Burden of pelvic organ prolapse in Ethiopia: a systematic review and meta-analysis

Female genital prolapse and risk of psychiatric disorders: A two-sample Mendelian randomization analysis

BACKGROUND

There is a growing body of evidence suggests a strong link between female genital prolapse (FGP) and mental health. However, the causal relationship between FGP and psychological disorders remains unclear.

OBJECTIVES

Bidirectional Mendelian Randomization (MR) analysis has been applied to investigate the potential impact of FGP on the risk of seven common psychiatric disorders.

METHODS

The two-sample MR analysis was conducted using genetic instruments such as Inverse variance weighted (IVW), MR Egger, weighted median, simple mode, and weighted mode from the genome-wide association study (GWAS) summary data in European populations. In addition, the Cochrane's Q test, MR-Egger intercept test, MR pleiotropy residual sum and outliers (MR-PRESSO) test and leave-one-out analysis were employed to assess the sensitivity and heterogeneity.

RESULTS

The MR results revealed that FGP exhibited a potential marginal protective effect on bipolar disorder (BD) (odds ratio(OR) = 0.92, 95%confidence interval (95%CI: 0.85-0.99, P = 0.03) as well as schizophrenia(OR = 0.91, 95%CI:0.85-0.98, P = 0.01). Nevertheless, there was no causal correlation between genetically predicted FGP and obsessive compulsive disorder (OCD) (OR = 0.98, 95%CI:0.80-1.20, P = 0.84),depression (broad) (OR = 1.00, 95%CI:0.99-1.01, P = 0.76), major depression(OR = 0.98, 95%CI:0.94-1.03, P = 0.43), anxiety disorders (OR = 1.00, 95%CI:0.94-1.07,P = 0.97) and post-traumatic stress disorder(PTSD) (OR = 1.18, 95%CI:0.88-1.57,P = 0.27),respectively. In addition, BD was found to have a potential significant influence on FGP in the inverse MR analysis (OR = 0.83, 95%CI:0.72-0.97, P = 0.02). No significant heterogeneity or horizontal pleiotropy detected, and the results were deemed stable based on sensitivity analysis and leave-one-out test .

LIMITATIONS

There are shortcomings such as data limitations, population bias, potential pleiotropy, and stratified analysis.

CONCLUSIONS

While there is potential causal relationship between FGP and BD or schizophrenia, it does not exhibit any correction with OCD, depression (broad), major depression, anxiety disorders and PTSD among European populations.

Pelvic Organ Prolapse Surgery: Postoperative Quality of Life in Ethiopian Women

INTRODUCTION AND HYPOTHESIS

Pelvic organ prolapse (POP) has a profound influence on a woman's quality of life (QoL). Assessment of QoL using patient-reported outcome (PRO) measures in pelvic organ prolapse surgery is common practice in developed countries, but despite the burden of POP in developing countries, such as Ethiopia, the use of PROs to record preoperative and postoperative QoL scores is limited. This study is aimed at assessing the QoL among Ethiopian women with POP before and after surgery using the validated Pelvic Organ Quality of Life (P-QoL) questionnaire. Additionally, we will compare postoperative QoL measurements of reconstructive procedures with those of obliterative procedures.

METHODS

This is a prospective observational study conducted at a single hospital in Ethiopia on women who were scheduled for surgery for symptomatic POP. Patients' QoL was assessed preoperatively using the P-QoL questionnaire and at each subsequent follow-up visit for 1 year (3, 6, 9, and 12 months). Patients undergoing an obliterative procedure were evaluated and compared with those having reconstructive procedures.

RESULTS

The mean score for general health perceptions, prolapse impact, role limitations, physical limitations, social limitations, and emotions was 0 at 12 months postoperatively. Despite significant improvements from baseline, personal relationships, sleep or energy disturbance, and symptom severity measures continued to negatively impact QoL at 12 months postoperatively.

CONCLUSIONS

Quality of life among Ethiopian women with POP is poor across all domains. Native tissue repair employing either reconstructive or obliterative methods significantly improves QoL across all domains up to 12 months postoperatively. The use of validated tools to assess PROs is essential to provide evidence-based care that improves QoL in ways that are meaningful to patients.

Quality of life and its associated factors among women with pelvic organ prolapse who attend gynecology clinics Southern Ethiopia 2022

INTRODUCTION

Pelvic organ prolapse is the implosion of one or more pelvic floor structures which affect womens quality of life by compromising overall health, physical, social, structural, functional and emotional well-being.

OBJECTIVE

To assess the quality of life and its associated factors among women with pelvic organ prolapse who attend gynecology clinics at Gurage zone hospitals, Southern Ethiopia 2022.

METHODS

Facility-based cross-sectional study was applied in gurage zone hospital from April, 30 to Jun 30, 2022. Systematic random sampling was employed to select 416 women. Interview based structured questionnaires were applied to collect the data. The collected data were analyzed using Statistical Produte and Service Solution. Binary and multivariable logistic regressions were fitted to assess the association between dependent and independent variables. P-value < 0.05 was used to declare the final statistical significance.

RESULT

The mean (SD) score of quality of life in this study was 53.57 (21.59). The most affected domains were general health perception and physical limitation (mean (SD) score 67.45 29.24) and (64.26 32.36)) respectively. Had no formal education (AOR = 1.50, 95% CI: 1.02, 3.12), stage III/IV POP (AOR = 2.02, 95% CI: 1.19, 3.60), constipation (AOR = 3.51, 95% CI: 2.12, 7.21), urge urinary incontinence (AOR = 3.89, 95% CI: 2.32, 6.95), and not did regular physical exercise (AOR = 2.18, 95% CI: 1.41, 3.37) were significantly associated with poor quality of life.

CONCLUSION

More than half of the participants in this study had impaired quality of life. The factor associated with quality of life was had no formal education, stage III/IV, constipation, urge urinary incontinence, and regular physical activity. It is recommended to have access education, counseling regular physical activity, detection, and management of its comorbidity.

