Exploring the role of socio-economic and cultural factors influencing the occurrence of VVF in Northern Nigeria

Towoju, Folake Veronica (2023) Exploring the role of socio-economic and cultural factors influencing the occurrence of VVF in Northern Nigeria. Doctoral thesis (PhD), Manchester Metropolitan University.

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Abstract

Background Access to a range of adequate care, and support during pregnancy and after delivery is required to prevent maternal morbidity, however, difficulties accessing appropriate healthcare by pregnant women is a significant problem in low- and middle-income countries, especially in Nigeria. Though there are multiple, significant, maternal morbidities or complications, obstructed fistula was identified as the one that impacts most women especially, in sub-Saharan Africa. There are two major kinds of obstructed fistula common in developing countries, namely, Vesico Vaginal Fistula (VVF) and Recto Vaginal Fistula (RVF) (Tebeu et al., 2012). This study focuses on vesicovaginal fistula because it has the most debilitating impact and is most prevalent in developing countries, especially Nigeria, where it is also increasing in prevalence in the Northern Nigeria geopolitical zones (Ijaya et al., 2010). VVF is an avertible tragedy, and a preventable complication of pregnancy resulting in an abnormal passage or channel between the vagina and the bladder. The impacts include stillbirth, physical and psychological trauma for the victim. Maternal healthcare has been jeopardised especially in low- and middle-income countries giving rise to occurrence of VVF. While the quality of available healthcare is a concern, socioeconomic and cultural factors has been identified as critical factors leading to its occurrence. The literature review identified evidence gaps including, a lack of in-depth exploration of the individual's risk of being at risk (due to socio-economic/cultural factors), the experiences of VVF women, influence on practitioners’ service delivery, available interventions, and the challenges in delivering VVF services. Aims This study aimed to (1) explore the socio-economic and cultural factors influencing VVF occurrence among women in Northern Nigeria and (2) Identify potential interventions to address the increasing prevalence of VVF in Northern Nigeria. Methods A critical interpretivist approach and purposive sampling was used to explore participant experiences of VVF. A 1:1 semi-structured interview was conducted with twenty-two VVF patients and ten VVF practitioners from across the three geopolitical zones of Northern Nigeria. The interviews were transcribed, and thematic analysis of the data completed guided by Braun and Clarke (2006). Findings The findings of this study produced three overarching themes which are:  Socioeconomic and inter-connections with cultural factors influencing the prevalence of VVF.  Occurrence of VVF and challenges hindering access to healthcare.  Potential solutions to reduce the prevalence of VVF. The findings indicate the negative impact of multiple, inter-related socio economic and cultural factors on women’s health outcomes and experiences, specifically in relation to their perceived value and role in society, associated risk of VVF and access to preventative and treatment services. Conclusions Reducing VVF prevalence may not be realistic without in-depth exploration and adequate prevention of the risk of being at its risk. VVF may continue to thrive where there is no improvement in maternal healthcare services, poverty, poor quality of education status or access to education and dominance of predisposing cultural practices. This study identified causes and suggested strategies for preventing VVF occurrence, resulting in specific recommendations for future policy, practice, and research, whilst also highlighting the implications of leaving these unaddressed, for economic recovery and achieving Sustainable Development Goals (SDGs) among women in Northern Nigeria.