Declaration1

I am here by declaring that the bachelor thesis titled impact of obstetrical fistula on
mothers in case of Isniino MCH

Is my own work and account, this thesis contains no material that has been submitted
previously or have been accepted the award of any degree of impact this thesis is my own
work and effort.
Declaration 2
I am confirm that the work reported in thesis was carried out by the candidate under my
supervision and submitted to the faculty of clinical midwifery with my approval as the
supervisor

Supervisor Abdul fatah jibril ararso

Signature……………………..

Date / / /2020
Declaration 3
I certify that this proposal is submitted with my approval as the dean of faculty of clinical
midwifery at university of health science

Dean of faculty of clinical midwifery.

Mrs. Rosina Rugorirwera

Signature………………………

Date / /2020
DEDICATION

I would like to dedicate this work for my beloved and honorable parents, my lovely mother
Khadra jama muse and my father Mamud Guul Abdi.
Approval sheet

This thesis entitled impact of obstetrical fistula on mothers in case of Isniino MCH.
Fulfillment of requirement for the degree of bachelor of clinical midwifery has been
examined and approved Rector of the University of Health Science,

Prof.Abdirizak Hussein Hassan

Signature ………………………….

Date / / /2020
ACKNOWLEDGEMENTS
In the name of Allah, the Most Gracious and the Most Merciful

Alhamdulillah, all praises to Allah for the strengths and His blessing in completing this
thesis. My appreciation goes to many people and organizations that have assisted me
throughout the completion of this research. Such an Endeavour is time-consuming and is not
possible without persistence, perseverance, assistance, support, and encouragement of some
inspiring individuals including my family, supervisor, friends, and my colleagues.

First and foremost, I have been extremely lucky to have a Supervisor my Teacher Abdul fatah
jibriil ararso who cared so much about my work, and who responded to my questions and
queries so promptly.

Professor Abdirizak Hussein Hassan head of university of Health science, for his great
support, encouragement and valuable comments that helped me to attend and complete the
bachelor degree in Clinical midwifery.

Special recognition goes out to my best friend Eng Isaac Osman A/rahman and my teacher
Mr. ahmed isse ow ahmed who inspired me and provided constant encouragement during the
entire process, as well as continuously proofing my document.

I am indebted to my parents for their encouragement and support my lovely father Mahmud
Guul Abdi was a great inspiration to me, and his love for knowledge was the founding
grounds for my love of knowledge. He invested so much in educating me and always
encouraged me to reach for the stars. My mother Kharo jama muse has been such source of
strength, support and encouragement throughout my bachelor journey and I thank her for her
patience with me.

She had such faith in me even during the times when I felt exhausted from the work that I
had to do.

I am truly indebted to both of them for their warm than am sure that they would be proud of
my achievements.

I also thank my family who encouraged me and prayed for me throughout the time of my
research. This thesis is heartily dedicated to my mother who took the lead to heaven before
the completion of this work.
Without the help of those who participated in this study, this study would have not been
possible. I thank all the participants for their assistance. I thank you for trusting me by
sharing such a precious part of yourself with me, and for your strong desire to empower the
community through your experiences. My deepest appreciation and gratitude to each and
every person, who in some way or the other assisted me in making this thesis a reality.

May the Almighty God richly bless all of you.

Abstract
Background:-Somalia has some of the worst maternal health indicators in the world. The
fertility rate is very high as are infant and maternal mortality rates, malnutrition is chronic,
early marriage is common, and most deliveries are done at home without the presence of a
skilled attendant. Women in Somalia live in a highly insecure context where healthcare
infrastructure and maternal health programs have been disrupted and limited in availability
for decades. Facilities tend to be dilapidated, basic equipment and medications are in short
supply, and there is a lack of trained medical personnel throughout the country. All of these
factors are indicative of a high rate of maternal morbidities such as obstetric fistula.

Aim: - The aim of this study was to determine impact of fistula on mother, specifically cause,
risk factors, psychological problem and complications related to fistula in Isniino MCH.

Methods:-The study was adept of descriptive study design and targeted midwives , doctors
and mothers living in Isniino MCH

Results: - After 25 self-administrated questionnaire and interview, we have find out that
shows the cause of obstetrical fistula 40% (n=10) of respondents were caused fistula
macrosemia (big baby), while 24% (n=6) of respondents were obstetric labour, while 20%
(n=5) of respondents were caused precipitate labour, while 12% (n=3) of respondents caused
by episiotomy, 4% (n=1) of respondents were don’t known cause of fistula. The complication
of obstetrical fistula 52 %( n=13) majority of respondents caused by urine and fecal
incontinency, while 9 %( n=9) were caused Infection, while 8% (n=2) of respondents have no
information, while 4% (n=1) of respondents caused foot drops. Also fistula can read to fear
of another pregnancy as confirmed by 84 %( n=21) , to psychological problem as asserted by
84 %( n=21) of respondent and Social Stigma according to 64% (n=16) of respondents
neither 20% (n=5) who replied No and 16% (n=4) who aren’t well informed this

Conclusion:- After our research , we confirm that macrosomia and bad obstetrical practice
can leans to fistula and related complications such as urine and fecal incontinence , fear of
pregnancy , psychological problem and social stigma. We encourage all women to avoid
home delivery and join a nearest hospital in case of fistula

Key words: - Obstetrical fistula – Fear of pregnancy – social stigma

ABBREVIATIONS

1. VVF :- Vesicovaginal fistula

2. RVF:- Rectovaginal fistula
3. UVF :- Urethrovaginal fistula
4. UVF :- Ureterovaginal fistula
5. UGF: - Urogenital fistula
6. UNFPA :- United Nations fund for population activates
7. NGOs :- Non-governmental organization
8. WHO :- World health organization