Prevalence and associated factors of symptomatic pelvic floor disorders among women living in Debre Tabor Town, Northwest Amhara, Ethiopia

BACKGROUND

Pelvic floor disorders are a group of disorders affecting the pelvic floor that include clinically definable conditions such as pelvic organ prolapse, urinary incontinence and fecal incontinence. These conditions silently affect millions of women worldwide and related problems are not well disclosed by women due to associated social stigma or lack of access to services in developing countries. Thus, the magnitude and related burden of these conditions vary, and little is known about them. This study was conducted to assess the magnitude and associated factors of symptomatic pelvic floor disorders in Debre Tabor town, Northwest, Ethiopia, from May 30-July 30, 2020.

METHOD

A community-based cross-sectional study was conducted on child bearing women (> 15 years) who resided in Debre Tabor Town from May 30-July 30, 2020. The participants were selected through multistage systematic random sampling. The data were collected via a structured questionnaire through face-to-face interviews, entered into Epi-info-7.2, and subsequently analyzed using SPSS version 20. The prevalence of pelvic floor disorders was presented along with the 95% CI.

RESULTS

A total of 402 women participated in this study, 59 (14.7%; 95% CI; 11.4, 18.2) of whom reported one or more types of pelvic floor disorders. The most prevalently reported pelvic floor disorders were pelvic organ prolapse (13.9%; 95% CI: 10.9, 17.4), urinary incontinence (10.9%; 95% CI: 7.4, 9.2) and fecal incontinence (7.7%; 95% CI: 5.2, 10.2). Additionally, aging, multiparity and having early marriage (< 18 yrs.) were identified as potential risk factors associated with pelvic floor disorders.

CONCLUSIONS

The prevalence of symptomatic pelvic floor disorders in the current study was high. Thus, early detection, preventive and treatment strategies should be considered. In addition, it is better to educate the community and women on the association of early marriage and multiparty with PFDs.

Prevalence and associated factors of depression among women with advanced pelvic organ prolapse in Northwest Ethiopia: cross-sectional study

BACKGROUND

Depression is a symptom characterized by sadness, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, feelings of tiredness and poor concentration. One of the most common mental illnesses in the world and a major contributor to morbidity and mortality is depression. The purpose of this study was to ascertain the prevalence of depression and the risk factors associated with it in women who had advanced pelvic organ prolapse.

METHODS

A facility-based cross-sectional study was conducted to determine depression among advanced pelvic organ prolapse women at Gondar University Comprehensive Specialized Hospital. All women who have advanced pelvic organ prolapse were consecutively included till it reached a total of 367 participants over four months. A structured questionnaire was used to obtain the sociodemographic characteristics, clinical characteristics and depression status of the participants. Depression measures were obtained by using the Patient Health Questionnaire tool, which is validated in the Ethiopian local language for chronic illnesses including pelvic organ prolapse using a cut point of five and above, which is considered to indicate depression. Women who screened positive were linked to a psychiatric clinic for further evaluation and treatment. Data was entered into a computer using Epi Info version 3.5.3 and then exported to STATA version 14 for analysis. Multivariable logistic regressions were fitted and odds ratios with 95% confidence intervals with a P value less than 0.05 were used to identify statistically significant factors.

RESULTS

The prevalence of depression was found to be 47.1% (95% CI: 43-52%). Being rural (AOR = 4.8; CI: 1.11-16.32), having a history of divorce because of pelvic organ prolapse (AOR = 5.5; CI: 1.85-16.32) and having a history of urinary symptoms (AOR = 3.1; CI: 1.12-8.59) were found to be independently associated with depression.

CONCLUSIONS

The prevalence of depression among women with advanced pelvic organ prolapse in this study is high as compared to other studies. Depression screening strategies should be designed for the early identification and treatment of depression among women with advanced pelvic organ prolapse.

Prevalence and risk factors of pelvic organ prolapse among women in Sidama region, Ethiopia: A community-based survey

BACKGROUND

Pelvic organ prolapse is a descent of the vaginal compartments and the surrounding organ due to loss of support of the vaginal tissue. It has a significant psychological, physical, and social impact that affects women's quality of life. However, its true prevalence is unknown due to the variability in the methods used to diagnose the disorder.

OBJECTIVES

This study aimed to determine the prevalence of pelvic organ prolapse and its associated risk factors among women in Sidama region, Ethiopia.

STUDY DESIGN

A community-based cross-sectional survey was conducted in the Dale-Wonsho Health and Demographic Surveillance Site, Sidama region, from March to October 2023.

METHODS

A multi-stage stratified cluster sampling was used to select a sample of 816 women. Anatomical prolapse was diagnosed based on the standardized pelvic organ prolapse quantification method, and symptomatic prolapse was assessed by patient-reported symptoms. A complex survey-based modified Poisson regression was used to assess the risk factors associated with prolapse.

RESULTS

A total of 815 participated in the interview, and 779 (95.6%) underwent pelvic examination to assess for prolapse status. Anatomical prolapse (Stages II-IV) was observed in 241 (30.9%; 95% confidence interval = 24-38.7) of the participants. The prevalence of symptomatic pelvic organ prolapse was 78.5% (95% confidence interval = 69.1-85.7) among women with anatomical prolapse (189/241). This prevalence falls to 24.27% (95% confidence interval = 19.98-29.16) for the total sample population. Higher frequency of childbirth, prolonged heavy lifting activities, and prolonged labor increased the likelihood of developing anatomical prolapse. Childbirth at an early age and prolonged heavy lifting activities were significantly associated with symptomatic prolapse.

CONCLUSION

Anatomical prolapse and symptomatic prolapse are high in the study area. Parity, prolonged heavy lifting, prolonged labor, and early age childbirth were associated with pelvic organ prolapse. Community-based education and interventions that focus on the modification of risk factors are needed.

