Vesico Vagina Fistula - The Silent Killer of Young Nigerian Girls

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What is Vesico Vagina Fistula (VVF)?

Vesico vaginal fistula is a medical condition that occurs when there is an abnormal opening or passage, between the bladder and the vagina. It is also known as Obstetric Fistula (OF).

This can result in the urine continuously leaking from the bladder into the vagina. Causing discomfort, embarrassment, and even infection.

The World Health Organization (WHO) estimates that there are about 2 million untreated cases of VVF in Asia and Sub-Saharan Africa. 

Nigeria has 150,000 cases of VVF. According to the United Nations Population Fund (UNFPA), 12,000 new cases are recorded each year,

Causes of VVF

There are many causes of VVF such as Pelvic Radiation Therapy and gynecological surgery. But, the most common cause in Nigeria is obstructed labour.

VVF often occurs as a complication of prolonged obstructed labor. Obstructed Labor is the inability of labour to continue, often after 12 hours. Due to a mismatch between the fetal size and the mother's pelvis.

The pressure of the fetal head on the vaginal wall can cause tissue damage. And may create a hole between the bladder and the vagina.

The underlying causes of VVF are;

Firstly, early marriage and pregnancy. This is a common occurrence in Northern Nigeria. Hence, the prevalence of VVF is highest in the region.

A pregnant girl under age 18 has a higher risk of obstructed labour because her birth canal most times is not fully developed. 

Ijaiya et al (2010) in their review of fistula cases in Nigeria, stressed that many  VVF patients in Northern Nigeria had an early marriage. Also, the 2018 Nigeria Demographic Health Survey (NDHS) reported that teenage pregnancy rates in the North West were 28.5% and 24.5% in the North East regions.

Secondly, Unskilled Traditional Birth Attendants (TBAs). Every childbirth should be watched by a skilled birth attendant, to discover difficulties early and take appropriate action. 

Unfortunately, only 43.3% of deliveries in Nigeria are supported by experienced health workers. The rate is extremely low in some states, for example, 5.4% in Sokoto.

In addition, access to emergency obstetrics services is nearly non-existent in the North.

Other barriers are poverty, illiteracy and ignorance.

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Let us see some effects of VVF 

• Isolation: Victims are often considered outcasts. Due to the odour and related shame of urine leakage.

• Lost dreams: Victims go through a lot of psychological and emotional trauma. And may live unfulfilled lives, especially if they never have access to treatments.

• Vaginal or urinary tract infections that keep coming back.

You may ask, does VVF have a cure?

The only option to treat vesicovaginal fistula is surgery to close the opening. 

When bladder injury is the root of the issue, extra operations may be required to address it. Vesicovaginal fistula surgery typically has excellent results.

So what has the Nigerian government done so far?

Generally, there has been a reporting gap between funds approved for the treatment of VVF patients across the country and their release. 

The Federal Ministry of Health launched a program in 2019. It is called the National Strategic Framework for the Elimination of Obstetric Fistula in Nigeria (2019-2023). The overall goal is preventing, treating and reintegrating victims into society.

While we believe that progress has been made, we await an official report from the Federal Ministry of Health.

However, the following strategies can be integrated into any program approach in combating VVF in Nigeria. Be it a governmental, non-governmental, or individual intervention.

They are grouped into preventive and curative measures.

Preventive Measures

• Ratification of the 2003  Child Rights Acts by all states; 

• Delaying the age of first pregnancy;

• Sensitizing community members on the effects of harmful cultural practices;

• Equipping Primary Health Clinics (PHCs) to provide obstetric care services and

• Improved nutrition plan for women and girls

Curative Measures

• Providing psychosocial support services for victims;

• Skills training and business empowerment programs to ensure their reintegration into society;

• Sensitizing the husbands of victims to gain their understanding and support.

In conclusion, victims suffering from VVF did not choose their conditions. In reality, they are powerless in the face of harmful traditional beliefs.

So, the least practicing communities can do is support the victims' recovery process. Living with VVF is enough trauma, neglect should not be a part of the experience.