Contents
Declaration1..........................................................................................................................................I
Declaration 2........................................................................................................................................II
Declaration 3.......................................................................................................................................III
DEDICATION....................................................................................................................................IV
Approval sheet.....................................................................................................................................V
ACKNOWLEDGEMENTS...............................................................................................................VI
Abstract.............................................................................................................................................VIII
CHAPTER ONE..................................................................................................................................1
1.0 Introduction...............................................................................................................................1
1.1 Backgrounds..............................................................................................................................1
1.2 Problem statement.....................................................................................................................3
1.3 purpose of study.........................................................................................................................3
1.4: Objectives of the study.............................................................................................................4
1.4.1: General objective...............................................................................................................4
1.4.2: Specific objective...............................................................................................................4
1.5 Research question......................................................................................................................4
1.6 Hypotheses.................................................................................................................................4
1.7 Significant of the study..............................................................................................................4
1.8 Study limitation..........................................................................................................................5
1.9 scopes of study............................................................................................................................5
CHAPTER TWO:-..............................................................................................................................6
2.0 literature review.........................................................................................................................6
2.1 Introduction...............................................................................................................................6
2.2 History........................................................................................................................................6
2.3 Definition....................................................................................................................................7
2.4 Epidemiology..............................................................................................................................7
2.5 Symptoms of obstetric fistula....................................................................................................8
2.6 Causes of obstetrical fistula.......................................................................................................8
2.7 Different types of obstetric fistula............................................................................................8
2.7.1. Vesicovaginal fistula (VVF)...............................................................................................9
2.7.2. Recto-vaginal Fistula (RVF)............................................................................................10
2.7.3 A urethra-vaginal fistula..................................................................................................10
2.7.4. A uretero-vaginal fistula..................................................................................................10
2.7.5. Vesico-uterine fistula.......................................................................................................10
2.8 Risk factors of obstetrical fistula............................................................................................11
2.8 1. Poverty..............................................................................................................................11
2.8.2. Malnutrition.....................................................................................................................11
2.8.3. Lack of education.............................................................................................................12
2.8.4. Early childbirth................................................................................................................12
2.8.5. Lack of healthcare...........................................................................................................13
2.8.6. Status of women...............................................................................................................13
2.9 Impact Obstetric fistulae.........................................................................................................13
2.9.1 Physical..............................................................................................................................14
2.9.2 Social..................................................................................................................................14
2.9.3 Psychological.....................................................................................................................15
2.10 Diagnosis.................................................................................................................................16
2.11 Treatments.............................................................................................................................16
2.11.1 Surgery............................................................................................................................16
2.11.3. Catheterization...............................................................................................................17
2.12 Prevention..............................................................................................................................18
2.13 Complication of obstetrical fistula........................................................................................19
2.14 Midwives role of obstetrical fistula.......................................................................................20
2.15. Conceptual frame work........................................................................................................20
CHAPTER THREE.......................................................................................................................21
3.0 RESEARCH METHODOLOGY...........................................................................................21
3.1 Introduction.............................................................................................................................21
3.2 Research design........................................................................................................................21
3.6 Sample size:-.............................................................................................................................22
3.7 sample technique......................................................................................................................22
3.8 Data collection instruments.....................................................................................................22
3.9 Data Collection.........................................................................................................................23
3.10 Data Analysis plan.................................................................................................................23
3.11.1 Includes of researches.........................................................................................................23
3.11.2 Excludes of researches........................................................................................................23
3.12 Ethical consideration.............................................................................................................23
4.1 OVERVIEW............................................................................................................................25
4.2 Profile of respondents..............................................................................................................25
4.4 respondent of age.....................................................................................................................26
4.5 Respondent of education levels...............................................................................................27
4.6 Respondent of marital status..................................................................................................27
4.7 Respondents of occupations....................................................................................................28
4.8 Respondents of income monthly.............................................................................................28
4.9 Respondents of number of children........................................................................................29
4.10 Do you know any information about obstetrical fistula?....................................................29
4.11 What are causes of obstetrical fistula?.................................................................................30
4.12 What are the signs or symptoms of obstetrical fistula?......................................................30
4.13 Do you know impact of obstetrical fistula?..........................................................................31
4.14 What are the complications of obstetrical fistula?..............................................................31
4.15 Do you belief that impact of obstetrical fistula?..................................................................32
4.16 Obstetrical fistula can lead to fear of another pregnancy?.................................................32
4.17 Do you think that obstetrical fistula can be reduced?.........................................................33
4.18 Can obstetrical fistula lead psychological problems?..........................................................33
4.19 You think that any relationship between impact of obstetrical fistula to social stigma?34
4.20 Can obstetrical fistula leads women social stigma?.............................................................34
4.21 How do you manage women have obstetrical fistula?.........................................................35
4.22 Do you attend health center to take health education to ward impact of..........................35
Obstetrical fistula?........................................................................................................................35
4.23 Which are better pregnancy women to delivery at home or health center?......................36
4.24 did you think obstetrical fistula have another management rather than surgery............36
5.0 F INDING CONLUSIONS AND RECOMMENDATIONS.................................................37
5.1 Introduction.............................................................................................................................37
5.2 Summary of the Findings........................................................................................................37
5.3 Conclusions..............................................................................................................................39
5.4 Recommendation.....................................................................................................................40
 CHAPTER ONE
1.0 Introduction
This chapter presents Background of impact of obstetrical fistula on the mother in world and
Africa and also problem statement, purpose of study, objective of the study, scope, limitation,
significance as well as the review of the chapter.

1.1 Backgrounds
Women with fistula live in a state of distress and in fear of their future life, an obstetric fistula
has a devastating impact on affected women and their families.

Obstetric fistula is a preventable maternal morbidity that results from prolonged and obstructed
labour 1. It commonly occurs when there is Cephalo pelvic disproportion. Unless there is skilled
obstetric intervention this disproportion creates pressure on the tissues and then prolonged
2
ischemia was cause tissue necrosis leading to fistula formation It causes life-long disabilities
and poor quality of life 3,4

WORLD WIDE

In the developed world it is very rare and faded away 100 years ago following improved
obstetric care5, while it remains the prevalent cause of maternal morbidity in the developing
world 6,7 It affects more than 2 million women worldwide, with at least 50,000 to 100,000 new
cases occurring annually 8Among which the majority is from resource-poor countries where the
health system is9,10 ineffective The majority of obstetric fistula cases are in Africa and Asia 1
Continuous and uncontrollable leaking of urine and/or feces can lead to life-changing
stigmatization of the women 11,12. Therefore women with fistula live in a state of distress and a
fear of their future life13. The consequence of obstetric fistula is devastating for those affected
women and their families14,15Beyond the medical conditions, the social consequences are severe,
and affected women are often ostracized from their community, divorced, abandoned, and
16,17
remain childless .Women living with fistula may be blamed by the community members for
their condition, viewing it as punishment for sin or a venereal disease or curse , 17 The women are
unable to participate in religious activities and social gatherings, and are considered unhygienic
18,19 .
IN AFRICA
Obstetric fistula remains a major public health problem in developing world where unattended
obstructed labor is common and maternal mortality is unacceptably high. It is a tragedy in
developing world because of illiteracy, poverty, ignorance and lack of health facilities.

An obstetric fistula is preventable and treatable condition, the untreated condition remains in
developing countries.20

Ethiopia is one example of developing countries with poor maternal health care as well as high
prevalence of obstetric fistula.

In Ethiopia approximately 26,000 women living with this disability with an additional 9000 new
cases annually.

Typical fistula patients in Ethiopia are young peasant girls who are married in their early teens to
farmers with little or no education. The girls are given heavy tasks in the household and are
poorly educated. They have no access to any health institution during pregnancy and in labor are
often helped during labor by women of the village to deliver at home and usually deliver a dead
baby after being in labor for days.

Many research findings have documented about the most important immediate clinical causes of
obstetric fistula. But in Ethiopia, the underlying factors and consequences of the problem are not
yet fully identified and adequately documented. Understanding the epidemiology of obstetric
fistula and its determinants helps to design appropriate interventions on the basis of scientific
evidences

IN SOMALIA
Somalia has some of the worst maternal health indicators in the world. The fertility rate is very
high as are infant and maternal mortality rates, malnutrition is chronic, early marriage is
common, and most deliveries are done at home without the presence of a skilled attendant.
Women in Somalia live in a highly insecure context where healthcare infrastructure and
maternal health programs have been disrupted and limited in availability for decades. Facilities
tend to be dilapidated, basic equipment and medications are in short supply, and there is a lack of
trained medical personnel throughout the country. All of these factors are indicative of a high
rate of maternal morbidities such as obstetric fistula.

Until recently, there were no regular fistula services available in Somalia. Women were forced to
travel to Somaliland or neighboring Ethiopia to seek treatment, but instability and high transport
costs rendered this option impossible for most women.

There is high quality fistula care in Mogadishu through fistula treatment facilities at Hanno and
Benadir Hospitals.

On the International Day to End Obstetric Fistula, 23 May 2017, the Puntland Ministry of Health
and UNFPA convened a high profile ceremony to commemorate the occasion. The purpose of
the event was to renew the momentum gathered since 2013 in previous campaigns to end
obstetric fistula and to increase public awareness about the condition.The Minister of Health for
Puntland Dr. Abdinasir Osman Cuuke highlighted the staggering number of women living with
obstetric fistula around the world. “Two million women or girls are estimated to live with
obstetric fistula, with up to a million more developing the condition,” said Dr. Cuuke.

1.2 Problem statement

After the destruction of Somali government, these country undergo civil war that leads the
country to enter very serious situation like instability, lack of health, low social economic status
and diminished the educational status. All the health service in clinical are diminished, because
the budgets from the government and other agencies are stopped result from war. The mothers
whose need health care service is missed because service of become money so if mother not
enable to bring that money was not be getting health need, so that money women faced
complication during labour including fistula. . Delayed of care and lack of skilled health workers
also associated with higher cases of fistula and lack emotional support women have obstetrical
fistula.

1.3 purpose of study

To determine’ impact of obstetrical fistula on the mother in case Isniino MCH
1.4: Objectives of the study
1.4.1: General objective
Determine impact of obstetrical fistula on the mothers in case Isniino MCH

1.4.2: Specific objective

 To describe complication of obstetrical fistula one mother

 To determine psychological and emotional problems of mother obstetrical fistula one
mother
 To describe prevention of obstetrical fistula one mother
 To find out socio-demographic characteristics of the respondents?

1.5 Research question

 What are complications of obstetrical fistula one mother?

