AN ASSESSMENT OF THE PREVALENCE AND CONTRIBUTING RISK FACTORS OF OBSTETRIC FISTULA IN RURAL NIGERIA

CHAPTER ONE INTRODUCTION 1.1 Background of the Study Obstetric fistula is a devastating health condition that typically arises when a baby’s head becomes stuck in the birth canal during prolonged obstructed labour. This prolonged pressure on the mother’s internal tissues eventually results in the formation of a fistula—an abnormal hole between the vagina and either the bladder or rectum. This condition causes uncontrollable leakage of urine or feces (Ahmed & Holtz, 2017). It is widely recognised as a severe consequence of inadequate maternal healthcare and is particularly prevalent in low-resource environments, especially rural communities in developing countries like Nigeria. Globally, obstetric fistula has long been considered a major public health issue. While its prevalence has significantly decreased in industrialised countries due to the advancement of modern obstetric care, it remains alarmingly common in regions such as sub-Saharan Africa and South Asia. These areas suffer from limited access to skilled birth attendants and emergency obstetric services (Wall, 2022). According to the World Health Organization (WHO), between 50,000 and 100,000 new cases of obstetric fistula occur annually worldwide, with the majority found in rural, underserved regions (WHO, 2018). Nigeria, being the most populous country in Africa, bears a significant burden of this condition. Estimates suggest that between 400,000 and 800,000 women in Nigeria currently live with obstetric fistula, with approximately 12,000 to 20,000 new cases emerging each year (UNFPA, 2017). The northern regions of the country are particularly affected due to high rates of early marriage, teenage pregnancy, and limited access to quality maternal healthcare (Ibrahim et al., 2016). Multiple factors exacerbate the vulnerability of women in rural Nigeria. These include widespread poverty, low levels of education, inadequate healthcare facilities, and cultural practices that favour home births and discourage the use of modern medical services. In many rural areas, childbirth is often carried out at home without the assistance of trained healthcare workers, greatly increasing the risk of prolonged labour and, ultimately, fistula development (Wall, 2022). A primary driver of the high incidence of obstetric fistula in rural communities is the lack of timely access to quality maternal care. Healthcare centres are frequently located far from where people live, and poor transportation infrastructure further hinders women from reaching these facilities during labour (Adler et al., 2015). Additionally, the shortage of skilled birth attendants means that complications are often mismanaged or go untreated, leading to adverse outcomes. Cultural factors also play a significant role in the persistence of obstetric fistula. Early marriage and adolescent pregnancies remain common in rural areas of Nigeria, increasing the risk of obstructed labour due to the underdeveloped pelvises of young girls (Ibrahim et al., 2016). The preference for home deliveries, driven by tradition and mistrust of formal healthcare services, further increases the likelihood of labour complications that may result in fistula formation (Ahmed & Holtz, 2017). Socioeconomic challenges like poverty and low educational attainment further compound the problem. Women from impoverished backgrounds often lack the financial means to afford transportation or cover hospital costs associated with childbirth. Additionally, limited education impairs their ability to recognise the importance of seeking skilled medical assistance during delivery, resulting in delays that can have fatal or debilitating consequences (Wall, 2022). In recognition of the seriousness of this issue, the Nigerian government, in collaboration with international organisations such as the United Nations Population Fund (UNFPA), has implemented various interventions aimed at both preventing and treating obstetric fistula. These efforts include expanding access to emergency obstetric care, training healthcare providers in fistula repair, and raising awareness about the importance of skilled birth attendance (UNFPA, 2017). Despite these initiatives, challenges persist. Many affected women are deterred from seeking medical help due to the stigma surrounding obstetric fistula, leading to isolation and deeper marginalisation (Ahmed & Holtz, 2017). Furthermore, the limited availability of fistula repair services leaves many women untreated, thereby prolonging their physical and emotional suffering. It is against this backdrop that the current study seeks to examine the prevalence and risk factors associated with obstetric fistula in rural Nigeria. 