Surgical management practice of pelvic organ prolapse among Ethiopian gynecologists, 2021: a descriptive study

INTRODUCTION

Pelvic Organ Prolapse is the descent of one or more of the anterior vaginal wall, posterior vaginal wall, the uterus, or the apex of the vagina. Surgical intervention addresses both anatomical defect and associated symptoms. The landscape of prolapse surgery has been evolving constantly over years. Emerging evidences either support or challenge existing surgical treatment options, making urogynecology a dynamic field. In Ethiopia, the surgical management of pelvic organ prolapse has transitioned from abdominal to vaginal hysterectomy, supplemented later by McCall's culdoplasty. Disparities exist in the national uniformity of surgical approaches, linked to the establishment of Urogynecology centers in certain institutions.

OBJECTIVES

This study was done to assess the surgical management practice of Ethiopian gynecologists on pelvic organ prolapse.

METHODS

A cross-sectional study encompassing all Gynecologists in Ethiopia took place between January to June 2021. Information was gathered through online Google forms crafted in English. Subsequently, the collected data underwent verification, coding, and entry into Epi info 7 before being exported to SPSS version 22 software for descriptive statistical analysis.

RESULTS

We reached 280 gynecologists out of the 450 practicing in the Ethiopia making 62% response rate. Anterior colporrhaphy (98.6%), vaginal hysterectomy with McCall's cul-do-plasty (51.8%), and Posterior colporrhaphy (97.5%) were the most commonly performed surgical procedures for anterior vaginal wall prolapse, apical prolapse (uterine/cervical), and posterior vaginal wall prolapse respectively. Only 3.2% and 0.7% of the gynecologists conducted abdominal and vaginal paravaginal repair for anterior vaginal wall prolapse. Sacrospinous ligament fixation and sacrocolpopexy for apical prolapse were carried out by 32.9% and 9.3% of the gynecologists respectively. Site-specific posterior repair for posterior vaginal wall prolapse was performed only by 23.9% of the gynecologists. The main reasons mentioned not to perform paravaginal repair, sacrocolpopexy, sacrospinous ligament fixation, and site-specific posterior repair were lack of skill and lack of appropriate materials.

CONCLUSION AND RECOMMENDATION

Most gynecologists in Ethiopian continue to perform vaginal hysterectomy and colporrhaphy procedures for treatment of pelvic organ prolapse due primarily to lack of skill and appropriate materials to perform the alternative procedures. Implementing short term training on alternative surgical treatment options of pelvic organ prolapse with provision of suitable materials and increasing the number of urogynecologists in the country in the long run holds the potential to enhance the standard of care of women with the condition.

Pelvic floor dysfunction: prevalence and associated factors

BACKGROUND

Pelvic floor dysfunction in women encompasses a wide range of clinical disorders: urinary incontinence, pelvic organ prolapse, fecal incontinence, and pelvic-perineal region pain syndrome. A literature review did not identify any articles addressing the prevalence of all pelvic floor dysfunctions.

OBJECTIVE

Determine the prevalence of the group of pelvic floor disorders and the factors associated with the development of these disorders in women.

MATERIAL AND METHODS

This observational study was conducted with women during 2021 and 2022 in Spain. Sociodemographic and employment data, previous medical history and health status, lifestyle and habits, obstetric history, and health problems were collected through a self-developed questionnaire. The Pelvic Floor Distress Inventory (PFDI-20) was used to assess the presence and impact of pelvic floor disorders. Pearson's Chi-Square, Odds Ratio (OR) and adjusted Odds Ratio (aOR) with their respective 95% confidence intervals (CI) were calculated.

RESULTS

One thousand four hundred forty-six women participated. Urinary incontinence occurred in 55.8% (807) of the women, fecal incontinence in 10.4% (150), symptomatic uterine prolapse in 14.0% (203), and 18.7% (271) reported pain in the pelvic area. The following were identified as factors that increase the probability of urinary incontinence: menopausal status. For fecal incontinence: having had instrumental births. Factors for pelvic organ prolapse: number of vaginal births, one, two or more. Factors for pelvic pain: the existence of fetal macrosomia.

CONCLUSIONS

The prevalence of pelvic floor dysfunction in women is high. Various sociodemographic factors such as age, having a gastrointestinal disease, having had vaginal births, and instrumental vaginal births are associated with a greater probability of having pelvic floor dysfunction. Health personnel must take these factors into account to prevent the appearance of these dysfunctions.

The prevalence of pelvic organ prolapse and associated factors in Ethiopia: a systematic review and meta-analysis

Background

Pelvic organ prolapse (POP) affects millions of women globally, with resource-limited countries, such as Ethiopia, carrying the highest burden. Previously, the prevalence of POP was estimated using seven studies. However, this study lacks generalization because of the limited number of studies and low geographical representation. In total, 12 additional primary studies were conducted after this review, and their reported prevalence was significantly variable across the studies. In addition, different new factors were reported in the primary studies. Therefore, this study aimed to update the pooled prevalence of POP and its associated factors in Ethiopia.

Methods

This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Articles that were published between 2000 and 2023 were searched using the African Journal of Online, ScienceDirect, DOAJ, PubMed, and Google Scholar. The quality of the studies was evaluated using the modified Newcastle-Ottawa quality assessment tool. The data were extracted using Microsoft Excel and analyzed by Stata version 11. A random effect model was used to investigate the pooled prevalence of POP and its associated factors. The I2 test and Egger's regression test were used to detect the presence of heterogeneity and publication bias across studies, respectively.

Result

A total of 21 studies met the inclusion criteria and represented the data of 14,575 women. The pooled prevalence of POP was found to be 22.70%. History of home delivery (pooled odds ratio (OR) =2.93, 95% CI =1.46, 5.91), prolonged labor (OR = 4.63, 95% CI = 2.56, 8.38), history of perineal tear (OR = 4.83, 95% CI = 2.31, 10.11), instrumental delivery (OR =3.70, 95% CI =2.01, 6.81), grand multipara (OR = 5.42, 95% CI = 4.06, 7.23), family history of POP (OR = 3.30, 95% CI = 2.07, 5.25), and carrying heavy objects (OR = 3.23, 95% CI = 2.22, 4.70) were significantly associated with POP.

