report of the rapid assessment of vesico-vaginal fistulae in nigeria

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AETIOLOGICAL FACTORS OF VVFObstructed labour is the precedent of most cases of VVF in Nigeria (3). InLawson’s series of 377 patients he operated upon at University College HospitalIbadan, 97.7% of the cases were due to obstetric causes. (3) The various obstetriccauses in this series included; obstructed labour 343 (92.9%), operatic trauma dueto vaginal delivery 4 (1.1%), operative trauma during caesarean section 15 (4.1%)and ruptured scar 7 (1.9%).In a study of 1443 patients with VVF operated upon in Zaria, 83.8% were due tolabour complications. (17) In a series of 840 cases of VVF at the University ofNigeria Teaching Hospital in Enugu, 98% of the cases were due to obstetriccauses. (29)In Waaldijk’s series in Katsina, 470 out of 500 (94%) of cases operated over fiveyears were due to obstetric causes. Prolonged obstructed labour due tocephalopelvic disproportion remains the major cause of VVF. The prolonged andunrelieved pressure of the presenting part of the foetus against the maternal pelvicwall results in necrosis of the intervening vagina, bladder and other structures inthe area. The mechanical mechanism by which VVF is formed followingobstructed labour has been well described for years (5).In the Zaria VVF study, 50.9% of the patients with VVF due to labour had been inlabour for 2 or 3 days before delivery and 18.1% reported having been in labourfor more than 4 days (17). The clinical condition of the patients with suchprolonged labours seen in hospitals is confirmation of the prolonged and strenuousnature of the labour.24
In this study, it was found that the longer the duration of labour the more likelywere the lesions to be of larger size, associated with fibrosis in the vagina, moreinaccessible during operation and associated with worse foetal prognosis. For thepatients with VVF due to obstructed labour in the Zaria study 64.4% reported thatthey delivered at home. Of the remainder only 6.9% delivered at the ABU teachinghospital in Zaria, the others delivered in centres some of which had no facilities fordoing caesarean sections, majority of which had neither trained obstetricians noradequate services and were not easily accessible to the patients from the rural area.Those cases that delivered in ABU teaching hospital had a better foetal prognosisoverall compared to the total sample of VVF patients. This could be attributed tothe use of caesarean section and neonatal care in the hospital. It is noteworthy thatdelivering in a hospital in a case of obstructed labour improves the maternalprognosis as well as decreasing the foetal wastage. The care in the puerperiumincluding continuous catheterisation improves the chance of spontaneous healingof very small fistulae.TRADITIONAL SURGERY INCLUDING GISHIRI CUTTINGIn all parts of the country, certain traditional practices have resulted in theformation of VVF. One of the most occurring factors, in all parts of the country, isthe vaginal insertion of various herbs and medicaments for the traditional treatmentof various conditions such as dysperunia, infertility, congenital vaginal septum,vaginal infections, amenorrhoea, vaginal discharge and to procure abortion.Lawson (19) has noted that it is probably the highly alkaline vehicles of thesepreparations rather than the herbal contents, which damage the vaginal wall. Theherbal content may also act by releasing various substances that cause coagulativenecrosis of the vaginal epithelium. The irritating chemicals introduced into thevagina damage the epithelium by producing chemical burns. In severe cases, theresulting necrosis may involve the full thickness of the vaginal wall and lead into25
Page 1 and 2: REPORT OF THE RAPIDASSESSMENTOFVESI
Page 3 and 4: LIST OF TABLETable 1States policy &
Page 5 and 6: CHAPTER 1INTRODUCTIONIn the past de
Page 7 and 8: AimThe overall aim of the rapid ass
Page 9 and 10: • Officers in-charge of hospitals
Page 11 and 12: causes, cancers and radiation thera
Page 13 and 14: The work of Dr. Ann Ward OFR at St.
