulaVesico Vaginal fistula (VVF) which is also called obstetric fistula is an abnormal opening between the urinary bladder and the vagina or between the vagina and the rectum (RVF).This is caused as a result of prolong labor where the child presses against the normal itinerary in that respectby developing the hole between the vagina and the urinary bladder (WHO def).Globally, 529,000 women were estimate d to have died every year due to pregnancy and childbirth related complication. Almost 90 percent of this death is from Africa and Asia. Generally, 5 percent of this death is expected to have experience from obstructed labor (UNFPA/Nigeria 2005).According to M.J Metro report in 2006 indicated as VVF is not new disease it has been in existence for decades. He further highlighted that, in the third world countries by and large in the west 90% of VVF cases are caused by bladder trauma during hysterectomy surgery. Nowadays, advanced technologies from developed countries such as Europe and part of North America have eliminated the disease (VVF) in there region (M.J.Metro 2006).In the same report of metro 2006, he stated that, VVF is an uncomfortable disease the victims should be more serious towards their person-to-person hygiene.In a WHO report of 2006 indicates that, about 2 million women living with untreated VVF, while 50,000 to 100,000 new cases are reported every year (WHO 2006).T he increase on figures could be due to stigma that associated with the situation. Also in another report from WHO study on global burden of disease, stated that, if 2% of the obstructed labor are caused by VVF, then 130,000 women are going to be affected with the condition (WHO 1998 243-66).A study report published from UK indicated that, out of 166 cases treated deep down 18 year, only 21 cases are caused by obstetric complications. Another report from Nigeria stated that, out of 377 cases of VVF 369 cases are caused by childbirth (Lawson J. 1998, 83 454-456).82.3. Situation of vesico vaginal fistula in NigeriaThe millennium Development Goals (MDGs) targeted at reducing the proportion of women dying in childbirth by three quarter by 2015 become unrealistic in Nigeria. (Adeyemi Ezekiel). The reason behind it is that, the country has made less progress in reducing maternal and mortality than any other sub-Saharan African countries. The maternal mortality rate in Nigeria estimated as 800nto 1,500 per 100,000 live birth (WHO 2006).The Northern part of the country has generally worse indicators with an estimated maternal mortality rate of 1,500/100,000 live birth. The high maternal mortality rate affects the basic health services in the country (NDHS 2003).According to UNFPA report, Nigeria approximately to have an estimate of 400,000 and 800,000 women affected with VVF condition while, 20,000 new cases are recorded every year. Most of these patients are from the northern part that lives in the rural areas where they find it difficulties in accessing proper medical care. (UNFPA/Fistula Nigeria 2005). Also statistics shows that, most of the VVF victims are below 20years.The underlying cause of VVF in Nigeria is due to prolong obstructed labor and mostly the young ages are at risk due to early marriage and early childbirth where there body is still in the stage of developing (WHO2006). In 2002, a multi-sectorial committee was setup by the Federal Ministry of Health to find the solution to the problem. At the same time the committee identifies Engender Health along with UNFPA/Nigeria to conduct a nationwide needs assessment in order to develop a framework and action plan for the liquidation of fistula in Nigeria.Although Nigeria has been taking measure to address productive health and maternal health problems, the implemented interventions have not reach optimum coverage to throw the desired impact. (NDHS 2008).92.4 TYPES OF FISTULAMany surgeons have described fistula according to their experience during repair. In 1852 Sims also classified fistula by its spatial relation in the vagina. According to (Cater, Palumbo et al. 1952) stated that, it is difficult to describe the reported cases of fistula but, the beat method is to identify it during the actual operation and the result.Mayor clinic doctor has in short classified six types of vaginal fistulaVesico vaginal fistula- is abnormal opening between the vagina and urinary bladderUreterova ginal fistula- is abnormal opening that connect the vagina and the ducts which carry the piss from the kidney to the bladder.Urethrovaginal fistula- is an opening between the vagina and the tube that carries the urine out.Rectovaginal fistula- an opening between the vagin and the opening anus.Colovaginal fistula- the opening between the vagina and the large intestine.Enterovaginal fistula- an opening between the small intestine and the vagina.102.5. CAUSES OF VVFMany publications and journals have their different versions on the causes of vesico vaginal fistula. According to medicine for African