Risk Factors of Vesico-Vaginal Fistulae in Maiduguri, Nigeria: A Case-Control Study

Abstract

Vesicovaginal fistula (VVF)--a direct communication between the bladder and the vagina--is a major gynecological problem in Nigeria resulting in leakage of urine into the vagina. The major cause of VVF in West Africa is pressure necrosis due to prolonged labor. In Nigeria, VVF has social, economic, and religious implications. Many women with VVF are regarded as social outcasts and marriages have dissolved as a result. In this study epidemiological pattern of VVF as it presents to tertiary hospitals in Maiduguri, Northern Nigeria is explored, along with recommendations for lowering mortality. A retrospective study of 241 cases of VVF was done. 148 patients without the disease were controls. Interviews were undertaken and 2 years of records were reviewed. Information collected included demographic variables. Specific information on the history of VVF was also collected. Aspects of traditional practices and customs were noted. Prolonged labor constituted 75.9% of the total cases. "Gishiri cut," an incision commonly done is the 2nd most common cause (6.2%). Other causes included cervical carcinoma (1.7%), surgical trauma (3.1%), and infection (2.1%). No cause could be found in 10.4%. Earlier age at marriage for VVF patients was significant with a chi square value of 27.0 (P0.001). More than 1.4 (26.9%) of the fistulae occurred in women 15 years; more than 1.2 (58.8%) of them were 18 years. Height was found to be related to fistulae: 51.9% had a height of below 150 cm but only 37.1% of the controls had the same height measurement (t=4.52; P0.001). The relative risk for VVF when the height was 150 cm was calculated to be 1.83 for this study. Of the women who had VVF, 49.9% were married, compared to 85.3% of the controls (P0.001). A much higher proportion of fistula patients were divorced than controls. For the short term, the problem can be helped by health education. In the long run, it will be reduced by less pregnancies in girls under 18, a situation which will occur with more widespread formal education of girls.