Conclusion

The pooled prevalence of POP was high in Ethiopia. The Ministry of Health and clinicians should emphasize counseling on modifiable risk factors and develop further prevention strategies.

Quality of life and its associated factors among women diagnosed with pelvic organ prolapse in Gynecology outpatient department Southern Nations, Nationalities, and Peoples region public referral hospitals, Ethiopia

BACKGROUND

Pelvic organ prolapse is an important public health issue that influences millions of women's lives; through limitations on physical, social, and sexual activities as well as psychological distress. However, there were no reports on the quality of life for women with pelvic organ prolapse in Ethiopia. Therefore this study amid to assess the magnitude of quality of life and its associated factors among women who diagnosed with pelvic organ prolapse in Gynecology outpatient departments in Southern Nations, Nationalities, and Peoples region public referral hospitals; Ethiopia.

METHOD

An institutional-based cross-sectional study was conducted in Southern Nations, Nationalities, and Peoples region of public referral hospitals from May 1-July 4, 2022 among 419 diagnosed women with pelvic organ prolapse. A validated tool was used to collect the data. The collected data were entered into Epidata version 3.1 and analyzed using the Statistical Package for Social Sciences. Bivariable and multivariable logistic regression was computed. The p-value of < 0.05 was used to declare the final statistical significance.

RESULT

A total of 409 women with pelvic organ prolapse were included in the study, giving a response rate of 97.6%. The overall poor quality of life was 57.5%. Regarding the quality of life domains; personal relationships (73.6%), were highly affected, and sleep/energy (24.2%) was the least affected domain. Stage III/IV prolapse (AOR = 2.52, 95% CI: 1.34, 4.74), menopause (AOR = 3.21, 95% CI 1.75, 5.97), unmarried women (widowed, divorced) (AOR = 2.81, 95% CI: 1.48, 5.32), and longer duration of prolapse (AOR = 5.8, 95% CI: 3.13, 10.81), were significantly associated with poor quality of life.

CONCLUSION

More than half of women with pelvic organ prolapse had a poor quality of life. Stage III/IV prolapse, longer duration of prolapse, menopause women, and unmarried women are statistically significant factors for the quality of life of women with Pelvic organ prolapse.

Inequality in healthcare-seeking behavior among women with pelvic organ prolapse: a systematic review and narrative synthesis

INTRODUCTION

Pelvic organ prolapse (POP) affects women's quality of life in various aspects. However, evidence on the healthcare-seeking behavior of women with POP is limited. Therefore, this review aimed to identify and synthesize the existing evidence on the healthcare-seeking behavior among women with POP.

METHODS

This systematic review and narrative synthesis of the literature on healthcare-seeking behavior among women with POP was conducted from 20 June to 07 July 2022. The electronic databases PubMed, African Journals Online, Cumulative Index to Nursing and Allied Health Literature, African Index Medicus and Directory of Open Access Journal, and Google Scholar were searched for relevant literature published from 1996 to April 2022. The retrieved evidence was synthesized using a narrative synthesis approach. The characteristics of included studies and the level of healthcare-seeking behavior were summarized in a table and texts. Error bar was used to show the variability across different studies.

RESULTS

A total of 966 articles were retrieved of which only eight studies with 23,501 women (2,683 women with pelvic organ prolapse) were included in the synthesis. The level of healthcare-seeking behavior ranges from 21.3% in Pakistan to 73.4% in California, USA. The studies were conducted in four different populations, used both secondary and primary data, and were conducted in six different countries. The error bar shows variation in healthcare-seeking behavior.

CONCLUSIONS

The level of health-care seeking behavior among women with POP is low in low-income countries. There is substantial variability in the characteristics of the reviewed studies. We recommend a large-scale and robust study which will help to better understand the healthcare-seeking behavior among women with POP.

Delay in seeking treatment and associated factors among women with pelvic organ prolapse in Wolaita zone, Southern Ethiopia: Hospital based mixed method study

BACKGROUND

Despite increasing efforts to improve access to diagnosis and treatment services, women with pelvic organ prolapse tend to stay at home for years before getting treatment. A large number of women, particularly in rural areas do not get early diagnosis and treatment, and they come with an advanced stage; but the reason for this appears unclear. Thus, this study aimed to determine the proportion and associated factors of delay in seeking treatment among women with pelvic organ prolapse (POP) in the Wolaita zone, Southern Ethiopia.

METHODS

A hospital-based cross-sectional study mixed with qualitative method was conducted in the Wolaita zone, Southern Ethiopia, from September to October 2021. A total of 422 women with pelvic organ prolapse were selected by systematic random sampling for quantitative data. The women recruited for in-depth interviews were purposefully selected until data saturation reaches via phenomenological study design. The quantitative data were collected by interviewer-administered questionnaire and reviewing clients' medical records via an open data kit and then exported to and analyzed with a statistical package for social science version 25. The associated variables were determined by conducting a logistic regression model and are presented with the crude odds ratio (COR) and adjusted odds ratio (AOR) with their respective 95% confidence intervals (95%CI). All statistical tests were conducted at a 5% level of significance. The interview was first transcribed, coded, and categories and themes were generated by applying thematic analysis.

RESULTS

The study showed that 82.0% (95% CI: [74.8-89.3%]) of women with POP delayed seeking treatment. The delay to seek treatment was associated with a lack of support (AOR = 4.9; 95% CI [1.8-13.2]), low-income (AOR = 6.4; 95% CI [2.2-19.2]), fear of disclosure (AOR = 5.0; 95% CI [1.3-19.2]) and fear of social stigma (AOR = 4.6; 95% CI [1.5-14.2]). The reasons for the delay were feeling shameful to disclose, fear of stigma and cultural and spiritual beliefs.

