Research article

Knowledge and Attitudes of Nursing Staff Towards Obstetric Fistula at The Abeche University Hospital, Chad

Vadandi Valentin¹*, Mahamat Ali Mahamat², Temga Ouang Michael², Vounouzia Barthelemy¹, Minguemadji Allah siyangar², Ndormadjita Allah siyangar³, Abdelmahamoud Chene¹, Konan Paul Gerard⁴ and Rimtebaye Kimassoum²

¹Urology Department, University Hospital Center, Abeche, Chad

²Urology Department, University Hospital of National Reference, N’Djamena, Chad

³Urology Department, University Hospital of Renaissance, N’Djamena, Chad

⁴Urology Department, University Hospital Center, Abidjan, Cote d’Ivoire

Submission: February 28, 2024; Published: March 11, 2024

*Corresponding author: Vadandi Valentin, Senior Assistant in Urology-Andrology at Adam Barka University in Abéché. Head of the Clinical Department of the University Hospital of Abéché, Chad.

How to cite this article: Vadandi V, Mahamat Ali M, Temga Ouang M, Vounouzia B, Minguemadji Allah s, et al. Knowledge and Attitudes of Nursing Staff Towards Obstetric Fistula at The Abeche University Hospital, Chad. Open Access J Surg. 2024; 15(2): 555909. DOI: 10.19080/OAJS.2024.15.555909.

Abstract

Introduction: Prevention of obstetric fistula (OF) remains a challenge in Chad where its incidence is 464 cases/year. The present study aims to determine the knowledge and attitudes of nursing staff towards OF.

Patients and Method: This was a cross-sectional, descriptive and analytical study including nursing staff at the Abéché University Hospital. The survey took place from March to May 2023 and the sampling was exhaustive. Data collection was done using a form including a questionnaire on sociodemographic parameters, knowledge and attitudes. Participation in the study was voluntary and individual.

Results: participation in the study was 76.11%. Emergency department staff were the most represented, followed by gynecology-obstetrics staff with 34.4% and 20.91% of cases respectively. Nurses represented 53.17% of participants followed by doctors (23.52%). An exact definition of of was reported by 7.84% of participants and it was partial in 80.39%. The level of knowledge of risk factors was considered good in 12.41%. Exact knowledge of clinical signs was reported by 74.5% of cases. Among the participants, 1.96% reported that the treatment of OF is traditional. Knowledge about means of prevention was considered good by 13.72% (n=21), and attitudes by 26.79%? FO knowledge was influenced by profession (doctor, p=0.011) and attitudes by service (p=0.004) and profession (doctor, p=0.001).

Conclusion: OF is a curable disease whose prevention remains possible and requires good knowledge of the disease and the promotion of safe motherhood. This study should serve as a basis for the establishment of the FO module in the curriculum of healthcare personnel and the promotion of continuing training for its eradication.

Keywords: Obstetric Fistula; Knowledge; Attitudes; CHU-A; Abéché; Chad

Abbreviations: OF: Obstetric Fistula; UNFPA: United Nations Fund for Population Activities

Introduction

Obstetric fistula (OF) is a public health problem and affects more than 2 million women worldwide [1]. It is a disease that results from underdevelopment of the health system. The incidence of fistula cases is 464 cases/year in Chad and the victims are young women, living in remote areas, often divorced [2,3]. Its management, although surgical, must first be preventive. This prevention requires good knowledge of the disease, which is an essential element in promoting lower-risk motherhood. The present study aims to determine the knowledge and attitudes of nursing staff towards OF.

Methodology

This was a cross-sectional, descriptive and analytical study aimed at determining the level of knowledge and attitudes of health personnel at CHU-A towards OF. The survey took place from March to May 2023 and included healthcare personnel (doctors, midwives, nurses) with exhaustive sampling. Data collection was done using a form containing a questionnaire on sociodemographic parameters, knowledge and attitudes. Participation in the study was voluntary and individual and the questionnaire was given to participants without interpretation.

Results

A total of 153 out of 201 healthcare staff took part in the study, representing a participation rate of 76.11%. Emergency department staff were the most represented, followed by gynaecology-obstetrics staff with 34.4% (n=53) and 20.91% (n=32) of cases respectively. Nurses represented 53.17% (n=63) of participants, followed by doctors 23.52% (n=36) (Table 1). An exact definition of FO was reported by 7.84% of participants (n=12) and was partial in 80.39% (n=123).