 What are psychological and emotional problems of mother obstetrical fistula one
mother?
 Describe the prevention of obstetrical fistula one mother?
 What are the socio-demographic characteristics of the respondents?

1.6 Hypotheses
There is relationship between the delaying the age of first pregnancy, delivery assisted by well
trained midwifery and prevention of obstetrical fistula in positive way.

1.7 Significant of the study

The stakeholders of health in Isniino MCH was benefit from this study by obtaining variable
information that various have contributed. This information was enable the district to tell
whether to finding obtained to impact of obstetrical fistula in case of Isniino MCH and other
districts was find this study is very use full where by the identified this study was be help full to
other researchers especially in continuation of various studies related to this project.

Alternatively, the study was also be use full to those researchers in experienced skill of
developing research studies; they was make this study a source of their reference.
The government was also find the information use full by identifying impact obstetrical fistula in
case of Isniino MCH and other districts and come up with possible solution that reducing the
case in Isniino MCH

1.8 Study limitation

Really in my study Allah made me easy for everything so that I didn’t face so more limitations
except little limitations. This study as mentioned earlier only covers Isniino MCH

It would have been interesting to cover the impact of obstetrical fistula on the mother all punt
land regions. However due to the limitation of time and finances this study was limit to Isniino
MCH only.

1.9 scopes of study

This research is limited in terms of scope because it was only conducted in one district of the
Bari region in punt land state of Somalia. Also limited time 7 months (November up to May)
prior to the data collection process.

My target population was be mothers in Isniino MCH faced the complication of fistula and have
high risk to fistula e.g. presetited labour And prime gravid, and some poor populations life have
been included in the sample.

The findings of this research could therefore not be generalized to other communities in Bossaso
Other limitations identified during the research process have been discussed in chapter 5
CHAPTER TWO:-
2.0 literature review
2.1 Introduction
Obstetric fistula:-is a medical condition in which a hole develops in the birth canal as a result
of childbirth.21 ,22This can be between the vagina and rectum, ureter, or bladder. It can result
in incontinence of urine or feces.21 Complications may include depression, infertility, and social
isolation.21

Risk factors include obstructed labor, poor access to medical care, malnutrition, and teenage
pregnancy.21,23 The underlying mechanism is poor blood flow to the affected area for a prolonged
period of time.21 Diagnosis is generally based on symptoms and may be supported by use
of methylene blue.24

Obstetric fistulae are almost entirely preventable with appropriate use of cesarean
section Treatment is typically by surgery.21 If treated early, the use of a urinary catheter may help
with healing, Counseling may also be useful. 24

 An estimated 2 million women in sub-Saharan Africa, Asia, the Arab region, and Latin
America have the condition, with about 75,000 new cases developing a year It occurs very rarely
in the developed world.21 It is considered a disease of poverty.25

2.2 History

Evidence of Obstetric Fistula goes all the way back to 2050 BCE when Queen Henhenit obtained
a fistula.

The first acknowledgments to the Obstetric Fistula date back to various Egyptian documents
known as the papyri. These documents, including rare medical engravings, were found of the
entrance of a tomb located in the necropolis of Saqquarah, Egypt. The tomb belonged to an
unknown physician who lived during the 6th dynasty.

The translation of this document became legible with the invention of the Rosetta stone in
1799.26
In 1872, the Ebers papyrus was discovered in a mummy from the Theban acropolis. This papyrus
is 65 feet long, 14 inches wide, consisting of 108 columns each about 20 lines, now resides in the
library at the University of Leipzig. The gynecological reference in this papyrus addresses
uterine prolapsed, but at the end of page three, there seems to be a mention of the vesico-vaginal
fistula, warning the physician against trying to cure it saying, “prescription for a woman whose
urine is in an irksome place: if the urine keeps coming and she distinguishes it, she was be like
this forever. [26] This seems to be the oldest reference to vesico-vaginal fistula, one which
articulates the storied history of the problem.

2.3 Definition

A fistula: - is an abnormal connection (an opening) between two internal organs or between an
internal organ and the surface of the body.

An Obstetric fistula: - is a hole between the vaginal and rectum or bladder that is caused by
prolonged obstructed labor, leaving women incontinent of urine or feces or both.

2.4 Epidemiology

Obstetric fistulae are common in the developing world, especially in sub-

Saharan Africa (Kenya,27 Mali, Niger,28 Nigeria, Rwanda, Sierra Leone, South Africa, Benin,
Chad, Malawi, Mali, Mozambique, Niger, Nigeria, Uganda, and Zambia) and much of South
Asia (Afghanistan, Bangladesh, India, Pakistan, and Nepal). According to the World Health
Organization (WHO), an estimated 50,000 to 100,000 women develop obstetric fistulae each
year and over two million women currently live with an obstetric fistula.29 In particular, most of
the two million-plus women in developing nations who suffer from obstetric fistulae are under
the age of 30.28 Between 50 and 80% of women under the age of 20 in poor countries develop
obstetric fistulae (the youngest patients are 12–13 years old). 30 Other estimates indicate about
73,000 new cases occur per year.31
2.5 Symptoms of obstetric fistula include:-

1. Flatulence, urinary incontinence, or fecal incontinence, which may be continual or only

happen at night 32
2. Foul-smelling vaginal discharge
3. Repeated vaginal or urinary tract infections
4. Irritation or pain in the vagina or surrounding areas.
5. Pain during sexual activity.32

 Other effects of obstetric fistulae include stillborn babies due to prolonged labor, which
happens 85% to 100% of the time, severe ulcerations of the vaginal tract, "foot drop",
which is the paralysis of the lower limbs caused by nerve damage, making it impossible
for women to walk, infection of the fistula forming an abscess,33 and up to two-thirds of
the women become amenorrhea.34

2.6 Causes of obstetrical fistula

Factors for obstetric fistula include poverty, malnutrition, inadequate health systems,
detrimental traditional practices, and lack of skilled attendants, limited access to
emergency Caesareans, unequal gender relations, and the contributing factors of an often
poor economic situation. It is important to note however, that fistula can affect all
women, not only adolescents, however most commend cause are:-

 Prolonged labour

 Obstruction of labour

 Precipitate labour

 Episiotomy

2.7 Different types of obstetric fistula

There are several possible types of obstetric fistula. These include the following:
1. vesicovaginal fistula (VVF):- between the bladder and vagina
2. rectovaginal fistula (RVF):- between the rectum and vagina
3. urethrovaginal fistula (UVF):- between the urethra (bladder outlet) and vagina
4. ureterovaginal fistula :-between the ureters (kidney tubes) and the vagina
 5. vesicouterine fistula:- between the bladder and the uterus (womb).

Some times more than one type of fistula may occur at the same time, where damage is severe.

2.7.1. Vesicovaginal fistula (VVF)

Vesicovaginal fistula (VVF) is a subtype of female urogenital fistula (UGF). is the most

common type of obstetric fistula

Figure 2.1

Presentation

Vesicovaginal fistula, or VVF, is an abnormal fistulous tract extending between

the bladder (vesica) and the vagina that allows the continuous involuntary discharge of urine into
the vaginal vault.

In addition to the medical sequela from these fistulas, they often have a profound effect on the
patient's emotional well-being.

Figure 2.2 Vesicovaginal fistula

2.7.2. Recto-vaginal Fistula (RVF)
RVF formation results as a complication of an underlying disease, injury or surgical event.
Diseases of the vagina or the pelvic organs can be complicated with a persistent connection
between the rectum and vagina. The common causes of rectovaginal fistula are35

Common causes of recto-vaginal fistula are

1. Obstetric-related injury

2. Surgical procedure3. Diverticular disease.

4. Crohn's disease

5. Malignancy

6. Radiation7. Non-surgical injuries and foreign bodies: 

2.7.3 A urethra-vaginal fistula 

An urethrovaginal fistula is an abnormal passageway between the urethra and the vagina. It
results in urinary incontinence as urine continually leaves the vagina. It can occur as
an obstetrical complication, catheter insertion injury or a surgical injury.

2.7.4. A uretero-vaginal fistula 

A ureterovaginal fistula is an abnormal passage way existing between the ureter and the vagina.

It presents as urinary incontinence. Its impact on women is to reduce the "quality of life
dramatically.

