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THE INFLUENCE OF MEDIA CAMPAIGNS ON VESICO VAGINAL FISTULA PREVENTION AND CONTROL IN NORTH WEST NIGERIA
ABSTRACT
Vesico Vaginal Fistula is an abnormal communication between the urinary bladder and the vagina that result into constant involuntary discharge of urine into the vagina. This research work evaluated the influence of media campaigns on Vesico Vaginal Fistula prevention and control in North West Nigeria. In executing this study the researcher used explanatory mixed research method. Australian National Statistical Services (NSS) online calculator was used to draw a manageable sample size of 428 from the entire population of North Western Nigeria (35, 786, 944). Three measuring instrument: questionnaire, interview and observation were used to generate both qualitative and quantitative data. Five research questions were raised and findings revealed that respondents are exposed to VVF campaigns in the region. However, the level of exposure seem to be relatively high. It was equally found out that the knowledge level of the people of North West Nigeria on VVF is high. From the study it was also found that radio and seminar /workshop forms the major sources of information to the people. The challenges associated with the use of the media in campaigns against VVF were as well discovered to include: language, frequency of the awareness campaigns and boring awareness progammes. The level of the influence of the campaigns on VVF prevention and control is moderately high. Based on the findings the study recommends that the campaigns planners should ensure they use local languages during the campaigns, skilled counselors should be used during the seminars, the awareness campaign should inform the people on the consequences of early marriage.
TABLE OF CONTENTS
Title Page…………………………………………………………………………………………………. i
Certification…………………………………………………………………………………………….. ii
Dedication………………………………………………………………………………………………… iii
Acknowledgements………………………………………………………………………………….. iv
Table of Content………………………………………………………………………………………. v
Abstract……………………………………………………………………………………………………. viii
CHAPTER ONE: INTRODUCTION
- Background of the study………………………………………………………………………. 1
- Statement of the Research Problem……………………………………………………… 4
- Objectives of the Study………………………………………………………………………… 6
- Research Questions……………………………………………………………………………… 6
- Significance of the Study……………………………………………………………………… 7
- Scope of the Study……………………………………………………………………………….. 8
- Operational Definition of Terms………………………………………………………….. 8
References…………………………………………………………………………………………… 10
CHAPTER TWO: LITERATURE REVIEW
2.0 Focus of the Review…………………………………………………………………………….. 12
2.1 An Overview of Vesico Vaginal Fistula………………………………………………. 12
2.2 Causes of Vesico Vaginal Fistula…………………………………………………………. 15
2.3 Psycho-Social Consequences of VVF on its Victim……………………………… 24
2.4 Empirical Studies………………………………………………………………………………… 27
2.5 Theoretical Frame work……………………………………………………………………….. 38
References………………………………………………………………………………………….. 41
CHAPTER THREE: METHODOLOGY
3.1 Research Design………………………………………………………………………………….. 47
3.2 Population of the Study……………………………………………………………………….. 49
3.3 Sample Size…………………………………………………………………………………………. 49
3.5 Measuring Instruments………………………………………………………………………… 55
3.6 Validity and Reliability of Measuring Instrument………………………………… 56
3.7 Methods of Data Presentation and Analysis…………………………………………. 57
References ……………………………………………………………………………………….. 58
CHAPTER FOUR: DATA PRESENTATION AND ANALYSIS
4.1 Data Presentation and Analysis……………………………………………………………. 59
4.2 Discussion of Findings…………………………………………………………………………. 99
References………………………………………………………………………………………….. 104
CHAPTER FIVE: SUMMARY, CONCLUSION AND RECOMMENDATIONS
5.1 Summary……………………………………………………………………………………………… 105
5.2 Conclusion………………………………………………………………………………………….. 107
5.3 Recommendations……………………………………………………………………………….. 107
Biography…………………………………………………………………………………………… 110
Appendix……………………………………………………………………………………………. I-VII
CHAPTER ONE
INTRODUCTION
1.1 Background of the Study
Vesico-Vaginal Fistula (VVF) is a sub type of Obstetric Fistula. It is an abnormal disorder that occurs between the urinary bladder and the vagina. This can lead to constant/involuntary discharge of urine into the vagina. It is associated with women alone; and can be caused by severe birth morbidity resulting from prolonged labour (Obstetric Fistula), severe sexual violence (Traumatic Fistula) or surgical errors (Iatrogenic Fistula).This disorder in the urinary track causes deterioration in the tissues between the vagina and the bladder or rectum. This deterioration subjects women to great discomfort, pains and embarrasses women in the control of their urine or faeces. However, while some women find support/help from families and friends, many others suffer from social isolation and most of these women are the impoverished members of the society (USAID, 2003, p. 1).
