Women are frequently viewed as a vulnerable gender in the majority of poor nations for a variety of reasons, and issues like vesicovaginal fistula (VVF) after pregnancy, childbirth, and puerperium further increase their vulnerability. Even though their sexual freedom has already been restricted, these women frequently perceive themselves as being different from other women in a number of ways. They find it difficult to enjoy their sexuality; they may also develop other infectious diseases; and they age more quickly and easily than their peers who have not had their womanhood restricted. Thus, the victims’ health and well-being are destroyed by this depressing condition. They frequently have a wretched existence for the duration of her life when she loses faith in living a fulfilling life [1].

In the medical field, “vesico” refers to the bladder [2]. The improper connection between the urinary tract and the vagina that causes an uncontrollable leak of urine into the vaginal tract is known as a vesicovaginal fistula (VVF). VVF is defined by WHO (2018) as an improper communication between the vagina and the bladder that causes urine to continuously and involuntarily flow into the vaginal vault. VVF happens when the pelvis contracts, labor is prolonged and blocked (typically because the pelvis is too narrow for the baby to pass through), and the tissues between the bladder and vagina become ischaemic [3]. A few weeks later, the woman develops a fistula and tissue sloughing. Vaginal or urinary tract infections, poor hygiene, gas or stool leaking through the vagina, irritated or inflamed skin surrounding the vagina, an abscess (a swollen, potentially fatal clump of infected tissue with pus), and the possibility of fistula formation are just a few of the complications that could result from this. Uncontrolled urine flow into the vagina is the primary sign of VVF [4].

VVF is quickly becoming one of the most crippling health issues in Osun State, Nigeria. This happens to young married women who are underage. Due to a lack of understanding and the inability to pay for qualified healthcare providers during pregnancy, the majority of these married women are either underage or have a carefree attitude. Instead of contacting medical facility providers, they turn to older female family members, neighbors, and friends who have been pregnant for advice on their current pregnancy and its complications. This puts them at risk for obstructed and prolonged labor, which can result in VVF.

It has been noted that teenage girls have little knowledge of VVF. In their study, Raji et al. discovered that two-thirds of respondents ascribed VVF to divine punishment and over half thought it was caused by an evil spirit [5]. In contrast to the 2008 NDHS figure of 30.7%, the Morhason-Bello et al. study revealed a 52% rise in awareness regarding vaginal fistulas [1][5]. In comparison to older persons in Nigeria, it is still a cause for concern, especially among the younger generation. The Nigerian government’s and development partners’ increasing focus on obstetric fistula prevention and treatment over the past ten years may be the reason for the observed decline in the prevalence of vaginal fistula awareness in the 2018 NDHS [6]. Young people, who are typically at risk of obstructed labor due to an insufficient pelvis, are more likely to have VVF.

The degree of VVF awareness may not always correspond to sufficient information that can assist women in making the right choices about prevention and care access. Even among people who claimed to be aware of fistula, some studies have found a sizable percentage of misconceptions regarding the etiology or risk factors for VVF [7]-[9]. VVF can have devastating implications. Early adolescence is a time when having sufficient awareness about VVF may help prevent it.

Research on VVF prevention is currently lacking, according to studies [5]. Additionally, Lawal et al. showed that both male and female teenagers had little knowledge of VVF [2]. However, if childbearing is postponed until young women reach physical and sexual maturity, all deliveries are handled by trained birth attendants, and women experiencing obstructed labor have access to prompt Cesarean sections, the likelihood of fistulae developing can be decreased. One could argue that a lack of awareness about VVF prevention accounts for the majority of VVF instances. In order to ascertain secondary school girls’ pre- and post-intervention knowledge of vesico-vaginal fistula prevention in Ilesa-East LGA, Osun State, this study is being conducted as an intervention.

The majority of participants in both the experimental (67; 55.8%) and control (69; 57.5%) groups were between the ages of 12 and 14, according to Table 1. According to the demographic data on the female students’ living arrangements, 60 (50.0%) of the participants in the control group and 65 (54.2%) of the participants in the experimental group lived with their parents. According to participant religion, 77 (64.2%) in the control group and 71 (59.1%) in the experimental group were Christians.

Table 1. Socio-demographic characteristics of the participants.

The pre-intervention mean scores of participants in the control and experimental groups for vesico-vaginal fistula are shown in Table 2. In the control group, 77 individuals (64.3%) scored below average, while 23 (19.6%) and 20 (16.1%) received average and above-average knowledge mean scores on vesico-vaginal fistula, respectively. In the experimental group, 22 (18.4%) had average knowledge scores, 19 (15.8%) had above-average scores, and 79 (65.8%) had below-average scores. Vesico-vaginal fistula patients’ pre-intervention general knowledge mean scores were 5.23 ± 1.97 (34.9%) in the control group and 5.07 ± 2.01 (33.8%) in the experimental group, with a mean difference of 0.16.

