Introduction: Obstetric fistula is prevalent in sub-Saharan Africa. In Nigeria, it is more prevalent in the North compared to the South; and mainly rural. Urbanization has had significant impact on global health. Rapid urbanization is predicted to intensify in developing countries where fistula is endemic, but the pattern of presentation of obstetric fistula in urban areas is yet to be described. Objective: The objective of the study was to find out if obstetric fistula exists in Kaduna metropolis, and if it does, to explore the pattern of presentation. Methodology: Women living with obstetric fistula were mobilized from Kaduna metropolis for free screening and repair. They were screened using direct dye and three swab tests. Consenting patients with confirmed obstetric fistula were included in the study. Their socio-demographic and clinical data were captured using Microsoft Access and analyzed with Statistical Package for Social Sciences (SPSS) version 17. Results: All twenty three consenting women confirmed to have obstetric fistula lived within Kaduna city and had phone contacts. A depreciating proportion of primiparous women presented with obstetric fistula in Kaduna metropolis as multiparous women were in majority. The women also appeared to have higher height and weight measures and majority of them had access to fistula repair. They married early and were mostly uneducated and illiterate. Conclusion: Obstetric fistula afflicts women living in Kaduna metropolis. Women living with fistula in Kaduna metropolis appear to present different socio-demographic features, suggesting an emerging trend related to urbanization.
Obstetric fistula is the occurrence of an abnormal connection between the female genital tract and the urinary tract and/or the gastrointestinal tract, leading to continuous leakage of urine and/or faeces through the vagina following prolonged obstructed labour [
It has been estimated that over two million women with obstetric fistula await treatment globally [
The “typical fistula patient” was described as a small, short, illiterate, poor, rural divorcee, who got pregnant at an early age and developed obstetric fistula from her first labour that lasted at least two days and resulted in a stillborn foetus [
Widespread urbanization is a recent phenomenon with significant impact on human development and health [
We therefore hypothesize that obstetric fistula exists in urban areas. This study sought to find out if obstetric fistula exists in Kaduna metropolis and if so, then explore its socio-demographic pattern of presentation.
This was a descriptive cross-sectional study located in Kaduna metropolis. Kaduna city is the colonial capital of Northern Nigeria. It is located in North Western geopolitical zone which has the second largest burden of obstetric fistula in Nigeria [
Community mobilization was done through the FOMWAN hospital network to women groups, worship centres, hospitals, clinics markets and community leaders in Kaduna metropolis. Women with incontinence of urine and or faeces were invited for free screening and surgical repair of obstetric fistula at FOMWAN hospital Kaduna during a week-long fistula outreach in September 2014. All consenting women confirmed to have obstetric fistula were enrolled into the study.
Their socio-demographic and clinical data were captured on a Microsoft Access database. Data points collected include: age at presentation, educational level, marital status, place of delivery, and method of delivery. Others include: parity, origin of fistula, and delivery in which fistula occur, duration of incontinence, previous repair, foetal outcome, number of living children and duration of labour. Their heights and weights were measured.
The women were subsequently screened for fistula by digital genital examination. Speculum examination was done where a digital examination could not confirm the diagnosis. Where both examinations could not give a satisfactory diagnosis, direct dye test and finally a 3 swab test was done.
Of the 25 women who responded for the screening, 23 consenting women confirmed to have female genital fistula were included into the study. Of the two women excluded, one did not have genital fistula and the other had fistula from non-obstetric cause. The data obtained was cleaned and exported to Statistical Package for Social Sciences (SPSS) version 17 for descriptive analysis.
Approval for the study was obtained from the Management of FOMWAN Hospital.
A total of 25 women who responded to the community mobilization were screened for obstetric fistula. All twenty three women confirmed to have obstetric fistula who consented to the study were resident in the city of Kaduna when they developed the fistula, and could be contacted by mobile telephone.
