EVALUATION ON STRATEGIES OF VESICOVAGINAL FISTULA PREVENTION AND MANAGEMENT BY NURSES OF YAOUNDÉ CENTRAL HOSPITAL IN CAMEROON

Chapter One

 Introduction

1.1 Background to the Study

 Regardless of global efforts to improve maternal healthcare, Vesicovaginal fistula (VVF) has become a severe and debilitating condition affecting women of reproductive age. Among the three types of obstetric fistula (OF), scholars have reported the eminence vaginal vesicositis (VVF) to have degenerated in industrialized countries, a major burden in developing countries. According Ndouname (2021) 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 Organization (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  (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.

Medically, Vesicovaginal fistula (VVF) is a severe medical condition characterized by an abnormal connection between the bladder and the vagina, leading to continuous and involuntary discharge of urine into the vaginal vault. In a study by Muleta & Simon (2020) risk factors for VVF include early marriages, prolonged labor, lack of skilled birth attendants, malnutrition, and poverty. Concisely, women who marry young and give birth before their bodies are fully developed are at a higher risk of obstructed labor, which can result in VVF.  

Significantly, Nurses play a crucial role in both the prevention and management of VVF. Tebeu (2022) highlighted that even though prevention of VVF has many dimensions and involves improving maternal healthcare services, providing access to skilled birth attendants, and promoting awareness about the dangers of prolonged labor. Kimani (2015) averred that that nurses as frontline healthcare workers, they are often the first point of contact for women in labor, and their ability to recognize the risk factors for VVF and provide timely interventions can be life-saving.  Studies by Nwendidi & Nanaokposi (2023) shows that timely access to emergency obstetric care can significantly reduce the risk of VVF by preventing prolonged, obstructed labor and nurses are critical in the postoperative management of women who have undergone surgical repair for VVF, providing care that promotes healing and prevents recurrence. Their roles also extend to community education, where they can raise awareness about VVF prevention strategies and encourage early healthcare-seeking behaviors among women. Additionally, the management of VVF involves both surgical and nonsurgical interventions. While surgical repair is the most common treatment for VVF, nonsurgical interventions, including counseling and rehabilitation, are crucial for the holistic recovery of affected women. Nurses are central to these management strategies, providing care before, during, and after surgery, and ensuring that women receive the necessary support to reintegrate into their communities’ post-surgery (Adler 2023). 

In Cameroon, national healthcare policies have increasingly focused on improving maternal healthcare services as part of broader efforts to reduce maternal morbidity and mortality (Braxton & Oandover 2023). However, the successful implementation of these policies depends largely on the knowledge and capacity of healthcare workers, particularly nurses, to provide effective VVF prevention and management. Therefore, nurses must be equipped with the necessary skills and knowledge to detect early signs of obstructed labor, manage labor complications, and provide postoperative care to VVF patients. This study seeks to explore the effectiveness of these strategies and identify areas for improvement.

1.2 Statement of the Problem

In recent times, Vesicovaginal fistula (VVF) a subtype of Obsterics Fistula is a significant public health issue in Cameroon, with profound impacts on affected women's physical and social well-being. In modern medicine, the condition is largely preventable through timely obstetric care and skilled birth attendance, yet it continues to persist, particularly in rural and underserved regions. Although efforts have been made to improve maternal healthcare in the country, there remains a gap in understanding how healthcare providers, particularly nurses, contribute to the prevention and management of VVF.

Despite the critical role of nurses, there is limited research on the specific strategies they employ in preventing and managing VVF, particularly in healthcare settings such as the Yaoundé Central Hospital. Existing studies have focused on the clinical aspects of VVF management, with limited attention given to the role of nurses in preventing the condition. For instance, research by Tebeu (2022) has highlighted the importance of skilled birth attendance in reducing the risk of VVF but has not extensively examined the strategies employed by nurses in preventing and managing the condition. Furthermore, while surgical interventions are widely recognized as the primary treatment for VVF, there is a lack of comprehensive research on the postoperative care and rehabilitation strategies implemented by nurses of which inadequate postoperative care can lead to complications, including fistula recurrence (Kimani 2015). The gap in the existing literature highlights the importance of this study, which seeks to evaluate the strategies used by nurses in both preventing and managing VVF. By focusing on the Yaoundé Central Hospital, Cameroon

1.3 Objectives of the Study

The objectives of this study is focused on evaluation on strategies of vesicovaginal fistula prevention and management by nurses of Yaoundé Central Hospital in Cameroon. Specifically, the study seeks:

To assess the knowledge of nurses on the risk factors associated with vesicovaginal fistula (VVF) in Yaoundé Central Hospital

TO investigate the techniques employed by nurses at the Yaoundé Central Hospital in preventing vesicovaginal fistula (VVF).