2.7.5. Vesico-uterine fistula

Vesicouterine fistula is a rare type of urogenital fistula. The major risk factor is a previous
cesarean section, which explains the growing number of reported cases in literature.

Clinical manifestations vary and can be discrete and misleading. The diagnosis of VUF should
be considered when there is a history of previous cesarean section. The vaginal tampon dye test
is an easy diagnostic test. Treatment of VUF is mostly surgical with the surgical approach
depending on the skills of the surgeon. The limited results are reassuring with no apparent effect
on patient’s future fertility. An elective cesarean section is preferred after surgical VUF repair.
2.8 Risk factors of obstetrical fistula
1. Poverty
2. Malnutrition
3. Lack of education
4. Early child birth
5. Lack of health care
6. Status of women

2.8 1. Poverty

Poverty is the main indirect cause of obstetric fistulae around the world. As obstructed labor and
obstetric fistulae account for 8% of maternal deaths worldwide36 and “a 60-fold difference in
gross national product per person shows up as a 120-fold difference in maternal mortality ratio,”
impoverished countries produce higher maternal mortality rates and thus higher obstetric fistula
rates.37 Furthermore, impoverished countries not only have low incomes, but also lack adequate
infrastructure, trained and educated professionals, resources, and a centralized government that
exist in developed nations to effectively eradicate obstetric fistulae.38

According to UNFPA, “Generally accepted estimates suggest that 2.0-3.5 million women live
with obstetric fistulae in the developing world, and between 50,000 and 100,000 new cases
develop each year.

All but eliminated from the developed world, obstetric fistula continues to affect the poorest of
the poor: women and girls living in some of the most resource-starved remote regions in the
world.39

2.8.2. Malnutrition
One reason that poverty produces such high rates of fistula cases is the malnutrition that exists in
such areas.40 Lack of money and access to proper nutrition, 41as well as vulnerability to diseases
that exist in impoverished areas because of limited basic health care and disease prevention
methods, cause inhabitants of these regions to experience stunted growth. Sub-Saharan Africa is
one such environment where the shortest women have on average lighter babies and more
difficulties during birth when compared with full-grown women. This stunted growth causes
expectant mothers to have skeletons unequipped for proper birt proper birth, such as an
underdeveloped pelvis.48 

2.8.3. Lack of education

High levels of poverty also lead to low levels of education among impoverished women
concerning maternal health. This lack of information in combination with obstacles preventing
rural women to easily travel to and from hospitals lead many to arrive at the birthing process
without prenatal care. This can cause a development of unplanned complications that may arise
during home births, in which traditional techniques are used. These techniques often fail in the
event of unplanned emergencies, leading women to go to hospital for care too late, desperately
ill, and therefore vulnerable to the risks of anesthesia and surgery that must be used on them. In a
study of women who had prenatal care and those who had unbooked emergency births, “the
death rate in the booked-healthy group was as good as that in many developed countries, [but]
the death rate in the unbooked emergencies was the same as the death rate in England in the 16th
and 17th centuries.” In this study, 62 unbooked emergency women were diagnosed with obstetric
fistulae out of 7,707 studied, in comparison to three diagnosed booked mothers out of 15,020
studied.50 In addition, studies find that education is associated with lower desired family size,
greater use of contraceptives, and increased use of professional medical services. Educated
families are also more likely to be able to afford health care, especially maternal healthcare.42

2.8.4. Early childbirth

In sub-Saharan Africa, many girls enter into arranged marriages soon after menarche (usually

between the ages of 9 and 15). Social factors and economic factors contribute to this practice of
early marriages. Socially, some grooms want to ensure their brides are virgins when they get
married,

so an earlier marriage is desirable. 43 Economically, the bride price received and having one less
person to feed in the family helps alleviate the financial burdens of the bride's family. 44 Early
marriages lead to early childbirth, which increases the risk of obstructed labor, since young
mothers who are poor and malnourished may have underdeveloped pelvises. In fact, obstructed
labor is responsible for 76 to 97% of obstetric fistulae. 45
2.8.5. Lack of healthcare

Even women who do make it to the hospital may not get proper treatment. Countries that suffer
from poverty, civil and political unrest or conflict, and other dangerous public health issues such
as malaria, HIV/AIDS, and tuberculosis often suffer from a severe burden and breakdown within
the healthcare system. This breakdown puts many people at risk, specifically women. Many
hospitals within these conditions suffer from shortages of staff, supplies, and other forms of
medical technology that would be necessary to perform reconstructive obstetric fistula repair.
[citation needed]
 There is a shortage of doctors in rural Africa, and studies find that the doctors and
46
nurses who do exist in rural Africa often do not show up for work.

Poverty hinders women from being able to access normal and emergency obstetric care because
of long distances and expensive procedures. For some women, the closest maternal care facility
can be more than 50 km away.

In Kenya, a study by the Ministry of Health found that the "rugged landscape, long distances to
health facilities, and societal preferences for delivery with a traditional birth attendant
contributed to delays in accessing necessary obstetric care.47

Emergency cesarean sections, which can help avoid fistulae caused by prolonged vaginal
deliveries, are very expensive.

2.8.6. Status of women

In developing countries, women who are affected by obstetric fistulae do not necessarily have
full agency over their bodies or their households. Rather, their husbands and other family
members have control in determining the healthcare that the women receive. 42 For example, a
woman's family may refuse medical examinations for the patient by male doctors, but female
doctors may be unavailable, thus barring women from prenatal care. [43] Furthermore, many
societies believe that women are supposed to suffer in childbirth, thus are less inclined to support
maternal health efforts.48

2.9 Impact Obstetric fistulae

Obstetric fistulae have far-reaching physical, social, economic, and psychological consequences
for the women affected. According to UNFPA, “Due to the prolonged obstructed labour, the
baby almost inevitably dies, and the woman is left with chronic incontinence. Unable to control
the flow of urine or faeces, or both, she may be abandoned by her husband and family and
ostracized by her community. Without treatment, her prospects for work and family life are
virtually nonexistent.49

2.9.1 Physical

The most direct consequence of an obstetric fistula is the constant leakage of urine, feces, and
blood as a result of a hole that forms between the vagina and bladder or rectum. 50 This leaking
has both physical and societal penalties. The acid in the urine, feces, and blood causes severe
burn wounds on the legs from the continuous dripping.51 Nerve damage that can result from the
leaking can cause women to struggle with walking and eventually lose mobility. In an attempt to
avoid the dripping, women limit their intake of water and liquid, which can ultimately lead to
dangerous cases of dehydration.

Figure 2.3 Leakage of urine and feces

2.9.2 Social
Physical consequences of obstetric fistulae lead to severe sociocultural stigmatization for various
reasons. For example, in Burkina Faso most citizens do not believe an obstetric fistula to be a
medical condition, but as a divine punishment or a curse for disloyal or disrespectful
behavior.52 Other sub-Saharan cultures view offspring as an indicator of a family's wealth.

A woman who is unable to successfully produce children as assets for her family is believed to
make her and her family socially and economically inferior.

A patient's incontinence and pain also render her unable to perform household chores and
53
childrearing as a wife and as a mother, thus devaluing her  Other misconceptions about
obstetric fistulae are that they are caused by venereal diseases or are divine punishment for
sexual misconduct. As a result, many girls are divorced or abandoned by their husbands and
partners, disowned by family, ridiculed by friends, and even isolated by health
workers.54 Divorce rates for women who suffer from an obstetric fistula range from 50% 55to as
high as 89%.56

Now marginalized members of society, girls are forced to live on the edges of their villages and
towns, often to live in isolation in a hut where they was likely die from starvation or an infection
in the birth canal. The unavoidable odor is viewed as offensive.

Figure 2.4 Social stigmas.