1.2 Statement of the Problem Obstetric fistula is a debilitating condition that continues to affect large numbers of women in rural Nigeria, particularly those from economically disadvantaged and marginalised communities. Despite improvements in maternal health services, the incidence of this condition remains disturbingly high. Caused primarily by prolonged and obstructed labour without timely medical intervention, obstetric fistula results in a distressing condition where an abnormal opening develops between the birth canal and the bladder or rectum, leading to chronic incontinence (UNFPA, 2021). The burden on affected women is multifaceted, involving not just physical discomfort but also social exclusion and severe psychological distress. The persistence of this condition in rural parts of Nigeria can be attributed to a mix of factors, including the lack of skilled birth attendants, poor healthcare infrastructure, cultural practices like early marriage and early childbearing, and low socioeconomic status (Tebeu et al., 2022). These factors collectively contribute to higher rates of obstructed labour, which, when left untreated, result in fistula formation. Additionally, the stigma associated with obstetric fistula often prevents women from coming forward to seek medical care, leaving many to suffer in silence. Even with the support of the government and international organisations, there is still a significant gap in our understanding of the exact prevalence and contributing risk factors in rural areas. Therefore, this study aims to explore the prevalence and determinants of obstetric fistula in Nigeria. 1.3 Objective of the Study The primary goal of this research is to examine the prevalence and risk factors of obstetric fistula in rural areas of Nigeria. The specific objectives include: i. To evaluate the level of awareness about obstetric fistula among women in rural Nigeria. ii. To determine the prevalence of obstetric fistula among women of reproductive age in rural Nigeria. iii. To identify and assess the risk factors that contribute to obstetric fistula in rural Nigeria. 1.4 Research Questions This study seeks to answer the following research questions: i. What is the level of awareness about obstetric fistula among women in rural Nigeria? ii. What is the prevalence of obstetric fistula among women of reproductive age in rural Nigeria? iii. What are the major risk factors that contribute to obstetric fistula in rural Nigeria? 1.5 Significance of the Study The findings of this research will be valuable to several stakeholders. For the Ministry of Health, the study will uncover barriers to accessing timely and effective maternal healthcare and provide actionable recommendations for designing targeted interventions that can help prevent obstructed labour—the main cause of obstetric fistula. This information will assist both policymakers and healthcare professionals in formulating more effective maternal health programs, particularly in rural areas where the incidence of obstetric fistula is highest. Furthermore, this research will make an important contribution to academic literature, expanding the current body of knowledge on maternal health and serving as a useful reference for future researchers and scholars interested in similar topics. 1.6 Scope of the Study This study focuses specifically on understanding the prevalence and risk factors of obstetric fistula in rural Nigeria, with a particular emphasis on Bindawa Local Government Area in Katsina State. Empirically, it examines the level of awareness among women, the rate of occurrence of the condition among women of reproductive age, and the risk factors contributing to its prevalence. Geographically, the research is confined to Bindawa LGA, which serves as the focal point for data collection and analysis. 1.7 Limitation of the Study As with many research undertakings, this study faced several limitations: Time Constraints: The researcher had to balance the time demands of conducting this study with attending lectures and fulfilling other academic responsibilities. Financial Limitations: Expenses such as printing, typesetting, sourcing literature, and collecting data added financial strain. Limited Availability of Resources: Accessing relevant literature on the subject was challenging due to the limited number of existing studies focused on obstetric fistula in this specific context. 1.8 Definition of Terms Obstetric Fistula: A medical condition characterised by an abnormal passage between the vagina and the bladder or rectum, usually resulting from prolonged obstructed labour. It causes continuous leakage of urine or feces (Ahmed & Holtz, 2007). Prevalence: The proportion of a specific population affected by a condition at a given time. In this context, it refers to the number of women in rural Nigeria living with obstetric fistula. Risk Factors: Conditions or variables that increase the likelihood of a health issue. Here, it relates to the social, cultural, economic, and healthcare-related elements that contribute to the development of obstetric fistula. Rural Nigeria: Areas outside major cities and towns in Nigeria, often characterised by low population density, limited access to healthcare, and strong adherence to traditional customs that can affect maternal health. Maternal Healthcare: Medical services provided to women during pregnancy, childbirth, and the postnatal period. This includes antenatal care, skilled birth assistance, emergency services, and postpartum support. Prolonged Obstructed Labour: A condition where labour continues longer than normal because the baby’s head cannot pass through the mother’s pelvis, potentially leading to severe complications like obstetric fistula if not managed promptly.