To evaluate the role of nurses in the management of VVF cases, including postoperative care and rehabilitation.

To identify the challenges nurses, face in implementing VVF prevention and management strategies at the Yaoundé Central Hospital.

To recommend strategies for improving nurse-led VVF prevention and management efforts in healthcare facilities.

Research Questions

What are Nurses’ level of knowledge on the risk factors associated with vesicovaginal fistula (VVF) in Yaoundé Central Hospital?

What techniques do nurses at the Yaoundé Central Hospital use to prevent vesicovaginal fistula (VVF)?

How do nurses at the Yaoundé Central Hospital contribute to the management of VVF cases, particularly in postoperative care and rehabilitation?

What challenges do nurses face in implementing VVF prevention and management strategies at the Yaoundé Central Hospital?

What strategies can be recommended to improve nurse-led efforts in preventing and managing VVF in healthcare facilities?

Research Hypotheses

Ho1:The level of knowledge of nurse on the risk factors associated with vesicovaginal fistula (VVF) in Yaoundé Central Hospital is low

Ho2: There is no significant role nurses play in prevention and management of vesicovaginal fistula (VVF) at the Yaoundé Central Hospital.

1.6 Significance of the Study

The practical significance of this study lies in its potential to improve maternal healthcare outcomes through an evaluation of the strategies employed by nurses in preventing and managing VVF. By identifying gaps in knowledge and implementation, this study can inform healthcare policies and training programs aimed at enhancing the role of nurses in maternal healthcare. The findings of this study will provide valuable insights for healthcare administrators and policymakers seeking to improve maternal healthcare services and reduce the incidence of VVF in Cameroon.

Theoretically, this study contributes to the growing body of research on VVF prevention and management by focusing on the role of nurses, a group often overlooked in VVF research. While most studies focus on clinical and surgical aspects of VVF management, this study provides a comprehensive evaluation of the strategies used by nurses, contributing to a better understanding of their role in preventing and managing this condition. The findings will also serve as a basis for future research on the impact of nurse-led interventions in maternal healthcare.

Scope of the Study

The study will focus on evaluating the strategies used by nurses in preventing and managing vesicovaginal fistula (VVF) at the Yaoundé Central Hospital. The content scope will include an assessment of the nurses' knowledge, the preventive and management strategies they employ, and the challenges they face in implementing these strategies. The geographical scope is limited to the Yaoundé Central Hospital in Cameroon.

1.8 Limitations of the Study

Commonly, within academic endeavors like this, there are bound to be constraints which limits the study’s finding either because of the methodology, scope or analysis. For this study, one limitation of this study is the potential for biased responses from nurses due to the sensitive nature of the topic. Nurses may overestimate their knowledge and the effectiveness of their strategies to portray themselves in a positive light. To minimize this limitation, the study will employ anonymous surveys and in-depth interviews to encourage honest responses.

Another limitation is the focus on a single healthcare facility. While the findings will provide valuable insights into the strategies used by nurses at the Yaoundé Central Hospital, they may not be generalizable to other healthcare facilities in Cameroon or other sub-Saharan African countries. However, the lessons learned from this study can still be relevant to similar settings with comparable healthcare challenges.

1.9 Definition of Terms

Vesicovaginal Fistula (VVF): A condition characterized by an abnormal connection between the bladder and the vagina, resulting in the continuous leakage of urine.

Prevention Strategies: Interventions aimed at preventing the occurrence of VVF, including access to skilled birth attendants and emergency obstetric care.

Postoperative Care: The care provided to patients after surgical treatment for VVF, including monitoring, counseling, and rehabilitation.

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