CONCLUSIONS

More than three-fourths of women with POP delayed seeking treatment, and improving support, improving the economy, raising awareness, and involving influential people in interventions are all necessary to avert it.

Characteristics and outcomes of patients with pelvic organ prolapse: an analysis of data from Mulago National Referral Hospital from 2007-2016

INTRODUCTION

Pelvic organ prolapse (POP) is associated with negative physical, social, psychological, and sexual experiences. There is paucity of data in low and middle income countries like Uganda. The purpose of this study was to describe clinical characteristics and outcomes of patients undergoing surgery for POP from 2007 to 2016.

METHODS

The study was conducted at Mulago National Referral Hospital from 2014 to 2016. We conducted a retrospective review of the urogynecology surgical records using a standardized medical record abstraction form. Data of 222 POP patients were abstracted and managed using REDCap. Analysis was performed using Stata statistical software, v14.

RESULTS

The mean participant age and parity was 57 years and 7 respectively. Ninety four percent of participants presented with a mass protruding from the vagina, 38% with uterine prolapse and 32% with cystocoele. Anaemia and hypertension were common comorbidities. Women underwent a variety of surgery types, and 35% experienced persistent pain post-operatively. At hospital discharge, 83% had achieved either complete resolution or improvement in their condition.

CONCLUSIONS

Measures encouraging presentation for care as soon as symptoms are experienced and reduction of total fertility rate will be beneficial. Patients with POP should be routinely screened for anaemia and hypertension.

Prevalence of pelvic floor disorders in the Eastern Mediterranean region: A meta-analysis

OBJECTIVES

High prevalence of risk factors for pelvic floor disorders (PFD) in the Eastern Mediterranean may result in higher rates of prevalence of PFD in comparison to other regions. Despite individual studies, there are no clear statistics on the cumulative prevalence of PFDs in the East Mediterranean region. The aim of this study was to investigate the prevalence of PFDs in the Eastern Mediterranean region.

METHODS

A literature search without language restriction was conducted in PubMed, Cochrane database and Web of Science from 2016 to 01 June 2022. Cross-sectional and cohort studies that reported prevalence of urinary incontinence (UI), constipation, fecal incontinence (FI) and pelvic organ prolapse (POP) among women in the Eastern Mediterranean region were included. Study quality was assessed according to the Joanna Briggs Institute critical appraisal tool. Data were pooled and meta-analysed using a random effects model.

PROSPERO

CRD42021283127 RESULTS: The search yielded 390 articles, from which 12 studies containing 9905 patients were included. Five studies were high quality and seven were low quality. The prevalence of POP (12 studies, 9905 participants), UI (5 studies, 2340 participants), constipation (4 studies, 2045 participants) and FI (1 study, 166 participants) was 39% (95% CI 21-57; I2 99.8%), 48% (95% CI 16-80; I2 99.7%), 39% (CI 17-60; I2 99.1%) and 14% (95% CI 9-20) respectively.

CONCLUSION

In meta-analysis pooling studies of mixed quality, a high prevalence of PFDs was seen in the Eastern Mediterranean region.PROSPERO No.: CRD42021283127.

Pelvic Organ Prolapse and its Associated Factors Among Women: A Facility Based Cross-sectional Study

Pelvic organ prolapse is the downward descent of female organs, including the bladder, small bowel, and large bowel, resulting in the protrusion of the vagina, uterus, or both. This disorder, exclusive to women, causes psychological trauma and social withdrawal, leading to an increased rate of gynecologic surgery. To assess the Pelvic Organ Prolapse and its associated factors among Women Visiting public Hospitals in south west Ethiopia. An institution-based cross-sectional study was conducted among gynecologic patients. A total sample size of 408 was allocated to the institutions proportional to their previous month's case load. Data were collected using an interviewer-administered structured questionnaire. The collected data were coded and entered into EpiData version 3.1, then exported to SPSS version 20 for descriptive and inferential analysis. Adjusted odds ratios (AOR) along with a 95% confidence level were estimated, and a P-value < .05 was considered statistically significant. Out of the intended sample size, 393 women participated in the study, resulting in a response rate of 96.3%. The overall magnitude of pelvic organ prolapse among the study participants was 19.8% (95% CI: 16.0, 24.1). Factors significantly associated with pelvic organ prolapse were place of residence (AOR = 2.21, 95% CI: 1.11, 4.40), parity (AOR = 2.82, 95% CI: 1.39, 5.72), age at first pregnancy (AOR = 2.32, 95% CI: 1.27, 4.26), and place of delivery of the first child (AOR = 4.18, 95% CI: 1.97, 8.85). The prevalence of pelvic organ prolapse is high. Place of residence, parity, age at first pregnancy, and place of delivery of the first child were factors significantly associated with pelvic organ prolapse. Therefore, different stakeholders, programmers, and implementers should take aggressive steps to prevent early pregnancy, train health professionals to encourage women to use family planning, and promote institutional delivery.

Prevalence of symptomatic pelvic organ prolapse and associated factors in Southern Nations, Nationalities, People's Region referral hospitals, Ethiopia

INTRODUCTION AND HYPOTHESIS

Pelvic organ prolapse is one of the major causes of morbidity among women that affect their quality of life. Despite the severity of the problem, there is limited information in Ethiopia. Therefore, this study was aimed at assessing the prevalence of symptomatic POP and its associated factors.

METHODS

An institution-based cross-sectional study was carried out in the referral hospitals of Southern Nations, Nationalities, People's Region, Ethiopia. Women were initially interviewed about their prolapse symptoms using validated questionnaires, and if they answered yes to one or more of the questions, they were examined by gynecologists using simplified POP quantification. Pelvic examination results and patient-reported symptoms were used to determine symptomatic POP. A multivariate logistic regression analysis model was used to identify factors associated with symptomatic prolapse.

