ASSESSMENT ON HEALTHCARE WORKERS KNOWLEDGE ON MANAGEMENT OF VESICOVAGINAL FISTULA IN DOUALA GENERAL HOSPITAL, CAMEROON

Chapter One

Introduction

1.1 Background to the Study

It no doubt that regardless of global efforts to improve maternal healthcare, VVF remains a significant public health issue in many parts of the world with more burden on developing countries. According Ndouname (2021) vaginal vesicositis (VVF) affects both low- and middle-income nations as well as high-income countries but the highest prevalence of VVF is observed in rural areas. The World Health Organisation (WHO, 2018) reports that there are an estimated 50,000 to 100,000 documented cases of OBF globally each year and the data for sub-Saharan Africa (SSA) are astonishing, with an incidence rate of vaginal vesicositis (VVF) reaching 10 instances per 1000 natal births. Similarly a study conducted by Habatamu et’al (2023), fistula impacts around 2-3 million women globally, with  average prevalence in Central Africa and high incidence in South Asia and Sub-Saharan Africa where  30,000 to 130,000 women experience the development of obstetric fistulas during childbirth.

Medically, Vesicovaginal fistula (VVF) is a severe medical condition characterized by an abnormal connection between the bladder and the vagina, leading to continuous and involuntary discharge of urine into the vaginal vault. This condition, predominantly caused by prolonged obstructed labor, is a significant public health concern in many developing countries, including Cameroon (Tebeu et al., 2012. 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. 

Significantly, the management of VVF requires a stringent approach, involving not only surgical repair but also comprehensive post-operative care, including counseling and rehabilitation and healthcare workers play a crucial role in the management of VVF, from the initial diagnosis to the provision of surgical care and post-operative support. However, the effectiveness of VVF management is heavily dependent on the knowledge and skills of healthcare workers. In many cases, healthcare workers in low-resource settings may lack the necessary training to effectively manage VVF, leading to suboptimal outcomes for patients (Adler et al., 2013). At the Douala General Hospital in Cameroon, one of the leading healthcare facilities in the country, the management of VVF is a critical aspect of maternal healthcare. Considering the hospital's status as a referral center, it receives a significant number of VVF cases, particularly from rural areas where access to obstetric care is limited. The hospital's healthcare workers, therefore, play a vital role in managing these cases, from diagnosis to treatment and post-operative care. However, the level of knowledge among healthcare workers regarding the management of VVF is a key determinant of the quality of care provided to patients (Kimani et al., 2015).

Given the critical role of healthcare workers in managing VVF, it is essential to assess their knowledge level and limitations that may hinder effective patient care. In the context of Douala General Hospital, where VVF cases are prevalent, such an assessment is crucial for improving the quality of care and ensuring better outcomes for patients. This is necessary according To Tabitha (2023) for streamlined lined support for healthcare workers who may need additional training or interventions that can be developed to enhance their knowledge and skills, ultimately leading to improved management of VVF and in general improve obstetrics care in the country.

1.2 Statement of the Problem

Vesicovaginal fistula (VVF) remains a significant public health issue in Cameroon. 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 Doula, 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' knowledge and practices, may contribute to the ongoing challenges in managing this condition. According to Nanade (2023), the management of VVF in healthcare facilities like Douala General Hospital is crucial for addressing this issue; however, the effectiveness of such management is heavily dependent on the knowledge and skills of healthcare workers. This is because, Inadequate knowledge among healthcare workers can lead to delayed diagnosis, inappropriate treatment, and poor post-operative care, exacerbating the suffering of VVF patients.

Existing studies have highlighted the challenges faced by healthcare workers in low-resource settings when managing VVF. For instance, research by Abimenon (2023) indicates that many healthcare workers in sub-Saharan Africa lack specialized training in VVF management, resulting in suboptimal patient car and the situation is further complicated by the limited availability of resources and infrastructure necessary for effective VVF management. , A study by Nielsen & Nancy (2019) found that healthcare workers who received specialized training in VVF management were more likely to provide effective care, resulting in better patient outcomes. On the other hand, healthcare workers with limited knowledge of VVF were more likely to encounter challenges in managing the condition, leading to complications and poor patient satisfaction. This highlights the importance of continuous education and training for healthcare workers, particularly in specialized areas such as VVF management.

