PERCEIVED HEALTHCARE FACILITY CAUSES OF VESICOVAGINAL FISTULA AMONG FEMALE PATIENT IN CAMEROON

Chapter one

Introduction

1.1 Background to the Study

Globally, among the many challenges women suffer during childbirth which also lives with them afterwards, Vesicovaginal fistula (VVF) stands out as a devastating condition that severely impacts the lives of affected women in developing countries. Vesicovaginal fistula (VVF) according to Tebeu & Winifred (2022) is a kind of obstetric fistula that arises when extended blocked labour causes a gap between the bladder and the vagina, leading to persistent and unmanageable urine leaking. Wall (2012) defines Vaginal Vesicositis (VVF) as an anomalous connection between the bladder and the vagina, resulting in persistent and unmanageable urine leaking mostly through the vaginal canal. This syndrome is mostly attributed to extended obstructed labour, which is widespread in areas with poor availability of timely and sufficient obstetric treatment. Despite global efforts to improve maternal healthcare, VVF remains a significant public health issue in many parts of the world, including Cameroon.

Prevalently, Ndouname (2021) reckoned that vaginal vesicositis (VVF) affects both low- and middle-income nations as well as high-income countries but the highest prevalence of VVF is observed in rural areas. The World Health Organisation (WHO, 2018) reports that there are an estimated 50,000 to 100,000 documented cases of OBF globally each year and the data for sub-Saharan Africa (SSA) are astonishing, with an incidence rate of vaginal vesicositis (VVF) reaching 10 instances per 1000 natal births. Similarly a study conducted by Habatamu et’al (2023), fistula impacts around 2-3 million women globally, with  average prevalence in Central Africa and high incidence in South Asia and Sub-Saharan Africa where  30,000 to 130,000 women experience the development of obstetric fistulas during childbirth. Consequently, Eniola & Kadijat (2023) mentioned that VVF not only induces bodily pain but also gives rise to significant psychological and social ramifications, frequently culminating in stigmatization and the experience of isolation. VVF-afflicted women are often marginalized, having their lives significantly changed by a disease that may be avoided with prompt and sufficient obstetric treatment. Other problems include childlessness from loss of viable foetus from pregnancy associated with VVF, secondary infertility, vaginal stenosis by fibrosis and bands, amenorrhoea, high and unaffordable costs of repair and elective caesarean section among those who get pregnant later. Psychosocial problems of the patients include depression, loss of husband’s affection, divorce and rejection by the society. 

Essentially, prevalence of VVF is closely linked to the availability and quality of healthcare facilities, particularly in rural areas where access to skilled birth attendants and emergency obstetric care is limited (Tebeu  2022). The condition is often exacerbated by the lack of adequate healthcare infrastructure, insufficiently trained healthcare providers, and the delays in receiving appropriate care during labor and delivery. These healthcare facility-related factors are critical contributors to the persistence of VVF among women in Cameroon, highlighting the need for targeted interventions to address these systemic issues. According to Ahmed & Holtz (2017) healthcare facilities play a significant role in the occurrence of Vesicovaginal fistula (VVF), particularly in low-resource settings where access to quality maternal care is limited. Inadequate healthcare infrastructure, insufficiently trained personnel, and delayed or inappropriate interventions during prolonged obstructed labor are key contributors to the development of VVF. In many cases, the absence of timely and effective emergency obstetric care, such as cesarean sections, exacerbates the risk of VVF, as prolonged pressure on the bladder and vaginal wall during obstructed labor leads to tissue necrosis and fistula formation (Danso, 2017). Additionally, the lack of essential medical supplies and poor facility management further complicates the situation, highlighting the critical need for improvements in healthcare delivery to prevent such debilitating conditions.

1.2 Statement of the Problem

In recent times, Vesicovaginal fistula (VVF) remains a significant health challenge in Cameroon, particularly among women in rural and underserved areas. Despite efforts to improve maternal healthcare services, the condition continues to affect a considerable number of women, leading to severe physical, psychological, and social consequences. One of the primary factors contributing to the persistence of VVF is the inadequacy of healthcare facilities in providing timely and appropriate care during childbirth. The lack of essential medical supplies, poorly trained healthcare perso nnel, and delays in receiving care are all critical issues that contribute to the development of VVF (WHO, 2016).