2.9.3 Psychological

Some common psychological consequences that women with a fistula face are the despair from
losing their child, the humiliation from their smell, and inability to perform their family
roles.57 Additionally, a fear of developing another fistula in future pregnancies exists.58

Obstetric fistula is not only debilitating physically, but emotionally. A woman is presented with
an array of psychological trauma that she must oftentimes deal with herself unless provided with
ample resources..  Although the psychological impacts center around the woman experiencing
the fistula, others around them, and especially loved ones, feel the impact as well. The same
study references this: “This attitude was often shared by their family members, both husbands
and female relatives.”59 Women with obstetric fistula face severe mental health issues, among
women with obstetric fistula from Bangladesh and Ethiopia 97 percents screened positive for
potential mental health dysfunctions and about 30% had major depression.60
2.10 Diagnosis
 In vesico vaginal fistula :- one such special test to place three cotton wool swab in the
vagina , one above other and to run methyl len blue dye into bladder.
 If only the lowest swab stains the fistula is urethral.
 If the middle swab stains, it is vesical
 If no swab stains but the upper most swab is wet, the fistula is ureterial.

 In recto vaginal fistula:-the patient complain incontinence of faeces my be obvious or

extremely difficult to identify, and photocopy or introduction of dyes may be required.

2.11 Treatments
2.11.1 Surgery

The nature of the injury varies depending on the size and location of the fistula, so a surgeon
with experience is needed to improvise on the spot. 61 Before the person undergoes surgery,
ntreatment and evaluation are needed for conditions including anemia, malnutrition, and malaria.
Quality treatments in low-resource settings are possible (as in the cases of Nigeria and
Ethiopia).62

Treatment is available through reconstructive surgery.63 Primary fistula repair has a 91% success
rate.64 The corrective surgery costs about US$100 – 400, 65 and the cost for the entire procedure,
which includes the actual surgery, postoperative care, and rehabilitation support, is estimated to
cost $300–450.

Initial surgeries done by inadequately trained doctors and midwives increase the number of
follow-up surgeries that must be performed to restore full continence.66 

Successful surgery enables women to live normal lives and have more children, but it is
recommended to have a cesarean section to prevent the fistula from recurring.

Postoperative care is vital to prevent infection. Some women are not candidates for this surgery
due to other health problems. In those cases, fecal diversion can help the patient, but not
necessarily cure them.67
Figure 2.5
Rehabilitate fistula patients

2.11 .2 Challenges

Challenges with regards to treatment include the very high number of women needing
reconstructive surgery, access to facilities and trained surgeons, and the cost of treatment. For
many women, US$300 is a price they cannot afford. Access and availability of treatment also
vary widely across different sub-Saharan countries. Certain regions also do not have enough
maternal care clinics that are equipped, wasing to treat fistula patients, and adequately staffed. At
the Evangelical Hospital of Bemberéke in Benin, only one expatriate volunteer obstetrics and
gynecology doctor is available a few months per year, with one certified nurse and seven
informal hospital workers.68 In all of Niger, two medical centers treat fistula patients.69

Another challenge is the lack of trained professionals to provide surgery for fistula patients As a
result, non physicians are sometimes trained to provide obstetric services. For example, the
Addis Ababa Fistula Hospital has medical staff without formal degrees, and one of its top
surgeons was illiterate, but she had been trained over years and now regularly successfully
performs fistula surgery.70

2.11.3. Catheterization
Fistula cases can also be treated through urethral catheterization if identified early enough.

The Foley catheter is recommended because it has a balloon to hold it in place.

The indwelling Foley catheter drains urine from the bladder.

These decompress the bladder wall so that the wounded edges come together and stay together,
giving it a greater chance of closing naturally, at least in the smaller fistulae.

About 37% of obstetric fistulae that are treated within 75 days after birth with a Foley catheter
resolve.

Even without preselecting the least complicated obstetric fistula cases, a Foley catheter by
midwives after the onset of urinary incontinence could treat over 25% of all new fistulae.71

Figure 2.6 Foley catheters

2.12 Prevention

Prevention is the key to ending fistulae. UNFPA states that, “Ensuring skilled birth attendance at
all births and providing emergency obstetric care for all women who develop complications
during delivery would make fistula as rare in developing countries as it is in the industrialized
world.”  In addition, access to health services and education – including family planning, gender
equality, higher living standards, child marriage, and human rights must be addressed to reduce
the marginalization of women and girls. Reducing marginalization in these areas could reduce
maternal disability and death by at least 20%. 72 Prevention comes in the form of access
to obstetrical care, support from trained health care professionals throughout pregnancy,
providing access to family planning, promoting the practice of spacing between births,
supporting women in education, and postponing early marriage. Fistula prevention also involves
many strategies to educate local communities about the cultural, social, and physiological factors
of that condition and contribute to the risk for fistulae. One of these strategies involves
organizing community-level awareness campaigns to educate women about prevention methods
such as proper hygiene and c are during pregnancy and labor. 73 Prevention of prolonged
obstructed labor and fistulae should preferably begin as early as possible in each woman's life.
For example, improved nutrition and outreach programs to raise awareness about the nutritional
needs of children to prevent malnutrition, as well as improve the physical maturity of young
mothers, are important fistula prevention strategies.

It is also important to ensure access to timely and safe delivery during childbirth measures
include availability and provision of emergency obstetric care, as well as quick and safe cesarean
sections for women in obstructed labor. Some organizations train local nurses and midwives to
perform emergency cesarean sections to avoid vaginal delivery for young mothers who have
underdeveloped pelvises.74 Midwives located in the local communities where obstetric fistulae
are prevalent can contribute to promoting health practices that help prevent future development
of obstetric fistulae. NGOs also work with local governments, like the government of Niger, to
offer free cesarean sections, further preventing the onset of obstetric fistulae

Several organizations have developed effective fistula prevention strategies. One, the Tanzanian
Midwives Association, works to prevent fistulae by improving clinical healthcare for women,
encouraging the delay of early marriages and childbearing years, and helping the local
communities to advocate for women's rights.75

2.13 Complication of obstetrical fistula

Women who develop OF secondary to prolonged obstructed labor are affected by multiple
devastating medical and psychosocial sequelae. Along with urinary and/or fecal incontinence,
they are at risk for other urologic diseases such as renal failure, gynecologic sequelae such as
vaginal stenosis and infertility, and neurologic disorders including foot drop. Perhaps the most
devastating consequence is the impact OF can have on their psychosocial life.

These women are subject to serious depression. Due to their odor, the constant dribble of urine
down their legs, and the puddles of urine that surround their feet if they stand for too long, they
are shunned by their families and are physically isolated from their community. Some women
are kept in separate huts away from the rest of the village, or they are divorced and left to fend
for themselves. Others are forced to leave their villages and become beggars. This isolation and
abandonment have led some women to suicide.76
2.14 Midwives role of obstetrical fistula
1. Midwives play an important role in the prevention of obstetric fistula and the management and
rehabilitation of clients living with obstetric fistula.

2. improvements-in-quality-of-care

3. Preventing Obstetric Fistula during Pregnancy, Labour, and Delivery

4. Management of Clients with Obstetric Fistula during Repair Surgery

5. Counseling Clients with Obstetric Fistula.

2.15. Conceptual frame work

Independent
variable
Confounding Dependent
variable
variable

Lack community to
awareness to stigma of  Good skills
client fistula
of midwives
 Lack of health
 .ANC
care
 PNC
 Traditional
 Delivery in
birth Background
variable:- health unit
attendance
 Post
 Lack  Age
 State operative
prevention Of
 Gravida care
fistula
 Lacke of  Para

proper
instruments
 CHAPTER THREE
3.0 RESEARCH METHODOLOGY
3.1 Introduction
The previous chapter the researcher have dealt with the identification, selection and statement of
the problem, the importance of literature review and formulation of study objectives now the
researcher must decide exactly how is going to achieve the stated objectives This chapter was
presents detailed information of how the required data was be sourced, processed, analyzed and
interpreted to achieve the research objectives.

3.2 Research design

This was be descriptive cross-sectional research design to assess the level of factor associated
with impact of obstetrical fistula on mothers. This was chosen because of its suitability f this
kind of research in terms of time and cost

3.3 Study area

The study of area was Isniino MCH

3.4 Study period

The study begin son Nov 2019 until April 2020

3.5 Research population

The target population for the study is the doctors, midwives and mothers in child bearing age in
Isniino MCH. The accessible population individuals with targeting specially in localization
health worker and mothers visited in Isniino MCH. The study was cover at Isniino MCH total
population of 50 This is clarified in the table below Table 3.1 accessible populations

Respondents Frequency Percentages

Doctors 10 20%
Midwives 20 40%
Mothers in child bearing 20 40%
Total 50 100%
3.6 Sample size:-
The researcher selected 25 persons from mothers, doctors and midwives, so a sample through
randomly selected by 50% using this formula.