While Douala General Hospital is one of the leading healthcare facilities in the country, it is not immune to these challenge of the daunting task of managing complex VVF cases with limited resources and support. Although the hospital receives a significant number of VVF cases, particularly from rural areas, there is limited research on the knowledge and skills of the healthcare workers responsible for managing these cases. This gap in the literature highlights the need for a comprehensive assessment of healthcare workers' knowledge regarding VVF management. Such an assessment is crucial for identifying areas where additional training or support may be needed to improve patient outcomes.The current study aims to address this gap by assessing the knowledge of healthcare workers at Douala General Hospital regarding the management of VVF. 

1.3. Objectives of the Study

The broad objective of the study is focused on assessment on healthcare worker’s knowledge on management of vesicovaginal fistula in Douala General Hospital, Cameroon. Specifically, the study seeks

To assess the level of knowledge among healthcare workers at Douala General Hospital regarding the causes and risk factors associated with vesicovaginal fistula (VVF).

To evaluate the knowledge of healthcare workers on the diagnosis and early detection of VVF in female patients.

To examine the awareness of healthcare workers regarding the available treatment options and post-operative care for VVF patients.

To recommend strategies for improving VVF of healthcare workers management at Douala General Hospital.

1.4 Research Questions

What is the level of knowledge among healthcare workers at Douala General Hospital regarding the causes and risk factors associated with vesicovaginal fistula (VVF)?

How knowledgeable are healthcare workers about the diagnosis and early detection of VVF in female patients?

What is the level of awareness among healthcare workers regarding the available treatment options and post-operative care for VVF patients?

What are that strategies can be recommended for improving VVF management at Douala General Hospital?

1.5. Research Hypotheses

Ho: There level knowledge of healthcare workers at Douala General Hospital regarding the management of vesicovaginal fistula (VVF) is low.

Hi: There level knowledge of healthcare workers at Douala General Hospital regarding the management of vesicovaginal fistula (VVF) is high.

1.6 Significance of the Study

This study holds practical significance as it aims to improve the quality of healthcare provided to VVF patients in public hospitals. By assessing the knowledge of healthcare workers and identifying gaps in their understanding of VVF management, the study provides valuable insights that can be used to develop targeted training programs and interventions. These programs can enhance the skills of healthcare workers, leading to better patient outcomes and a reduction in the incidence and recurrence of VVF. Moreover, the study's findings can inform policy decisions at the hospital and national levels, contributing to the broader effort to improve maternal healthcare in Cameroon.

Theoretically, this study contributes to the existing body of knowledge on VVF management by providing empirical evidence on the knowledge levels of healthcare workers in a major healthcare facility in Cameroon. The study's findings can be used to inform future research on VVF management in similar settings, particularly in low-resource environments where healthcare workers face numerous challenges. Additionally, the study highlights the importance of continuous education and training for healthcare workers, which is a critical component of effective healthcare delivery.

1.7 Scope of the Study

The content scope of this study focuses on assessing the knowledge of healthcare workers regarding the management of vesicovaginal fistula (VVF). Specifically, the study will examine healthcare workers' understanding of the causes, diagnosis, treatment, and post-operative care of VVF patients. The geographical scope of the study is limited to Douala General Hospital, one of the leading healthcare facilities in Cameroon. The study will involve healthcare workers, including doctors, nurses, and midwives, who are directly involved in the management of VVF cases at the hospital.

1.8 Limitations of the Study

One of the limitations of this study is the potential for bias in self-reported knowledge among healthcare workers. Since the study relies on surveys and interviews to assess healthcare workers' knowledge, there is a possibility that respondents may overestimate their understanding of VVF management. To mitigate this limitation, the study will incorporate objective assessments, such as knowledge tests or case scenario evaluations, to complement the self-reported data.

Another limitation is the study's focus on a single healthcare facility, Douala General Hospital. While this focus allows for an in-depth assessment of the knowledge of healthcare workers at the hospital, the findings may not be generalizable to other healthcare facilities in Cameroon. However, the study's findings can still provide valuable insights that can be applied in similar settings, particularly in low-resource

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 healthcare providers have regarding the healthcare facility-related causes and management of VVF.

Healthcare Facility Causes: The factors within healthcare facilities, such as inadequate infrastructure, lack of trained personnel, and delayed interventions, that contribute to the incidence of VVF among female patients.

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