Etiological Factors Associated With Vesico-Vaginal Fistula Among Women Admitted at Bugando Medical Centre in Mwanza Tanzania.
Ruta, Ilankunda. Afla SAUT/WBUCHS/MD/1756/T/05
Etiological Factors Associated With Vesico-Vaginal Fistula Among Women Admitted at Bugando Medical Centre in Mwanza Tanzania. - Mwanza, Tanzania: St. Augustine University of Tanzania [SAUT] : ©2010 - 36 Pages Includes References
Abstract;
Background: VVF is an abnormal fistulous tract, extending the bladder and the vagina that allows the continuous involuntary of urine the vaginal vault. It is subtypes of female genital fistula (UGF). The earliest evidence of a VVF was found in 1923, when Derry examined the mummified body of Queen Henhenit (2050 BC). The magnitude of the fistula problem worldwide in unknown but believed to be immense.
In developed countries, the predominant cause of VVF is problem obstructed labor (97%). But there are other numerous factors that contributed to the development of VVF such as; marriage and conception at an early age, chronic malnutrition, poor access to medical facilities during childbirth and lack of qualified health care professional and gynecological procedures. In contrast the developing countries that practice modern obstetrics have a low rate of UGFs and VVF remains the most common types (6). The majority of UGFs is developed countries are a consequence of gynecological surgery such as total abdominal hysterectomy (TAH).
Studies by WHO show that Nigeria may have one of the highest fistula prevalence rates in Africa. An estimated 400,000 to 800,000 Nigerian women are living fistula, 20,000 new cases added each year (11). WHO estimates that two million women in developing countries are living with fistula while additional 50,000 to 100,000 new cases occur each year. The figures are based on the women seeking treatment (10). It is most common in poor communities in Sub Saharan Africa and South Asia where access to obstetric care is limited (14). The first international effort to address the problem of VVF was in 2003 when UNFPA and its partners launched a global campaign to end fistula (13). The campaign is now active in more than 30 countries in Sub Saharan Africa, South Asia and Arab states. (www.newsfromafrica.org).
Objective of the study: The main objective of the study was to determine prevalence and the risk factors associated with VVF among women admitted at Bugando medical centre in Mwanza Tanzania.
Methodology: A retrospective sectional was conducted among women with VVF who have been admitted at Bugando medical centre in Mwanza, Tanzania, from January to August, 2009. Data was collected over four weeks from September to October, 2009
Results: A total of 385 patient’s information was obtained their medical records and data was collected by the principal investigator. 96.9% of all these women had prolonged obstructed labor and most of them delivered by caesarian section (49.9%) had normal vaginal delivery and only 9.4% had instrumental delivery. Most of the women with VVF were found to be between 13-25 years old (49%). Almost all of these women didn’t have any knowledge about VVF (99.0%) and their level of education ranged from none to primary education 64.7% had their first pregnancy at the age below 18 years and 34.8% of all these women had VVF during their first pregnancy. Almost all of them had access of obstetrical prenatal care (93.8%) had previous history of pelvic or vaginal surgery.
Conclusion: Regardless of the fact that many studies about VVF have been conducted in different of Africa, the true incidence and prevalence of VVF in Africa and Tanzania especially is unknown. Prolonged obstructed labor still remains the major cause of VVF in developing countries (96.9%) and most of the VVF sufferers are still women under 30 years of age. Most of these women are still conceiving at a very young age – 64.7% had their first pregnancy when they were below 18 years of age –and the first pregnancy still has a greater impact in VVF development.
Whereas in previous students it showed that one of the factors that contributed to VVF was poor access to prenatal care, this study showed that almost all the women (93.8%) had access to prenatal care and most of these women were aged between 13-25 years, but still this age group remains to be the highly affected group.
So it reasons that access to prenatal care was not a major contributing factor to these women in this study but rather there were other major factors associated with their VVF problem; such as, prolonged duration of labor, marriage and conception at a young age, previous history of pelvic or vaginal surgery, poor means of transportation and lack of knowledge concerning VVF on both causes and preventive measures.