This is clarified in table below

Table 3.2 simple size

Respondents Frequency Percentages

Doctors 5 20%
Midwives 10 40%
Mothers in child bearing 10 40%
ages
Total 25 100%

3.7 sample technique

Sampling procedure is a process in which a number of individuals are selected for a study in
such a way that the larger group from which these individuals were selected is represented by
them. The respondents were being chosen using simple random sampling techniques because
they give equal chance of representation to every subject.

3.8 Data collection instruments

In this research the researcher try a comprehensive self-administered questionnaire guide to be
developed covering all aspects of the study variables was be designed covering demographic
information of the respondents and consideration of the dependant variables and independent
variables.

The researcher is using the most common method of data collection instrument that
is(quantitative data) especially in our research we use interviews and self-administered
questionnaires.

3.9 Data Collection

The research design is descriptive, chief data was be collected through a semi structured close
ended questionnaires; the less important data was be collected through the use of both theoretical
and observed literature available and from various documents in Isniino MCH . Questionnaires
was be issued randomly to impact of obstetrical fistula on mothers Each instrument was be
implemented based on the objectives of the study that the researcher want to achieve, therefore
the researcher was use appropriately data collection instrument in order to achieve identified
research objectives and therefore get answers to the questions asked.

3.10 Data Analysis plan

The study was generate both qualitative and quantitative data,

The researcher was use descriptive nature tables, graphs, and pie charts which show percentage
and proportion of data collected from respondent questionnaire and data collected from
secondary source.

Thus user of research finding was easily understand the outcomes and recommendation given by
researcher

3.11 Selection criteria

3.11.1 Includes of researches

The research includes doctors, midwives and mothers in child bearing age attend in Isniino MCH

3.11.2 Excludes of researches

The research excludes by women under 15 years old, menopause women and mothers not attend
in Isniino MCH.

3.12 Ethical consideration:

These studies involving human subjects so the researcher In any ethical review the following
points must be stated clearly for approval:-

 The known benefits and risks or disadvantages for the subject in the study
 Exact description of the information to be delivered to the subjects of the study and when
it was be communicated orally or in writing. The researcher consider the freedom of
subjects to withdraw from the study
 Indicate how the information obtained from participants in the study was be kept
confidential
 CHAPTER FOUR
4.0 PRESENTION, ANALYSIS AND INTERPRETATION OF DATA
4.1 OVERVIEW

This chapter presents data collected, analysis and interpretation from the finding
The data was collected using instruments questionnaire, interview guide and documentations,
which was highlighted under the researcher’s methodology. In this chapter, more emphasis has
been placed on the interpretation of raw data in relation to the set objectives and the research
questions as set for the study.

4.2 Profile of respondents:

The researcher prepared questionnaires and interview guide appropriate for this study. The
questionnaires were administrated using both personal administrations with no the spot
collection where the researcher delivered the questionnaire in person and waited for the
respondents to fill them then went back with them. Personal administration with collection after
time was employed to give the respondent sample time to answer the questionnaire and consult
other resource material and other documents.

The researcher distributed 25 questionnaires to persons in Isniino MCH. All the questionnaires
were completed and returned back. This means that questionnaire which has been completed
represented a good response rate which was considered sample for the objectives of the study.

4.3 respondent of gender

Figure 4.3 genders of the respondents

12%

female
male

88%

As illustrated above figure 4.3 shows the gender of respondents while the majority of
respondents 88% (n=22) were female while 12% (n=3) were male.

4.4 respondent of age

Table 4.4 age of the respondent

Frequency Percent

15----25 16 64.0
26----35 6 24.0
36---49 3 12.0
Total 25 100.0

As illustrated above table 4.4 shows age of respondents 64% (n=16) about gender of the
respondent between 15-25yrs, while 24 %( n=6) of the respondents were between 26-35yrs,
while 12 %( n=3) of the respondents were 36-49yrs.

4.5 Respondent of education levels

Figure 4.5 Respondent of education levels
 70%

60%

50%

40%

30% 64%

20%

10% 16% 16%

0% 4%
Illiteracy Primary level Secondary level University

As illustrated above figure 4.5 level of educations 64% (n=16) the majority of respondents were
level of education at university level, while 16% (n=4) of the respondents were primary level,
while 16% (n=4) of the respondents were illiteracy, while 4% (n=1) of the respondents were
secondary level.

4.6 Respondent of marital status

Table 4.6 marital status of respondents

Frequency Percent
Single 14 56%
Married 11 44%
Total 25 100%

As illustrated above table 4.6 shows marital status of respondents 56% (n=14) of the majority of
respondents were single, while 44 % (n=11) of the respondents were married.

4.7 Respondents of occupations

Figure 4.7 occupations respondents
 Chart Title

Business woman
Business woman; 4%

House Wife House Wife; 32%

Student Student; 64%

0% 10% 20% 30% 40% 50% 60% 70%

As illustrated above 4.7 shows occupation of respondents 64% (n=16) majority of the
respondents were students, while 32% (n=8) of the respondents were house wife, while 4% (n=1)
of the respondents were business women.

4.8 Respondents of income monthly

Table 4.8 income monthly of respondents

Frequency Percent As illustrated

$100-----$150 17 68%
above table 4.8
200-----$250 3 12%
300-----$350 5 20% shows the
Total 25 100% income of
respondents the majority of respondents 68% (n=17) were b/w $100-$150, while 20% (n=5) of
the respondents were b/w $300-$350, while 12% (n=3) of the respondents were b/w $ 200-$250

4.9 Respondents of number of children

Figure 4.9 Number of children of the respondents
 8%

16%
None
1---3
4---6
60% Above 6
16%

As illustrated above figure 4.9 shows the majority of respondents 60% (n=15) have no
children, while 16%(n=4) of the respondents were have children b/w 1-3, while 16%(n=4) of
the respondents were have children b/w 4-6 , while 8%(n=2) of the respondents were have
children above 6.

4.10 Do you know any information about obstetrical fistula?

Table 4.10 Do you know any information about obstetrical fistula?

Frequency Percent

Yes 21 84%

No 4 16%
Total 25 100%

As illustrated above table and figure 4.10 shows information the respondents about known fistula
84% (n=21) the majority of the respondents were answer yes were 16% (n=4) answer no.

4.11 What are causes of obstetrical fistula?

Figure 4. 11 What are causes of obstetrical fistula?
 40%
40%
35%
30% 24%
25% 20%
20%
15% 12%
10%
5% 4%
0%
r
bou ou
r
y
a )
l lab om by
d o t a wn
u cte ita
te
pisi igb no
k
bstr cip E
ia
(b
n`
t
o re m o
P o Id
rs
ac
M

As illustrate above figure 4.11 shows the cause of obstetrical fistula 40% (n=10) of respondents
were caused fistula macrosemia (big baby), while 24% (n=6) of respondents were obstetric
labour, while 20% (n=5) of respondents were caused pricipatete labour, while 12% (n=3) of
respondents caused by episiotomy, 4% (n=1) of respondents were don’t known cause of fistula.
4.12 What are the signs or symptoms of obstetrical fistula?
Table 4.12 what are the signs or symptoms of obstetrical fistula
Signs and symptoms Frequency Percent
Irritation or pain in the vagina 14 56%
or surrounding areas
I don`t known 1 4%
recurrent of infection of vagina 10 40%
or urinary tract
Total 25 100%

Table 4.12 shows sing and symptoms of obstetrical fistula the majority of respondents 56%
(n=14) say have Irritation or pain in the vagina or surrounding areas, while 40% (n=10) have
recurrent of infection of vagina or urinary tract, while 4% (n=1) don’t known.

4.13 Do you know impact of obstetrical fistula?

Figure 4.13 Do you know impact of obstetrical fistula?
 4

Yes
No

96

Above figure 4.13 shows about how to know of respondents about impact of fistula the majority
of respondents 96% (n=24) say yes, while 4 %( n=1) of respondents say No.

