NGO calls for increased awareness to address VVF prevalence in Nigeria

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By Abiodun Azi
Lagos, Sept. 18, 2020 An NGO, Centre for Women’s Health and Information (CEWHIN), has called on the three tiers of government to increase awareness in order to address the prevalence of Vesico Vaginal Fistula (VVF) in Nigeria.

Its Programme Officer, Mrs Tolulope Ajayi, told the News Agency of Nigeria (NAN) on Friday in Lagos that VVF “is a preventable calamity, which has been an age-long menace in developing countries”.

Naija247news reports that CEWHIN is an NGO with the support of Rise Up– an initiative of the Public Health Institute of the John Hopkins University, U.S.

Vesicovaginal fistula, a tear from the bladder to the vagina, is one of the most serious gynaecological problems found in Hausa and Fulani women in northern Nigeria.

Its prevalence is associated with a high frequency of cephalopelvic disproportion resulting in difficult deliveries and birth injuries.

Ajayi said Nigeria has the highest prevalence of Vesico Vaginal Fistula (VVF) in the world with between 400,000 and 800,000 women living with the problem, out of the two million cases recorded globally.

According to her, of about 20,000 new cases occurring annually, 90 per cent of the cases go untreated.

“This implies that about 55 women are infected by Vesico Vaginal Fistula and 18,000 cases are untreated daily.

“In Nigeria alone, 800,000 to one million women are estimated to be awaiting repair. The annual obstetric fistula incidence is estimated at 2.11 per 1000 births.

“It is more prevalent in Northern Nigeria than Southern Nigeria. Obstetric fistula accounts for 84.1 per cent to 100 per cent of the Vesicovaginal fistula and prolonged obstructed labour is consistently the most common cause (65.9%-96.5%),” she said.

Ajayi said that increased awareness that the condition could result from birth injury was obviously desirable, particularly among women, whose health is directly affected by it.

She said that since men were the major decision-makers, it was also important that they receive information on the subject.

“Women who suffer vesicovaginal fistula patients, as a result of childbirth or cuts made by midwives, have to face a life of emotional and physical incapacity.

“It is essential to prevent the condition in a society where health services are scarce.

“The first step should be to make communities aware of how this can be achieved through health education programmes for both men and women.

“Provision of access to affordable quality healthcare by victims of vesico-vaginal Fistula. Provision of free education to indigent young girls,” she said.

Ajayi said that certain birth practices also caused the condition.

“Traditional midwives, when treating prolonged obstructed labour and numerous other problems of women, may cut into the vagina (the gishiri cut) and in some cases create a tear between the vagina and bladder.

“Sociocultural factors play an important role in placing women at risk of the condition, in particular, the early marriage of girls, a custom defended on the ground that it prevents premarital sex and unwanted pregnancies.

“Unfortunately, girls are predisposed to vesicovaginal fistula, if they marry at extremely young ages, because they are likely to become pregnant long before their bodies have reached a stage of maturity consistent with safe delivery.

“Unskilled birth attendance and late presentation to the health facilities is also a contributory factor to vesico-vaginal fistula.

“Perhaps the greatest barrier to preventing vesicovaginal fistula is the ignorance among villagers of the danger of unsupervised delivery in women at risk. In rural communities, people know little about health,” she said.

The CEWHIN programme officer said economic factors also serve as a disincentive to the use of modern health facilities for prenatal, delivery, and postnatal care.

“Hospitals are often located in urban areas and for people with extremely limited resources it is expensive to travel to them from remote villages.
“Some hospitals do not have sufficient capacity to admit all pregnant women and
they were poorly equipped and staffed.

“Another risk factor is the low status of women. Married women are allowed out of the household only in exceptional circumstances, such as a death in the family or severe illness.

“Education for girls is given low priority. Wives are excluded from important decision-making, and their husbands often choose not to send them for medical care at government hospitals because most of the doctors are men,” Ajayi said.

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