Maternal morbidity and mortality is an issue that requires attention worldwide this is because of the important role women play in the family and society at large. One of the major reproductive health challenges facing women in sub Saharan Africa is obstetric fistula (Stanton et al, 2007). In developed countries obstetric fistula is almost nonexistent due to the improvement in emergency obstetric care facilities (Creanga and Genadry, 2007). In contrast, women in developing countries are still suffering from the scourge of this medical condition (Tinuola and Okau, 2009). This view was supported by Tebeu et al, 2009 who revealed that obstetric fistula is common in low resource countries while it is rare in high resource countries. The entire burden of this disease is mainly confined to the “fistula belt” which extends across the northern half of sub Saharan Africa to the south of Asia (WHO, 2006). Consequently the global morbidity and mortality from obstetric fistula has been on the increase over the years (Mohammad, 2007). It has been estimated that 50,000 to 100,000 women worldwide develop obstetric fistula annually adding to the pool of women who are living with the disease (Shittu et al, 2007). However, the figures have been reported to be have been underestimated this is because most women with obstetric fistula live in isolation and fear of rejection and hence do not seek medical care resulting in a vast majority of unreported cases (Tsui et al, 2007). Ahmed and Holtz, 2007 estimated that close to half of the total burden of obstetric fistula is recorded in Nigeria alone. The country remains at the centre of the international resolve to tackle this disease due to its large population and its poor maternal mortality rates (Zheng and Anderson, 2009). The World Health Organisation (WHO) stated that one out of every nine maternal deaths occurs in Nigeria with obstetric fistula as the major threat to women’s reproductive health (WHO, 2006). Ahmed and Holz (2007) divided the effects of obstetric fistula into physical consequences, social and economic effects. The physical consequences includes: skin problem (this resulting from direct and constant irritation by urine), amenorrhoea, vaginal stenosis, bladder infection, neurological injury leading to foot drop, intra uterine scarring and hypothalamic dysfunction (Ahmed and Holz, 2007). The social and economic effects enumerated includes: divorce, disturbed sexual life, poor quality of life, weight loss and stigmatisation (Wegner et al, 2007). Across Africa and Asia treatment of obstetric fistula is through a variety of setting such as the specialist fistula centres, fistula units in general and specialist hospitals and at times treatment can be accessed through gynaecology and urological departments and fistula camps in rural and remote areas (Donnay and Ramsey, 2006). Small fistulas close without surgery through continuous bladder drainage although this is only possible if the woman presents within three months of child birth (Donnay and Ramsey, 2006). Donnay and Ramsey, 2006 added that a surgical technique for the closure of obstetric fistula was first described by J. Marion Sims in the mid eighteen hundreds and that these techniques involve the surgical closure of the fistula with the use of tissue grafts.

However the dynamic nature of this medical problem requires a skilled professional that has a sound knowledge of this condition (Cook et al, 2004). The number of women with unrepaired obstetric fistula in Nigeria is between 800,000 to 100,000 while the average cost of treatment in Nigeria is USD $300 which is beyond what the average woman can afford due to extremely poverty that exist in the country as 75% of its inhabitants live below USD $1 per day (UNICEF, 2009). In 2001 the United Nations Population Fund (UNFPA) brought together brought together potential partners in London in order to launch an initiative which aims to address obstetric fistula especially in developing countries by gathering data and provide funding towards prevention and treatment (Wegner et al, 2007). The stakeholders involved are: the Addis Ababa fistula hospital, Columbia hospital, Averty Maternal Deaths and Disability Program (AMDD), the International Federation of Gynaecology and Obstetrics (FIGO) and the World Health Organisation (WHO) (UNICEF, 2009). This lead to the inauguration of the Foundation for Women’s Health Research and Development (FORWARD) in Nigeria to improve the socio-economic status and health of women who have either been treated or those who require intervention for obstetric fistula (Shittu et al, 2007). This project located in Kano state (northern Nigeria) is been funded by the United Kingdom Department for International Development (DFID) and the international partners listed above (Shittu et al, 2007). This has lead to increase awareness of obstetric fistula in Nigeria however; a lot needs to be done in order to reverse the increasing trend of this condition (WHO, 2006). Stigmatisation which women with obstetric fistula suffer remains a major concern for public health programmes committed to addressing this medical condition (Donnay and Ramsey, 2006).

1.2 PROBLEM STATEMENT

The importance of tackling obstetric fistula in Nigeria cannot be overemphasised as it poses a major setback to the reproductive health of young girls and women in this West African country (WHO, 2006). A six month assessment of nine African countries conducted by the United Nations Population Fund in 2002 revealed that an estimated one million women are suffering from the burden of obstetric fistula in Nigeria and that this trend is on the increase (Wall, 2007). As the country’s population approaches the 200million mark the number of women with obstetric fistula may be tripled if the pertinent issues on this medical condition are not addressed (UNICEF, 2009). This view was supported by the World Health Organisation (WHO) findings that stated that forty percent of the global burden of obstetric fistula is recorded in Nigeria and at the current rate of management it will take three hundred years to clear the backlog of women who needs surgical intervention if no new cases is recorded (Shittu et al, 2007). This has reflected in increase in Nigeria’s maternal mortality rate as one out of every maternal death occurs in this country and most women who survive the ordeal of child birth are faced with compromised health status with obstetric fistula being the foremost (UNICEF, 2009). Galadachi et al 2007, reiterated this fact by stating that maternal mortality rate in Nigeria is one of the highest in the world accounting for 948 maternal deaths per 100,000 live births and further more for each maternal death that occur 15 to 20 other women suffer from either long and short term maternal morbidities among this is obstetric fistula. The stench of urine and faeces associated with obstetric fistula makes affected women vulnerable to domestic violence and suicidal adhesions among others (Mohammad, 2007). For this reason the World Health Organisation emphasised that management women with obstetric fistula require a holistic approach that does not only see this disease as a medical problem but also addresses the psycho-social impact it has on their lives and families (WHO, 2006). In rural communities in Nigeria the women with this disease are often blamed for their condition and are seen as a failure to motherhood this has contributed to being ostracised from their communities (Kelly and Winter, 2009). The increasing incidence of obstetric fistula posses a major threat to the attainment of the UNICEF fifth millennium development goal which aims to reduce maternal mortality between 1990 and the year 2015 and also to achieve a universal access to reproductive health by the same year (Galadachi et al, 2007). Hence, the impact of obstetric fistula on women, their families, health care, public health and clinical research is enormous and requires urgent attention (Kelly and Winter, 2009). For this to be addressed, a sound knowledge of the risk factors that predispose women in Nigeria to developing obstetric fistula needs an indebt understanding and this is the premise of this research study.

1.3 STUDY QUESTION

What are the risk factors that are associated with obstetric fistula among women in Nigeria?

1.4 AIM OF STUDY

The principal aim of this study is to explicitly explore the risk factors that predispose women in Nigeria to obstetric fistula.

1.5 OBJECTIVES

To critically explore the risk factors associated with obstetric fistula in Nigeria.

To shed more understanding on the difficulties faced by women living with this disease.

To proofer recommendations and how these risk factors can be fully addressed in order to improve the reproductive health of women in Nigeria.

1.6 STUDY JUSTIFICATION

On a global scale the continued increase in the incidence of obstetric fistula in low resource countries is one of the most visible indicators of the enormous gap that exist in the maternal health care services between the developed and developing world (WH