Nigeria

Nigeria is the most populous nation in Africa. It is situated in West Africa, surrounded by Benin, Niger, Chad, and Cameroon, with the Atlantic Ocean’s Gulf of Guinea to the south. Only 12% of women in Nigeria have ever used any form of contraception. Although Nigerians make up 2% of the world’s population, they account for 10% of all maternal deaths. The northern part of Nigeria reports lower rates of contraceptive use, antenatal care, and assisted deliveries than other regions of the country, resulting in the worst maternal mortality. Fistula Care has focused its efforts in five northwestern states and one southeastern state.

USAID-supported fistula services in Nigeria began in 2007. Fistula Care works with six hospitals to prevent and repair fistula and/or to train health professionals about fistula case management:

• Faridat Yakubu General Hospital, Zamfara State
• Maryam Abacha Women and Children’s Hospital (MAWCH), Sokoto State
• Birnin Kebbi Specialist Fistula Center, Kebbi State
• Laure Fistula Center at Murtala Mohammed Specialist Hospital, Kano State
• Babbar Ruga Hospital, Katsina State
• The Southeast VVF Center, Ebonyi State

Program Results

As of June 2010 (since October 2007):

• A total of 5,111 fistula repair surgeries supported.
• 35 doctors and 93 nurses were trained in fistula repair surgery, with two surgeons reaching "advanced trainer" status.
• As many as 8,165 women accepted a family planning method through the project.
  

Up to 800,000 women may have fistulas in Nigeria and have not been repaired, with more than 20,000 new fistulas occurring annually, according to a 2008 UNFPA release. To address some of this backlog, Fistula Care Nigeria has mobilized surgeons to take part in intensive campaigns to repair fistula.

Supported Sites

Faridat Yakubu General Hospital is a large public hospital that provides women with comprehensive emergency obstetric care and family planning services. It has 24 beds for patients seeking fistula repair.

Maryam Abacha Women and Children’s Hospital (MAWCH) 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.

Combining all public and private health facilities in Kebbi State, there is just one hospital bed per 1,230 people. The Birnin Kebbi Specialist Fistula Center provides 48 beds for fistula patients. The center also provides antenatal care and refers women with obstructed labor.

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, repairing approximately 350 women each year.

Babbar Ruga Hospital also serves as a training site for surgical teams perfecting their fistula repair skills. 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 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. Fistula Care support to the Southeast VVF Center began in January 2009. See here for an interview with the Southeast VVF Center’s fistula surgeon, Dr. Sunday Adeoye.

Program Activities

Strengthening services

Fistula Care Nigeria has been working with the hospitals in Zamfara, Sokoto, and Kebbi 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. Advanced fistula surgeons are going to be supported to polish their skills through visits with other master surgeons elsewhere in West Africa. Two of the sites in Zamfara and Sokoto states are now prepared to serve as additional training centers for simple fistula repair surgery. Fistula Care Nigeria plans to assess new hospitals as potential sites that will be equipped when surgical teams are ready to provide services. In the meantime, Fistula Care is organizing periodic campaigns at three of the supported sites that bring together fistula surgeons from multiple hospitals to perform surgery, to address the backlog of women who require fistula surgery.

Improving fistula prevention

Fistula Care Nigeria tackles the need for fistula prevention from several angles. Fistula Care is working with six community-based organizations in three states and religious leaders in order to increase awareness about fistula prevention and treatment. 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 is also supporting family planning services at eight district hospitals and health centers.

Analyzing and reporting data

Fistula Care Nigeria 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 are participating in the global prospective study on the determinants of postoperative outcomes of fistula repair.

Encouraging a supportive policy environment

Fistula Care supports and participates in a national fistula task force, which is currently working to organize a national seminar on fistula. Fistula Care is also working with the Nigerian government and local leaders to form a network of advocacy champions.