Table 2. Pre-intervention knowledge mean score of participants on the vesico-vaginal fistula in the control and experimental group.

The pre-intervention mean score for vesico-vaginal fistula prevention in the control and experimental groups is displayed in Table 3. Regarding the prevention of vesico-vaginal fistula, 88 (73.2%) participants in the control group scored below average, whereas 32 (26.8%) had mean scores in the average range. In the experimental group, 31 (25.8%) had average knowledge of vesico-vaginal fistula prophylaxis, while 89 (74.2%) had below-average scores. Pre-intervention mean scores for vesico-vaginal fistula prevention were 2.33 ± 0.76 (38.8%) in the control group and 2.31 ± 0.81 (38.5%) in the experimental group, with a mean difference of 0.02.

Table 3.Pre-intervention knowledge on prevention: mean score of participants on the vesico-vaginal fistula among female participants in the control and experimental group.

The control and experimental groups’ post-intervention knowledge mean score on vesico-vaginal fistula is displayed in Table 4. In the control group, 69 individuals (57.1%) scored below average, while 32 individuals (26.8%) and 19 individuals (11.1%) received average and above average knowledge mean scores on vesico-vaginal fistula, respectively. In the experimental group, 81 (67.5%) had knowledge scores above average on vesico-vaginal fistulas, while 39 (32.5%) received ordinary scores. Participants’ post-intervention knowledge scores on vesico-vaginal fistula were 5.91 ± 2.06 (39.4%) in the control group and 12.88 ± 3.32 (85.9%) in the experimental group, with a mean difference of 6.97.

The control and experimental groups’ post-intervention mean scores for participants’ knowledge of vesico-vaginal fistula prevention are displayed in Table 5. In the control group, 34 participants (25.6%) scored at average on the knowledge of vesico-vaginal fistula prevention, while 86 participants (71.1%) scored below average. Regarding knowledge of vesico-vaginal fistula prevention, 42 (35.0%) of the experimental group scored average, while 78 (65.0%) scored above average. Participants’ post-intervention skill mean score on vesico-vaginal fistula prevention was 2.57 ± 0.93 (42.8%) in the control group and 4.93 ± 1.01 (82.2%) in the experimental group, with a mean difference of 2.36.

Table 4.Post-intervention knowledge mean score of participants on vesico-vaginal fistula in the control and experimental group.

Table 5.Post-intervention knowledge on prevention: mean score of participants on the vesico-vaginal fistula among female participants in the control and experimental group.

The pre-intervention mean scores of vesico-vaginal fistula participants in the control and experimental groups did not differ significantly, according to Table 6 (mean difference = 0.16, t(174) = 1.27, p = 0.271). As a result, there is no discernible difference between the control and experimental groups’ pre-intervention mean scores for vesico-vaginal fistula.

The results presented in Table 7 indicated no significant difference in the pre-intervention knowledge mean score of participants on the prevention of vesico-vaginal fistula between the control and experimental groups (Mean difference = 0.02, t(174) = 1.50, p = 0.154). Therefore, there is no statistically significant difference in the pre-intervention knowledge mean score of participants on the prevention of vesico-vaginal fistula between the control and experimental groups.

Results in Table 8 indicated that there is statistically significant difference in the post-intervention knowledge mean score of participants on vesico-vaginal fistula in the control and experimental group (mean difference = 6.97, t(174) = 5.09, p = 0.000).

Table 6.An independent t-test showing the difference between pre-intervention mean scores on the knowledge of vesico-vaginal fistula among female participants.

Table 7.An independent t-test to show the difference in pre-intervention mean scores for knowledge of the prevention of vesico-vaginal fistula between the control and experimental groups.

Table 8.An independent t-test showing the difference in post-intervention mean knowledge scores on vesico-vaginal fistula among female participants.

An improper connection between the vagina, rectum, and/or bladder that may develop after prolonged and obstructed labor is known as an obstetric vesico-vaginal fistula, according to the World Health Organization [2]. This ultimately results in ongoing fecal or urinary incontinence. Vesicovaginal fistulas are holes between the bladder and the vagina, while rectovaginal fistulas are holes between the rectum and the vagina [2].

