Reproductive morbidity among Iranian women; issues often inappropriately addressed in health seeking behaviors

Cervical cytology and associated factors among tribal women of Karnataka, India

BACKGROUND

Reproductive well-being is a crucial element of women's health. Due to the asymptomatic nature of gynaecological morbidities, women rarely seek medical advice in the initial period leading to delayed diagnosis and poor prognosis of subsequent disease. The present study aimed to explore the cervical cytology and its associated risk factors among women from tribal communities of the southern part of coastal Karnataka, India.

METHODS

Papanicolaou (Pap) smear test was performed among 1140 women from three tribal populations, to detect cervical lesions, infections and reactive changes. A semi-structured questionnaire was administered to collect data on socio-demographic and reproductive characteristics of the study population.

RESULTS

The most predominant gynaecological complaint among the participants was severe lower back ache (77.6%), followed by white discharge per vagina (29.0%) and menstrual irregularities (25.9%). Of the 1140 women screened, 12.4% showed cervical microbial infections, 23.6% were reported to have reactive changes, and 0.2% had epithelial cell abnormalities in the cervix. Cervical microbial infections were found to be associated with younger age group, low socio-economic status and younger age at sexual debut.

CONCLUSION

Most of the symptoms suggestive of gynaecological morbidities reported in this study are preventable or treatable. Strengthening ongoing cervical cancer screening programme and implementation of health education programmes among tribal population would be the right policy approach to prevent, detect and treat these symptoms at an early stage and to achieve acceptable health outcomes among tribal women.

Polycystic Ovary Syndrome and Pelvic Floor Dysfunction: A Narrative Review

Pelvic floor dysfunction is one of the most common disorders in women that is associated with social and economic consequences. In general, this disorder imposes direct and indirect costs on the economy of various societies. This review aimed to investigate pelvic floor dysfunction in women with polycystic ovary syndrome (PCOS). In this narrative review, the published articles on pelvic floor dysfunction were examined in PubMed, Scopus, Web of Sciences and Google Scholar. We searched for terms related to polycystic ovary syndrome and pelvic floor dysfunction. Inclusion criteria of this research were observational, experimental, and review studies. In this investigation, the complications associated with polycystic ovary syndrome were examined as risk factors for pelvic floor dysfunction. In this narrative review, we discuss about changes in hormone levels, obesity and overweight, hormonal medications and complications such as diabetes and metabolic disorders and obstetric complications of PCOS can be involved in the pathophysiology of pelvic floor dysfunctions, including stress urinary incontinence and pelvic organ prolapse in women with PCOS. This review highlights knowledge gaps about protective effect of hyperandrogenism on pelvic floor dysfunction as well as destructive effect of metabolic changes on pelvic floor dysfunction in women with PCOS. Further cohort and prospective studies are recommended in women with PCOS to investigate the concept of pelvic organ dysfunction in these women.

"Tender Care": Iranian Women's Needs to Cope with Hysterectomy and Oophorectomy- A Qualitative Content Analysis Study

BACKGROUND

Gynecological surgeries associated with loss of feminine organs evoke more personal, interpersonal and psychological distress that may diminish women's quality of life. Women need and seek support to cope with various distresses which may change over the course of diagnosis to treatment. This study aimed to explore Iranian women's needs to cope with hysterectomy and oophorectomy.

METHODS

This qualitative study was conducted in Kerman and Tehran, Iran from 2015 to 2017. Thirty interviews were conducted with 28 eligible participants including 24 main participants including one gynecologist, one midwife and one nursing faculty member, one gynecologist and one midwife and 2 husbands. They were recruited through purposeful sampling. Data were collected through semi-structured and in-depth interviews and analyzed with Graneheim and Lundman's method of conventional content analysis. The trial version of the MAX QDA 10 Software was used to manage the coding process.

RESULTS

"Tender care" emerged as the main theme. It was comprised of three categories: "to be well-informed, "to be treated with compassion in healthcare setting", and "to be welcomed in the society".

CONCLUSION

Women after hysterectomy/oophorectomy were preoccupied with many physical and emotional concerns. They need a whole package of care which consists of proper information to know what to do, a well-prepared/trained healthcare setting to meet their needs, and visibility in the society as a whole person. A multidisciplinary approach must be activated to meet their coping requirements and it is necessary to address these needs in each level of healthcare services.