4.14 What are the complications of obstetrical fistula?

Table 4.14what is the complications of obstetrical fistula
Frequency Percent
urine and fecal 13 52%
incontinency
Infection 9 36%
foot drops 1 4%
I don`t known 2 8%
Total 25 100%

Above table 4.14 shows complication of obstetrical fistula 52 %( n=13) majority of respondents
caused by urine and fecal incontinency, while 9 %( n=9) were caused Infection, while 8 %( n=2)
of respondents have no information, while 4% (n=1) of respondents caused foot drops.

4.15 Do you belief that impact of obstetrical fistula?

Figure 4.15do you belief that impact of obstetrical fistula?
 4%

Yes
No

96%

Above figure 4.15 shows the believes of respondents about impact of fistula the majority of
respondent 96% (n=24) say Yes, were 4% (n=1) answer No.
4.16 Obstetrical fistula can lead to fear of another pregnancy?

Table 4.16 Obstetrical fistula can lead to fear of another pregnancy?

Frequency Percent
Yes 21 84%
No 1 4%
I don`t known 3 12%
Total 25 100%

Above table 4.16 shows about fear of pregnancy leads about obstetrical fistula 84 %( n=21) the
majority of respondents say Yes, while 12% (n=3) of respondents don’t have information, 4%
(n=1) of respondents say No.

4.17 Do you think that obstetrical fistula can be reduced?

Figure 4.17Do you think that obstetrical fistula can be reduced?
 I don`t known 4%

No 8%

Yes 88%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Above figure and

table 4.17 shows
Frequency Percent
88% (n=22) the of
Yes 21 84%
No 3 12% respondents think to
I don’t known 1 4% reduce obstetrical
Total 25 100%
fistula say Yes, while
8 %( n=2) of
Above table and figure 4.18 shows about psychological problem leads the respondents say No,
obstetrical fistula 84 %( n=21) the majority of respondent say Yes, while while 4 %( n=1) of
12 %( n=3) of respondents answer No, while 4% (n=1) of respondents respondents say
don’t have information. don’t known.

4.19 You think that any relationship between impact of 4.18 Can
obstetrical fistula to social stigma? obstetrical fistula
Figure 4.19 you think that any relationship between impact of obstetrical lead psychological
problems?
fistula to social stigma?

Table 4.18 Can

76% obstetrical fistula
80%
70% lead psychological
60% problems?
50%
40%
30% 16%
20% 8%
10%
0%
Yes No I don`t known
Above figure 4.19 shows relationship b/w obstetrical fistula and social stigma about fistula 76%
(n=19) s the majority of respondents answer Yeas, while 16% (n=4) answer No, while 8 %( n=2)
of respondents have no information.

4.20 Can obstetrical fistula leads women social stigma?

Table 4.20 Can obstetrical fistula leads women social stigma?
Frequency Percent
Yes 16 64%
No 5 20%
I don`t known 4 16%
Total 25 100%

Above table and figure 4.20 shows about social stigma leads abeostetrical fistula 64% (n=16)
the majority of respondents say Yes, while 20% (n=5) of respondents answer No, while 16%
(n=4) not well informed and answer by I don’t know.
4.21 How do you manage women have obstetrical fistula?
Figure 4.21 how do you manage women have obstetrical fistula?

16%

heath center
at home

84%

Above figure 4.21 shows how the respondents to mange fistula 84% (n=) the
majority of respondents manage by surgery, while 8% (n=) manage by
catheterization, while 4 %( n=) mange by drugs, while 4% of respondents do
not have any information about management of fistula.

4.22 Do you attend health center to take health education to ward impact of
Obstetrical fistula?
Table 4.22 Do you attend health center to take health education to ward impact of obstetrical
fistula?
Frequency Percent
Yes 18 72%
No 7 28%
Total 25 100%

Above table 4.22 shows about respondents attend health center to take information to ward
impact of obstetrical fistula 72% (n=18) of majority respondents well informed attend health
center while 28% (n=7) of respondents answer No.
4.23 Which are better pregnancy women to delivery at home or health center?
Figure 4.23 Which are better pregnancy women to delivery at home or health center?

16%

heath center
at home

84%

Above table and figure 4.23 shows 84% (n=21) the majority of respondents were preferred to
delivery at health center while 16% (n=4) preferred to delivery at home.
4.24 did you think obstetrical fistula have another management rather than surgery
Frequency Percent
Table
Yes 11 44% 4.24 did
No 10 40% you think
I don`t known 4 16%

Total 25 100%

obstetrical fistula have another management rather than surgery?

Above table and figure 4.22 shows the represented about obstetrical fistula have another
management rather than surgery 44% (n=11) majority of respondents say Yes, were 40% (n=10)
of respondent say No, 16% (n=4) of respondents have no information and answer I don’t know.

CHAPTER FIVE
5.0 F INDING CONLUSIONS AND RECOMMENDATIONS
5.1 Introduction
This chapter presents the summary of findings, conclusion and recommendations of the results
from chapter four as related to the views of scholars in the literature review and the background
of the study. The conclusion reached is based on the discussion of the findings. The
recommendations are made from the findings and expert opinion from the literature review. The
areas of further research have been explored emanating from the objectives in the entire study.

5.2 Summary of the Findings

The major findings of the study was interpreted and presented in relation to the objectives of the
study .During the analysis of the data presented in chapter 4four the research found out 4.3
shows the gender of respondents while the majority of respondents 88% (n=22) were female
while 12% (n=3) were male and 4.4 shows age of respondents 64% (n=16) about gender of the
respondent between 15-25yrs, while 24 %( n=6) of the respondents were between 26-35yrs,
while 12% (n=3) of the respondents were 36-49yrs and 4.5 level of educations 64% (n=16) the
majority of respondents were level of education at university level, while 16% (n=4) of the
respondents were primary level, while 16% (n=4) of the respondents were illiteracy, while 4%
(n=1) of the respondents were secondary level and 4.6 shows marital status of respondents 56%
(n=14) of the majority of respondents were single, while 44 % (n=11) of the respondents were
married and 4.7 shows occupation of respondents 64% (n=16) majority of the respondents were
students, while 32% (n=8) of the respondents were house wife, while 4% (n=1) of the
respondents were business women and 4.8 shows the income of respondents the majority of
respondents 68% (n=17) were b/w $100-$150, while 20% (n=5) of the respondents were b/w
$300-$350, while 12% (n=3) of the respondents were b/w $ 200-$250 and 4.9 shows the
majority of respondents 60% (n=15) have no children, while 16%(n=4) of the respondents were
have children b/w 1-3, while 16%(n=4) of the respondents were have children b/w 4-6 , while
8%(n=2) of the respondents were have children above 6.

and 4.10 shows information the respondents about known fistula 84% (n=21) the majority of the
respondents were answer yes were 16% (n=4) answer No.
and 4.11 shows the cause of obstetrical fistula 40% (n=10) of respondents were caused fistula
macrosemia (big baby) , were 24% (n=6) of respondents, while 20% (n=5) of respondents were
caused pricipatete labour, while 12% (n=3) of respondents caused by episiotomy, 4% (n=1) of
respondents were don’t known cause of fistula and 4.12 shows sing and symptoms of obstetrical
fistula the majority of respondents 56% (n=14) say have Irritation or pain in the vagina or
surrounding areas, while 40% (n=10) have recurrent of infection of vagina or urinary tract, while
4% (n=1) don’t known and tables 4.13 shows about how to know of respondents about impact of
fistula the majority of respondents 96% (n=24) say yes, were 4 %( n=1) 0f respondents say No
and 4.13 shows complication of obstetrical fistula 52 %( n=13) majority of respondents caused
by urine and fecal incontinency, while 9 %( n=9) caused Infection, while 4% (n=1) of
respondents caused foot drops , while 8%(n=2) of respondents have no information
and 4.14 shows complication of obstetrical fistula 52 %( n=13) majority of respondents caused
by urine and fecal incontinency, while 9 %( n=9) caused Infection, while 8%(n=2) of
respondents have no information, while 4% (n=1) of respondents caused foot drops and 4.15
shows the believes of respondents about impact of fistula the majority of respondent 96% (n=24)
say Yes, were 4% (n=1) answer No.
4.16 shows about fear of pregnancy leads about obstetrical fistula 84 %( n=21) the majority of
respondents say Yes, while 12% (n=3) of respondents don’t have information, 4% (n=1) of
respondents say No.