The mean age of marriage, 15.5 years corroborate other reports in Northern Nigeria [
VARIABLE | FREQUENCY | PERCENTAGE | ||
---|---|---|---|---|
Age at first marriage in years | Mean | 15.5 (SD = 3.2) | ||
Range | 12 - 23 | |||
Age at which fistula developed in years | Mean | 24.5 (SD = 11.1) | ||
Range | 8 - 49 | |||
Age at presentation in years | Mean | 37.4 (SD = 12.9) | ||
Range | 20 - 70 | |||
Weight in Kg | Mean | 53.3 (SD = 14.9) | ||
Range | 35 - 100 | |||
Height in cm | Mean | 152.2 (SD 5.2) | ||
Range | 144 - 165 | |||
Education | None | 16 | 69.6% | |
Primary | 6 | 26.1% | ||
Secondary | 1 | 4.3% | ||
Literacy | Illiterate | 21 | 91.3% | |
Literate | 2 | 8.7% | ||
Marital status | Married | 16 | 69.6% | |
Divorced | 4 | 17.3% | ||
Separated | 1 | 4.3% | ||
Widow | 2 | 8.7% | ||
Occupation | Housewife | 10 | 45.5% | |
Petty trader | 12 | 54.5% |
the high prevalence of obstetric fistula among primigravidae as reported among typical fistula women living in the rural areas [
This study shows that though the age at marriage does not appear to be affected by urban living, it does appear to affect when women have the fistula. Only 27.3% of fistula women in Kaduna metropolis were primiparous while 72.7% were multiparous. The fact that most of the fistula women in Kaduna metropolis were multiparous who had previous normal vaginal deliveries is a significant departure from previous reports [
Danso et al. reported a bimodal distribution of women with genital fistula in Ghana: primiparous women predominated, but there was a second peak of multiparous women with three or four children [
VARIABLE | FREQUENCY | PERCENTAGE | |
---|---|---|---|
Parity | 1 | 6 | 27.3% |
3 | 4 | 18.2% | |
5 | 2 | 9.1% | |
6 | 2 | 9.1% | |
8 | 4 | 18.2% | |
9 | 1 | 4.5% | |
10 | 2 | 9.1% | |
12 | 1 | 4.5% | |
Delivery in which fistula occurred | First | 10 | 47.6% |
Subsequent | 11 | 52.4% | |
Previous repair | Yes | 17 | 77.3% |
No | 5 | 22.7% | |
Number of living children | 0 | 8 | 36.4% |
1 | 4 | 18.2% | |
2 | 2 | 9.1% | |
3 | 4 | 18.2% | |
4 | 1 | 4.5% | |
7 | 2 | 9.1% | |
10 | 1 | 4.5% | |
Method of delivery | Caesarean | 7 | 31.8% |
Extraction | 4 | 18.2% | |
Vaginal-spontaneous | 11 | 50.0% |
the tendency of birth weights to increase with subsequent gestations [
Furthermore, a depreciating proportion of primiparous women presenting with obstetric fistula in Kaduna metropolis might suggest some influence of urbanization like improved access to caesarean delivery which is known to prevent fistula formation; or improved girl child nutrition and lower childhood infections permitting full pelvic growth. Although we have insufficient data to fully comment on prior caesarean delivery in this study, improved nutrition and or lower childhood infection appear to have been suggested by higher mean weight and height of 53.3 kg and 152.2 cm (
Interestingly, 100% of fistula women in this study could be contacted by mobile phone, even though not all of them owned one. Urbanization imposes population density and reduces distance [
In this study, 77.3% of women have had previous repair of their fistula. This is at sharp variance with other reports where the majority of the women were from rural areas [
Nevertheless, some characteristic findings related to “the typical fistula patient” have persisted among fistula women in Kaduna metropolis. For instance 69.6% of the women from this study never attended any form of school. This appears to have arisen from the deep seated cultural and religious influence in Northern Nigeria where this study was conducted. Other findings similar to “the typical fistula patient” include: early age at marriage (15.5 years), high level of illiteracy (91.3%), stillbirths (81%) in fistula related delivery corroborates with other studies [
This institutional based survey might have limited participation from the community; hence the small sample size calls for caution in reaching conclusions from this study and limits generalization. Nevertheless, the study raises interesting issues requiring further investigation.
The finding of women living with obstetric fistula in Kaduna city confirms the hypothesis that obstetric fistula exists in Kaduna metropolis. Women living with obstetric fistula in Kaduna metropolis present some unique socio-demographic features compared to other published reports, suggesting an emerging trend that could have been influenced by urban living.
Other typical socio-demographic features of rural dwelling women living with obstetric fistula persisted regardless of urban dwelling, suggesting a set of core features related to the aetiology of obstetric fistula.
Further research could focus on confirming these findings; and a comparative analysis of urban or rural fistula within a region.
Prevention strategies for obstetric fistula should focus on causative characteristics regardless of rural versus urban living.
Women living with obstetric fistula in urban areas could be contacted by mobile phone as a means to improving communication for compliance, prevention, follow up and other aspects of fistula programming.
We declare no conflict of interest.
Lengmang, S.J. and Degge, H. (2017) Characteristics of Obstetric Fistula in Kaduna Metropolis. Open Journal of Obstetrics and Gynecology, 7, 734-741. https://doi.org/10.4236/ojog.2017.77074