Prevalence and the associated trigger factors of urinary incontinence among 5000 black women in sub-Saharan Africa: findings from a community survey: PREVALENCE AND TRIGGER FACTORS OF UI AMONG WOMEN IN SUB-SAHARAN AFRICA

Magnitude of Symptomatic Pelvic Floor Dysfunction and Associated Factors Amongst Women in Western Ethiopia: A Cross-Sectional Study

The goal of this research was to determine the extent of pelvic floor dysfunction and the factors that contribute to it. The study design was community-focused and cross-sectional, and participants were chosen using a systematic random sampling technique. For data entry and cleansing, we used EPI data version 3.1 software, and for analysis, we used Statistical Package for the Social Sciences version 26. The 95% confidence interval was predicted, and the factor with a significant level less than 0.05 was chosen for multivariate logistic regression analysis. The overall Magnitude of pelvic floor dysfunction was 37.7% [(95% confidence interval (31.7-42.5)]. The most common type of pelvic floor dysfunction is overactive bladder, which was reported by 135 of all participants. Pelvic organ prolapse accounted for 92 (30.4%) of all cases, and 4 factors were found to be significantly associated with pelvic floor dysfunction. In this study, age 55 years [(AOR = 2.1; 95% CI: (1.52-6.42)], heavy labor work for more than 10 years [(AOR = 3.21; 95% CI: (1.86-5.72) grand-multipara, and being menopause [(AOR = 4.03; 95% CI: (2.20-8.27)] were linked to symptoms of pelvic floor dysfunction. The magnitude of pelvic floor dysfunction in this study was slightly higher than in Ethiopian studies. Pelvic floor dysfunction has been linked to heavy load lifting, low socioeconomic status, recurrent vaginal deliveries, chronic cough, and menopause. Screening and treatment of pelvic floor disorders should be prioritized in collaboration with regional and zonal health departments.

Estimated burden, and associated factors of Urinary Incontinence among Sub-Saharan African women aged 15-100 years: A systematic review and meta-analysis

Hospital and community based-studies had been conducted for Urinary Incontinence (UI) in Sub-Sahara Africa (SSA) countries. A significant limitation of these studies is likely under-estimation of the burden of UI in SSA. It is therefore, imperative that a well-structured systematic review and meta-analytical models in SSA are required to accurately and reliably estimate the burden of UI. Medline/PubMed, Google Scholar, Africa Journal Online (AJOL) were searched to identified data on burden of UI studies in SSA. Two independent authors performed the initial screening of studies based on the details found in their titles and abstracts. The quality of the retrieved studies was assessed using the Newcastle-Ottawa Quality Assessment instrument. The pooled burden of UI was calculated using a weighted inverse variance random-effects model. A sub-group and meta-regression analyses were performed. Publication bias was checked by the funnel plot and Egger's test. Of the 25 studies included, 14 were hospital-based, 10 community- based, and 1 university-based studies involving an overall 17863 participants from SSA. The systematic review showed that the prevalence of UI ranged from 0.6% in Sierra Leone to 42.1% in Tanzania. The estimated pooled burden of UI across all studies was 21% [95% CI: 16%-26%, I2 = 91.01%]. The estimated pooled prevalence of stress UI was 52% [95% CI: 42%-62%], urgency UI 21% [95% CI: 15%-26%], and mixed UI 27% [95% CI: 20%-35%]. The common significant independent factors were; parity, constipation, overweight/obese, vaginal delivery, chronic cough, gestational age, and aging. One out of every five women in SSA suffers from UI. Parity, constipation, overweight/obesity, vaginal delivery, chronic cough, gestational age, and age were the most important risk variables. As a result, interventions aimed at reducing the burden of UI in SSA women aged 15 to 100 years old in the context of identified determinants could have significant public health implications.

