Socio-economic Factors Associated with Patients with Vesicovaginal Fistula in Machakos County, Kenya

Background: Vesico-Vaginal Fistula (VVF) is traumatic fistulous tract extending between the bladder and the vagina that allows the continuous involuntary discharge of urine into vaginal vault. The patient has urine wetting and soaking her innerwear, before dripping down her legs. The accompanying smell is awful and most communities consider such women as outcasts.

Methods: This study was conducted among 34 patients with Vesico-vaginal fistula purposively selected from 10 sub counties of Machakos County, Kenya. To supplement the results from these patients, their case notes, 14 of the patients’ husbands, 25 women group leaders from the County, 48 Community Health Workers (CHWs), and 177 healthcare workers in the County were interviewed.

Results: Their ages ranged between 15 and 35 years with mean and median years of 22.3 years. A majority of the patients (62%, n=21) were below 23 years, (29%, n=10) had no formal education and (82%, n=28) came from households earning less than sh6, 000 a month. All of them developed the complication as they delivered at home with either the assistance of a CHW or a relative. By the time the study was carried out, they had sought after treatment at a Referral Hospital and were awaiting appointments for surgical repair. Ten out of 14 husbands (71.4%) who had monogamous marriages with their wives reported that they tolerated their wives’ conditions but could not sleep together due to the stench”. The women group leaders reported that these patients were shy to face the society and tended to lead a secluded life of their own away from the glare of society. The healthcare workers attributed the VVF condition mainly from obstructed labor due to Malpresentation of the baby at delivery, Cephalopelvic disproportion (CPD), maternal distress or Cervical dystocia.

Conclusion: Vesico- vaginal fistula is a problem that occurs mainly amongst the young and poor mothers with prolonged obstructed labor which is not supervised by skilled medical attendants. Its prevalence can be reduced through enlightenment of the public and ensuring that mothers deliver their babies under safe hands of skilled birth attendants.