Associated factors of pelvic organ prolapse among patients at Public Hospitals of Southern Ethiopia: A case-control study design

Determinants of pelvic organ prolapse among adult gynecologic patients in Mekelle University Ayder Comprehensive Specialized Hospital, Tigray, Ethiopia: Case control study design

BACKGROUND

Pelvic organ prolapse is a major cause of morbidity among women in both high-income and low-income countries. Despite the severity of the problem, the risk factors associated with pelvic organ prolapse has been poorly understood in Ethiopia mainly in the study area. Hence, the purpose of this study was to identify determinants of pelvic organ prolapse among adult gynecologic patients at Mekelle University Ayder Comprehensive Specialized Hospital.

OBJECTIVE

To identify determinants of pelvic organ prolapse among adult gynecologic patients in Mekelle University Ayder Comprehensive Specialized Hospital, Tigray, Ethiopia, 2024.

METHODS

Hospital-based case-control study design was conducted from March 01, 2024 to May 30, 2024. All cases diagnosed with pelvic organ prolapse were enrolled in the study. Then, 4:1 control-to-cases ratio was applied. Data were entered into Epi Data version 4.6 and analyzed using SPSS version 21. Figures and tables were used for descriptive statistics. Variables with P-value less than 0.2 during binary logistic regression were labeled as candidates for multivariable logistic regression to identify independent predictors of pelvic organ prolapse at p-value < 0.05. The overall model fitness was checked by Hosmer Lemeshow at a P-value > 0.05. Finally, variables with P-value less than 0.05 and a 95% confidence interval of adjusted odds ratio were considered significant factors for the determinants of pelvic organ prolapse.

RESULTS

A total of 478 participants were recruited with a 100% response rate for both cases and controls. Low income (AOR=3.3; 95% CI: 1.1-9.7), vaginal tear (AOR=6.6; 95% CI: 2.5-17.6), menopausal status (AOR=9.2, 95% CI:2.3-37.4), body mass index <18 kg/m2 (AOR=6.3, 95% CI: 2.7-14.4), body mass index ≥25 (AOR= 5.6, 95% CI: 1.5-21.2) and chronic constipation (AOR=6.4, 95% CI: 2.9-13.9) were identified as determinants of pelvic organ prolapse.

CONCLUSIONS

In this study, income of the participant, vaginal tear, menopausal status, body mass index (both underweight and overweight), and chronic constipation were factors found to be significantly associated with pelvic organ prolapse. Therefore, creating awareness about risk factors of pelvic organ prolapse, screening and early intervention, weight management program, and hormonal support is recommended.

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.

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.