4.17 shows 88% (n=22) the of respondents think to reduce obstetrical fistula say Yes, while 8 %(
n=2) of respondents say No, while 4 %( n=1) of respondents say don’t known and 4.18 shows
about psychological problem leads the obstetrical fistula 84 %( n=21) the majority of respondent
say Yes, while 12 %( n=3) of respondents answer No, while 4% (n=1) of respondents don’t have
information.
4.19 shows relationship b/w obstetrical fistula and social stigma about fistula 76% (n=19) s the
majority of respondents answer Yeas, while 16% (n=4) answer No, while 8%(n=2) of
respondents have no information.

4.20 shows about social stigma leads aboestetrical fistula 64 %(n=16) the majority of
respondents say Yes, while 20% (n=5) of respondents answer No, while 16% (n=4) not well
informed and answer by I don’t know.

4.21 shows how the respondents to mange fistula 84% (n=) the majority of respondents manage
by surgery, while 8% (n=) manage by catheterization , while 4%(n=) mange by drugs , while 4%
of respondents do not have any information about management of fistula.

4.22 shows about respondents attend health center to take information to ward impact of
obstetrical fistula 72% (n=18) of majority respondents well informed attend health center while
28% (n=7) of respondents answer No.

4.23 shows 64% (n=21) the majority of respondents were preferred to delivery at health center
while 16% (n=4) preferred to delivery at home.

4.24 represented about obstetrical fistula have another management rather than surgery 44%
(n=11) majority of respondents say Yes, were 40% (n=10) of respondent say No, 16% (n=4) of
respondents have no information and answer I don’t know.

5.3 Conclusions
25 persons were in Isniino MCH interview about impact of obstetrical fistula on mothers to socio
demographic, education, occupational status impact of obstetrical fistula on mothers.

According investigation dependent variable and independent variable in multi variety analysis
age, occupation, marital status, level of education significant associated with impacts of
obstetrical fistula on mothers, many TBA not protected mothers to fistula so that caused may
problems included psychological and social stigma.

The researcher has explained the impact of obstetrical fistula in Isniino MCH the main objective
of this study was to determine the impact of obstetrical fistula, for gathering further information;
the researcher used cross- sectional descriptive method and pie charts.
 The main achievement was the majority of respondents well informed were 84% positively
answer yes while 16% of respondents negatively don’t have information.

The majority of obstetrical fistula cause was a big baby 40%, while obstruct labour 24%,
precipitate labour 20%, episiotomy 12% and 4% don’t have information, also the achievements
was reach the majority complication caused obstetrical fistula are urine and fecal incontinency
52%, also 36% of respondents causes infection, 4% caused foot drops,8% not well informed , So
that they need to prevent mothers obstetrical fistula during labour.

The majority of respondents 96% positively believe impact of obstetrical fistula while 4% were
negatively.

Also The main achievements were the majority of respondents 84% positively the obstetrical
fistula can lead fear another pregnancy while 4% were negatively and 12% were not well
informed.

The majority impact of obstetrical fistula social stigma where 64% of respondents positively
while 20% negatively and 16% of respondent don’t know.

5.4 Recommendation

1. Increase Awareness of mothers to birth at health center

2. Prevention of prolonged and obstructed labor
3. improved nutrition and outreach programs to raise awareness about the nutritional needs
of children to prevent malnutrition, as well as improve the physical maturity of young
mothers
4. Encouraging mother has previous precipitate labour to birth at hospital
5. improvements-in-quality-of- health center to prevent obstetrical fistula
6. Counseling community to avoid social stigma mothers have obstetrical fistula
7. Support the mothers have psychological trauma that faced obstetrical fistula
8. Awareness community to reduce to practice of early marriages.
APPENDIXA:- REFFERENCE
1

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fistula. Int J Gynecol Obstet. 2007;99(Suppl 1):S1–3.

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APPENDIX B :-QUESTIONNAIRE
Dear sir/madam

I am Farhia Mahmud Guul student at university of health science Basso faculty of clinical
midwifery. I would like to conduct a research dissertation about Impact of obstetrical fistula on
mothers in case Isniino MCH
I would highly thank you for helping me to have the necessary information for the research.
I am promising you that the data I gathered will keep and use for academic purpose only.
This is the request you to answer and complete the questionnaire gently and honestly as your view.
I am appreciating you for devoting your valuable time to answer the question bellows.
Questionnaire

 Do not write your name on these questionnaires.

 The research for academic purpose monetary not money.
 All information will be private.
 Please fill in the space providing the best your knowledge.
 You free to choose not fill it .

Please tick out the brackets in front of the following questions

Part 1: Socio-Demographic Information

1. What is your gender?

Male ( )

Female ( )

2. How old are you?

15----25 ( )
26----35 ( )
36---49 ( )

3. What is the level of your education?

Illiteracy ( )
Primary level ( )
Secondary level ( )
University ( )
4. What is your marital status?
Single ( )
Married ( )
Widowed ( )
Divorce ( )
5. What is your occupation?
Student ( )
House Wife ( )
Business woman ( )
Office work ( )
Or another work ( )
6. How much do you Income monthly?
$100-----$150 ( )
$200-----$250 ( )
$300-----$350 ( )
Above ( )
7. Number of your children?
None ( )
1---3 ( )
4---6 ( )
Above 6 ( )

Part 2
8. Do you know any information about obstetrical fistula?

Yes ( )
No ( )

9. What are causes of obstetrical fistula?

Obstructed labour ( )

Precipitate labour ( )

Episiotomy ( )
Macrosomia (big baby) ( )
I don`t known ( )

10. What are thesigns or symptoms of obstetrical fistula?

Irritation or pain in the vagina or surrounding areas ( )

Pain during sexual activity ( )
I don`t known ( )
Recurrent of infection of vagina or urinary tract ( )

11. Do you know impact of obstetrical fistula?

Yes ( )
No ( )
12. What is the complication ofobstetrical fistula?

Urine and faecal incontinency ( )

Renal failure ( )

Infections ( )
Foot drops ( )
I don`t known ( )

Part 3

13. Do you belief the impact of obstetrical fistula?

Yes ( )
Non ( )
14. Obstetrical fistula can lead to fear of another pregnancy?
Yes ( )
No ( )
I don`t known ( )

15. Do you think that obstetrical fistula can be reduced?

Yes ( )
No ( )
I don`t known( )

16. Canobstetricalfistula lead psychological problems?

Yes ( )
No ( )
I don`t know ( )

17. Do you think that any relationship between impact of obstetrical fistula to social stigma?
Yes ( )
No ( )
I don`t known ( )

18. Can obstetrical fistula leads women social stigma?

Yes ( )
No ( )
I don`t known ( )

Part 4

19. How do you manage women have obstetrical fistula?

By surgery ( )
By Catheter ( )
 By drugs ( )
I don`t known ( )

20. Do you attend health center to take health education to ward impact of obstetetrical fistula?

Yes ( )

No ( )

I don`t know ( )

21. Which is a better pregnancy woman delivery at home or health canter?

a) Home ( )

b) Health centre ( )

22. Did you think obstetrical fistula have another management rather than surgery?

Yes ( )
No ( )

I don`t know ()

APPENDIX C:-TIME FRAME FOR THE STUDY

NO PHASE TIME PERSON
1. Selecting and discussing November /2019 Researcher
the title and Dean
of faculty
Development of background ,objectives ,and 23/Nove /2019 Researcher
2. problem statement
APPENDIX D:- BUDGET OF THE STUDY
1).stationary:

A: writing material:

Pipers…………………………………………………………………..2$

Pens………………………………………………………………….....1$

B: Printing service:

Questionnaire………………………………………………………..$3

All Page of the book ………………………………………………..$24

2).travelling expenses:

travelling I’m used one foot ……………………………………free

3).Computer analysis:

A).computer analysis……………………………………………….Free

B).Internet…………………………………………………………….$ 65

4).Fee:

A).supervisor fee……………………………………………….........$100

TOTAL COST……………………………………………………..$ 195