AN ASSESSMENT OF MID-WIVES PERCEPTION OF THE INCIDENCE OF VESICOVAGINAL FISTULA AMONG FEMALE PATIENTS IN FMC, LAGOS STATE.

CHAPTER ONE

INTRODUCTION

Background of the study

Maternal morbidity remains a pressing global health challenge, particularly in developing countries where women of reproductive age face significant health risks related to childbirth. While some women suffer complications that may lead to the death the child or mother, others live with underlying health condition that may take while before they get their system back. Among these risks, Vesicovaginal fistula (VVF) stands out as a devastating condition that severely impacts the lives of affected women.. Vesicovaginal fistula (VVF) is a kind of obstetric fistula that arises when extended blocked labour causes a gap between the bladder and the vagina, leading to persistent and unmanageable urine leaking (Tebeu & Winifred 2022). Wall (2012) defines vaginal vesicositis (VVF) as an anomalous connection between the bladder and the vagina, resulting in persistent and unmanageable urine leaking mostly through the vaginal canal. This syndrome is mostly attributed to extended obstructed labour, which is widespread in areas with poor availability of timely and sufficient obstetric treatment.

Prevalently, vaginal vesicositis (VVF) affects both low- and middle-income nations as well as high-income countries. However, the highest prevalence of VVF is observed in low- and middle-income countries. According to the World Health Organisation (WHO, 2018), there are an estimated 50,000 to 100,000 documented cases of OBF globally each year. The data for sub-Saharan Africa (SSA) are astonishing, with an incidence rate of vesicoerectile dysfunction (VVF) reaching 10 instances per 1000 natal births. According to a study conducted by Habatamu et’al (2023), fistula impacts around 2-3 million women globally, with a greatest prevalence in South Asia and Sub-Saharan Africa. Each year, some 30,000 to 130,000 women in Sub-Saharan Africa alone experience the development of obstetric fistulas during childbirth. The prevalence of VVF in Nigeria is notably high in women of reproductive age residing in rural regions with restricted availability of healthcare facilities. 

 Consequently, Eniola & Kadijat (2023) mentioned that VVF not only induces bodily pain but also gives rise to significant psychological and social ramifications, frequently culminating in stigmatization and the experience of isolation. VVF-afflicted women are often marginalized, having their lives significantly changed by a disease that may be avoided with prompt and sufficient obstetric treatment. Other problems include childlessness from loss of viable foetus from pregnancy associated with VVF, secondary infertility, vaginal stenosis by fibrosis and bands, amenorrhoea, high and unaffordable costs of repair and elective caesarean section among those who get pregnant later. Psychosocial problems of the patients include depression, loss of husband’s affection, divorce and rejection by the society. 

Essentially, midwives play a crucial role in the prevention and management of VVF, particularly in settings where the healthcare infrastructure is weak. Their perceptions and attitudes towards the condition can significantly influence the quality of care provided to women at risk of or suffering from VVF. In Nigeria, where the healthcare system is often overstretched, the role of midwives becomes even more essential. They are often the first point of contact for pregnant women, especially in rural areas, and their ability to recognize the early signs of obstructed labor and other risk factors associated with VVF can make a significant difference in preventing the condition (Wall, 2012). Even though obstetric fistula is preventable with simple and effective technology for monitoring the progress of labor that is readily available in health facilities, observational studies by Uzondu & Adesua (2023) highlighted that it is either not being used at all or incorrectly used by obstetric caregivers like Midewives. And in some case midwives keep laboring mothers at public health centers beyond the limited time for normal labor and refer them after it is too late with a full bladder, which contributes to obstetric fistula.

Owing to the important role played by Midwives in Federal Medical centers especially during obstetrics care, their perception of midwives towards the incidence of VVF can be influenced by several factors, including their level of training, experience, and the resources available to them. A study by Gharoro and Agholor (2019) highlighted that midwives who received specialized training in maternal health were more likely to recognize the signs of obstructed labor and take appropriate action to prevent VVF. However, in many parts of Nigeria, midwives often work in challenging environments with limited resources, which can hinder their ability to provide the necessary care. This situation is exacerbated by the lack of continuous professional development opportunities for midwives, which limits their ability to stay updated on best practices in VVF prevention and management (Ojeme, 2023). More so, the cultural and socio-economic context in which midwives operate also affects their perception and management of VVF as in many Nigerian communities, traditional beliefs and practices surrounding childbirth can influence the actions of midwives. For instance, in some areas, the preference for home births over hospital deliveries, due to cultural or financial reasons, increases the risk of complications such as VVF . Midwives working in these contexts may face challenges in convincing women and their families of the importance of seeking skilled care during childbirth, which is crucial in preventing conditions like VVF. This study is focused on the perceptions of midwives regarding the incidence of VVF among female patients in FMC, Lagos State

1.2 Statement of Problem

In recent times, Vesicovaginal fistula (VVF), though more prevalent in rural settings due to limited access to quality healthcare,  has also become a significant concern in urban areas of Nigeria. Although considerable efforts have been made to reduce the incidence of VVF through improved maternal healthcare services, the condition remains prevalent, particularly in areas where access to timely and adequate obstetric care is limited.  In Lagos State, an urban area with better healthcare infrastructure, the expectation is that the incidence of VVF should be lower compared to rural areas. However, the persistence of VVF cases in this region suggests that other factors, including healthcare providers' perceptions and practices, may contribute to the ongoing challenges in managing this condition (WHO, 2016).