Prevalence, social impact and help-seeking behaviour among women with urinary incontinence in the Gulf countries: A systematic review

BACKGROUND

Urinary incontinence (UI) in women is a common problem worldwide. It has a major impact on the physical and social activities and interpersonal relationships. The societies in the Gulf countries are conservative and favours large families, high parity and short inter-pregnancy intervals. Moreover, there is a high prevalence of gestational diabetes with many macrosomic babies. This study aimed to review the published literature on UI among women in this region.

METHODS

All published literature which investigated the prevalence, social impact and help-seeking behavior in women with UI in the Gulf countries was reviewed.

RESULTS

Nine studies met the criteria and were very heterogeneous. None of them was a true population-based study and all except one, investigated subjects from healthcare facilities. The prevalence of UI ranged from 20.3% to 54.5%. Stress UI was the main type reported. The main predisposing factors were chronic respiratory diseases and constipation. There was a large impact on the quality of life with major interference with prayers (34-90%) and sexual relationships (18-57%). The main reasons for not seeking medical advice were embarrassment to see doctors especially male doctors and the belief that UI is common, normal or incurable disease.

CONCLUSIONS

There is a need for true whole population-based studies of UI in this region with the use of validated international questionnaires. UI was shown to have a major impact on the act of prayers and sexual relationships. A large proportion of women are still embarrassed to discuss the issue with doctors especially male doctors.

Symptomatic pelvic floor disorders and its associated factors in South-Central Ethiopia

Introduction

Pelvic floor disorders (PFD) are gynecologic health problems containing a wide variety of clinical problems; the most prevalent problems are pelvic organ prolapse, fecal incontinence, and urinary incontinence. It is a significant women’s health problem for both developed and developing countries. One in five women in Ethiopia experiences at least one major type of pelvic floor disorders. Despite the severity of the problem, due attention was not given, and no study has been conducted on pelvic floor disorders in the Gurage Zone.

Objective

To determine the prevalence and associated factors of symptomatic pelvic floor disorders among women living in Gurage Zone, SNNPR, Ethiopia, 2020.

Methodology

Community-based cross-sectional study was conducted from February to March 2020 among 542 women residing in the Gurage Zone. A multi-stage sampling method was used to select the participants. Interviewer administered, pretested questionnaires containing questions related to pelvic organ prolapse, urinary, and fecal incontinence was used. The urinary incontinence severity index questionnaire was used to assess the severity of urinary incontinence. Epi-Info x7 was used to record data, and SPSS was used to analyze the data. Binary logistic regression with 95% CI was used to explore the relationship between PFD and other independent variables. After multivariable logistic regression analysis variables with P-value less than 0.05 was used to determine significant association.

Result

A total of 542 participants were included in this study. Overall, 41.1% of the participants reported one or more symptoms of pelvic floor disorders. Urinary incontinence had the highest prevalence (32.8%), followed by pelvic organ prolapse (25.5%) and fecal incontinence (4.2%). History of weight lifting >10 Kg (AOR = 3.38; 95% CI: 1.99, 5.72), ≥5 vaginal delivery (AOR = 11.18; 95% CI: 1.53, 81.58), and being in menopause (AOR = 3.37; 95% CI: 1.40, 8.07) were identified as possible contributing factors in the development of a pelvic floor disorders.

Conclusion

The prevalence of symptomatic PFD was higher compared to other similar studies in Ethiopia. Heavy weight lifting, repetitive vaginal deliveries and menopause were factors significantly associated with PFD. Expansion of technologies and building basic infrastructures, health education on kegel exercise and promotion of family planning should be considered as a prevention strategy.

Do future healthcare professionals have adequate knowledge about risk factors for stress urinary incontinence in women?

