BELIEFS, BARRIERS, AND CYCLICAL PATTERN OF CARE: EXPLAINING TREATMENT PATHWAYS OF VESICOVAGINAL FISTULA PATIENTS IN EBONYI AND PLATEAU STATES, NIGERIA

Abstract

Vesicovaginal Fistula (VVF), which is an abnormal opening between the bladderand the vagina that results in uncontrollable leakage of urine, remains a major public health concernamong women in sub-Saharan Africa. In Nigeria, VVF is perceived to be caused by multiplefactors, including obstetric complications, spiritual forces and bad omen. These perceptionsstrongly influence the treatment options women pursue, resulting in diverse treatment pathways.The study adopted the Health Belief Model as its theoretical framework and employed acomparative qualitative design. Data were generated through in-depth interviews and key InformantInterviews involving forty (40) VVF patients (20 per state) and eight (8) healthcare professionals(4 per state) in Ebonyi and Plateau States. The data were analysed using thematic content-analysis.Findings revealed multiple treatment pathways involving repeated movements between homeremedies, traditional healers, faith-based centres, primary health care facilities, hospitals andspecialized VVF centres. Key factors influencing treatment pathways included perceived causes ofVVF, financial constraints, place of delivery and distance to health facilities. Cues to actionincluded a doctor’s referral, media publicity and significant others. Although some contextualdifferences were observed between the two states, treatment pathways were largely similar. Thefindings contribute to understanding sociocultural determinants of delayed VVF treatment andinform future sensitization efforts on the causes and appropriate treatment of VVF to reduce delaysand improve health outcomes.