Assessing burden, risk factors, and perceived impact of uterine fibroids on women’s lives in rural Haiti: implications for advancing a health equity agenda, a mixed methods study

Abstract

Background Uterine fibroids, the most common cause of gynecologic surgery, have a reported lifetime cumulative incidence of 59% among Black women in the U.S. Uterine fibroids increase mortality, morbidity, and negatively impact the quality of women’s lives. To our knowledge, no study has been published in the literature about fibroids in Haiti. We conducted a mixed methods study to assess the burden and risk factors of uterine fibroids, as well as their effects on women’s quality of life. Methods A convergent mixed methods study was conducted between October 1, 2019 and January 31, 2020 at MUH’s (Mirebalais University Hospital) OB-GYN outpatient department. Quantitatively, in a cross-sectional study 211 women completed a structured questionnaire. In-depth interviews with a subset of 17 women with fibroids and 7 family members were implemented for the qualitative component. Descriptive statistics were calculated for clinical and social demographic variables. Logistic regression was performed to examine associations between fibroids and related risk factors. An inductive thematic process was used to analyze the qualitative data. A joint display technique was used to integrate the results. Results The prevalence of uterine fibroids was 60.1%. Anemia and infertility were the most frequent complications— 52.6% and 33.6%, respectively. Factors associated with uterine fibroids included income decline (OR = 4.7, 95% CI: 2.1–10.9, p = < 0.001), excessive expenses for transport (OR = 4.4, 95% CI: 1.6–12.4, p = 0.005), and family history with uterine fibroids (OR = 4.6, 95% CI: 1.6–13.6, p = 0.005). In contrast, higher level of education and presence of micro polycystic ovarian syndrome were found to be protective (OR = 0.3, 95% CI: 0.1–0.9, p = 0.021) and (OR = 0.2, 95% CI: 0.1–0.97, p = 0.044), respectively. Qualitative findings demonstrated that uterine fibroids deeply affected the quality of women’s lives. The concept of a poverty cycle of uterine fibroids emerged. Conclusions A vicious cycle of poverty and women’s experience with fibroids demonstrate the long-term struggle that women endure. Health system strengthening, social support, and economic improvement are keys to alleviate women’s suffering and promote social justice through access to adequate care for women with uterine fibroids in Haiti.

Global, regional, and national time trends in incidence, prevalence, years lived with disability for uterine fibroids, 1990-2019: An age- period-cohort analysis for the Global Burden of Disease 2019 study

“…Oftentimes, African women present late in the course of disease when broids have grown to unmanageable proportions and are causing debilitating health issues, such as severe hemorrhage and grave anemia. Not only that, lacking highly skilled experts, poor quality of services, unaffordable pharmaceutical costs and poor nutritional status together aggravates morbidity and mortality in African countries [29,30]. On this ground, education and increased awareness of the symptoms of uterine broids as well as international collaborations and support such as provide healthcare and transfer skills, medical supplies donation, facilities construction may ameliorate the current situation [29,31].…”

Delayed presentation of giant uterine fibroids in a Nigerian private specialist health facility

“…In a previous report by Millien et al, it was revealed that patients with fibroids may at times refuse surgery for fibroids because of the fear of losing their fertility, the reputation of the hospital and its personnel, the desire to be pregnant before surgery, the lack of income to look for care and peer advice. 11 Millien et al report concluded that “vicious cycle of poverty negatively impacts access to care for uterine fibroids.” 12…”

“…11 Millien et al report concluded that "vicious cycle of poverty negatively impacts access to care for uterine fibroids." 12 Ultrasound was the initial screening tool for uterine fibroids because it is non-invasive and cost-effective. 13,14 Ultrasound is easily available even in low-and middleincome settings and can be performed in out-patient basis.…”