RESULTS

A total of 1,196 respondents were included in this study. The prevalence of symptomatic POP was found to be 20.1%. Age of women ≥55 years (AOR=8.39; 95% CI 3.41-20.62), carrying heavy objects for ≥ 5 h (AOR= 5.18; 95% CI 2.51-10.69), parity ≥4 times (AOR=2.98; 95% CI 1.60-5.53), history of home delivery (AOR= 2.90; 95% CI 1.50-5.61), giving birth through assisted vaginal delivery (AOR=5.01; 95% CI 1.73-14.53), history of chronic constipation (AOR=2.66; 95% CI 1.38-5.15), and a history of a chronic cough (AOR=9.18; 95% CI 4.52-18.61) were associated with symptomatic POP.

CONCLUSIONS

In this study the prevalence of symptomatic POP is high. Older age, long hours of carrying heavy objects, a high parity, last birth through assisted vaginal delivery, a history of home delivery, a history of chronic constipation, and a history of a chronic cough were found to be associated with symptomatic POP.

Determinants of pelvic organ prolapse at public hospitals in Hawassa city, Southern Ethiopia, 2020: unmatched case control study

Introduction

Even though the Pelvic organ prolapse (POP) is outstanding gynecologic problem, most private and asymptomatic nature of the illness makes it the “hidden epidemic.” The aim of this study was to identify the determinants of POP.

Methods

Facility based unmatched case control study was conducted from June 15 to September 10, 2020. All cases diagnosed with POP were enrolled in the study by using consecutive random sampling method by assuming that patient flow by itself is random until the required sample size was obtained. Then 1:2 cases to control ratio was applied. A structured interviewer-administered questionnaire and chart review for type and degree of prolapse was used. Epi-data was used for data entry and SPSS were used for analysis. Chi square test and binary and multivariable logistic regression analysis was employed. Multicollinearity was checked.

Result

On multivariate logistic regression, heavy usual work load(AOR = 2.3, CI(1.066–4.951), number of pregnancy ≥ 5(AOR = 3.911, CI(1.108–13.802), birth space of < 2 years(AOR = 2.88, CI(1.146–7.232), history of fundal pressure (AOR = 5.312, CI(2.366–11.927) and history of induced labor (AOR = 4.436, CI(2.07–9.505) were significantly associated with POP with P value < 0.05 and 95% CI after adjusting for potential confounders.

Conclusion

Heavy usual work load, having pregnancy greater than five, short birth space, history of induced labor, and history of fundal pressure are independent predictors of pelvic organ prolapse. Hence the responsible body and obstetric care providers should counsel the women about child spacing, minimizing heavy usual work load and effect of multigravidity on POP. Incorporation of health education on those risk factors related to POP on antenatal and postnatal care should be considered. The obstetric care providers also avoid fundal pressure and labor induction without clear indication and favorability, and the hospital officials set a law to ban fundal pressure during labor.

One in ten ever-married women who visited health facilities for various reasons have pelvic organ prolapse in Harari regional state, Eastern Ethiopia

Background

Pelvic organ prolapse remains a neglected public health problem in developing countries. The burden of pelvic organ prolapse varies by region and ranges from 9 to 20%. It poses an impact on women’s quality of life and affects their role at the community and family level. Although it has negative consequences and extensive burden, the true feature of pelvic organ prolapse is not well known among ever-married women attending health facilities for various reasons in the study area. Therefore, this study was aimed to assess the magnitude of pelvic organ prolapse and associated factors among ever-married women attending health care services in public Hospitals, Eastern Ethiopia.

Methods

A facility-based cross-sectional study design was conducted from March 4th to April 5th, 2020 among 458 ever-married women attending public Hospitals in Harar town, Eastern Ethiopia. The study subjects were selected through systematic sampling. The data were collected using a structured questionnaire through face-to-face interviews. Data were analyzed using SPSS version 22 (IBM SPSS Statistics, 2013). The prevalence was reported by proportion and summary measures. Predictors were assessed using a multivariable logistic regression analysis model and reported using an adjusted odds ratio with 95% CI. Statistical significance was declared at p-value < 0.05.

Result

Of 458 women enrolled in the study, 10.5% of them had pelvic organ prolapse based on women’s reporting of symptoms. History of lifting heavy objects [AOR = 3.22, 95% CI (1.56, 6.67)], history of chronic cough [AOR = 2.51, 95% CI (1.18, 5.31)], maternal age of greater than or equal to 55 years [AOR = 3.51, 95% CI (1.04, 11.76)], history chronic constipation (AOR = 3.77, 95% CI (1.54, 9.22) and no history of contraceptive utilization [AOR = 2.41, 95% CI (1.13, 5.05)] were significantly associated with pelvic organ prolapse.

Conclusion

In this study, one in ten ever-married women who visited health facilities for various reasons have pelvic organ prolapse. Modifiable and non-modifiable risk factors were identified. This result provides a clue to give due consideration to primary and secondary prevention through various techniques.

Pelvic organ prolapse and associated factors among women admitted to gynecology ward at the Hiwot Fana Comprehensive Specialized Hospital, Harar, eastern Ethiopia

Objectives

The major aim of this study was to assess the magnitude of pelvic organ prolapse and its associated factors among patients admitted to the gynecology ward at Hiwot Fana Specialized University Hospital, eastern Ethiopia.

Methods

A retrospective review of records was undertaken at Hiwot Fana Specialized University Hospital. We used a simple random sampling technique to pick 387 gynecology ward-admitted patient records from 30 December 2020 to 10 January 2021. Data were extracted from maternal medical charts using a pretested checklist. The extracted data were entered into EpiData version 3.1 and then exported into SPSS version 25 for analysis. Binary logistic regression was carried out to observe a significant correlation between independent and pelvic organ prolapse. An adjusted odds ratio and 95% confidence interval was used to report the result. A p-value of less than 0.05 was used to declare statistical significance.

