The problem of vesico-vagina fistula still remains a ravaging scourge in resource-poor countries of which Nigeria is visibly prominent. A majority of the cases are attributed to prolonged complicated labour due to inaccessibility of adequate and immediate obstetric health care. Complicated labour arises as a result of narrow pelvis bones of victims due to suffering from poor nutrition. While the above factors are noted as the direct cause to the prevalent of VVF, there are other socio-cultural conditions which predispose victims to this disease. Notable among them are the following: poverty; marital age; illiteracy; hazardous traditional practices, such as female circumcision. VVF victims often live an unworthy life. Many of them have been abandoned or divorced by their husbands and become ostracised by families and societies because of their repulsive smell and inability to engage in sexual activity and bear children. VVF victims suffer both physical and social consequences, many of them find it difficult to engage in any economic activity, surviving the hardship is very complicated and pathetic; some victims turn to street begging, while others survive through hawking of “bagged” water and selling firewood. Most studies conducted on the problem of Vesico vaginal fistula are done from the medical perspectives, often neglecting the psycho-social consequences faced by the sufferers. This study, however, discusses the socio-cultural and the psychological consequences of the disease. Locally and internationally, attempts are being made to eradicate the problem of VVF, however, if the Nigerian government does not recognise the incidence of VVF as a major public health issue, it will continue to ravage lives of Nigerian women, hence increasing maternal mortality in the country. This study proffers recommendations to help eradicate or alleviate the problem in Nigeria.

<p>The problem of vesico-vagina fistula still remains a ravaging scourge in resource-poor countries of which Nigeria is visibly prominent. A majority of the cases are attributed to prolonged complicated labour due to inaccessibility of adequate and immediate obstetric health care. Complicated labour arises as a result of narrow pelvis bones of victims due to suffering from poor nutrition. While the above factors are noted as the direct cause to the prevalent of VVF, there are other socio-cultural conditions which predispose victims to this disease. Notable among them are the following: poverty; marital age; illiteracy; hazardous traditional practices, such as female circumcision. VVF victims often live an unworthy life. Many of them have been abandoned or divorced by their husbands and become ostracised by families and societies because of their repulsive smell and inability to engage in sexual activity and bear children. VVF victims suffer both physical and social consequences, many of them find it difficult to engage in any economic activity, surviving the hardship is very complicated and pathetic; some victims turn to street begging, while others survive through hawking of “bagged” water and selling firewood.</p><p>Most studies conducted on the problem of Vesico vaginal fistula are done from the medical perspectives, often neglecting the psycho-social consequences faced by the sufferers. This study, however, discusses the socio-cultural and the psychological consequences of the disease. Locally and internationally, attempts are being made to eradicate the problem of VVF, however, if the Nigerian government does not recognise the incidence of VVF as a major public health issue, it will continue to ravage lives of Nigerian women, hence increasing maternal mortality in the country. This study proffers recommendations to help eradicate or alleviate the problem in Nigeria.</p>

Les progrès continus de la recherche scientifique dans le domaine de la santé ont entraîné une augmentation de l'espérance et de la qualité de vie. Ainsi, le développement de nouveaux médicaments et des dispositifs médicaux a permis d'améliorer les conditions sanitaires et la prise en charge des patients au prix d'une inflation des dépenses de santé. Ces évolutions ont eu pour conséquences d'inciter les états à mettre en place des procédures d'évaluation de l'efficacité et de la gestion des risques liés à ces nouvelles approches thérapeutiques. Plus récemment, les restrictions budgétaires liées à la crise économique dans de nombreux pays de l'OCDE ont contraint les états à diminuer la part de leur budget consacré à la santé. Cette situation les a conduits à mettre en place des politiques de santé basées sur l'optimisation des ressources.En ce sens, l'évaluation médico-économique et la pharmaco-épidémiologie constituent pour les acteurs de santé et pour les décideurs politiques un outil d'analyse décisionnelle particulièrement légitime. Ils sont aujourd'hui de plus en plus intégrés dans les réflexions sur les stratégies de soins et dans la mise en place des programmes de santé. L'objectif de notre travail de recherche a été à travers deux projets, d'étudier l'intérêt de l'évaluation médico-économique et de la pharmaco-épidémiologie en chirurgie pédiatrique. Ainsi, dans une première partie plus théorique, une synthèse des différentes études de pharmaco-économie, de pharmaco-épidémiologie a été conduite et un état des lieux des études d'évaluation médico-économiques dans la chirurgie de l'enfant a été réalisé. Dans une seconde partie plus pratique, les deux projets concernant la chirurgie pédiatrique sont présentés :- Le projet 1 (pharmaco-économie) présente l'évaluation et l'analyse coût-efficacité dutraitement du reflux vésico-urétéral de grade modéré chez l'enfant.