Investigating the Influence of Sociodemographic, Lifestyle and Clinical Factors on Vesicovaginal Fistula (VVF) Severity in Sokoto, Nigeria

Abstract

Vesicovaginal fistula (VVF) remains a major public health challenge in developing countries, particularly in sub-Saharan Africa, where limited access to quality maternal healthcare contributes to its persistence. Despite extensive studies on VVF in Nigeria, limited research has examined how sociodemographic, lifestyle, and clinical factors jointly influence the severity of the condition in Sokoto State using a multilevel modelling approach. This study therefore investigated these factors among women in Sokoto State, Nigeria. Primary data were collected from 402 respondents at the Gynaecology Department of Maryam Abacha Women and Children Hospital using a structured questionnaire covering sociodemographic characteristics, lifestyle behaviours, reproductive history, and clinical factors. The outcome variable (VVF severity) was coded as a binary response. Data were analysed using descriptive statistics, chi-square tests, and multilevel logistic regression. Bivariate analysis showed significant associations between VVF severity and age, education, socioeconomic status, smoking, illicit drug use, place of delivery, prolonged labour, and parity. Multilevel logistic regression identified age (OR = 1.83, 95% CI: 1.05–2.12), socioeconomic status (OR = 1.51, 95% CI: 1.03–1.95), illicit drug use (OR = 2.34, 95% CI: 1.76–2.77), place of delivery (OR = 2.03, 95% CI: 1.73–2.54), prolonged labour (OR = 1.64, 95% CI: 1.06–1.97), and parity (OR = 1.54, 95% CI: 1.04–1.88) as significant predictors of severe VVF. The final model showed the best fit compared to alternative models based on AIC and BIC values.

The study concludes that VVF severity is driven by a combination of sociodemographic, lifestyle, and clinical factors. Strengthening maternal healthcare services and promoting institutional delivery are essential for reducing VVF severity in the region.