The Burden of vesico-vaginal fistula in ILE-IFE, south western Nigeria

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Background: Vesicovaginal fistula is a major cause of severe morbidity and potential mortality , which can result in marital disruption, rejection, and eventual destitution. Methodology: A retrospective study of all cases of vesicovaginal fistula managed over a 30 year period between 1 st January 1984 and 31 st December 2013 at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria. Relevant data were obtained from the case notes and analyzed for the demographics, clinical features, management and outcome using SPSS version 20. Result: There were 213 patients with vesicovaginal fistula over the period of the study with a prevalence of 3.9 per 1000 deliveries. The age range was 15-45 years with a mean age of 24.8 years. Most of them were primiparous, (52.1%) and of the low social class (84.5%). Obstetric fistula accounted for 93.9%. The majority of them (64.8%) did not have antenatal care during the antecedent pregnancy. Labor was attended by unskilled attendants in about 90% of them while 92% labored for at least 24hours. The juxta-cervical fistula was the most common anatomical type (47.0%). The overall success rate at repair was 76.4%. Stillbirth rate in the antecedent pregnancy was 67.5%. Other associated morbidities included chronic vulva excoriation, obstetric palsy, and secondary amenorrhea. Conclusion: Vesicovaginal fistula (VVF) is a major public health problem in developing countries with too many calamities as shown in this study. Improving the educational and economic status of women in Nigeria will go a long way in empowering them to access quality antenatal care. This will also enhance hospital delivery thereby preventing prolonged obstructed labor which is a strong etiological factor for VVF. Decentralization of treatment centers and training of specialists in fistula surgery is very important to improving treatment outcomes.

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