Management of Obstetric Fistula in Nigeria Overview

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Management of Obstetric Fistula in
NigeriaOverview

• Presentation at the Africa Regional Conference on
  Obstetric Fistula
• Nouakchott, Mauritania
• 12th December 2007
• Kabir Abubakar, MD

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Introduction

• Population 140 million (2006 census)
• MMR 704/100,000
• of women with skilled attendant at delivery 36
• In Nigeria obstetric fistula is found everywhere
  if one looks for it, but is more common in the
  northern parts.
• Fistula Treatment sites 13 (only 2 in the South)

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Services

• Obstetric Fistula services provided under the
  national fistula programme-led by FMOH in
  collaboration with States, partners and NGOs
• Coverage Treatment available in 13 sites namely,
  Abakaliki, Katsina, Kano, Wudil, Gusau, Jos,
  Sokoto, Kebbi, Hadeja, Maiduguri, Jahun, Uyo and
  Zaria
• A national treatment and research centre is
  planned for Abuja

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Services

• Obstetric Fistula Services under the national
  programme include
• Surgical Treatment
• Rehabilitation
• Prevention
• Training

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Surgical Management

• All the sites have dedicated theatres, and
  trained doctors who perform surgeries.
• Dr. Kees the Chief consultant goes round the
  centres (in the north) periodically to perform
  more complex repairs and reconstructions
• In 2006 these centres performed 1,674 repairs
  (235 RVF) This include 179 done in the rep of
  Niger and exclude the nos from Jos and Uyo where
  400-500 repairs each are done annually

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Surgical Management

• In 2006, the FMOH in collaboration with UNFPA
  developed a standard national curriculum for
  treatment, training and rehabilitation-a major
  step forward
• Success rate in 95
• A few fistula camps have been organized following
  the fortnight
• Challenges regarding treatment is inadequate nos
  of dedicated doctors as those trained usually
  move on after some years therefore the need to
  keep training

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Rehabilitation

• Only 4 of the sites have functional
  rehabilitation centres
• The purpose built rehabilitation centre-Kees
  Waldjick Centre was commissioned last week by the
  first lady of Nigeria
• Training of Social workers using adapted
  curriculum has been done in Kano and Katsina.
  This should improve the capacity of social
  workers in counseling of clients

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Rehabilitation

• One of the key challenge in rehabilitation is the
  inadequate no of personnel to run the centres and
  variety of vocational skills that these women can
  learn
• Many of the women are not ready to stay in the
  rehab centres once they are no longer incontinent

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Prevention

• This should be the focus of efforts to eliminate
  obstetric fistula by focusing on improving
  maternal services especially obstetric services
• Obstetric fistula is a major public health issue
• Advocacy and awareness creation efforts had
  resulted in many states committing to providing
  free maternal and child health services, but a
  lot needs to be done to improve availability and
  quality of Emergency obstetric services
• Awareness creation and advocacy is continuing to
  reduce barriers created by socio-cultural
  practices to promote use of health services

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Prevention

• A new initiative in community based prevention is
  the Virgin Unite supported intervention in Kano
  and Katsina. 20 women many of them fistula
  clients and 10 men have been trained as community
  educators.
• They have in the short interval identified 50
  women in Kano and 30 in Kankara and brought them
  forward for treatment.
• In addition, these educators are mobilizing women
  for maternal health services
• Fistula Module has been included in the DHS to be
  conducted in 2008

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Training

• Training of doctors/nurses is ongoing by Dr.
  Kees, for nationals and others from the sub
  region-Ghana, Liberia and others.
• Training is also done in Jos and Uyo centre
• The Katsina centre has trained a total of 680
  doctors/nurses
• Training of Social workers is just commencing
  with the support of UNFPA
• A new initiative with support from Virgin Unite
  is the training of Fistula clients as Fistula
  Voices by Population media council. These women,
  who have been trained as community educators
  would host radio programmes and help in awareness
  creation

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Challenges

• Increasing number of actors in obstetric
  fistula-Government-Federal and States,UNFPA,
  USAID (Acquire) Rotary International, NGOs.
• Coordination of all these actors has been a
  challenge-this is necessary to ensure the full
  implementation of the National Strategic
  Framework
• Attrition of trained doctors/nurses
• Overcoming the socio-cultural barriers
• Scaling up access to quality obstetric care

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