Worldwide, there have been differing degrees of community knowledge of vesico-vaginal fistulas. Through public health initiatives, VVF campaigns have raised community awareness and increased community involvement. The pre-intervention knowledge of both the control and experimental groups on the prevention of vesicovaginal fistula in our study was generally low. This finding corroborated that of the 2024 National Demographic Health Survey, which showed a sub-optimal increase in the level of awareness of obstetric fistula (OF). The percentage of women who have ever heard of OF was 48% compared to33% in 2008 [11]. Also, this finding was similar to the report from a research conducted among a few medical facilities in the Zamfara region of northwest Nigeria, where 97.6% of participants had never heard of VVF [12]. It also corroborated the report of the survey by Kamel et al., where only 23.3% of Ethiopian women of reproductive age who participated in the survey reported having heard about obstetric fistulas [13].

This result also reflects the research conducted by Raji et al., who discovered that two-thirds of their respondents linked VVF to divine retribution, and more than half thought it was caused by malevolent spirits. Also, a sizable percentage of people who claimed to be aware of fistulas had misconceptions about the reasons or risk factors for VVF [13].

Programs for community-based education have become a crucial tactic in the fight against obstetric fistula and its recurrence. By educating women and their communities on reproductive health, birth readiness, and the value of professional obstetric care, these programs seek to empower women and their communities.

According to Ihudiebube-Splendor et al. (2014), community screening and awareness initiatives in Nigeria greatly enhanced the early detection of women who were at risk and raised the number of referrals for prompt obstetric interventions [14].

Preventive education aimed at women of reproductive age and healthcare stakeholders also increased awareness and implementation of preventive actions, according to Uyanwune et al. (2024). However, regular implementation, community involvement, and integration into current healthcare frameworks are necessary for such programs to be sustainable and effective [15].

There was a statistically significant improvement in the experimental group in our study compared with the control. This corroborated the importance of educational intervention in shaping the knowledge of female adolescents with regard to the prevention of vesicovaginal fistula.

In a fistula hospital in Northern Nigeria, a pilot research examining the usefulness and viability of using a vesicovaginal fistula (VVF) patient education leaflet was conducted among fistula patients. A six-paneled instructional pamphlet explaining the causes, treatment options, and preventative strategies of VVF was studied by women who were either awaiting or had previously undergone VVF surgery. Participants provided thorough answers to a questionnaire that addressed the brochure material in addition to answering demographic information. Fifty patients, with a mean age of 26.1 years, were included in the convenience sample. All of these women thought the information in the pamphlet was helpful. Participants recommended working in a hospital (80%), teaching other women (30%), and preventing early marriage (8%) as ways to reduce VVF. Financial constraints (84%) and transportation issues (30%) were the main obstacles to prevention and treatment. The study found that women can learn about the causes, treatment, and prevention of VVF by using a straightforward, inexpensive educational pamphlet [16].

Similar community-based strategies have shown promise in addressing other maternal morbidities in sub-Saharan Africa [17][18]. Demonstrated that community screening and education programs in Nigeria improved the early identification and referral of obstetric fistula cases, thereby preventing more severe outcomes. The present study builds upon this foundation by focusing on female adolescents who will soon embark on childbearing.

Lastly, the community as a whole benefits from this intervention in addition to individual participation. Cultural norms around early marriage, hazardous childbirth, and gendered access to healthcare—all known causes of obstetric fistula—can be gradually changed by educational initiatives.

The findings from this study should be interpreted in light of the following limitations: first, the non-randomized, school-based design may limit the generalizability of the findings. Also, the short post-intervention follow-up might have only tested recall and not necessarily the impacts on the knowledge of the participants. Finally, the limited generalizability beyond the selected schools should also be considered.

In summary, the current study showed that community-based educational initiatives can considerably improve knowledge of female adolescents on Vesicovaginal fistula and its prevention. To accomplish the worldwide objective of eradicating obstetric fistula, future initiatives should take a comprehensive strategy, integrating education into existing programs, thereby making a significant contribution to the expanding body of research supporting community-driven, education-centered approaches in the battle against one of the most avoidable yet devastating maternal morbidities.

Abigail Adebisi Abioye, Gladys Obiageli Oluwasanmi, Busayo Temilola Akinbowale, and Victoria Adenike Adeniyi contributed to conceptualization, initial write up and final reading of the manuscript. Roseline O. Folami, Oladayo Damilola Akinwale, Akinyele Akin Akinbowale, Musiliat Olufunke Akinbade, Olajide Emmanuel Babalola, and Akintunde Olusegun Fehintola were involved in data collection, data analysis, revision of the manuscript, and proofreading. All the authors were involved in the final reading and submission of the manuscript.