Wurzburg Road 35, BMC Premises, Post Code: 33102: P. O. Box 1464, Mwanza – Tanzania: Phone: +255 28 298 3384: Fax: +255 28 298 3386: Email: vc@bugando.ac.tz : www.bugando.ac.tz
--Obstetrics and Gynecology
Etiological Factors Associated With Vesico-Vaginal Fistula Among Women Admitted at Bugando Medical Centre in Mwanza Tanzania. - Mwanza, Tanzania: St. Augustine University of Tanzania [SAUT] : ©2010 - 36 Pages Includes References
Abstract;
Background: VVF is an abnormal fistulous tract, extending the bladder and the vagina that allows the continuous involuntary of urine the vaginal vault. It is subtypes of female genital fistula (UGF). The earliest evidence of a VVF was found in 1923, when Derry examined the mummified body of Queen Henhenit (2050 BC). The magnitude of the fistula problem worldwide in unknown but believed to be immense.
In developed countries, the predominant cause of VVF is problem obstructed labor (97%). But there are other numerous factors that contributed to the development of VVF such as; marriage and conception at an early age, chronic malnutrition, poor access to medical facilities during childbirth and lack of qualified health care professional and gynecological procedures. In contrast the developing countries that practice modern obstetrics have a low rate of UGFs and VVF remains the most common types (6). The majority of UGFs is developed countries are a consequence of gynecological surgery such as total abdominal hysterectomy (TAH).
Studies by WHO show that Nigeria may have one of the highest fistula prevalence rates in Africa. An estimated 400,000 to 800,000 Nigerian women are living fistula, 20,000 new cases added each year (11). WHO estimates that two million women in developing countries are living with fistula while additional 50,000 to 100,000 new cases occur each year. The figures are based on the women seeking treatment (10). It is most common in poor communities in Sub Saharan Africa and South Asia where access to obstetric care is limited (14). The first international effort to address the problem of VVF was in 2003 when UNFPA and its partners launched a global campaign to end fistula (13). The campaign is now active in more than 30 countries in Sub Saharan Africa, South Asia and Arab states. (www.newsfromafrica.org).
Objective of the study: The main objective of the study was to determine prevalence and the risk factors associated with VVF among women admitted at Bugando medical centre in Mwanza Tanzania.
Methodology: A retrospective sectional was conducted among women with VVF who have been admitted at Bugando medical centre in Mwanza, Tanzania, from January to August, 2009. Data was collected over four weeks from September to October, 2009
Results: A total of 385 patient’s information was obtained their medical records and data was collected by the principal investigator. 96.9% of all these women had prolonged obstructed labor and most of them delivered by caesarian section (49.9%) had normal vaginal delivery and only 9.4% had instrumental delivery. Most of the women with VVF were found to be between 13-25 years old (49%). Almost all of these women didn’t have any knowledge about VVF (99.0%) and their level of education ranged from none to primary education 64.7% had their first pregnancy at the age below 18 years and 34.8% of all these women had VVF during their first pregnancy. Almost all of them had access of obstetrical prenatal care (93.8%) had previous history of pelvic or vaginal surgery.
Conclusion: Regardless of the fact that many studies about VVF have been conducted in different of Africa, the true incidence and prevalence of VVF in Africa and Tanzania especially is unknown. Prolonged obstructed labor still remains the major cause of VVF in developing countries (96.9%) and most of the VVF sufferers are still women under 30 years of age. Most of these women are still conceiving at a very young age – 64.7% had their first pregnancy when they were below 18 years of age –and the first pregnancy still has a greater impact in VVF development.
Whereas in previous students it showed that one of the factors that contributed to VVF was poor access to prenatal care, this study showed that almost all the women (93.8%) had access to prenatal care and most of these women were aged between 13-25 years, but still this age group remains to be the highly affected group.
So it reasons that access to prenatal care was not a major contributing factor to these women in this study but rather there were other major factors associated with their VVF problem; such as, prolonged duration of labor, marriage and conception at a young age, previous history of pelvic or vaginal surgery, poor means of transportation and lack of knowledge concerning VVF on both causes and preventive measures.
Wurzburg Road 35, BMC Premises, Post Code: 33102: P. O. Box 1464, Mwanza – Tanzania: Phone: +255 28 298 3384: Fax: +255 28 298 3386: Email: vc@bugando.ac.tz : www.bugando.ac.tz
--Obstetrics and Gynecology