Hassan M A, Ekele B A
Department of Obstetrics and Gynaecology, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria.
Ann Afr Med. 2009 Apr-Jun;8(2):122-6. doi: 10.4103/1596-3519.56241.
So much has been written on vesicovaginal fistula (VVF) but there is little on the patients' perspective of the condition. The objectives of this study were to determine the knowledge of patients who have developed VVF on the causes of the fistula and their attitude toward measures that would prevent future occurrence.
The questionnaire-based survey was conducted on VVF patients on admission from June to August 2003 at Maryam Abacha Women and Children Welfare Hospital, Sokoto, Nigeria. The case notes of the patients were reviewed after the interview to match the responses from the patients with those documented in the folders. Focus group discussions were held with the maternity staff to ascertain the content and quality of existing counseling.
One hundred and thirty patients were studied out of which 121 (93%) had no formal education. Teenagers constituted 37%, while 57% were primiparae. Thirty-five (27%) patients were divorced or separated because of the VVF. There were seven cases of recurrence after a previous successful repair. Prolonged obstructed labor was the cause of the VVF in 110 (85%) patients and 77 (70%) correctly attributed their problem to the prolonged labor. The 33 patients who could not identify the prolonged obstructed labor as the cause either attributed their condition to God/destiny or to the operation that was done to relief the obstruction and therefore would not have hospital delivery in their subsequent pregnancies. From the focus group discussions, it was confirmed that pre and post-operative counseling were inadequate.
Even though majority (70%) of the patients knew the cause of their fistula from the health talks, some (32%) would still not change from risky obstetric behavior. Mandatory provision of accurate and appropriate information and education to all VVF patients and their relatives or spouses by trained counselors should be ensured. Such information and education should emphasize the etiology and management of obstetric fistula in order to prevent a recurrence.
关于膀胱阴道瘘（VVF）已有诸多著述，但从患者角度对该病症的描述却很少。本研究的目的是确定患有膀胱阴道瘘的患者对瘘管成因的了解情况以及他们对预防未来复发措施的态度。
2003年6月至8月，在尼日利亚索科托的玛丽亚马·阿巴查妇女儿童医院，对入院的膀胱阴道瘘患者进行了问卷调查。访谈后查阅患者病历，将患者的回答与病历记录进行比对。与产科工作人员进行了焦点小组讨论，以确定现有咨询服务的内容和质量。
共研究了130名患者，其中121名（93%）未接受过正规教育。青少年占37%，初产妇占57%。35名（27%）患者因膀胱阴道瘘而离婚或分居。之前成功修复后有7例复发。110名（85%）患者的膀胱阴道瘘是由产程延长梗阻所致，77名（70%）患者正确地将其问题归因于产程延长。33名无法确定产程延长梗阻为病因的患者，要么将病情归因于上帝/命运，要么归因于为解除梗阻而进行的手术，因此在后续妊娠中不会选择在医院分娩。焦点小组讨论证实，术前和术后咨询服务不足。
尽管大多数（70%）患者从健康讲座中了解了瘘管的成因，但仍有一些（32%）患者不会改变危险的产科行为。应确保由经过培训的咨询师向所有膀胱阴道瘘患者及其亲属或配偶强制提供准确和适当的信息及教育。此类信息和教育应强调产科瘘的病因和管理，以防止复发。