Results

Among 387 responded women, 39 (10.1%; 95% confidence interval = 8.3-15.6) of them had at least one stage of pelvic organ prolapse. Multiparty (adjusted odds ratio = 1.88, 95% confidence interval = 1.41-10.60), grand multiparty (adjusted odds ratio = 2.63, 95% confidence interval = 1.53-12.90), older maternal age (adjusted odds ratio = 2.29, 95% confidence interval = 1.220-7.52), lifting a heavy object (adjusted odds ratio = 4.61, 95% confidence interval = 2.31-15.83), and having chronic cough (adjusted odds ratio = 2.39, 95% confidence interval = 1.10-5.19) were significantly associated with pelvic organ prolapse.

Conclusion

Among women admitted to the hospital because of gynecological morbidity, one in ten of them had pelvic organ prolapse. Multiparty, advanced maternal age, having a chronic cough, and lifting heavy objects were identified to be risk factors for pelvic organ prolapse. Tailored primary prevention would enhance the well-being of reproductive-age women.

Global burden and trends of pelvic organ prolapse associated with aging women: An observational trend study from 1990 to 2019

Purpose

Worldwide, about 40% of women will experience pelvic organ prolapse (POP), and this proportion is expected to increase with the aging of the population. We investigated the global, regional and national influenza burden in the past 30 years through the age and sociodemographic index (SDI).

Patients and methods

Data were extracted from the Global Burden of Disease (GBD) 2019 database for 195 countries and territories between 1990 and 2019. Estimated annual percentage changes (EAPCs) were used to explore the age-standardized incidence rate (ASIR) and age-standardized disability adjusted life years (AS-DALYs) trends, and the corresponding 95% uncertainty intervals (UI). In addition, the time cut-off points of 1990 and 2019 were used to separately analyze the incidence rate and DALYs.

Results

In 2019, the global ASIR and AS-DALYs for POP were 316.19 (95%UI: 259.84-381.84) and 10.37 (95%UI: 5.79-17.99) per 100,000 population, respectively. Moreover, from 1990 to 2019, the ASR of both showed a downward trend, and EAPCs were -0.46 (95%CI: -0.52 to -0.4) and -0.53 (95%CI: -0.58 to -0.47), respectively. In addition, DALYs of POP also showed a downward trend in most regions and countries with high SDI. From 1990 to 2019, the global incidence rate and DALYs rate were highest in the 65-75 and ≥60 age groups, respectively.

Conclusion

Over the past three decades, the incidence and DALY of POP have been decreasing from 1990 to 2019. However, POP remains a major health problem, especially among females in less developed countries. Primary and secondary prevention measures of POP should be integrated into the practice of healthcare professionals dealing with aging women.

Risk factors of pelvic organ prolapse at Asella Teaching and Referral Hospital: Unmatched case control study

Background

Prolapse is one of the sub-types of pelvic floor dysfunction (PFD) which occurs due to abnormal fall of the pelvic organs from their normal anatomic positions. Although the cause of prolapse is multifactorial, it primarily occurs due to pregnancy and vaginal delivery. Hence, the present study aimed to identify risk factors of prolapse among women who undergo gynecological surgery.

Materials and methods

Facility-based-unmatched case–control design was employed. Cases were all gynecological women who were diagnosed with pelvic organ prolapse (POP) at Asella teaching referral hospital (ATRH) while controls were all charts of gynecological women who were diagnosed with other gynecological problems rather than POP at ATRH. For each case, two controls were selected using a simple random sampling technique. The data were entered into Epidata version 4.3.1 and finally exported to SPSS version 25 for further analysis. Then variables that had an association in the bivariate model (p &lt; 0.25) were entered and analyzed by a multivariable conditional logistic regression model to identify the independent effect of different factors. Statistical significance was declared at p &lt; 0.05.

Results

A total of 147 cases and 293 controls were included in this study. Women who had a history of chronic cough, previous pelvic floor surgery, constipation, and vaginal tear during delivery, history of pelvic trauma, age of the women, rural resident, and maternal gravidity were strongly associated with prolapse at p-value of &lt; 0.05. Multigravida [adjusted odds ratio (AOR) 2.987 (95% CI 1.237–6.853), p = 0.014], age &gt;50 years [AOR: 2.496 (95% CI 1.372–4.539), p = 0.003], women with a history of pelvic floor surgery [AOR: 0.3.666 (95% CI 1.328–10.124), p = 0.012], women who had diabetes mellitus [AOR: 4.676 (95% CI 0.908–24.075), p = 0.065], and resided in rural areas [AOR = 1.878; (95% CI: 0.984–3.585), I2 = 47.5%, p = 0.056] were the independent predictors were of prolapse.

Conclusions

In this study, women with diabetes mellitus, previous pelvic floor surgery, rural residents, being multigravida, and age &gt;40 were independent predictors of prolapse. Therefore, delivering health education by focusing on the identified risk factors was strongly recommended.

Dysmenorrhea and associated symptoms in Ethiopia: A systematic review and meta-analysis

Introduction:

Dysmenorrhea is the most common gynecologic compliant and reproductive health problem among adolescents, young, and reproductive age group. Dysmenorrhea has psychological, physical, and behavioral impact on adolescent girls in different regions.

Objective:

This systematic review and meta-analysis aimed to assess the overall prevalence of dysmenorrhea, its pain intensity and associated symptoms in Ethiopia and compare with other countries.

Methods:

Literatures from PubMed, MEDLINE, EMABSE, CINHAL, SCOPUS, Hinari, Africa journals, and Google scholar were retrieved. Eligible cross-sectional studies were included for meta-analysis. I2 statistics was calculated to check heterogeneity. Subgroup analysis based on outcome of interest was performed. Sensitivity analysis was undertaken to examine the level of heterogeneity.