BACKGROUND

Stress urinary incontinence worsens living conditions as far as the occupational, social, mental, physical and sexual aspects of a woman's life. Despite its real impact on the everyday lives of millions of women around the world, this problem is still disregarded and treated only as a discomfort associated with personal hygiene. Could this be due to negligence on the part of medical personnel in this matter and perhaps this lack of knowledge and proper information intended for women with stress urinary incontinence? Implementing educational activities to increase knowledge about urinary incontinence will translate into better educated women and earlier implementation of urinary incontinence treatment in the future. To properly educate women at risk of urinary incontinence, one needs to be familiar with the condition, in particular the risk factors for its development. The purpose of the study was to evaluate the degree of knowledge of students graduating from medical faculties have regarding risk factors for stress urinary incontinence in women and assess where the students' knowledge of this problem came from.

METHODS

The research involved 1581 final year students of medical faculties: nursing and midwifery (258), medicine (432), physiotherapy (402) and other medical (489). The author's survey was used for the research. The chi2 test was used for analysis.

RESULTS

Students in faculties of nursing and midwifery, general medicine, physiotherapy, and other medical faculties could correctly list stress urinary incontinence risk factors in 88.8%, 81.7%, 74.4% and 51.9% of their answers respectively (p < 0.01). The most frequently mentioned source of knowledge about stress urinary incontinence was higher level education in 82.6%, 89.8%, 90.0% and 34.4% of the respective groups' replies (p < 0.001).

CONCLUSIONS

Nursing and midwifery students had the greatest theoretical knowledge of stress urinary incontinence, and lesser knowledge was found among general medicine students, while physiotherapy students and students of other medical faculties had the least theoretical knowledge about risk factors for urinary incontinence. It is advisable that more emphasis be placed on educating students about stress urinary incontinence due to their insufficient knowledge, in particular for future doctors and physiotherapists who will have direct contact with patients.

Urinary incontinence and its relation to delivery circumstances: A population-based study from rural Kilimanjaro, Tanzania

OBJECTIVES

To investigate the prevalence and risk factors of urinary incontinence (UI), the different UI subtypes and the association between UI and delivery circumstances.

DESIGN

Cross-sectional population-based study conducted in Kilimanjaro Region, Tanzania.

PARTICIPANTS AND SETTINGS

1048 women aged 18-90 women living in rural Kilimanjaro. Simple random sampling was done to select villages, households and participants. Community health workers helped in identifying eligible women and trained nurses/midwives conducted face-to-face interviews. Data were analysed using descriptive statistics and Univariate and Multivariate logistic regression modelling.

RESULTS

The overall prevalence rate of UI was 42%. When focusing on the different types of UI, 17% of the women had stress UI, 9% had urge UI and 16% had mixed UI. Only one woman (0.1%) with vesico-vaginal fistula was identified. UI was found to be significantly associated with increasing parity (OR = 2.41 (1.55-3.74). In addition, women who in relation to their first delivery had delivered at home or had been in labour for more than 24 hours, had increased adjusted ORs of 1.70(1.08-2.68) and 2.10(1.08-4.10), respectively, for having UI.

CONCLUSION

UI is common in rural Tanzania and of the subtypes of UI, Stress Urinary Incontinence (SUI) is the commonest followed by Mixed Urinary Incontinence (MUI). Home delivery, prolonged labour and increasing parity especially having 5 or more deliveries are associated with increased risk for developing UI.

Urinary incontinence: prevalence, pattern, and opportunistic screening in Ile-Ife, Nigeria

INTRODUCTION AND HYPOTHESIS

Urinary incontinence is a source of health-related poor quality of life. It is, however, rarely disclosed, except when specifically enquired about by the healthcare provider. This study determined the prevalence of urinary incontinence and opportunistic screening for it in women attending a general outpatient clinic.

METHODS

A total of 1,250 consenting women attending a general outpatient clinic in Ile-Ife, a semi-urban town in Southwest Nigeria, were recruited into this cross-sectional study. Confidential post-consultation interviews were performed in each patient to determine whether they had been asked about urinary incontinence and whether they felt that they ought to have been asked. The Questionnaire for Urinary Incontinence Diagnosis (QUID) was administered to determine the prevalence and pattern of urinary incontinence. Results were expressed as proportions and compared using the Chi-squared test.