Contextually, in Cameroon, the healthcare system faces numerous challenges, including inadequate infrastructure, insufficient funding, and a shortage of skilled healthcare providers. These issues are particularly acute in rural areas, where the risk of VVF is highest. Healthcare providers working in these settings often have to contend with limited resources and challenging working conditions, which can negatively impact the quality of care they provide. Notably,  previous studies have primarily focused on the clinical aspects of VVF, such as its prevalence, causes, and treatment options. However, there is a lack of research that specifically examines the role of healthcare facilities in contributing to the incidence of VVF. Understanding the perspectives of healthcare providers on this issue is crucial for identifying the gaps in the healthcare system that need to be addressed to reduce the occurrence of VVF. This study aims to fill this gap by assessing the perceived healthcare facility causes of VVF among female patients in Cameroon.

1.3 Objectives of the Study

The study is broadly focused on perceived healthcare facility causes of VVF among female patients in Cameroon. Specifically, the study seeks:

To assess healthcare providers' knowledge of the healthcare facility-related causes of vesicovaginal fistula (VVF) among female patients in Cameroon.

To explore healthcare providers' perceptions of the incidence of VVF among female patients in healthcare facilities in Cameroon.

To examine the factors within healthcare facilities that healthcare providers believe contribute to the incidence of VVF in Cameroon.

To evaluate the strategies employed by healthcare providers in Cameroonian healthcare facilities to prevent and manage VVF.

1.4 Research Questions

What is the level of knowledge among healthcare providers regarding the healthcare facility-related causes of vesicovaginal fistula (VVF) among female patients in Cameroon?

How do healthcare providers perceive the incidence of VVF among female patients in healthcare facilities in Cameroon?

What factors within healthcare facilities do healthcare providers believe contribute to the incidence of VVF in Cameroon?

What strategies are employed by healthcare providers in Cameroonian healthcare facilities to prevent and manage VVF?

1.5 Research Hypotheses

Ho: There is no significant impact of facility-related causes and the incidence of vesicovaginal fistula (VVF) among female patients in Cameroon.

Hi: There is a significant impact of facility-related causes and the incidence of vesicovaginal fistula (VVF) among female patients in Cameroon.

1.6 Significance of the Study

The practical significance of this study lies in its potential to inform the development of targeted interventions aimed at improving maternal healthcare services in Cameroon. By identifying the healthcare facility-related factors that contribute to the incidence of VVF, the study will provide valuable insights for healthcare policymakers, administrators, and practitioners. These insights can be used to design and implement strategies that address the specific challenges faced by healthcare providers in preventing and managing VVF, ultimately leading to improved maternal health outcomes.

Theoretically, this study will contribute to the existing body of knowledge on VVF, particularly in the context of healthcare facility-related causes. The findings will provide empirical data on the perceptions of healthcare providers regarding the factors within healthcare facilities that contribute to the incidence of VVF. This data can be used to inform future research on maternal health challenges in developing countries, with a focus on the role of healthcare systems in preventing and managing obstetric complications. Additionally, the study will help to bridge the gap in the literature concerning the impact of healthcare facility-related factors on maternal health outcomes, thereby enhancing our understanding of the systemic issues that need to be addressed to reduce the incidence of VVF.

1.7 Scope of the Study

The study will focus on the perception of healthcare providers regarding the healthcare facility-related causes of vesicovaginal fistula (VVF) among female patients in Cameroon. The content scope includes the knowledge of healthcare providers on VVF risk factors, their perceptions of VVF incidence, the contributing factors they identify within healthcare facilities, and the strategies they employ for VVF prevention and management. The geographical scope is limited to healthcare facilities in Cameroon.

1.8 Limitations of the Study

Like every academic endeavor, the study is not without limitations. One limitation of the study is the reliance on self-reported data from healthcare providers, which may be subject to bias. The perceptions and knowledge of healthcare providers may not fully represent the actual incidence and management practices of VVF in healthcare facilities in Cameroon. Additionally, the study is limited to healthcare facilities in Cameroon, which may affect the generalizability of the findings to other countries or regions.

Another limitation is the potential for variation in the training and experience levels of the healthcare providers participating in the study, which could influence their perceptions and responses. To mitigate this, the study will aim to include healthcare providers with varying levels of experience to ensure a more comprehensive understanding of the issue.

1.9 Definition of Terms

Vesicovaginal Fistula (VVF): An abnormal opening between the bladder and the vagina, leading to continuous and uncontrollable leakage of urine.

Perception: The understanding or interpretation that healthcare providers have regarding the healthcare facility-related causes and management of VVF.

Healthcare Facility Causes: The factors within healthcare facilities, such as inadequate infrastructure, lack of trained personnel, and delayed interventions, that contribute to the incidence of VVF among female patients.

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