In addition to this, the report of the National Foundation on Vesico- Vagina Fistulae (2003,p.19) enumerates major causes of VVF in Nigeria which includes, prolonged labour due to cephalopelvic disproportion, the pelvic of the teenage not being fully developed as at pregnancy, making the pelvis often two small for the baby. Prolonged labour of the baby’s head against the back of the pelvic bone produces ischemic necrosis of the intervening soft tissues (Andrew, 2011, p.13).
Early marriage is also, one of the major causes of VVF. Most of the Vesico Vaginal Fistula patients in Northern Nigeria had early marriages, 93.6% of Sokoto patients were married before or at 18years of age and 81.5% of Kano patients and 52% of Maiduguri fistula patients got married by 15years of age (Benjamin, 2010, p.294). It must also be noted that early marriage notwithstanding, it is not the only socio-cultural practices that leads to VVF. Female Genital Mutilations is a twin sister which is practiced everywhere in North Western Nigeria. The insertion of various herbs and medication for traditional treatment of various conditions such as, Dysperunia, Infertility, Congenital Vaginal Septum, Vaginal Infections, Amenorrhea, Vaginal discharge and to procure abortion. However, the preparation rather than the content of the herb damages the wall of the vagina (Lawson, 1998, p.15).
The physical, psychological and social consequences of this disorder are enormous. Robertson (1957, p.7) pointed out that, the misery of this condition has one of the most frightful affliction of human kind, “ hour by hour, night and day the leakage wet, excoriate and hurts the victim of this misfortune. Clothes are ruined, the bed becomes a night mare, sexual intercourse stops, a pariah is made and the family house is an outcast”. National foundation on Vesico Vaginal Fistula (2003.p.10)
Globally, over two million women are estimated to be living with VVF and majority of them are in Sub-Sahara Africa and South Asia. The Fistula in West Africa ranges between 1-4 /1,000 deliveries. An annual obstetric fistula incidence is estimated at 2:11 per 1000 birth (Benjamin, 2010, p. 294).
In 2008, Nigeria Demographic and Health Survey (NDHS) revealed that, Nigeria has about 545/100,000 maternal morbidity ratio, thereby contributing about 10% of the global burden. Similarly, majority of delivery occurs at home, while births attended by skilled Birth Attendants are estimated to be only 39% with very low contraceptives utilization rate (NDHS, 2008, p. 32).
In a recent report by the United Nation Population Fund Agency (2010, p. 22), it notes that, VVF and maternal death are immensely associated with complications related to pregnancies, and childbirth, and this has continued to pose a threat to women. The prevalence in Nigeria ranges from 100,000 to 1,000,000 cases, while the incidence is recently estimated at 20,000 cases per annum (UNPFA, 2010, p. 23). However, it is evident that Vesico Vagina Fistula is rampart in the Northern part of Nigeria due to several prevailing social-cultural factors such as, early marriage /pregnancies and low status of woman coupled with poor access and utilization of antenatal services (UNPFA, 2010, p. 23).