RESULTS

The subjects' ages ranged from 20 to 100 years (mean = 46.8 ± 17.7 years). Sixty-five women had urinary incontinence (prevalence = 5.2 %). QUID classified 30 (2.4 %), 23 (1.8 %), and 12 (1.0 %) of them as having urge, stress, and mixed incontinence respectively. None of them self-reported incontinence to their physicians. Only 9 incontinent (13.8 %) and 44 continent women (3.7 %) had opportunistic screening (p < 0.001). Fifty of the incontinent women (76.9 %) felt that their physician ought to have asked them about it. Forty-eight of them (73.8 %) did not consider incontinence a sufficient reason for presentation in hospital, but the majority (90.7 %) desired treatment.

CONCLUSION

Urinary incontinence was occasionally present, but usually undisclosed by women attending the general outpatient clinic, unless when specifically asked by their physicians. Opportunistic screening is therefore recommended in this setting.

Incontinence and Chronic Illness

Objetivo: explorar la producción y contenido de la información disponible a nivel mundial sobre el abordaje de la incontinencia urinaria (IU) e incontinencia fecal (IF) y su relación con la enfermedad crónica (EC). Materiales y métodos: a partir de una revisión de literatura en las bases de datos Cinahl, Ovid, Scielo, Medline y Psychoinfo, entre los años 2009 y 2012, bajo los descriptores de incontinencia urinaria e incontinencia fecal, en combinación con enfermedad crónica, con su traducción al inglés, se identificaron, analizaron y clasificaron los planteamientos sobre el tema de la incontinencia según relevancia para la comprensión de la misma en la situación de EC. Resultados: se presentan los estudios encontrados clasificados en cinco grandes grupos sobre IU e IF que incluyen los que ilustran la magnitud del problema por su frecuencia y tipología, los que establecen relación directa entre la incontinencia y la EC, los que describen otros factores asociados con la incontinencia y con la EC, los que abordan la forma de valorar la incontinencia y los que dan aportes respecto al manejo de la IU o IF en la EC. Conclusiones: la literatura tiene abundante producción científica en sus dos últimos años y a nivel mundial sobre la IU pero no en igual proporción sobre la IF. Existen modelos para la valoración, medición y comprensión del fenómeno así como para la intervención y atención puntual sobre la misma. No se reportan abordajes integrales al problema de la IU e IF en personas con EC.

Global prevalence and economic burden of urgency urinary incontinence: a systematic review

CONTEXT

The prevalence and economic burden of urgency urinary incontinence (UUI) are difficult to ascertain because of overlap with data on overactive bladder and other types of incontinence.

OBJECTIVE

To summarize the evidence on the global prevalence and economic burden of UUI.

EVIDENCE ACQUISITION

A PubMed search was performed used the following terms: (urgency urinary incontinence OR urge incontinence OR mixed incontinence OR overactive bladder) AND (burden OR cost OR economic OR prevalence). A similar search was conducted using Embase. English-language articles published from 1991 through 2013 on non-neurogenic UUI were retained.

EVIDENCE SYNTHESIS

We retained 54 articles (50 studies); 22 large-scale, population-based surveys indicated varying UUI prevalence estimates with ranges of 1.8-30.5% in European populations, 1.7-36.4% in US populations, and 1.5-15.2% in Asian populations, with prevalence dependent on age and gender. Nineteen smaller-scale studies supported these findings. Despite varying methods, 11 studies estimating the costs of UUI worldwide consistently concluded that the economic burden is substantial and will increase markedly as the population ages. In a 2005 multinational study, the annual cost-of-illness estimate for UUI in Canada, Germany, Italy, Spain, Sweden, and the United Kingdom was €7 billion. A US cost-of-illness study reported a total cost of $66 billion in 2007 US dollars. The costs of routine care and nursing home admissions for UUI were major contributors to the cost.