Knowledge of risk factors was considered good in 12.41% (n=19), average in 77.12% (n=118) and insufficient in 10.45% (n=16). Accurate knowledge of the clinical signs of FM was reported by 114, or 74.5% of cases. Of the participants, 95.42% (n=146) knew that obstetric fistula is treated surgically, while 1.96% (n=3) reported that obstetric fistula is treated traditionally. Knowledge of how to prevent obstetric fistula was considered good in 13.72% (n=21), average in 60.13% (n=92) and insufficient in 26.14% (n=40). Attitudes towards obstetric fistula were judged to be good in 26.79% (n=41), average in 52.28% (n=80) and insufficient in 20.91% (n=32). Knowledge of obstetric fistula was influenced by profession (doctor, p=0.011) and attitudes were influenced by department (p=0.004) and profession (doctor, p=0.001).

Comments

During the survey, 76.11% of nursing staff took part in the study. This participation rate is representative of all staff working at CHU-A and corroborates that of UNFPA in Madagascar in 2007, which found 71.6% of paramedical providers [4]. Emergency and gynaecology-obstetrics staff were the most represented. Nurses were the most represented, followed by doctors. This participation rate is proportional to the number of staff and the interest shown in the study. An exact definition of obstetric fistula was reported by 7.84% of participants and was partial in 80.39%. The frequency of obstetric fistula and its psycho-somatic consequences should attract the attention of nursing staff.

However, they do not know enough about it. This is because general practitioners and nurses are not taught the obstetric fistula module during their training. General practitioners and nurses. Tebeu also reports a low level of accurate knowledge of the definition of obstetric fistula (27.8%) in Cameroon in 2019 [5]. Indeed, it is during antenatal consultations that the prognosis of childbirth should be known and the place of delivery should be defined. However, only 12.41% of participants had a good level of knowledge of obstetric fistula risk factors and were therefore able to give a reliable prognosis of delivery. Analysis of obstetric fistula knowledge shows that front-line obstetric fistula prevention staff (midwives) do not have the necessary knowledge of the risk factors for the disease. This means that the notion of preventing obstetric fistula is not discussed during antenatal consultations.

In other words, not only is the obstetric fistula module not taught in medical training schools, but targeted training aimed at preventing obstetric fistula is also not organised to address the problem. Accurate knowledge of the clinical signs of obstetric fistula was reported by 74.5% of participants. This result is similar to that of the UNFPA in Madagascar in 2007, which found 80.2%. Of the participants, 95.42% (n=146) knew that obstetric fistula is treated surgically, while 1.96% (n=3) reported that obstetric fistula is treated traditionally. Although this proportion is low, it could be the result of a lack of referral for some patients. Attitudes towards obstetric fistula were judged to be good in 26.79% of cases. These concerned the management of obstetric fistula, prevention of recurrence and the general population. These attitudes were influenced by department (p=0.004) and profession (doctor, p=0.001). This result shows that knowledge of good practice was acquired in obstetric fistula management departments and the physician’s profession.

Conclusion

Obstetric fistula is a curable disease that can be prevented through good knowledge of the disease and the promotion of safe motherhood. This study should serve as a basis for the introduction of an obstetric fistula module in the curriculum of health personnel.

References

1. WHO (2006) Obstetric fistula: guiding principales for clinical management and programme developpement. Geneva: World Health Organization.
2. (2012-2016) Plan d’action du programme pays Tchad-UNFPA.
3. Vadandi V (2020) Aspects cliniques et therapeutiques des fistules vesico-vaginales obstétricales A l’Hôpital Régional d’Abéché au Tchad Revue Africaine d’Urologie et d’Andrologie 2(1): 1
4. (2007) UNFPA-Madagascar. Analyse-situation-de-base-sur-les-lampleur-et-les-impacts-des-fistules-obstetricales-a-Madagascar.
5. Tebeu PM, Ngameni H, Nebardoum D, Tseunwo TCT4, Fetse TTG, et al. (2019) Connaissances, Attitudes et Pratiques des Professionnels de Santé des Districts de Santé du Koung-Khi et De la Mifi à l’Ouest-Cameroun Vis-À-Vis des Fistules Obstétricales. Health Sci Dis 20(2).