The Federal Government of Nigeria through the Federal Ministry of Health (FMH) in conjunction with United Nation Population Fund Agency (UNFPA) recognized that Vesico Vagina Fistula cannot be addressed in isolation but as part of an integrated effort to improve sexual and reproductive health, including the aim of reducing maternal mortality and morbidity and as such, National Strategic Frame Work for Eradication of fistula in Nigeria was developed to ensure a holistic approach for fistula intervention, prevention, treatment and care as well as rehabilitation and reintegration campaign to end fistula( Lawrence, 2010, p.9).
In other to address this issue, a lot of awareness campaigns (e.g. Campaign to End Fistula, sponsored by UNPFA) are on by the government, NGOs, private individuals and organizations. The mass media, particularly the radio tends to be the major carriers of the VVF campaign messages in the North West Nigeria.
Despite all the campaigns going on in North Western Nigeria, the problem of VVF is still at an alarming rate. For instance, Medicine San Frontier (Doctors without borders) is vigorously battling VVF in all the states of the North Western Nigeria with numerous awareness campaigns, free treatment of VVF patients and rehabilitation / reintegration programmes. Despite all these, many people are still left in the dark in what actually causes VVF, its prevention and control. (Lawrence, 2010, p.9).
Given the above scenario, it becomes imperative to investigate the influence of media campaigns on Vesico Vagina Fistula prevention and control in North West Nigeria.
1.2 Statement of Problem
Wall (2001, p. 896) in his work,’Urinary incontinent in the developing world: The Obstetric Fistula” discovered that Vesico Vagina Fistula is relatively rare in developed and industrialized nations, but remains a nightmare in developing nations most especially Africa. It is one of the worst morbidities associated with delivery in this part of the world. WHO (2005, p.2) reveals that more than 2 million women and young girls live with VVF worldwide, and Africa has the largest number of those affected with VVF in the globe. Also, UNFPA’s Report in 2010 (p.34), states that there are over one million newborn children deaths yearly and for every woman who dies in childbirth, at least 20 percent suffered injuries, infections or disabilities. Tragically, an estimate of more than 2 million women and young girls in developing nations are affected, with not less than 100,000 new cases occurring yearly (UNFPA, 2010, p. 47). Comparing UNFPA’s Report of 2010 with the earlier report made by WHO in 2005, it becomes clear that there is an increase in this fistula problem. This condition leaves affected women and young girls in a state of despair; some are subjected to social humiliation as a result of the condition.
This reality can be averted, and efforts have been on by various organizations across the globe such as, Fistula Foundation of Nigeria, Women’s Missionary Society, WHO, White Ribbon Alliance, UNFPA, Human Right Watch, International Women’s Health Coalition, United Nations Foundation, Family Care International, and others have in one form or the other supported the campaigns on this, gave free treatment and aid to people that are affected.
The media have been employed to create awareness about the disease and as a major step towards preventing and controlling the disease. The extent to which these awareness campaigns have influenced the people to take preventive and control measures is the focus of this study. Therefore, this study examined the influence of Media Campaigns on Vesico Vagina prevention and control in North West Nigeria.
1.3 Objectives of the Study
Generally, every research is goal-oriented; the goal must be stated in clear terms to enable its realization. The broad objective of this study therefore is to find out the influence of media campaigns on Vesico Vagina prevention and control in North West Nigeria . Specifically, the research sought:
- To find the level of exposure of the people in North-Western Nigeria on Vesico Vagina Fistula campaigns.
- To ascertain the knowledge level of the people in North-Western Nigeria on Vesico Vagina Fistula.
- To find out their major sources of information.
- To find out the challenges associated with the use of the media in campaign against VVF
- To ascertain the level of influence of these campaigns in the prevention and control of VVF in North West Nigeria
1.4 Research Questions
The following research questions are formulated to guide the proper investigation of this research work. They are:
- What is the level of exposure on VVF campaigns among the people of North-Western Nigeria?
- What is the level of knowledge on VVF among the people of North-Western Nigeria?
- What is the major source(s) of information about VVF among the people of North West Nigeria?
- What are the challenges associated with the use of the media in campaign against VVF?
-
What is the level of the influence of the campaigns in the prevention and control of VVF?
