Document Type



Doctor of Philosophy (PhD)


Public Health

First Advisor's Name

Jessy G. Dévieux

First Advisor's Committee Title

Committee chair

Second Advisor's Name

Elena Bastida

Second Advisor's Committee Title

Committee member

Third Advisor's Name

Mariana Sanchez

Third Advisor's Committee Title

Committee member

Fourth Advisor's Name

Florence George

Fourth Advisor's Committee Title

Committee member


Vesico-Vaginal Fistula, VVF, prolonged labor, VVF quality of life, Nigeria, maternal and child health, VVF reconstructive surgery, Three delays model

Date of Defense



Vesico-Vaginal Fistula (VVF) is usually the result of obstructed and prolonged labor due to poor and delayed healthcare access. VVF has social consequences that negatively impact the quality of life of the affected women. The purpose of this mixed-methods exploratory study was to: 1) Assess the knowledge, attitudes, and beliefs (KAB) regarding VVF using an adapted KAB survey. The sample included a total of 92 Nigerian women, those who had been diagnosed with VVF (n=32) and those who did not have the condition (n=60); 2) Assess psychosocial and structural barriers and facilitators to seeking and receiving healthcare for VVF among 22 women, using 12 semi-structured interviews and 3 focus groups (n=17) as guided by the Three Delays Model; and 3) Assess the impact of reconstructive surgery on the quality of life (QoL) of a sample of 32 patients diagnosed with VVF as measured by pre- and post-surgery evaluations using the King Health Questionnaire (KHQ).

A cross-sectional case control study design was employed for Aim I. VVF patients reported more positive attitudes (p=.031) and higher religious fatalism beliefs (p<.001) when compared to controls. In Aim II, in-depth interviews and focus group discussions revealed that the major delays identified as barriers while seeking care for VVF were poverty, lack of awareness of the existence of the condition, poor understanding of the ailment, negative family influences, and believing the condition was a spiritual spell or curse. Free VVF surgery and positive family inputs were found to be facilitators for seeking care for VVF. In Aim III, a quasi-experimental pre- and post-design was used. We found significant improvements in the QoL scores for the domains assessed (ppp (p=003), Role Limitations (p=.031), Physical Limitations (p=.004), Social Limitations (p=.049), Emotions (p=.013), Severity Measures (p<.001), and Symptom Severity scale (p=.012), when compared to those who had unsuccessful surgeries. Outcomes from this study will inform the development of effective and culturally tailored intervention programs aimed at primary and secondary prevention of VVF in Nigeria.



Available for download on Friday, December 20, 2024

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