AN INVESTIGATION INTO THE PREVALENCE AND RISK FACTORS OF OBSTETRIC FISTULA IN RURAL NIGERIA. A CASE STUDY OF BINDAWA LGA, KATSINA STATE

CHAPTER ONE

INTRODUCTION

Background of the study

An obstetric fistula is a serious medical disorder that occurs when the baby's head becomes trapped in the delivery canal during protracted obstructed labour, resulting in continuous pressure on the mother's tissues. Ultimately, this pressure causes the development of a fistula, an anomalous aperture connecting the vagina with the bladder or rectum, leading to persistent urine or faecal incontinence (Ahmed & Holtz, 2017). This disease is a severe outcome of insufficient maternal healthcare, and it disproportionately impacts women in settings with little resources, especially in rural regions of developing nations such as Nigeria. Obstetric fistula has long been recognised as a significant public health concern across the world. Nevertheless, the occurrence of fistulas has dropped considerably with the introduction of contemporary obstetrics in industrialised nations. Conversely, the disease continues to be widespread in sub-Saharan Africa and South Asia, where there is little availability of trained birth attendants and emergency obstetric treatment (Wall, 2022). According to the World Health Organisation (WHO), the annual worldwide incidence of obstetric fistula is estimated to range from 50,000 to 100,000 new cases. The majority of these cases occur in rural regions of poor nations (WHO, 2018).

Obstructive fistula imposes a substantial burden on Nigeria, the most populous nation in Africa. The estimated number of women living with the disorder in Nigeria ranges from 400,000 to 800,000, with an annual incidence of around 12,000 to 20,000 new cases (UNFPA, 2017). Opetric fistula is most prevalent in the northern parts of the nation, characterised by frequent early marriages and teenage births, as well as restricted availability of maternal healthcare facilities (Ibrahim et al., 2016).

The vulnerability of rural communities in Nigeria is heightened by a confluence of variables, including poverty, limited access to education, insufficient healthcare infrastructure, and cultural norms that favour home deliveries and discourage the use of contemporary medical facilities. In these areas, women often have home deliveries without the presence of trained healthcare professionals, therefore increasing the likelihood of extended labour and subsequent development of fistulas (Wall, 2022). A multitude of risk factors contribute to the elevated incidence of obstetric fistula in rural Nigeria. One crucial determinant is the absence of timely and sufficient access to maternity healthcare. Healthcare institutions in rural locations are generally situated at a considerable distance from communities, and the transportation infrastructure is inadequate, which poses challenges for women to access these facilities during childbirth (Adler et al., 2015). Moreover, the scarcity of proficient birth attendants in rural regions worsens the issue, as birth attendants who lack expertise or have inadequate training are less prepared to manage difficulties after labour.

The prevalence of obstetric fistula is significantly influenced by cultural traditions. Premature marriage and teenage pregnancies are prevalent in rural Nigeria, resulting in an increased likelihood of obstructed labour caused by the undeveloped pelvis of young women (Ibrahim et al., 2016). Moreover, the inclination towards home births instead of hospital deliveries, influenced by cultural conventions and lack of confidence in official healthcare organisations, raises the probability of extended labour and the occurrence of fistulas (Ahmed & Holtz, 2017).

The issue is further exacerbated by socioeconomic variables such as poverty and inadequate levels of education. Women hailing from economically disadvantaged origins are less inclined to bear the expenses related to transportation to healthcare facilities or the costs included in hospital births. Furthermore, the limited educational attainment of women hampers their understanding of the need of seeking professional medical attention during labour, resulting in delays in obtaining emergency obstetric services (Wall, 2022). In acknowledgement of the gravity of the issue, the Nigerian government, in partnership with global entities like the United Nations Population Fund (UNFPA), has executed many initiatives targeted at the prevention and management of obstetric fistula. These interventions include enhancing the availability of emergency obstetric care, providing training to healthcare professionals in fistula repair, and promoting awareness on the significance of competent birth attendance (UNFPA, 2017). Notwithstanding these efforts, obstacles persist. The negative perception linked to obstetric fistula often discourages women who are afflicted from obtaining medical care, resulting in social seclusion and further marginalisation (Ahmed & Holtz, 2017). Furthermore, the restricted accessibility of fistula repair procedures results in a significant number of women being left without treatment, therefore perpetuating the physical and psychological repercussions of the disease.  Therefore, the researcher sought to investigate  the prevalence and risk factors of obstetric fistula in rural Nigeria. A case study of Bindawa LGA, Katsina State.