- Significance of the Study
It is a fact that health matters are key issues that must not be toyed with in any nation. At the same time, a healthy society is a wealthy society. The impact of this study will be felt positively in various fields, such as the health sector, governments, private individuals, NGOs, academics and others.
Academically, this research work will advance knowledge. The academic community will use this work as a reference point and in the execution of similar studies.
Professionals, NGO and other bodies like, WHO, UNICEF, UNFPA, USAID, MSF etc who are core partners in the campaign on VVF will find this study very useful in the implementations of some programmes, and decisions.
It will also be of immense help to the government, most especially those in the health sector. The outcome of the study will motivate government and non-governmental organization that are interested in women and child development to formulate health policies that will help rehabilitate VVF patients as well as eradicate the disease in Nigeria.
Theoretically, this study will serve as a platform to test the postulation of the theory used in the study.
- Scope of the Study
This study is carried out in North-Western Nigeria. This region is made up of, Jigawa State, Kaduna State, Kastina State, Kano State, Kebbi State, Sokoto State and Zamfara State. The indigenes of these states are mostly Muslims.
1.7 Operational Definition of Terms.
For the purpose of clarity, key variables were defined operationally.
Vesico Vaginal Fistula: Vesico Vaginal Fistula (VVF) is a subtype of female urogenital fistula (UGF). VVF is an abnormal fistulous tract extending between the bladder and the vagina that allows the continuous involuntary discharge of urine into the Vagina.When it occurs there is always the wetting of the victims clothing leading to a tear or wear off of the skin around the already damaged vagina.
Campaigns: These are media programmes that are aimed at fighting Vesico Vaginal Fistula by informing the people of North West Nigeria on the danger of VVF and how it can be prevented, detected or treated.
Influence: This refers to how the campaigns change the attitude, knowledge and behaviour of people of North Western Nigeria.
Knowledge: The level of information known to the people of North Western Nigeria on VVF.
VVF Prevetion: All conscious effort meant to limit or regulate Vesico Vaginal fistula in North Western Nigeria
VVF Control: All conscious effort meant to stop Vesico Vaginal Fistula occurrence in North West Nigeria
North Western Nigeria: This refers to the seven states of North Western Nigeria namely: Jigawa, Kaduna, Kastina, Kano, Kebbi, Sokoto and Zamfara.
References
Andrew, O. (2011). Africa: The effect of VVF in Africa. International Journal of Gynecology and Obstetrics.2, 6
Benjamin, G. (2010). Fistula in developing nations. Lagos: Kemi Press.
Lawrence, P. (2010). Vesico-vagina fistula: A tropical disease. London: Edward Arold
Lawson, J. (1998). Urinary Tract Injuries in Obstetrics and gynecology in the tropics and developing countries. London: Arnold
Nigeria Demographic Health Survey (NDHS). Religion, Gender and Educational Level of Nigerians. Retrieved March 23, 2012 fromwww.unicef.org/nigeria/ng_publicati
ions _Nigeria_2008_final_rep
The National Foundation on Vesico-Vaginal Fistula (2003). Report of the rapid assessment of vesico-vaginal fistula in Nigeria. Retrieved March 20, 2013 from http://www.endfitsula .org
United Nation Population Fund. (2010) Campaign to End Fistula. Retrieved March 3, 2012from http://www.endfistula.com/publications.htm
United States Agency for International Development (USAID) (2003). Mid Term Evaluation of Fistula Care Project. Retrieved February 21, 2012 from http://www.ghtechproject.com/…/nigeria%20mch-
Wall.L.L (2001) Urinary Incontinence in the Developing World: The Obstetric Fistula. Retrieved January 12,2013 from www.fistulafoundation.org
WHO (2005). Obstetric fistula, guiding principles for clinical management and programme development. Geneva, Switzerland.
THE INFLUENCE OF MEDIA CAMPAIGNS ON VESICO VAGINAL FISTULA PREVENTION AND CONTROL IN NORTH WEST NIGERIA
