International Organization
for Women and development
VVF at the National hospital of
Niamey/Niger
Dr Amoul Kinni ghaichatou
Plan
z Introduction
Niger/NHN
z I Methodology and patients
z II Epidemiological Results
z Conclusion
z Recommandations
z
1
Introduction
z Definition:
Fistula is a form of birth trauma that is one of the most disabling
disabling
condition women can experience. It takes from her family, children,
children,
vocation and feminity.
feminity.
It can be prevented and often repaired with continence in the
majority of women: Dr Weelesse R
z Expresses
system
a deficiency of the medical
Introduction
z Still
exist in Africa and Asia
z Study UNFPA in sub-Saharan Africa
z HNN, Lamorde, Zinder (3 Fistula surgery
centers in Niger)
z REF (NFE): Network for the Fistula
Eradication in Niger October 2003
2
Niger
Geography
Situation: west Africa
Surface: 1287000Km2
Capital: Niamey
Demography
Population:12 millions
Niger
Economy:
one of the poorest country in the
world (UNDP)
Education:
34% of the 40% girls
80% from Urban area
80% of adult illiterate
3
Niger
Health :
1/2 has access to health service
Maternal mortality:700/100 000
Child mortality:123/1000
3 MD and 11 nurses for 100000
The highest child birth:7,5/woman
National hospital of Niamey
Create in 1922
Capacity of 858 beds
Biggest hospital of the
country
4
Objective
z To
determine the epidemiological
and therapeutical characteristics
of the obstetrical FFV in the
NHN.
General
Treatment
z Surgical
Need of surgeon and qualified surgeon
5
General
Preventive treatment
z To
avoid the three delays during the
childbirth:
delay in the decision of research of the
treatment,
delay during transport
and delay in the assumption of
responsibility of the parturiante in the
center of health.
Method and patients
z Prospective
study from December 2003 to
February 2005 (14 months)
z FVV exclusively obstetrical
z 111 case including 104 operated on;
z HNN
z Evaluation in three months, independent
of the operator.
6
Results
z Epidemiologic
Provenance
Agadez
(Table I)
Fré
Fréquence
Pourcentage (%)
5
4,5
Dosso
30
27,0
Maradi
7
6,3
Niamey
5
4,5
Tahoua
5
4,5
58
52,3
1
0,9
111
100
Tillabery
Zinder
Total
Results
z The
average age of the patients is 26
years and half ;
z Extremes:
15 and 46 years
7
Results
z Age
of mariage: 83,6% of the cases
before 18 years.
z Matrimonial
statut: 51,4 % divorced
and 1,8% ignore their matrimonial
statut
Results
z
Current residence (table II)
Domicile actuel
Fréquence
Pourcentage
(%)
Parents
84
75,7
husband
22
19,8
Hospital
5
4,5
111
100
Total
8
Results
Current residence:
z
51,9% of the married patients live
with their parents
z 5,8%
of divorced live at NHN
Results
Row of the causal childbirth:
z 43,2%
of the patients had the fistula
with the first delivery
9
Results
Labor time hours (Table III):
Fré
Fréquency
Pourcentage
(%)
Less than 24 H
8
7,2
More than 24 H
103
92,8
Total
111
100
Labor time
Results
Place of delevery
z
35,1% delivered in residence
z
59,5% in maternity hospital
z
5,4% on the way of the health
center
10
Results
Mode of delivery :
z Vaginal:
zC
79,3%
Section: 20,7%
Results
z 62,2%
z 100%
do not have an alive child
of new born died
11
Results
Time before the surgery
z 71,2%
waited one year before being
operated
Results
Treatment other than surgery, 9,9% had
initially recourse to a traditional treatment.
Using of intensive heat source
12
Results
Associated signs:
z
z
23,4%:
dermatological;
1,8%: foot drop
Discussion
z
z
z
FFV is a pathology of the developing
countries;
It affects the young, primiparous, poor,
precociously married woman without
access to the health centers [ Watara,
Rochat, Hillary, Kess ]
The average age is 26 years in this study;
in the literature it varies from 22 to 28
ans.[Kell, Kwast and Rochat ]
13
Discussion
Matrimonial status and residence:
z
z
z
z
z
z
51,4% of the patients are divorced
Among the bride, only 19,8% live in their
husband
4,5% of the patients elected residence
with the HNN
To Mali, Watara reports that 69,9% live in
their conjugal home;
Dekou in Ivory Coast reports that only 20
% of patients are divorced.
Would the couple native of Niger be more
vulnerable vis-a-vis the drama of the dent
vésico vaginale ?
Discussion
z
z
z
In short, the nigerien woman with fistula
desease comes from a underpriviledged
sphere, is young and married early.
Often marginalized, she sees her fistula
statute replace her statute of married
woman.
Losing her femininity and very frequently
her child, she is a victim of her culture and
her tradition by early marriages and the
delay in the research of obstetrical care.
14
Conclusion
z Real
problem of public health
z Treatment
is surgical
zA
place of choice must be given to
the prevention, by an adequate
assumption of responsibility of the
childbirth.
Recommendations
To the authorities :
z
z
z
z
To create the conditions of access to the obstetrical care for
all the pregnant women.
To train a personnel qualified in the assumption of
responsibility of the obstetrical fistula.
To sensitize the population on the obstetrical fistula
and to place at its disposal the means to evacuate on time the
patients towards the qualified centers of health.
To the parents:
z
z
To educate the girls to reinforce their independence of
decision.
To avoid the practice of the harmful traditions for health.
15
Thank you
For your
attentio
n
16