journal classified the factors that contributed to the cause of vesico vaginal fistula as (MfA- VVF) firsthand factorChildbirth 8% of the VVF cases are prolong and obstructed labor where the deliveries are conducted by untrained skilled birth attendant or as a result of malpresentation of baby in the uterus which cause a lot of damage to the womans urinary tract.Hysterectomy or other gyne cological problem- This can be caused by accidental surgery that occur within the pelvic and may result to VVF.Gishiri cut or Salt cut- It is a conventional way of treatment by a traditional healers mostly practice in Nigeria and some part of west Africa. When a woman present Gishiri disease symptoms such as vulva itching, absence of menstruation, infertility or obstructed labor. As a result of these symptoms a local surgical cut in the frontal vagina wall of a woman was done for total cure.During removal of clitoris in a cognitive operation of female Genital mutilation or female circumcision the vaginal tissues and its surrounding will be scrapped thereby causes VVF.Secondary factorSexual transmission disease or previous pelvic inflammatory disease.Bladder rock candy or retain foreign body within the vaginaDiabetics2.5.3. Socio-cultural causesThe most underlying socio-cultural causes in Nigeria are Early marriage harmful traditional birth practices poverty and illiteracy.112.5 .4. Early marriageEarly marriage can be define as being marriage at the age of 15-24 years when the reproductive organs are not fully matured for taking responsibility as done by the adult. This will result t damage of the birth canal that will lead to vaginal fistula (John Zang). According to WHO/UNICEF, the recommended age of marriage is 25 to 26 years.In article 16, of the convention on the elimination of all forms of discrimination against women, specified the right to protect child marriage.I n a publication from unicef research centre on early marriage 2001 stated the guidelines on changing attitudes of families and societies towards child marriage.According to global assessment of child marriage it is estimated that, South Asia and Africa has the highest number of young women/young girls who are accustomed out into marriage at the age of 15-24years. These will affect their nutritional status which will lead to so many pregnancy- related complications and most of the time she has no say in making decision for herself.Also in another report from WHO 2006 indicate that more than 25% of women with fistula from Ethiopia and Nigeria are pregnant in the first place the age of 15years while over 80% of them also become pregnant at 18years of age.2.6. SOCIAL CONSEQUENCES OF VVFAlmost all the report from the medical professional person indicates the psychological consequences of women with VVF that bears. This is attributed due to lacj of support from the families and societies as a whole. Majority of these women faces great challenges in the society because of the odour from the incontinence of urine.12According to WHO report indicate that, women with VVF are facing difficulties to manage the urinary incontinence that causes odour from urine. The report also highlighted that, due to injury to the vaginal wall many complications may plagiarize even after obstetric repair of the VVF. These complications are narrowing of the vagina, secondary amenorrhea inabilit y to carry the child.However, (Murphy 1981 and Harrison 1983) stated that, the most traumatic aspect of VVF resulting to urinary incontinence and lost of child who sometime may lead to marital separation/divorce and also social excommunication.In another report from (WHO 2006), VVF patients are to be sympathized due to the lower social status of women in Nigeria. The most disheartening is that, they are abandoning by their husband and they have limited role within the family.2.7. TreatmentWomen with fistula face a lot of challenges which most of the time find difficult to disclose their situation. The only solution for their survivor is surgery and personal hygiene.A statement from WHO Maternal Health and Safe Motherhood program indicate that, the endemic VVF area should focus prevention aspect through impelling social changes that will improve the status of women.13CHAPTER 111RESEARCH METHODOLOGY3.1. Research DesignCross- sectional survey study among the married women of reproduct ive age in Birnin Kebbi LGA in Kebbi State, Nigeria.Focus base approach to assess the knowledge and attitude towards vesico vaginal fistula among people who live in Birnin Kebbi LGA, in Kebbi State, Nigeria.3.2 discover AreaBirnin- Kebbi LGA which lies in the centre of Kebbi State of Nigeria. A total of 45 wards - Nasarawa 1, Nasarawa 11, Dangaldima, Marafa, Gwadangwaji, Zauro, Ambursa, Gulumbe, Ujario, Kardi, Gawasu, ,Makera, Kola, Tarasa, Fadama,3.3. Study PopulationThe study will be among the married women of reproductive age 15-49yrs of age.3.4. Sample TechniqueSelection of Sample sites Systematic Randomly sampling