Ethiopia: an epidemiological study of vesico-vaginal fistula in Addis Ababa

Abstract

A 10% sample was drawn from 3000 records on vesicovaginal fistulae operations performed at the Addis Ababa Fistula Hospital for Poor Women with Childbirth Injuries and their content were analyzed. In 88% of the cases under review the operation was classified as successful. The results of this study underline the tremendous maternal health gains which can be achieved by appropriate obstetric care in case of obstructed labour. It also reinforced the need for early detection and referral of high risk births among the very young mothers who are likely to experience an obstructed labour, the loss of the child, vesico-vaginal fistulae and possibly a ruptured uterus. In the absence of likely increases in the availability of transport, the building of waiting homes at maternal clinics is encouraged so that women can await delivery in the vicinity of a referral centre. There is a need for increased attendance of delivery by trained personnel as well as for continuing education for both staff and traditional birth attendants. It is further recommended to train former patients as helpers for the dedicated care which needs to be extended to the unfortunate, and often stigmatized victims.

PIP: Vesicovaginal fistula (VVF) associated with obstructive labor is highly prevalent throughout many developing countries with poor access to health services. Prevalence of the condition is highest among young primigravida. The Addis Ababa Fistula Hospital for Poor Women with Childbirth Injuries was opened in 1975 and cares for approximately 500 fistula patients per year. There is open access to the facility, in which women are treated with respect and dignity. Upon completion of the operation to correct her fistula, each woman is given sufficient means to return home. She also receives a fistula card which contains essential information for her future obstetric and gynecological care. A sample of 309 records was drawn randomly from the total of 3000 records of vesicovaginal operations performed at the hospital during the period 1983-88, and analyzed. The women were of average age 22.4 years in the range of 9-45 years. 82% travelled at least 700 kilometers for treatment, walking an average of twelve hours and spending an average of 34 hours in a bus. More than 50% of the women were rejected by their husbands after the fistulae developed, leaving them without means. In 52% of cases, admission occurred within six months of fistula development, although 4% of women came only 10-20 years after developing their fistulae. 88% of cases reviewed were cured completely, 6% continued to suffer from urinary stress incontinence, and in 6% of cases the operation failed to produce the desired results. These results demonstrate the enormous maternal health gains which can be achieved with appropriate obstetric care in the case of obstructed labor. They also reinforce the need for early detection and referral of high-risk births among very young mothers who are likely to experience an obstructed labor, child loss, VVF, and possibly a ruptured uterus. Unless transport can be made readily available to women with VVF, waiting homes should be built at maternal clinics so that women can await delivery in the vicinity of a referral center. Trained personnel need to be more often in attendance during delivery, while staff and traditional birth attendants should receive continuing education. It is further recommended that former patients be trained to help provide care to women with VVF.