INVESTIGATION OF WOMEN'S PERCEPTION ON THE RISK FACTORS AND PREVENTION OF VESICOVAGINAL FISTULA IN BAMENDA REGION CAMEROON

Chapter One

Introduction

1.1 Background to the Study

All societies have different customs and beliefs which are unique to them and, these customs and beliefs make them to have different regard to obstetric fistula. Since no two individuals are the same, as even identical twins do not reason in the same manner has given rise to so many different regards to obstetric fistula in the Far North Region. Although the eminence of obstetric fistula (OF) is reported to have degenerated in industrialized countries, it is still a major problem in developing countries especially vaginal vesicositis (VVF). 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 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.

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, all of which are prevalent in the rural Cameroon specifically Northern region. 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.  In study by Kimani prevention of VVF relies on improving maternal healthcare, promoting education, and addressing socio-economic challenges that contribute to the condition. Kimani (2023) pointed that raising awareness among women about the risk factors and prevention strategies is essential for improving maternal health outcomes. Studies have emphasized the importance of community education in preventing VVF, as informed women are more likely to seek timely medical assistance and advocate for better maternal health services. 

Bizarely, most of the cases suffering from fistula live in remote areas, live in isolated areas wherein many do not have access to information and poor road network. This is a very big hindrance as it makes it very difficult to penetrate the communities to sort out these patients to go for treatment. These difficulties are superficial as there are different means of transportation to reach these communities but the worst hindrance of having access to obstetric fistula cases is the knowledge, attitude and perception of the community towards obstetric fistula. According to Ujaman (2020) VVF  affects numerous women of reproductive age  every day  however the knowledge, attitude and perception of obstetric fistula has to do with the community’s awareness of  fistula, what they belief is the causes of the condition, how they treat both the affected and infected persons in the community.

Consequently, Eniola & Kadijat (2023) mentioned that because VVF not only induces bodily pain but shame, hence those who are suffering from it belief they are a disgrace to themselves, their families and the entire community whichgives rise to significant psychological and social ramifications, frequently culminating in stigmatization and the experience of isolation. Uzobunu (2021) assert that 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. This deepens the need for a deeper understanding of women's perceptions of VVF risk factors and the preventive measures that can be implemented at the community level.

1.2 Statement of the Problem

Vesicovaginal fistula (VVF) remains a significant public health issue in Cameroon. Although considerable efforts have been made to reduce the incidence of VVF through improved maternal healthcare services, the condition remains prevalent, particularly in areas where access to timely and adequate obstetric care is limited. Studies have emphasized the importance of community education in preventing VVF, as informed women are more likely to seek timely medical assistance and advocate for better maternal health services (Kimani 2015). 

In the Bamenda region, women's knowledge and perceptions of VVF play a pivotal role in shaping their health-seeking behaviors and attitudes toward prevention. This is particularly important where cultural beliefs and practices may influence perceptions of maternal health and the risks associated with childbirth. To buttress this, Fredrick & Nyounguva(2021) assert that early marriage and childbirth are often viewed as cultural norms by rural women and this can increase the risk of obstructed labor as theier reproductive organs ar immature for child bearing and the subsequent development of VVF. Whereas in most scenarios these cultural factors when combined with inadequate healthcare services, create a complex environment that contributes to the persistence of VVF in the region. A study by Finindi & Nwendidi(2023) argued that when women have lttle knowledge about the risk factors associated to VVF, they are likely to make poor choice in term of marrying early and when they even suffer VVF, they might live in shame due to the stigma from family, hence find it difficult to seek appropriate medical attention.

Although studies have highlighted the clinical and medical aspects of VVF, but there is limited research on women's perceptions of the risk factors and preventive measures for the condition but there remains a gap in understanding how women in rural areas like Bamenda perceive the risks associated with childbirth and the preventive actions they can take. This lack of understanding hinders efforts to reduce the incidence of VVF and improve maternal health outcomes. Upon this premise, the study seeks to investigate Women's Perception on the Risk Factors and Prevention of Vesicovaginal Fistula in Bamenda Region Cameroon.