- Le projet 2 (pharmaco-épidémiologie) est une étude multicentrique prospective surl'épidémiologie de l'invagination intestinale aiguë de moins de 1 an (EPIstudy) / The continuing progress of scientific research in the field of health have led to increasingexpectancy and quality of life. Thus, the development of new medicines and medical deviceshave improved the health conditions and treatment of patients at the cost of inflation inhealth spending. These developments have effects for encouraging states to implementprocedures of effectiveness assessment and management of risks associated with these newtherapeutic approaches.More recently, budget cuts due to the economic crisis in many OECD countries havecompelled states to reduce the proportion of their budgets on health. This led them todevelop health policies based on resource optimization.In this sense, the health econoic evaluation and pharmacoepidemiology are for healthcarestakeholders and policy makers a tool for decisional analysis. They are now increasingly integrated into reflection on care strategies and the implementation of health programs. The objective of our research has been through two projects, to study the interest of the health economic evaluations and pharmacoepidemiology in pediatric surgery. Thus, in a first, theoretical part, it is a synthesis of various studies of pharmaco-economics, pharmacoepidemiology was conducted and an inventory of economic evaluation studies in pediatric surgery was performed. In the second part more convenient, both projects are presented in pediatric surgery :- Project 1 (pharmacoeconomic) presents evaluation and cost-effectiveness analysis oftreatment of moderate grade of vesicoureteral reflux in children.- Project 2 (Parmacoepidemiology) is a prospective multicenter study of theepidemiology of acute intussusception among infants (EPIstudy)

Obstetric Fistulas have a high prevalence rate in developing countries where there is a lack of immediate access to maternal health care for women. Although Obstetric Fistulas are physical injuries, they affect women’s psychosocial health. This analysis aims to display the inefficiency of focusing on surgical repairs as the only treatment option and to demonstrate the need to integrate mental health treatment at different Obstetric Fistulas treatment stages. A total of 8 research articles from both Pub Med and Web of Science met the inclusion criteria, and the analysis was done by country. The results showed the presence of depressive symptoms, although there is an immediate improvement in quality of life after surgical repair. In some cases, there was worsening of psychological symptoms due to residual incontinence with or without successful fistula closure. These results suggested that whereas surgical repairs positively impact Obstetric Fistula patients, it does not solve the depressive symptoms, which cause women to self-isolate and have suicidal ideations. The mental sequelae caused by Obstetrical Fistulas can only be resolved using structured mental health care that should be started before surgical repair and continued after repair.

Thesis (PhD)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: This study focuses on the problem of VVF-HIV/AIDS, stigmatization, the threat to the human dignity of women and the role of the church, with specific reference to the role of Evangelical Church Winning All (ECWA). In order to show this, models of practical theology methodology were used as theoretical and methodological basis for the study. Practical theology is as a study area deals with the praxis of God, i.e. salvific and eschatological involvement and engagement with the trajectories of human lives and the suffering of human beings. Within the context of theological reflection, it involves man’s attempt to express and portray the presence and will of God in such a way that meaning in life and comfort is contextually disclosed and discovered (Louw, 2008:71). Having established the latter, the focus falls firstly on the description of the conditions addressed in the study about VVF-HIV/AIDS and its prevalence in Northern Nigeria. A detailed contextual study also shows that a variety of factors impact negatively on the status and well-being of women in the area. Traditional, cultural, economic, political and religious factors are either uniquely applicable to or aggravate the status and well-being of the subjects of the research, namely women suffering from VVF-HIV/AIDS in Northern Nigeria. It specifically involves the social and political context in which they live. It also shows that the existence and extent of these factors increase the vulnerability of women to contracting the HIV as well as VVF. The extent to which these factors, in combination with the latter conditions specifically promote the stigmatization of these women and the forms such stigmatization takes are also explored. Moving on to the issue of human dignity: a historical overview is given of the concept and it is defined for the purposes of the study. The extent to which the human dignity is affected in the study area is then investigated in light of their context, with particular