Community awareness about risk factors, presentation and prevention and obstetric fistula in Nabitovu village, Iganga district, Uganda

  • BMC Pregnancy and Childbirth, Volume 13, Year 2013

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Study Justification:
– Obstetric fistula is a devastating problem for women in developing countries.
– Awareness about obstetric fistula is low in developing countries.
– The study aimed to assess the awareness about risk factors of obstetric fistula in a rural community in Uganda.
Study Highlights:
– Majority of the women and some men in the community were aware of obstetric fistula.
– However, there were misconceptions about its causes, clinical presentation, and prevention.
– Some attributed fistula to misuse of family planning, having sex during menstruation, curses, sexually transmitted infections, rape, and gender-based violence.
– Others attributed fistula to delays in accessing medical care, induced abortions, early age conception, utilization of traditional birth attendants, and complications during surgical operations.
Study Recommendations:
– Increase community awareness about the correct risk factors, clinical presentation, and prevention of obstetric fistula.
– Address misconceptions and myths surrounding obstetric fistula.
– Improve access to emergency obstetric care and family planning services.
– Promote the use of skilled birth attendants during delivery.
Key Role Players:
– Local government officials
– Community leaders
– Healthcare providers
– Non-governmental organizations (NGOs)
– Women’s groups and community-based organizations
Cost Items for Planning Recommendations:
– Awareness campaigns and educational materials
– Training programs for healthcare providers
– Infrastructure improvements for healthcare facilities
– Access to family planning services
– Support for skilled birth attendants
– Monitoring and evaluation of interventions

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is relatively strong, as it presents findings from a qualitative study conducted in a specific village in Uganda. The study used focus group discussions to explore the awareness of obstetric fistula risk factors in the community. The data was analyzed using thematic analysis, and the abstract provides a summary of the key findings. However, to improve the evidence, the abstract could include more specific details about the sample size, demographics, and the methodology used in the study. Additionally, it would be helpful to provide information about the limitations of the study and any potential biases that may have influenced the results.

Background: Obstetric fistula is a worldwide problem that is devastating for women in developing countries. The cardinal cause of obstetric fistula is prolonged obstructed labour and delay in seeking emergency obstetric care. Awareness about obstetric fistula is still low in developing countries. The objective was to assess the awareness about risk factors of obstetric fistulae in rural communities of Nabitovu village, Iganga district, Eastern Uganda.Methods: A qualitative study using focus group discussion for males and females aged 18-49 years, to explore and gain deeper understanding of their awareness of existence, causes, clinical presentation and preventive measures for obstetric fistula. Data was analyzed by thematic analysis.Results: The majority of the women and a few men were aware about obstetric fistula, though many had misconceptions regarding its causes, clinical presentation and prevention. Some wrongly attributed fistula to misuse of family planning, having sex during the menstruation period, curses by relatives, sexually transmitted infections, rape and gender-based violence. However, others attributed the fistula to delays to access medical care, induced abortions, conception at an early age, utilization of traditional birth attendants at delivery, and some complications that could occur during surgical operations for difficult deliveries.Conclusion: Most of the community members interviewed were aware of the risk factors of obstetric fistula. Some respondents, predominantly men, had misconceptions/myths about risk factors of obstetric fistula as being caused by having sex during menstrual periods, poor usage of family planning, being a curse. © 2013 Kasamba et al.; licensee BioMed Central Ltd.