CONCLUSIONS

UUI affects millions of men and women worldwide. Current evidence demonstrates the substantial economic burden of UUI to patients and society. Worldwide public health and clinical management programs are needed to improve UUI awareness and highlight the need for early diagnosis and management.

Incontinência urinária em mulheres que buscam exame preventivo de câncer de colo uterino: fatores sociodemográficos e comportamentais

Este estudo transversal objetivou investigar a associação entre, de um lado, fatores sociodemográficos e comportamentais e, de outro, a presença de incontinência urinária referida em 784 mulheres que buscam exame preventivo de câncer de colo uterino na Grande Florianópolis, Santa Catarina, Brasil. Foram obtidos dados sociodemográficos, estado de saúde, atividade física, constipação e índice de massa corporal, sendo utilizado o International Consultation on Incontinence Questionnaire-SF. A prevalência de incontinência urinária foi de 30,7% (16,5% perdiam urina uma vez por semana ou menos e 23,8% em pequena quantidade). Na regressão de Poisson bruta, estiveram associados à incontinência urinária os seguintes fatores: baixa escolaridade, renda por pessoa da família até um salário mínimo, etnia não caucasiana, excesso de peso corporal, pior autoavaliação do estado de saúde, constipação e idade. Após ajuste, seguindo modelo hierarquizado, permaneceram associados: escolaridade, etnia, estado de saúde e idade. A alta prevalência de incontinência urinária em mulheres que buscam exame de rastreamento do câncer de colo uterino justifica abordagens preventivas nesses espaços de atuação.

Pelvic floor disorders among women in Dabat district, northwest Ethiopia: a pilot study

INTRODUCTION AND HYPOTHESIS

Pelvic floor disorders affect many women in high-income countries. Since little is known about such disorders in Africa, this study aimed at assessing the prevalence and risk factors in an Ethiopian community. We also assessed the validity of a prolapse questionnaire.

METHODS

A community-based cross-sectional study was conducted among 395 women, recruited by a systematic random sampling technique. Women were interviewed about symptoms of urinary incontinence, faecal incontinence and pelvic organ prolapse by female nurses. Additionally, pelvic examinations were performed in 294 (74.2%) participants to assess anatomical prolapse using the simplified Pelvic Organ Prolapse Quantification staging system. Descriptive statistics and logistic regression analyses were employed.

RESULTS

The median age of participants was 35.0 years. Thirty-one women reported urinary incontinence (7.8%), 25 (6.3%) symptomatic pelvic organ prolapse and 2 (0.5%) faecal incontinence. Anatomical pelvic organ prolapse stage II-IV was detected in 162 (55.1%) of women who underwent pelvic examination. The questionnaire for prolapse assessment had poor validity (38.3% sensitivity and 95.4% specificity) even in cases of clinically relevant prolapse (stage III or IV). After adjustment, carrying heavy objects for 5 or more hours a day, history of prolonged labour and highland rural residence were associated with anatomical pelvic organ prolapse.

CONCLUSIONS

Self-reported incontinence seems low in northwest Ethiopia. The prevalence of symptomatic prolapse was low despite a high prevalence of prolapse signs. Notably, heavy carrying and prolonged labour increased the risk of anatomical prolapse stage II-IV. The methods of assessing pelvic floor disorders in a low-income context need further development.

Maternal demand for cesarean section: perception and willingness to request by Nigerian antenatal clients

Background

Contrary to the widely reported aversion to cesarean section in the West African subregion, maternal demand for cesarean section (MDCS) seems to be on the increase, and there is little evidence to explain this trend. The purpose of this study was to determine the perception and attitudes of Nigerian antenatal clients towards MDCS, their willingness to request MDCS, and the relationship between willingness to request MDCS and sociodemographic characteristics.

Methods

A cross-sectional survey was undertaken among 843 antenatal clients at Agbongbon/Orayan primary health care centers (PHCs), Adeoyo Maternity Hospital (SHC), and UCH Ibadan (THC), representing the three different levels of health care in Nigeria, ie, primary, secondary, and tertiary.