reference to the women suffering from VVF-HIV/AIDS. It is concluded that the stigmatization to which the VVF-HIV/AIDS sufferers in Northern Nigeria are subjected, indeed constitutes a serious threat to their human dignity. In answering the question of whether the church (ECWA) has a responsibility towards these women and to address the issue of their stigmatization, two pastoral theological perspectives were used, that of the nature of the church and that of the concept of human dignity from a theological perspective. According to this perspective human beings have been created in the image of God. Having established that, on theological grounds, such a responsibility exists, a possible pastoral theological model for addressing the issue of the stigmatization of women suffering from VVF-HIV/AIDS was proposed. The church’s response to the challenge of VVF-HIV/AIDS is to come from its deepest theological convictions about the nature of creation, the unshakeable fidelity of God’s love, the nature of creation, the nature of the body of Christ and the reality of Christian hope. The creation narrative, which affirms that humanity is created in the image of God, links human beings to the love of God, which is modelled in the incarnation of Jesus. Moving on to the data analysis, the extent of the challenges of VVF-HIV/AIDS sufferers and the level of knowledge of the pastors of the subject of the stigmatization of young adult females sufferers of VVF-HIV/AIDS and their treatment of the issue were evident. Finally, recommendations were drawn up in order to provide basic understanding and awareness to ECWA on how to objectively address the problem of VVF-HIV/AIDS in Northern Nigeria. / AFRIKAANSE OPSOMMING: Hierdie studie fokus op die probleem van VVF-HIV/AIDS, stigmatisering, die bedreiging van die menslike waardigheid van vroue en die rol van die kerk (ECWA). Om dit aan te toon, word die model van die praktiese teologie metodologie gebruik as 'n teoretiese en metodologiese basis vir die studie. Praktiese teologie handel oor die praxis van God, d.w.s. die verlossingsboodskap en eskatologiese betrokkenheid by en verbintenis met die trajekte van die menslike lewe en die lyding van die mens. Binne die konteks van teologiese refleksie, d.w.s. die menslike poging om aan 'n beeld van die teenwoordigheid en wil van God op so 'n manier uitdrukking te gee, word die betekenis daarvan in die lewe en troos kontekstueel geopenbaar en ontdek (Louw, 2008:71). Na laasgenoemde val die fokus eers op die beskrywing van die voorwaardes in die studie oor VVF-HIV/AIDS en die voorkoms daarvan in die noorde van Nigerië. ’n Gedetailleerde kontekstuele studie toon ook dat 'n verskeidenheid negatiewe faktore ‘n impak op die status en die welsyn van vroue in die area het. Tradisionele, kulturele, ekonomiese, politieke en godsdienstige faktore waarvan 'n paar óf uniek van toepassing is óf ‘n verswarende effek het op die navorsingskonteks van vroue wat in die noorde van Nigerië aan VVF-HIV/AIDS ly en spesifiek op die sosiale, politieke konteks waarin hulle leef. Daar word ook aangetoon dat die bestaan en omvang van hierdie faktore die vatbaarheid van vroue vir die kontraktering van die MIV-virus sowel as VVF, verhoog. Daar word ook gekyk na die wyse waarop hierdie faktore in kombinasie met bogenoemde voorwaardes spesifiek die bevordering van die stigmatisering van hierdie vroue teweegbring en na die vorme wat hierdie stigmatisering aanneem. Die kwessie van menslike waardigheid word ondersoek deur 'n historiese oorsig van die konsep te gee. Dit word vir die doeleindes van die studie gedefinieer. Die mate waarin menslike waardigheid in die studiearea ‘n rol speel, met spesifieke klem op die konteks van vroue wat ly aan VVF-HIV/AIDS, word ook nagegaan. Daar word tot die gevolgtrekking gekom dat die menswaardigheid van die VVF-HIV/AIDS lyers in die noorde van Nigerië tot 'n groot mate in die lig van die stigmatisering hulle aan onderwerp word, aangetas word. Ter beantwoording van die vraag of die kerk (ECWA) 'n verantwoordelikheid teenoor hierdie vroue het om hul stigmatisering aan te spreek, word twee pastorale teologiese perspektiewe gebruik: dié van die aard van die kerk en van die konsep van menswaardigheid vanuit 'n teologiese perspektief waarvolgens die mens na die beeld van God geskep is. Nadat vasgestel is dat, op teologiese gronde, so 'n verantwoordelikheid wel bestaan, word 'n moontlike pastorale teologiese model vir die aanspreek van die kwessie van die stigmatisering van vroue wat ly aan VVF-HIV/AIDS voorgestel. Die kerk se reaksie op die uitdaging van VVF-HIV/AIDS spruit uit sy diepste teologiese oortuigings oor die onwrikbare getrouheid van God se liefde, die aard van die skepping, die aard van die liggaam van Christus en die werklikheid van die Christelike hoop. Die skeppingsverhaal, wat bevestig dat die mensdom in die beeld van God geskep is, verbind die mens aan die liefde van God, wat in die inkarnasie van Jesus gemodelleer word. Daar word dan beweeg na die data-analise, die omvang van die uitdagings van VVF-HIV/AIDS lyers en die vlak van kennis van die pastore oor die onderwerp van die stigmatisering van die jong volwasse vroulike lyers aan VVF-HIV/AIDS en hulle behandeling van die probleem. Ten slotte word aanbevelings gemaak ten einde basiese begrip/bewustheid te verskaf oor hoe die ECWA die probleem van VVF-HIV/AIDS in die noorde van Nigerië objektief kan aanspreek.