Reasons for delay in accessing free treatment of obstetric fistula in South-East Nigeria ­ A qualitative study

Obstetric fistula continues to be a menace in Nigeria and other low- and middle-income countries. The national policy for its elimination makes surgical repair free in dedicated national centres. However, the majority of the clients present late for repair. The aim of the study was to explore the reasons for this delay in seeking treatment. It was a qualitative (exploratory) study carried out at the National Obstetric Fistula Centre (NOFIC), Abakaliki, Nigeria among obstetric fistula patients who presented for treatment with a duration of leakage of over six months. A consecutive sampling technique was used for patient recruitment. Data was collected from twenty patients using in-depth interviews. Thematic analysis of the responses and recurring patterns was done, with themes illustrated using the word cloud. The mean age of the participants was 37.1 years (range = 21-75 years) while the mean duration of leakage was 64.3 months (range = 8-564 months). Reasons for delay in accessing treatment of obstetric fistula were lack of awareness of the availability of free treatment in a specialized centre, delay in referral from index health care facilities, wrong information from health care workers, failed repairs at other health facilities, secondary delay due to transportation challenges, cultural beliefs and other issues peculiar to the patients. The commonest reason for the delay in accessing treatment for obstetric fistula is a lack of awareness on the part of patients, the public, and health workers. We recommend improved campaigns, advocacy, and community mobilization.

Determinants of Delivery Outcomes in Teenage Mothers at a University Teaching Hospital, South-Eastern, Nigeria.

Aim: This study aims at identifying some delivery outcome determinants in teenage mothers and evaluating the effect of booking in light of these parameters. Study Design: A retrospective study. Place and Duration of Study: Teenage mothers who delivered in a teaching hospital in Nigeria over a 5-year period (between 1st Jan, 2003 and 31st Dec, 2007). Method: Labour ward register and midwives report books were used to get their hospital numbers. These case notes were retrieved subsequently from the health records department and relevant data extracted. Results: There were 8,297 deliveries during the study period and 453 cases of teenage mothers giving a teenage delivery incidence of 5.5%. Of the total teenage deliveries, older teenage mothers (16-19 years) constituted 94.7% while younger teenage mothers were 5.3%. Booked teenage mothers were 83.5% while 16.5% were unbooked. Still birth rate was 87 per 1000. No maternal death was recorded among the teenage mothers. Older teenagers had better obstetric indices such as higher vaginal delivery rate, lower caesarean section and instrumental delivery rate, reduced blood loss, better Apgar scores and less intra uterine fatal deaths than younger teenagers. However, some of these were not statistically significant and in some cases, were barely marginal. Conclusion: Influence of age on teenage delivery and other biological risk factors may not be as much as earlier perceived. Paying special attention to the socio-economic condition of teenage mothers and by extension, their access to essential obstetric care, may obviate the poor obstetric outlook hitherto attached to it.