Statement of the problem

Obstetric fistula is a serious and incapacitating disease that mostly impacts women in rural Nigeria, especially those living in economically disadvantaged and underprivileged areas. Notwithstanding the progress made in maternal healthcare, the occurrence of obstetric fistula continues to be critically high in these regions. This disorder, marked by an atypical aperture between the birth canal and the bladder or rectum, often arises from prolonged, blocked labour without prompt medical assistance (UNFPA, 2021). The vulnerability of women afflicted with obstetric fistula is further compounded by the presence of persistent incontinence, social isolation, and intense psychological anguish. 

The enduring presence of obstetric fistula in rural Nigeria can be ascribed to a confluence of risk factors, encompassing insufficient availability of proficient birth attendants, inadequate healthcare infrastructure, cultural customs such as early marriage and childbearing, and low socioeconomic standing (Tebeu et al., 2022). These variables contribute to the elevated occurrence of obstructed labour, which, in the absence of timely and efficient medical intervention, results in the formation of fistulas. Moreover, the negative perception linked to obstetric fistula often discourages women from obtaining the essential medical care, resulting in their silent suffering. Despite the Nigerian government and foreign organisations' attempts to tackle this problem, there remains a substantial knowledge vacuum on the precise occurrence and risk factors linked to obstetric fistula in rural areas. Hence, the study investigate  the prevalence and risk factors of obstetric fistula in rural Nigeria. A case study of Bindawa LGA, Katsina State. 

1.3 Objective of the study

The broad objective of the study is to investigate  the prevalence and risk factors of obstetric fistula in rural Nigeria. A case study of Bindawa LGA, Katsina State. The specific objectives is as follows

To analyze the level of awareness about obstetric fistula among women in rural Nigeria

To determine the prevalence of obstetric fistula among women of reproductive age in rural Nigeria.

To assess the risk factors associated with obstetric fistula in rural Nigeria. 

1.4 Research questions

The following questions have been prepared to guide the study

What is the level of awareness about obstetric fistula among women in rural Nigeria?

What is the prevalence of obstetric fistula among women of reproductive age in rural Nigeria?

What are the risk factors associated with obstetric fistula in rural Nigeria?

1.5 Significance of the study

Findings of the study will be significant to the ministry of health as it will reveal the barriers to accessing timely and adequate maternal healthcare and also offer critical recommendation in designing targeted interventions to prevent obstructed labor, the primary cause of obstetric fistula. This will aid policymakers and healthcare providers in developing more effective maternal health programs, particularly in rural areas where the burden of obstetric fistula is highest.In addition, the study will be significant to the academic community as it will contribute to the existing body of knowledge and also serve as a guide to future researchers.

1.6 Scope of the study

The study focus on  the prevalence and risk factors of obstetric fistula in rural Nigeria. A case study of Bindawa LGA, Katsina State. Empirically, the study will  analyze the level of awareness about obstetric fistula among women in rural Nigeria, determine the prevalence of obstetric fistula among women of reproductive age in rural Nigeria and  assess the risk factors associated with obstetric fistula in rural Nigeria. 

Geographically, the study is delimited to Bindawa LGA, Katsina State

1.7 Limitation of the study

Like in every human endeavour, the researchers encountered slight constraints while carrying out the study. The significant constraints are: 

Time: The researcher encountered time constraint as the researcher had to carry out this research alongside other academic activities such as attending lectures and other educational activities required of her.

Finance: The researcher incurred more financial expenses in carrying out this study such as typesetting, printing, sourcing for relevant materials, literature, or information and in the data collection process.

Availability of Materials: The researcher encountered challenges in sourcing for literature in this study. The scarcity of literature on the subject due to the nature of the discourse was a limitation to this study

1.8 Definition of terms

Obstetric Fistula: A medical condition characterized by an abnormal opening between the vagina and the bladder or rectum, typically resulting from prolonged obstructed labor. This condition leads to continuous urinary or fecal incontinence (Ahmed & Holtz, 2007).

Prevalence: The proportion of a particular population found to be affected by a medical condition at a specific time. In this study, it refers to the percentage of women in rural Nigeria who are living with obstetric fistula.

Risk Factors: Variables or conditions that increase the likelihood of developing a disease or injury. In the context of this study, risk factors refer to the social, economic, cultural, and healthcare-related factors that contribute to the occurrence of obstetric fistula in rural Nigeria.

Rural Nigeria:  Areas in Nigeria that are located outside major urban centers, characterized by lower population density, limited access to healthcare services, and a higher prevalence of traditional practices that may impact maternal health.

Maternal Healthcare: Medical care and services provided to women during pregnancy, childbirth, and the postpartum period. It includes prenatal care, skilled birth attendance, emergency obstetric care, and postpartum support.

Prolonged Obstructed Labor: A labor that lasts longer than normal and in which the baby’s head is unable to pass through the mother’s pelvis, leading to complications. It is a major cause of obstetric fistula if not promptly managed.

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