The study was conducted in Nabitovu village, Muyira parish, Nambale Sub-county, Kigulu county, Iganga district, eastern Uganda. From the district data, the study setting (Nabitovu village) has a population of 154 households, and on average 8 people per family. It has about 1,232 people of whom about 50% are children. It was in this parish that several cases of fistula had been identified in a district survey. Most families depend on agriculture, and the major food crops are maize, potatoes and beans. The closest health units to the village are Nambale health centre III (government funded) and Nasuti health centre III which is private. These health units were used as screening centres for fistula patients, who were transferred to Iganga hospital (the district hospital) for surgery. From a previous survey [24], Iganga district has a high maternal mortality ratio of district is 397/100000, with a high fertility rate of 6.9, adolescent pregnancy rate of 37%, low women literacy rate of 48%, low family planning uptake of only 11.2%, and many cases of obstetric fistula in the sub-county. The reason for choosing the study setting was that this sub-county had the worst maternal health indicators in Iganga district [24]. Using focus group discussions (FGDs), data was collected about awareness of obstetric fistulas. Maximum variation sampling was done to obtain a representative sample of men and women of the age group 18–49 years. Participants were identified with the assistance of the civic leaders and invited to participate. Detailed personal information of the participants was not collected. The research team, with assistance of the civic leaders, identified the venue for the meeting, identified a suitable time for the meeting, explained the purpose of the meeting. Four FGDs of 10–14 participants were conducted as follows: two for men (one for young men between 18–35 years and one for older men who are above 35 years) and two for women (one for young women between 18–35 years and one for old women between 36-49 years). Each FGD involved a moderator who guided the discussions using an interview guide and a note taker. Issues explored included risk factors, presentation and prevention of obstetric fistula. Specific issues that were probed include awareness of continuous leakage of urine as a complication of childbirth, the local meanings attached to the complication of leakage after birth, what factors predispose to or cause his complication, awareness of the management of fistula and what needs to be done to prevent obstetric fistula. The sessions lasted from 40 minutes to one hour. Each FGD member was identified with a code under which information from each was written. The data analysis was done manually by content analysis to identifying key themes, focusing on issues that were mentioned frequently and frequently received particular emphasis during the group discussions. Deductive content analysis, as described by Cavanah [24], Graneheim and Lundman [25], and Hsieh and Shannon [26]. This process involved manual identification of codes identified as meaning units (words, phrases or statements that described the phenomenon according to the issues explored regarding obstetric fistulas). The codes were aggregated into categories using a categorization matrix. After a categorization, all the data were reviewed for content and coded for connection with the identified categories. Subcategories with similar codes were finally grouped together into larger main categories or themes, according interpretation of their similarities or differences. The identified categories were compared and agreed upon by consensus, depending on their similarities. Table  1 shows the codes, categories and major categories (themes) and how they were derived from meaning units or codes. Showing categories and meaning units derived from the transcripts This research was approved by the Department of Nursing and the ethics committee of the College of Health Sciences, School of Medicine, Makerere University. Permission to conduct the study was also obtained from the local council one (LC1) chairman of Nabitovu village. Confidentiality was assured and no names were written down during the discussions. Any community members who needed more information on obstetric fistula were refereed to the fistula treatment centre located at the health centre.

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Based on the information provided, here are some potential innovations that could be recommended to improve access to maternal health in Nabitovu village, Iganga district, Uganda:

1. Mobile health clinics: Implementing mobile health clinics that can travel to remote areas like Nabitovu village to provide maternal health services, including screenings, prenatal care, and education on obstetric fistula prevention.

2. Community health workers: Training and employing community health workers who can educate and raise awareness about the risk factors, presentation, and prevention of obstetric fistula within the village. These workers can also provide basic maternal health services and refer women to appropriate healthcare facilities.

3. Telemedicine: Establishing telemedicine services that allow healthcare professionals from larger healthcare facilities to remotely provide consultations and guidance to healthcare providers in Nabitovu village. This can help improve access to specialized care and reduce the need for women to travel long distances for medical consultations.

4. Maternal health education programs: Developing and implementing educational programs that specifically target women and men in Nabitovu village to increase their knowledge and understanding of maternal health, including obstetric fistula. These programs can be conducted through community workshops, radio broadcasts, and other accessible mediums.

5. Strengthening healthcare facilities: Investing in the improvement and expansion of healthcare facilities in the district, including Nambale health centre III and Nasuti health centre III. This can involve upgrading infrastructure, providing necessary medical equipment and supplies, and ensuring the availability of skilled healthcare professionals.

6. Collaboration with traditional birth attendants: Engaging and training traditional birth attendants in the village to recognize the signs and symptoms of obstetric fistula and refer women to appropriate healthcare facilities for timely intervention. This can help bridge the gap between traditional practices and modern healthcare.

7. Family planning services: Increasing access to and awareness of family planning services in Nabitovu village to help prevent unintended pregnancies and reduce the risk of obstetric complications, including obstetric fistula.

