Melah G S, Massa A A, Yahaya U R, Bukar M, Kizaya D D, El-Nafaty A U
Department of Obstetrics and Gynaecology, Federal Medical Centre Gombe, Gombe, Nigeria.
J Obstet Gynaecol. 2007 Nov;27(8):819-23. doi: 10.1080/01443610701709825.
This prospective comparative study of obstetric fistulae (OF) was aimed at identifying risk factors. A total of 80 obstetric fistulae treated at the gynaecological unit of the FMCG, and 80 inpatients without fistulae recruited randomly as controls formed the basis of this study. Through interview and case record review, information on age, parity and marital status was collected. Other features were educational status, occupation and booking status of the pregnancy that might have led to this condition. The duration of labour, place of birth and mode of delivery, including its outcome were also collected. The data were analysed using the Epi Info. The majority of the patients were Hausa/Fulani 87.5%, Muslims 91.2%, with large vesicovaginal fistulae (average size 5.0 cm) mainly resulting from obstructed labour (93.7%). Major risk factors included early age at first marriage (average 14 years), short stature (average height 146.2 cm) and illiteracy (96.3%). Also low social class and lack of gainful employment were factors. Failure to book for antenatal care (93.7%), and rural place of residence (95%) were also factors associated with acquiring the fistulae. Living far away (>3 km) from a health facility also contributed or predisposed to the development of an obstetric fistula. Social violence and stigma associated with the fistulae included divorce, being ostracised as a social outcast, and lack of assistance from relations in terms of finding and funding treatment. This study supports improved access to basic essential obstetric care, family planning services, and timely referral when and where necessary. Universal education will provide a long-term solution by improving the standard of living and quality of life. Especially important are media- and community-based programmes on the ills of teenage marriage and child pregnancy using cultural and religiously-based values to give sound advice. In a male dominated society, reaching out to men with traditionally palatable messages that will change their attitude and practices to taking responsibility in reproductive health could be a winning strategy.
这项关于产科瘘管病（OF）的前瞻性对照研究旨在确定风险因素。在联邦医疗中心妇科治疗的80例产科瘘管病患者，以及随机招募的80例无瘘管病住院患者作为对照，构成了本研究的基础。通过访谈和病例记录回顾，收集了年龄、胎次和婚姻状况等信息。其他特征包括教育程度、职业以及可能导致该病的妊娠登记状态。还收集了产程时长、出生地和分娩方式及其结果。使用Epi Info软件对数据进行分析。大多数患者是豪萨/富拉尼族（87.5%），穆斯林（91.2%），主要因产程梗阻（93.7%）导致大的膀胱阴道瘘（平均大小5.0厘米）。主要风险因素包括早婚（平均14岁）、身材矮小（平均身高146.2厘米）和文盲（96.3%）。社会阶层低和没有有收益的工作也是因素。未进行产前检查（93.7%）以及农村居住地（95%）也是与患瘘管病相关的因素。居住在离医疗机构较远（>3公里）的地方也促使或易患产科瘘管病。与瘘管病相关的社会暴力和耻辱包括离婚、被视为社会弃儿而遭排斥，以及在寻找和资助治疗方面得不到亲属的帮助。本研究支持改善基本产科护理、计划生育服务的可及性，以及在必要时及时转诊。普及教育将通过提高生活水平和生活质量提供长期解决方案。特别重要的是以文化和宗教价值观为基础，通过媒体和社区开展关于青少年婚姻和少女怀孕危害的项目，提供合理建议。在男性主导的社会中，向男性传达传统上易于接受的信息，改变他们在生殖健康方面的态度和行为，使其承担责任，可能是一项成功策略。