Even though midwives are critical to maternal healthcare delivery in FMCs, where they are responsible for managing labor and delivery, as well as providing postnatal care, their perception of the incidence of VVF can significantly influence how they approach the prevention and management of this condition. Previous studies have indicated that midwives' perceptions in rural areas are shaped by their clinical experiences, the resources available to them, and their level of training (Ojanuga & Ekwempu, 2021) however none has focused on Lagos State an urban setting .  More so, studies by Wada & Adebisi (2023) have primarily focused on the clinical aspects of VVF, with limited attention given to the perceptions of midwives who are directly involved in patient care. This gap in the literature highlights the need for research that explores midwives' views on VVF incidence, particularly in urban healthcare settings like FMCs in Lagos State.

1.3 Objectives of the Study

The broad objective of this sis study is focused on an assessment of mid-wives perception of the incidence of vesicovaginal fistula among female patients in FMC, Lagos State.

To assess midwives' knowledge of the risk factors associated with vesicovaginal fistula (VVF) among female patients in FMC, Lagos State.

To explore midwives' perceptions of the incidence of VVF among female patients in FMC, Lagos State.

To examine the factors that midwives believe contribute to the incidence of VVF in FMC, Lagos State.

To evaluate the strategies employed by midwives in FMC, Lagos State, to prevent and manage VVF.

1.4 Research Questions

What is the level of knowledge among midwives regarding the risk factors associated with vesicovaginal fistula (VVF) among female patients in FMC, Lagos State?

How do midwives perceive the incidence of VVF among female patients in FMC, Lagos State?

What factors do midwives believe contribute to the incidence of VVF in FMC, Lagos State?

What strategies are employed by midwives in FMC, Lagos State, to prevent and manage VVF?

1.5 Hypothesis

Ho: There is no significant relationship between midwives' knowledge of risk factors and their perception of the incidence of vesicovaginal fistula (VVF) among female patients in FMC, Lagos State.

Hi: There is a significant relationship between midwives' knowledge of risk factors and their perception of the incidence of vesicovaginal fistula (VVF) among female patients in FMC, Lagos State.

1.6 Significance of the Study

Practically, it will provide valuable insights into the perceptions of midwives regarding VVF incidence in an urban healthcare setting. By identifying the knowledge gaps and challenges faced by midwives in managing VVF, the findings can inform the development of targeted training programs and resource allocation strategies to enhance the quality of maternal healthcare in Lagos State and other similar urban areas. Furthermore, the study's outcomes can be used by healthcare policymakers to design interventions that address the specific needs of midwives, thereby reducing the incidence of VVF and improving patient outcomes.

Theoretically, the study will contribute to the existing body of knowledge on VVF, particularly in the context of urban healthcare settings. It will provide empirical data on midwives' perceptions of VVF incidence, which can be used to inform future research on maternal health challenges in Nigeria and other developing countries. Additionally, the study's findings will help to bridge the gap in the literature concerning the role of healthcare providers' perceptions in the management of obstetric complications, thereby enhancing our understanding of the factors that influence maternal healthcare practices.

1.7 Scope of the Study

The study will focus on the perception of midwives regarding the incidence of vesicovaginal fistula (VVF) among female patients in the Federal Medical Center (FMC), Lagos State. The content scope includes the knowledge of midwives on VVF risk factors, their perceptions of VVF incidence, the contributing factors they identify, and the strategies they employ for VVF prevention and management. The geographical scope is limited to FMC in Lagos State, Nigeria.

1.8 Limitations of the Study

Like every academic endeavor, the study is not void of limitations, one of  which is the reliance on self-reported data from midwives, which may be subject to bias. The perceptions and knowledge of midwives may not fully represent the actual incidence and management practices of VVF in FMC, Lagos State. Additionally, the study is limited to one healthcare facility, which may affect the generalizability of the findings to other FMCs or healthcare settings in Nigeria.

Another limitation is the potential for variation in the training and experience levels of the midwives participating in the study, which could influence their perceptions and responses. To mitigate this, the study will aim to include midwives with varying levels of experience to ensure a more comprehensive understanding of the issue.

1.9 Definition of Terms

Vesicovaginal Fistula (VVF): An abnormal opening between the bladder and the vagina, leading to continuous and uncontrollable leakage of urine.

Perception: The understanding or interpretation that midwives have regarding the incidence and management of VVF.

Incidence: The occurrence rate or frequency of new cases of vesicovaginal fistula among female patients in FMC, Lagos State.

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