1.3 Objectives of the Study

The broad objective of this study is focused on investigation of women's perception on the risk factors and prevention of vesicovaginal fistula in Bamenda Region Cameroon. Specifically, the study seeks:

To assess women's perceptions of the risk factors associated with vesicovaginal fistula (VVF) in the Bamenda region of Cameroon.

To evaluate women's knowledge of preventive measures for VVF in the Bamenda region.

To examine the socio-cultural factors influencing women's perceptions of VVF risk factors and prevention in the Bamenda region.

To identify recommend strategies for improving women's knowledge VVF risk factors and prevention in the Bamenda region..

Research Questions

How do women in the Bamenda region perceive the risk factors associated with vesicovaginal fistula (VVF)?

What is the level of knowledge among women in the Bamenda region regarding preventive measures for VVF?

What socio-cultural factors influence women's perceptions of VVF risk factors and prevention in the Bamenda region?

What  strategies can be recommended to improve women's knowledge VVF risk factors and prevention in the Bamenda region?

1.5 Research Hypotheses

Ho1: Women's perceptions on the risk factors associated with vesicovaginal fistula (VVF) in the Bamenda region of Cameroon is negative.

Ho2: The level of knowledge among women in the Bamenda region regarding preventive measures for VVF is low.

1.6 Significance of the Study

This study holds practical significance as it aims to improve maternal healthcare outcomes by investigating women's perceptions of vesicovaginal fistula (VVF) risk factors and prevention in the Bamenda region. By identifying gaps in women's knowledge and understanding of VVF, the study will provide insights that can be used to develop targeted community education programs and healthcare interventions. These programs will empower women to make informed healthcare decisions during childbirth, reducing the incidence of VVF and improving overall maternal health. Additionally, the findings of this study can inform public health policies and strategies aimed at addressing the socio-cultural factors that contribute to the persistence of VVF in rural areas.

Theoretically, this study contributes to the existing body of knowledge on VVF by exploring the socio-cultural dimensions of women's perceptions of the condition. While much of the literature has focused on the clinical aspects of VVF management, this study provides a unique perspective on the community-level factors that influence women's understanding of VVF risk factors and prevention strategies. The findings of this study will add to the growing body of research on maternal health in sub-Saharan Africa and can serve as a foundation for future studies on VVF prevention and women's health-seeking behaviors in similar contexts.

1.7 Scope of the Study

The content scope of this study focuses on investigating women's perceptions of the risk factors and prevention strategies for vesicovaginal fistula (VVF). The study will explore the socio-cultural factors that influence women's knowledge and attitudes toward VVF prevention. Geographically, the study is limited to the Bamenda region of Cameroon, a rural area where VVF prevalence is high. The study will involve women of reproductive age who have given birth or are at risk of developing VVF.

1.8 Limitations of the Study

Commonly, within academic endeavors like this, there are bound to be contraints which limits the study’s finding either because of the methodology, scope or analysis. For this study, one limitation y is the potential for bias in self-reported data. Since the study relies on surveys to assess women's perceptions of VVF risk factors and prevention, there is a possibility that respondents may provide socially desirable answers rather than accurate reflections of their knowledge and attitudes. However, to minimize this limitation, the study will use a combination of qualitative and quantitative methods to gather data, allowing for a more comprehensive analysis of women's perceptions.

Another limitation is the focus on a single region, Bamenda. While the study provides valuable insights into women's perceptions of VVF in this particular region, the findings may not be generalizable to other areas of Cameroon or sub-Saharan Africa. However, the socio-cultural factors and healthcare challenges faced by women in Bamenda are similar to those in many rural regions, making the findings relevant to broader maternal health initiative.

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 Bamend women have regarding the causes and management of VVF.

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