Tag Archives: obstetric fistula

Obstetric Fistula afflicts nearly 100,000 women in Kenya – Japheth Mati

The recently released findings of the 2014 Kenya Demographic and Health Survey (KDHS 2014) included, for the first time ever, an estimate of the prevalence of fistula in Kenya. After describing the condition, women were asked if they had ever experienced the symptoms of fistula, to which 1 percent responded in the affirmative. What this means is that 1 percent of women of childbearing age (15-49 years) had actually suffered a fistula, and based on the 2009 population census, this translates to at least 93,120 women.

As I read the KDHS results recently, I could not help recalling a post I made three years back, under the title “Remembering my fistula patients as Kenya observes FGM Day”. I was referring to the 1970s when I was one of two gynaecologists in the Department of Obstetrics and Gynaecology at the Kenyatta National Hospital (KNH), who had special interest in the treatment of urinary incontinence, the commonest cause of this being vesico-vaginal fistula (VVF). I remember that at any given day there would be one or two such cases in my ward.

This condition, which arises mainly from prolonged obstruction of labour during childbirth, is a preventable problem if only all pregnant women received skilled care during labour and delivery. Yet it has persisted as a major problem, decade after decade.

Dr Peter Candler way back in 1954 reported that obstetric VVF was the commonest gynaecological condition encountered at the King George VI Hospital (today’s KNH); and as I indicated above, it still was common in the 1970s. How sad it is that decades after independence, a substantial proportion of Kenyan women remain at risk of this tragedy. Today, the KDHS data tells us there could be well over 93,000 women living with the condition.

On the brighter side we must recognise the commendable efforts in the recent past towards improving access to surgical treatment of fistula. But the magnitude of the problem remains intimidating. How long will it take to clear the backlog, while at the same time new cases are being created?

Let us assume 10 hospitals undertook to operate 10 cases daily, 5 days a week, completing 500 surgeries per week. To do all 93,120 women at that speed would take 187 weeks or 3.5 years. But this assumes that no new cases are added throughout the 3.5 years and that each operation was successful, (which is not always the case!), and more importantly, the survey estimate of 1 percent was correct, (stigma could have affected responses). Finally, it is possible that a crush programme involving surgical camps may accomplish the task sooner, the cost and logistic nightmare notwithstanding.

On the whole, the above underlies the importance of prioritising prevention. Looking to the future, the hope lies in improving access to skilled maternal health care for all pregnant women, antenatal care and delivery services. This is the only way of eliminating the risk of obstetric fistula. In this regard, kudos to our First Lady! Her Initiative, Beyond Zero Campaign, is a practical demonstration of her love for the women and children of Kenya. Indeed, such level of commitment is unprecedented.

The KDHS 2014 has given us some hope- the proportion of women who received skilled care during delivery has increased from 44 percent in 2008/9 to 62 percent in 2014, while those who gave birth in a health facility increased from 42 percent in 2008/9 to 61 percent in 2014. Even though a lot remains to reach the MDG 5 target of 90% by 2015, this data is, nevertheless, extremely encouraging and motivating. Better late than never!

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