Results:

The prevalence of overall and primary dysmenorrhea in Ethiopia was 72% (95%CI 68–77) and 72.27% (95%CI 69.8–75.33) respectively. Back pain 56.62% (95%CI 46.68–66.57) and fatigue 51.51% (95%CI 40.08–62.94) were more common than headache 29.15% (95%CI 18.16–40.14) whereas moderate pain 41.03% (95%CI 33.98–48.07) was more common than mild 31.83% (95%CI 21.61–42.05) and severe pain intensity 21.57% (95%CI 14.24–28.89). The prevalence between small and large samples, Northern and South/West Ethiopia, and school girls and university students were nearly similar. Positive family history (OR = 4.05; 95%CI 3.15–5.20), early menarche (OR = 2.91; 95%CI 2.00–4.24) and irregular monthly menstrual cycle (OR = 1.87, 95%CI 1.23–2.84) were the predictors of dysmenorrhea.

Conclusion:

Compared with other countries, the prevalence of dysmenorrhea in Ethiopia is moderate, presenting as mainly back pain and fatigue with moderate pain intensity. Positive family history, early menarche, and irregular menstrual cycle are the positive contributing factors.

International urogynecology consultation chapter 1 committee 2: Epidemiology of pelvic organ prolapse: prevalence, incidence, natural history, and service needs

INTRODUCTION AND HYPOTHESIS

This narrative review describes the existing epidemiologic literature and identifies gaps regarding pelvic organ prolapse (POP) prevalence, incidence, natural history, and current and future service needs.

MATERIALS AND METHODS

A PubMed search identified relevant citations published in 2000 or later. Pre-specified criteria were used to screen titles, abstracts, and manuscripts, including reference sections. Study findings were summarized to define what is known, identify gaps in current knowledge, and suggest priority areas for future research.

RESULTS

The reported prevalence of POP varies widely (1-65%) based on whether its presence is ascertained by symptoms (1-31%), pelvic examination (10-50%), or both (20-65%). Most existing population-based surveys do not include physical examination data. White women from higher income countries are overrepresented in the existing literature. Incidence and natural history data are limited and consist mainly of cohorts that follow women after pregnancy or menopause. Given global increases in aging populations in well-resourced countries, the need for POP treatment is anticipated to increase in the coming decades. In lower and middle income countries (LMICs) where demographic trends are different, there is a dearth of information about anticipated POP service needs.

CONCLUSION

Future POP incidence, prevalence, and natural history studies should include non-white women from LMICs and should combine pelvic examination data with validated patient-reported outcome measures when feasible. Anticipated future service needs differ globally, with a greater demand for POP treatment services in well-resourced settings where aging populations are prevalent.

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.

Age and/or postmenopausal status as risk factors for pelvic organ prolapse development: systematic review with meta-analysis

INTRODUCTION AND HYPOTHESIS

Age is named as a risk factor for pelvic organ prolapse (POP), despite not being the primary outcome for many observational studies. Postmenopausal status is another associated factor but has many confounders. We aimed to systematically review the role of age and/or postmenopausal status in POP development.

METHODS

Systematic review addressing age and hormones, more specifically by postmenopausal status, from inception to March 2020 in four databases (PubMed, Embase, WOS, Cochrane Library). Quality of evidence was classified by the ROBINS-I classification for non-randomized studies. Experimental studies, animal studies, studies linking age with recurrent POP and case series were excluded. Effect estimates were collected from adjusted odds ratio plus 95% confidence intervals. Significance level was 5%. A discussion exploring mechanistic factors was also included.

RESULTS

Nineteen studies (11 cross sectional, 6 cohort and 2 case control) were included for quantitative analysis. Only two studies presented a low overall risk of bias for age; most of the domains were of moderate risk. Every additional year was responsible for a 10% increase in the risk to develop POP (OR = 1.102 [1.021-1.190]; i² = 80%, random analysis, p = 0.012). This trend was confirmed when age was dichotomized into a cutoff of 35 (p = 0.035) and 50 (p < 0.001) years. Although an increase in the risk for POP was noted in postmenopausal women, this did not reach statistical significance (OR = 2.080 [0.927-4.668], i² = 0%, p = 0.076).

CONCLUSION

Age is a risk factor for POP; postmenopausal status was not statistically associated with POP, prompting the need for further studies addressing this factor.

Risk factors for recurrence of pelvic organ prolapse after vaginal surgery among Ugandan women: a prospective cohort study

INTRODUCTION AND HYPOTHESIS

This study was aimed at determining the recurrence rate and risk factors for the recurrence of pelvic organ prolapse (POP), at 1 year post-vaginal reconstructive surgery in a resource-limited setting.

METHODS

We enrolled women who underwent vaginal surgery for POP at the urogynecology unit of Mbarara Regional Referral Hospital (MRRH) in southwestern Uganda between December 2018 and February 2020. The surgeries that were performed include anterior colporrhaphy for cystocele, posterior colporrhaphy for rectocele, vaginal hysterectomy with vault suspension for uterine prolapse, and cervicopexy in those with uterine prolapse where uterine-sparing surgery was desired. The women were followed up for a period of 1 year after surgery. Pelvic examinations in lithotomy position under maximum strain were carried out to assess for recurrence using the Pelvic Organ Quantification (POP-Q) system. Recurrence was defined as a prolapse of ≥POP-Q stage II. Descriptive analyses and multivariate log binomial regression were performed to determine risk factors for recurrence.

RESULTS

Of the 140 participants enrolled, 127 (90.7%) completed the follow-up at 1 year. The recurrence rate was 25.2% (32 out of 127). Most (56.3%) of the recurrences occurred in the anterior compartment and in the same site previously operated. Women aged <60 years (RR = 2.34; 95% CI: 1.16-4.72; p = 0.018) and those who had postoperative vaginal cuff infection (RR = 2.54; 95% CI: 1.5-4.3; p = 0.001) were at risk of recurrence.

CONCLUSION

Recurrence of POP was common. Younger women, and those with postoperative vaginal cuff infection, were more likely to experience recurrent prolapse after vaginal repair.