Results

The proportion of women aware of MDCS was 39.6%. Predictors of awareness were education and type of health facility. Women from THC and those with tertiary education and above were more likely to be aware of MDCS than others (P = 0.001). Doctors were major sources of information on MDCS (30.8%) as well as friends (24.3%). Common reasons reported for MDCS were fear of labor pains (68.9%), and fear of poor labor outcome (60.1%), and fear of fecal (20.2%) and urinary incontinence (16.8%). More women from the THC than other facilities believed that requests for MDCS should be granted (P < 0.001). However, willingness to request MDCS was low (6.6%). More than 50% of those willing to request MDCS would likely be criticized, mainly by their husbands. On multiple logistic regression, respondents at the THC were significantly more likely than those at the SHC or the PHCs to request cesarean section and to favor a woman’s right of autonomy to choose her mode of delivery.

Conclusion

The decision for MDCS is a difficult one, because willingness is low and criticism by partners of those who choose MDCS is high. Provision of epidural anesthesia and improved safety of vaginal delivery is recommended. This may prevent Nigerian women from making a difficult choice for MDCS based on fear of pain and poor labor outcome. The role of the male partner should be taken into consideration in order to make sustainable policies or guidelines for MDCS in developing countries.

Theories of urinary incontinence causation: aetiological descriptions by sub-Saharan African women

OBJECTIVE

To describe the perceived causes of urinary incontinence (UI) and factors associated with awareness of causes of UI among women in the community.

STUDY DESIGN

Secondary analysis of data extracted from the Ibadan Urinary Incontinence Household Survey (IUIHS), a multi-stage community survey conducted among 5001 women in Nigeria.

RESULTS

The mean age was 34.8 years (SD=14.2). The majority had at least secondary education and were currently married. Within this population, 13% had ever leaked urine. On their perception of possible aetiological factors of UI, 20.5% mentioned pelvic floor or bladder-related causes such as stress incontinence triggers and bladder problems; 14.6% mentioned uncontrollable factors such as medical comorbidity, age and prior surgery; 8.8% attributed the cause to being female; and 6.8% mentioned sex-related factors. Multiple logistic regression analysis revealed significantly lower odds of awareness of the aetiology of urinary incontinence among women aged less than 30 years, those with lower level of education, rural women, those with five or more children and women without history of urine leakage.

CONCLUSIONS

The study shows a low level of awareness of possible cause of UI amongst women surveyed. We recommend health education and mobilization of women on the right aetiological factors of UI.

Help-seeking behavior among women currently leaking urine in Nigeria: is it any different from the rest of the world?

OBJECTIVE

We examined help-seeking behaviors and factors influencing their choice of hospital care in women currently leaking urine.

MATERIALS AND METHODS

This study was part of a multistage community survey conducted among 5001 women in Nigeria who participated in the Ibadan Urinary Incontinence Household Survey. Help-seeking behavior was analyzed among 139 respondents currently leaking urine within the population surveyed.

RESULTS

The mean age of those currently leaking urine was 35.7 years (standard deviation = 15.8). Only 18 (12.9%) had ever sought help, of which 15 had received hospital care. Logistic regression analysis showed that the odds of seeking hospital care was higher among less educated women (odds ratio [OR] = 4.05, 95% confidence interval [CI]: 1.17-13.89) and among those with severe incontinence (OR = 4.20, 95% CI: 1.24-14.29). Reasons mentioned for not seeking hospital care include a belief that the condition is not life-threatening (51.2%), do not believe there is treatment (18.2%), lack of funds (1.7%), too shy to disclose (2.5%), afraid of complications (1.7%), other (2.5%), and no reason (22.3%).

CONCLUSION

This study shows that very few women, currently experiencing urinary incontinence have sought medical care (approximately 1 in 10); and that the barriers identified are similar to those identified in previous studies, except that these women lack the necessary funds to seek care.