will be done for the collection of data in 45 settlements from 15 wards3.4.1 Exclusion criteria areThe sample who are not Birnin Kebbi casesThe samples have never followed up doctor or refilled medical attention during 3 months prior to studyThe sample who are unable to communicate verbally and orally to interviewer appropriately143.5. Sample sizingYamane sample si ze Formulan=z2p (1-p)(e) 2n= (1.96)2 X 0.22 (1-0.22) = 264(0.05)2Where ,n = sample sizep = proportion of women of reproductive age in B/Kebbi LGA that are expected to have knowledge about vesico viginal fistula.e = Marginal error or accepted errorz = Standard value of 95% confidence interval of 1.96Sample size is 264 + 10% to add up in case of any missing value/data, the total sample size will be 264 + 26.4 (10%)= 2903.6. Measuring Tools be questionnaires are to be admitted on knowledge and attitude of married women towards vesico vaginal fistula.Face to Face interview will be carried out during the focus group discussion3.7. Validity and Reliability testValidity test3 Expert validity are to be selected from B/K LGA.Questionnaire will be checked and reviewed by these 3 experts.15Reliability testQuestionnaire will be pr-tested by the respondents who are comparable to the targeted respondents. The reliability of questionnaire will be statistically tested with the Crobachs Alpha, whic h its acceptable coefficient is more than0.743.8. Data CollectionConstructed questionnaires to be used on the followingsQuestionnairesGeneral and household information,Knowledge towards the sign and symptom of Vesico Vaginal Fistula.Attitude towards thePreventive Measures on the vesico vaginal fistulaAccess to the health facility- information and service.Focus group discussion women with and without VVF3.9. Data Analysis (Statistics)Questionnaire will be coded before entering into the computer.SPSS version 17 will be usedDescriptive statistic is to be used to analyze data which will describe the frequency, percentage, mean and standard deviation3.10. Ethical ConsiderationUnder the guidance of College of Public Health Sciences, and local authoritiesInterviewees will be informed and explainedInformed signed react16Have freedom to withdrawalConfidentialityConvenienceCan access to final report or resultsNot use for other purpose3.11. limitationThe study will not represent the general population of Birnin Kebbi LGA.Different socio-demographic group may have different practiceThe study will not represent for other types.17REFERENCES LISTMargaret Murphy (1981). Social Consequences of Vesico-Vaginal Fistula in Northern Nigeria. Journal of Biosocial Science, 13 , pp 139-150 doi10.1017/S0021932000013304Vesicovaginal fistula. Retrieved from the web15/08/2006. http//www.emedicine.com/med/topic3321.htmWall, L. L (1988) Dead Mothers and injured wives The Social Context ofmaternal morbidity and mortality among the Hausa of Northern Nigeria. Studies in family planning 29 341-359WHO (2006) Obstetric Fistula Guiding principles for clinical management and programme development. WHP Press Geneva Zacharin, R F. 1998. Obstetric Fistula. New York Springer-Verlag Wien.COMPASS 2006 FMOH partnership works to achieve Millennium Development Goal of change maternal health care Abuja, Nigeria September http//www.compassnigeria.org/site/PageServer?pagename=News_200609_FMoH_PartnershipH addad S, Fourier P Quality, Cost and Utilization of Health Services in Developing Countries A Longitudinal Study in Zaire. Soc Science Medicine 1995, 40 743-753.Metro (2006) Modification of OConnors technique for the treatment of VVFrepair described.Abu- Zahr C. Prolonged and obstructed labour, In Murray C. Lopez A. EdHealth dimensions of devolve on and reproduction the global burden of sextually transmitted diseases, HIV, maternal conditions, perinatal disorders and congenital anomalities, Cambridge Havard University Press for WHO. 1998 243-66Ijaiya MA, Aboyeji PA. Obstetric urogenital fistula the Ilorin experience, Nigeria. West Afr J Med 2004 23(1)7-9.http//Ezine terms.com/?expert=John_ZhangArticle Source http//EzineArticles.com/1016812Lawson J. Vesico -Vaginal fistula y a tropical disease. Trans R Soc. Trop. Med Hyg 1998 83 454-4561811. MfA VVF Vesicovaginal Fistulawww.medicinemd.com/Med/VesicoVaginal_Fistula_en.html12. AboutVaginal Fistulas Mayo Clinicwww.mayoclinic.org/vagin al-fistulas/about.htm19Time order of businessS/NActivities20122013Jun- AugSepOctNovDecJanFebMarAprMayJunJuly1Preparation and paper reviewxx2Detail and beam of light developmentxx3Ethical considerationxx4Research tool try out test validity and reliabilityx5Revise the toolx6Recruitment of interviewer teamxField work and data collectionxXData analysisxXReport writing and PresentationxxBudgetS/NITEMSBUDGET tical1Printing questionnaire-Photocopies-Stationery8,000Data collection-Photocopies Quest-Souvenir for respondent-Accommodation-Transportation cost-Data processing21,000Air fareMiscellaneous50,00020,000Total Thesis document process99,00