Vesicovaginal Fistula in Nigeria

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By Jovita Daniels BMR(PT), MSc. PhD

The incidence of vesicovaginal fistula (VVF) continues to be high in my beloved country of Nigeria, despite awareness of VVF worldwide. There are between 400,000 to 800,000 women currently living with VVF in Nigeria, which is the highest prevalence in the world. Nearly 20,000 new cases occur annually, and 90% go untreated.

Risk factors for VVF include early marriage, illiteracy, poverty, lack of access to good antenatal care, and lack of roads to transport patients. Most cases are in northern Nigeria, where transportation is a challenge.

The practices that lead to VVF have not been battled strongly enough to reduce the menace. There are VVF hospitals and clinics in Nigeria where surgeries are carried out on some patients who are lucky enough to get placement or an appointment. However, most of the post-repair patients still have residual incontinence, which physiotherapy could help manage. Unfortunately, the majority of centers and clinics have not employed a physiotherapist.

What is needed is more access to health care and trained physiotherapists and surgeons to treat women with VVF. Proactively women and men need to be educated on how this problem occurs and how increased government commitment to ending VVF could reduce the problem. More coordination of government health agencies and hospitals is needed so, together, they can best assist these women in childbirth, and fistulas are no longer such a risk to women’s health in Nigeria.

I will be presenting background on the incidence of VVF in Nigeria and the involvement of physiotherapists in the management of VVF patients at the APTA Combined Sections Meeting and encourage attendees to hear about this global problem.

Daniels is part of an international panel session on “Trauma-Induced Pelvic Floor Disorders: Implications for Physical Therapists” at CSM Thursday, February 16, from 11 a.m. to 1 p.m. in San Antonio, Texas.

AUTHOR: Jovita Daniels, BMR(PT), MSc. PhD, is a chief physiotherapist in charge of the Women’s Health Unit of the Physiotherapy Department at the Federal Medical Centre, Owerri. She also is an adjunct lecturer in the department of Biomedical Technology, Federal University of Technology, Owerri. Well-published in journals, she also has written two books: Antenatal Exercises: Going through Pregnancy and Labour with Ease and Postnatal Exercises: Regaining Your Shape Soon after Delivery. Daniels is the Nigeria chief delegate with IOPTWH and chairs the Imo State Chapter of the Nigeria Society of Physiotherapy.