Status of Iran's Primary Health Care System in Terms of Health Systems Control Knobs: A Review Article

BACKGROUND

After the establishment of Primary Health Care (PHC) program in Iran, health indicators have improved every year. This progress was so rapid that a number of shortcomings and weaknesses of the PHC program remained silent behind its successes. This study aimed to assess the status of Iran's PHC system (strengths, weaknesses, opportunities and threats) in terms of health system's control knobs.

METHODS

The search was conducted through two English 'databases of Web of Knowledge and PubMed, two English publications of Science Direct and Springer and two Persian databases of Magiran and SID. Keywords were selected from MeSH and included primary health care, PHC and Iran in both Persian and English. No time limit was considered.

RESULTS

Iran's PHC system has numerous successes in dealing with health system's control knobs; which largely part of that related to the health network implementation, the role of Behvarz, improvement of health indicators in rural areas and the elimination of urban-rural inequality, but there are some weaknesses, opportunities and threats in the Iranian PHC system as well.

CONCLUSION

By considering socio-economic changes the current structure of PHC system needs to be reformed to coordinate with phenomenon of chronic diseases, accidents and aging. The current information system in PHC does not provide the required information for decision makers and policy makers so it needs to be transformed to the electronic system with unique electronic health file for individuals.

A population-based study on infertility and its influencing factors in four selected provinces in Iran (2008-2010)

BACKGROUND

Infertility has a varied impact on multiple dimensions of health and functioning of women.

OBJECTIVE

We aimed to identify the burden of infertility and its influencing factors based on a population based study conducted in four provinces of Iran.

MATERIALS AND METHODS

A sample of 1126 women, aged 18-45 years, was selected using the multi stage, stratified probability sampling procedure; those met the eligibility criteria were invited for further comprehensive interview. This study used the definition of infertility proposed by World Health Organization "the woman has never conceived despite cohabitation and exposure to pregnancy for a period of 1 year". Results : The overall prevalence of lifetime infertility and current primary infertility were 21.1% (95% CI: 18.4- 23.8) and 6.4% (95% CI: 4.8-8) respectively. The probability of first pregnancy at the end of 2 years of marriage was 94% for all ever-married women. Infertility were observed as significantly higher among women age 31-35 (OR: 4.6; 95% CI: 1.9-11.5; p=0.001) and women with more than 9 years of education (OR: 2.8; 95% CI: 1.5-3.3; p<0.0001).

CONCLUSION

The necessities of modern living have compelled many women to postpone childbearing to their late reproductive years; however they must be informed of being at risk of infertility with ageing.

Estimating the prevalence of obstetric fistula: a systematic review and meta-analysis

BACKGROUND

Obstetric fistula is a severe condition which has devastating consequences for a woman's life. The estimation of the burden of fistula at the population level has been impaired by the rarity of diagnosis and the lack of rigorous studies. This study was conducted to determine the prevalence and incidence of fistula in low and middle income countries.

METHODS

Six databases were searched, involving two separate searches: one on fistula specifically and one on broader maternal and reproductive morbidities. Studies including estimates of incidence and prevalence of fistula at the population level were included. We conducted meta-analyses of prevalence of fistula among women of reproductive age and the incidence of fistula among recently pregnant women.

RESULTS

Nineteen studies were included in this review. The pooled prevalence in population-based studies was 0.29 (95% CI 0.00, 1.07) fistula per 1000 women of reproductive age in all regions. Separated by region we found 1.57 (95% CI 1.16, 2.06) in sub Saharan Africa and South Asia, 1.60 (95% CI 1.16, 2.10) per 1000 women of reproductive age in sub Saharan Africa and 1.20 (95% CI 0.10, 3.54) per 1000 in South Asia. The pooled incidence was 0.09 (95% CI 0.01, 0.25) per 1000 recently pregnant women.

CONCLUSIONS

Our study is the most comprehensive study of the burden of fistula to date. Our findings suggest that the prevalence of fistula is lower than previously reported. The low burden of fistula should not detract from their public health importance, however, given the preventability of the condition, and the devastating consequences of fistula.