8/8/2019 Determination of Origin of Obstetric Fistula in Patients Receiving Care in Ebonyi State, Nigeria

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Determination of Origin of Obstetric Fistula in Patients Receiving Care in Ebonyi State, NigeriaMiller, S.; Janko, M.; Bengston, A.; Kuhn, R.; Adeoye, S.

University of Denver, Josef Korbel School of International Studies

Background

Methodology 

Future work 

References

Obstetric Fistula Defined:

Obstetric fistula (OF) is an abnormal hole caused by the necrosis of the tissue between the birthcanal and surrounding areas due to obstructed labor. The tissues between the vagina, rectum, andbladder are the most often affected, resulting in incontinence.

Case data from Ebonyi State was obtained from hospital reco rds and data gatheredduring the Southeast Regional Fistula Centre¶s community outreach efforts. Thosedata were then anonymized during a six-week period spanning April and May 2009,

when investigator Angie Bengtson was in country. Those records were later matchedto Geographic Information System (GIS) data o btained from a private Nigerian firmusing ArcGIS 10 and Stata. Total cases and total repairs were mapped at the town

level in order to gain an understanding o f the spatial distribution of both fistula andtreatment within Ebonyi.

These data were then aggregated and mapped at the Local Government Area (LGA),and, using population and housing data fro m the 2006 Nigerian census, theinvestigato rs were able to estimate OF prevalence amo ng women of child bearing age.

 Another map showing the repair rate (repairs/total cases) at the LGA level wasconstructed f or further broad-based comparison.

In order to understand t he underlying econo mic conditions in Ebonyi in relation tofistula prevalence, the investigator s conducted a factor analysis of several keysocioeconomic variables and mapped the results so as to show the overallsocioeconomic status within each Local Government Area (LGA).

Finally, in an effort to begin to generate a patient profile, severa l indicators of fistulapatients that were collected from the patient charts were compared to corresponding

DHS data from the southeastern region of Nigeria.

1. Wall, LL. (2006) Obstetric vesicovaginalfistula as an international public-health problem. The Lancet . 368:1201-1209.2. United Nation Population Fund. (2003) Obstetric fistula needs assessment report: findings from nine African countries. New

York, NY: UNFPA. Available at: http://www.unfpa.org/fistula/docs/fistula-needs-assessment.pdf .

3. Stanton, C, Holtz, SA, Ahmed, S. ( 2007) Challenges in measuring obstetric fistula. International Journal of Gynecology &Obstetrics .

99(Supplement 1):S4-9.

4. Donnay, F, Ramsey, K. (2006) Eliminating obstetric fistula: progress in partnerships. International Journal of Gynecology and Obstetrics. 94:254²261.

5. Kabir, M, Abubaker, IS, Umar, UI. (2004) Medico-social problems of patients with vesico-vaginal fistula in MurtalaMohammed

Specialist Hospital, Kano. Annals of African Medicine. 2(2):54±7.

6. Harrison, K. (1996) Macroeconomics and the African mother. Journal of the Royal Society of Medicine . 89:361±2.

7. Miller, S, Lester, F, Webster M& Cowan B. (2005) Obstetric fistula: Apreventable tragedy. Journal Health. 50(4):286-94.

This is a preliminary investigation of ongoing work in the region, and is currently being

developed into a case control study.

Because social rehabilitation is the ultimate goal for fistula patients, and be cause designing

effective programs requires an understanding of patients' needs, this work seeks to provide

sound quantitative analysis in support of that goal.

Secondarily, it seeks to help make the current, qualitative literature on social rehabilitation of 

OF patients more robust.

In recent years, obstetric fistula has gained increasing attention as a major international

public health concern. Despite greater awareness of this issue, it remains a critical problem

about which relatively little is known.

Prevalence Estimates:

 Although it is often cited that there are three million cases of fistula world wide, w ith

approximately 50,000100,000 new cases each year, these numbers are methodologically

suspect and true prevalence and incidence r ates are not known (1,2).

Importantly, the large presence of fistula in the southeastern, Christian part of Nigeria

stands in contrast to prevailing assumptions that fistula is a problem isolated to the

northern, Muslim parts of the country.

Fistula is believed to be most common in areas of the world reporting high maternal mortalityrates, such as subSaharan Africa and Asia (3). Patients often suffer from various social and

clinical sequelae, including: Spousal abandonment (separation or divorce) in 36% of cases.

Social rejection in 53% of Nigerian cases; depression in 33% (4).

Repair facilities are not widely available, transportation costs and distances are high.

The cost of emergency obstetric care is prohibitive.

-The cost of a cesarean section in Nigeria is equivalent to 9 months of wages (5) .

Women often do not know that treatment exists, and 16-32% of women remain incontinent

even after surgical repair (6).

80% of women with OF never seek treatment (1).

Tracking Treatment

 Aggregated Analysis

Case Profile

Correlates

Starfish One by One Foundation

Ebonyi State University Teaching Hospital Staff 

South East Regional Fistula Centre Staff 

University of Denver Social Science Foundation

 Acknowledgements

Social Rehabilitation

The correlation between fistula

prevalence and poverty at the LGA

level was significant at the.01 level.

=.74; P-value = 0.006

The correlation between treatmentand poverty at the LGA level was

not significant at any level.

=-.03; P-value = 0.92

DiscussionPrevalence of Fistula at the LGA level was positively correlated with poverty (=.74; P = 0.006),

whereas the correlation between treatment of fistula and poverty was not statistically significant

(=-.03; P = 0.92).

Interestingly, women are developing fistula at a higher parity than what would otherwise beexpected from a review of the relevant literature. Furthermore, women who developed fistula

had a higher proportion of deliveries in a hospital than WOCBA in general, though this could be

due to a number of reasons, including the possibility that women w ho were at risk for 

developing fistula were identified and thus more likely to deliver in a hospital.

 As expected, women with fistula were of slighter stature than the average for the region, and

appear much more likely to be in a polygamous marriage.