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Nigeria is the most populous nation in Africa, with an estimated population of 147 million. Although Nigeria has approximately 2% of the world’s population, the 40,000 maternal deaths occurring there each year represent more than 10% of the 287,000 annual maternal deaths around the world according to UN estimates. Fifteen percent of women in Nigeria currently use any form of contraception. The northern part of Nigeria reports lower rates of contraceptive use, antenatal care, and assisted deliveries than other regions of the country, resulting in especially high maternal mortality rates.
USAID-supported fistula services in Nigeria began in 2007. In addition to supporting 19 prevention-focused facilities, Fistula Care works with ten hospitals to prevent and repair fistula and to train health professionals about fistula case management:
As of September 2013 (since October 2007):
Program Update: National Nigerian Meeting on Fistula
Program Update: Advocacy for a Mobile Clinic in Bulanyaki
Program Update: Ebonyi State's Legislation on Safe Motherhood
Program Update: Fistula Care Efforts to Raise Awareness on Fistula
Profiles of Nigerian Fistula Surgeons: Dr. Dantani Danladi, Dr. Saad Idris, Dr. Sunday Adeoye, Dr. Abubakar Bello, Dr. Ladan-Ibrahim Hassan, Dr. Dada Mansur, Dr. Steve Arigidi, and Dr. Musa Mohammed Birnin Tsaba.
Stories from the Field from Nigeria
|Babbar Ruga Hospital|
Babbar Ruga Hospital in Katsina State serves as a training site for fistula repair surgical teams. It has two wards and an operating theater for fistula repair, with another theater nearing completion. The center can accommodate up to 200 clients, with 80 clients in the postoperative wards. The center also provides family planning services.
Bauchi State Fistula Center is located in Ningi General Hospital and has a 50-bed capacity. It is the first of its kind in the North East geopolitical zone. The center started providing fistula repairs and family planning services in March 2011.
|Faridat Yakubu General Hospital|
Faridat Yakubu General Hospital is a public hospital in Zamfara State that provides women with comprehensive emergency obstetric care and family planning services. It has 24 beds for patients seeking fistula repair and nine beds for maternity services.
The Laure Fistula Center is the dedicated fistula section of the Murtala Mohammed Specialist Hospital in Kano. It has its own operating room and 24 beds for preoperative and postoperative care. It serves as a training site for surgical teams developing and honing their fistula repair skills. Kano has a large caseload of fistula repairs, performing approximately 350 fistula repair surgeries each year.
Maryam Abacha Women and Children’s Hospital (MAWCH) in Sokoto State was founded by the former first lady as the first national hospital specifically for women and children. Among a diverse array of other services, it offers comprehensive emergency obstetric care and family planning services. Fifty beds are available to women undergoing fistula repair surgery.
The National Fistula Center (formerly known as the Southeast VVF Center) is located in Abakaliki, the largest city in Ebonyi State. It is a fully equipped hospital with 100 beds, one obstetric and gynecology consultant who is also a fistula surgeon, and four trained fistula nurses. The Center is a participating site in the Fistula Care randomized controlled trial on catheter use after fistula surgery.
Ogoja Fistula Center is located at Ogoja General Hospital in Cross River State. The center has 24 beds for both preoperative and postoperative care, with a trained fistula surgeon and nurses who were trained in family planning and fistula management.
Sobi Specialist Hospital in Kwara State provides a range of general medical, surgical, pediatric, and gynecology services. The Fistula Care project trained a doctor and four nurses from this facility in fistula surgery and in pre- and postoperative care. A 24-bed ward has been designated for fistula repair services while the gynecology theater is used for fistula surgeries.
The University College Hospital at the University of Ibadan in Oyo State began operating in 1957 and today serves as a tertiary hospital with 850 beds in addition to providing training for doctors, nurses, midwives, and other health professionals. The hospital reserves 14 bed spaces for fistula clients but is expandable to 21 beds. Fistula Care began supporting the facility in February 2012 to address complex fistula cases, serve as a center for training, and accept referrals from nearby states in addition to providing family planning services.
Fistula Care has been working with supported sites to ensure the continued provision of fistula repair services. Staff from the hospitals are brought together to discuss how the quality of their services can be continuously improved. Two sites serve as training centers for simple fistula repair surgery. Fistula Care organizes periodic campaigns that bring together fistula surgeons from multiple hospitals to perform surgery, addressing the backlog of women who require fistula surgery.
Fistula Care tackles the need for fistula prevention from several angles. Fistula Care is working with community-based organizations in three states, religious leaders, and Ward Development Committees (WDCs) in order to increase awareness about fistula prevention and treatment. In addition to supporting family planning services at nine district hospitals and health centers, Fistula Care is also improving or introducing comprehensive emergency obstetric care services in health facilities, so that laboring women who reach a hospital in time will not develop fistula.
Fistula Care organizes a “media roundtable discussion” with journalists from television, radio, and print media organizations where journalists learn about fistula, its causes, and its prevention. Fistula Care uses this forum to train journalists on how to report about fistula, enlisting their support to increase media exposure as part of the fight against fistula.
Fistula Care partners with Radio Nigeria to produce a radio program called “Health Watch,” in which fistula clients share their experiences about life before and after fistula repair surgery. Listeners can call in to ask questions about fistula and reproductive health issues. The program spreads awareness about the free fistula services available and encourages expectant mothers to access antenatal care at health facilities. The program attracts 14 million listeners in Nigeria and beyond.
Fistula Care is working with community organizations, religious leaders, and hospital staff to promote documentation of all their activities. Site staff compile data quarterly, using the data to make decisions and improve the quality of services. Faridat Yakubu General Hospital, Maryam Abacha Women and Children’s Hospital, and Birnin Kebbi Specialist Fistula Center participated in the global prospective study on the determinants of postoperative outcomes of fistula repair. The National Fistula Center in Abakaliki is participating in the Fistula Care randomized controlled trial on catheter use after fistula surgery.
Fistula Care supports and participates in a national fistula task force. As part of its work with the National Obstetric Fistula Working Group, Fistula Care organized a meeting to adopt the National Strategic Framework on the Elimination of Fistula in Nigeria (2012–2017). Fistula Care works with the Nigerian government and with local leaders to form a network of advocacy champions. To read more about Her Excellency Josephine Elechi, a Fistula Care champion leading these efforts, click here.