It is important to note that these recommendations are based on the information provided and may need to be further assessed and tailored to the specific needs and context of Nabitovu village.
AI Innovations Description
Based on the study conducted in Nabitovu village, Iganga district, Uganda, the following recommendation can be developed into an innovation to improve access to maternal health:

Title: Mobile Health Education and Awareness Campaign

Description: Develop a mobile health education and awareness campaign focused on obstetric fistula and maternal health in Nabitovu village, Iganga district, Uganda. The campaign will aim to address the low awareness and misconceptions surrounding obstetric fistula and its risk factors. The campaign will utilize mobile technology, such as SMS messages and voice recordings, to disseminate accurate information about obstetric fistula, its causes, clinical presentation, and preventive measures. The campaign will also provide information on the importance of seeking timely medical care during pregnancy and childbirth.

Implementation Steps:
1. Collaborate with local healthcare providers, community leaders, and NGOs to develop accurate and culturally sensitive educational materials on obstetric fistula and maternal health.
2. Utilize mobile technology, such as SMS messages and voice recordings, to deliver educational content to community members in Nabitovu village.
3. Develop a schedule for sending regular educational messages to community members, focusing on different aspects of obstetric fistula and maternal health.
4. Conduct community workshops and information sessions to further educate community members about obstetric fistula and address any misconceptions or myths.
5. Provide information on the nearest healthcare facilities and services available for maternal health care, including antenatal care, skilled birth attendance, and emergency obstetric care.
6. Monitor the impact of the mobile health education and awareness campaign through surveys and feedback from community members.
7. Continuously evaluate and update the educational content based on community feedback and emerging research on obstetric fistula and maternal health.

By implementing this mobile health education and awareness campaign, the aim is to improve access to accurate information about obstetric fistula and maternal health, ultimately leading to increased awareness, early detection, and prevention of obstetric fistula in Nabitovu village, Iganga district, Uganda.
AI Innovations Methodology
Based on the provided information, here are some potential recommendations for improving access to maternal health in Nabitovu village, Iganga district, Uganda:

1. Increase community awareness about obstetric fistula: Develop and implement educational campaigns to raise awareness about the risk factors, clinical presentation, and prevention of obstetric fistula. This can be done through community meetings, workshops, and the distribution of informational materials.

2. Improve access to emergency obstetric care: Strengthen the referral system between the village health centers and Iganga hospital to ensure that women with obstetric complications, including fistula, can access timely and appropriate medical care.

3. Enhance family planning services: Increase the availability and utilization of family planning methods to prevent unintended pregnancies and reduce the risk of obstetric complications.

4. Train and support traditional birth attendants: Provide training and support to traditional birth attendants in the village to improve their knowledge and skills in safe delivery practices and early recognition of obstetric complications.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Baseline data collection: Collect data on the current awareness levels of obstetric fistula, access to emergency obstetric care, utilization of family planning services, and the role of traditional birth attendants in the village.

2. Intervention implementation: Implement the recommended interventions, such as educational campaigns, strengthening the referral system, and training traditional birth attendants.

3. Post-intervention data collection: After a certain period of time, collect data again to assess the impact of the interventions on awareness levels, access to emergency obstetric care, family planning utilization, and the practices of traditional birth attendants.

4. Data analysis: Analyze the pre- and post-intervention data to determine the changes in awareness levels, access to care, and utilization of services. Compare the data to evaluate the effectiveness of the interventions in improving access to maternal health.

5. Evaluation and adjustment: Based on the findings of the data analysis, evaluate the effectiveness of the interventions and make any necessary adjustments or modifications to further improve access to maternal health in the village.

It is important to note that this methodology is a general framework and may need to be adapted based on the specific context and resources available in Nabitovu village, Iganga district, Uganda.


Statistics:
Citations: 21
Identifiers:
DOI: 10.1186/1471-2393-13-229
Research Areas:
Community Interventions, Food Security, Health System and Policy, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health, Social Determinants, Violence and Injury
Study Countries:
Uganda
Study Design:
Cross Sectional Study, Exploratory Study, Phenomenological Study
Study Approach:
Mixed-methods, Qualitative, Quantitative
Participants Gender:
Male & Female
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