A study to determine women's intention to prevent Vesico-Vaginal Fistula recurrence in two repair centres in Zambia

Vesico vaginal fistula is the commonest urogenital fistula in Zambia. According to United Nations Population Fund, annual report (2009), the number of fistula repairs have increased from 133 in 2005 to 252 in 2008 country wide.The purpose of the study was to determine the association between intention to prevent Vesico vaginal fistula recurrence and knowledge of the risk factors of Vesico vaginal fistula recurrence, attitude towards Vesico vaginal fistula prevention and self esteem among women
with Vesico vaginal fistula in two repair centres in Zambia. A descriptive correlation cross sectional study design was used. Data were collected from a convenient sample of 75 women aged 15-41 years in Katete and Chilonga Mission Hospitals
using structured interview schedules. Data were analyzed using descriptive statistical (mean,standard deviation) and inferential statistical (spearman’s correlation coefficient, Regression).Literature review revealed that majority of the respondents were aged 15-19 years, married(75%), had primary education (75%) and developed Vesico vaginal fistula between the ages of
12-25 years (69%). Most of the respondents’ primary spoken language was Bemba (67%). All
the respondents were Christians. Some of the respondents were self employed (43%). Less
than half of the respondents took one hour or less to walk to the health care facility (37%).Almost half of the respondents (40%) had no children. More than one third of the respondents(39%) attended antenatal clinic for antenatal check up four times in the most recent pregnancy.Majority of the respondents (80%) delivered their last baby at the hospital. Almost two thirds of the respondents (69%) were in labour for more than 24 hours during the pregnancy that
resulted in the development of Vesico vaginal Fistula. Almost all the respondents (91%) were diagnosed with Vesico vaginal Fistula for the first time and prolonged obstructed labour was recorded as the cause of Vesico vaginal fistula for majority of the respondents (91%).Majority of the respondents (97%) had positive intentions to prevent Vesico vaginal fistula recurrence (Mean= 2.58; SD =0.31). More than half of the respondents (55%) knew the risk
factors of Vesico vaginal fistula recurrence (M = 0.59; SD = 0.165), 61% had positive attitudes towards Vesico vaginal fistula prevention (Mean = 2.09; SD = 0.289), and 52% had low level of self esteem (Mean = 1.5; SD =0.28).There was a significant positive relationship between intention to prevent Vesico vaginal fistula recurrence and attitude towards Vesico vaginal fistula prevention (r2 = 0.26, n=75,p=0.01, 2 tailed); and a significant negative relationship between intention to prevent Vesicovaginal fistula recurrence and self esteem (r2= -0.25, n=75, p=0.05, 2 tailed) but there was no significant relationship between intention to prevent Vesico vaginal fistula recurrence and knowledge of the risk factors of Vesico vaginal fistula recurrence.
Using multiple regressions, the model was significant with 2 independent variables
explaining 15% of the variance in intention to prevent Vesico vaginal fistula recurrence. The strongest independent variable (as assessed by the standardized regression coefficient,) was attitude (299) followed by self esteem (SD=0.270). Knowledge was not significant (SD=0.062).The recommendations of the study are that the Ministry of Health should introduce waiting homes in hospitals with emergency obstetric care so that repaired women can wait for delivery in their subsequent pregnancy, strengthen on the already existing policy on management of prolonged obstructed labour so as to enable skilled attendants to adhere to it when managing women with a repaired VVF and formulate Vesico vaginal fistula registers for easy follow up of repaired women.The major conclusion and implication of the study is that Ministry of Health needs to support community sensitization or public education on attitudes towards Vesico vaginal fistula prevention which will in turn improve intentions to prevent Vesico vaginal fistula recurrence among women.