Page 15 and 16: 2. Establishment of a VVF hostel an
Page 17 and 18: Other aspects that engaged the atte
Page 19 and 20: Several hospital-based studies repo
Page 21 and 22: In August 1988, Dr. Altine Tongo of
Page 23: who provided controls. A second con
Page 27 and 28: other sweet substances, thus preven
Page 29 and 30: on themselves (i.e. possible pathol
Page 31 and 32: OTHER CAUSESLabour and the factors
Page 33 and 34: epair while the patient was trying
Page 35 and 36: likely to have mid-vaginal and high
Page 37 and 38: secondary education and 33% primary
Page 39 and 40: All over the country male children
Page 41 and 42: again before any surgery. The attit
Page 43 and 44: faith it is at times difficult in t
Page 45 and 46: CHAPTER 4RESULTS FROM FIELD ASSESSM
Page 47 and 48: Curative ActivitiesHealth Facilitie
Page 49 and 50: The other crucial need for VVF repa
Page 51 and 52: ackgrounds, this makes their econom
Page 53 and 54: The data on the distribution of hea
Page 55 and 56: VVF Repair OutputAvailable evidence
Page 57 and 58: the details on the payments VVF pat
Page 59 and 60: • Rehabiltation• Training of Do
Page 61 and 62: CONSTRAINTS TO OPTIMAL VVF WORK IN
Page 63 and 64: IX. Lack of comsummables for VVF re
Page 65 and 66: The centre has seven doctors, ten n
Page 67 and 68: NASSARAWA STATEWe were not able to
Page 69 and 70: Patients profileThe few VVF patient
Page 71 and 72: InfrastructureThe facility had an o
Page 73 and 74: patients were expected to pay for a
Page 75 and 76:
thousand five hundred, surgery thre
Page 77 and 78:
Measures to reduce new cases- Econo
Page 79 and 80:
state government owned. Federal Med
Page 81 and 82:
STATE REPORT NORTH WEST ZONEStates
Page 83 and 84:
VVF work started here as far back a
Page 85 and 86:
to the patients. He identified the
Page 87 and 88:
Patient ProfileMost of the patient
Page 89 and 90:
gynaecologist in the hospitals and
Page 91 and 92:
patients come to the hospital from
Page 93 and 94:
equipment/theatre table trained nur
Page 95 and 96:
OGUN STATEAt the Ministry of Health
Page 97 and 98:
O & G state specialist Hospital Ado
Page 99 and 100:
RECOMMENDATIONSIn the process of th
Page 101 and 102:
Table 2: Facilities Involved with V
Page 103 and 104:
MedicalCentreQueenElizabethHospital
Page 105 and 106:
Table 4 : Doctors and Nurses Availa
Page 107 and 108:
UmulogboHoly RosaryHospital Emekuku
Page 109 and 110:
staff Working Trained Work VVFrepai
Page 111 and 112:
South East ZoneState Anambra Aghaez
Page 113 and 114:
HospitalAbohMbaiseFederalMedicalCen
Page 115 and 116:
REFERENCES1. Zacharin R.F. Obstetri
Page 117 and 118:
26. Lister U.G. Obstructed Labour-
Page 119 and 120:
Dear Sir or Madam:,We send you gree
Page 121 and 122:
(g) Name of the Hospitals involved
Page 123 and 124:
2. Trained VVF staffName ofYear ofD
Page 125 and 126:
5. How do VVF patients get their Su
Page 127 and 128:
Post operative; Cured, Uncured8. Wh
Page 129 and 130:
APPENDIX 2: LIST OF PERSONS CONTACT
Page 131 and 132:
KebbiKatsinawardVVF, Secretary Dr.
Page 133 and 134:
APPENDIX 4LIST OF DOCTORS AND NURSE
Page 135 and 136:
Dr. Sa’ad IdrisDr. Zubalru Iliyas
Page 137 and 138:
Medical anthropologistDr. Sandra BO
Page 139 and 140:
List of Nurses that receive trainin
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report of the rapid assessment of vesico-vaginal fistulae in nigeria

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