Determinants of pelvic organ prolapse among gynecologic patients in Bahir Dar, North West Ethiopia: a case–control study

Abstract

IntroductionPelvic organ prolapse (POP) is a significant public health problem in developing countries including Ethiopia. However, less has been documented on risk factors of POP. Therefore, the aim of this study was to identify the determinants factors of POP.MethodsAn unmatched case–control study was conducted among gynecologic patients in Bahir Dar city, North West Ethiopia, from July to October 2014. A total of 370 women (selected from outpatient departments) were included in the study. Cases (clients with stage III or IV POP) and controls (who declared free of any stages of POP) were identified by physicians using the Pelvic Organ Prolapse Quantitative Examination tool. Data analysis was carried out by SPSS version 20.0. Descriptive, bivariate, and multivariable logistic regression analyses were performed. Statistical differences were considered at P<0.05, and the strength of association was assessed by odds ratio (OR) and respective confidence intervals (CIs).ResultsThis study revealed that determinants such as age of women (>40 years) (adjusted OR [AOR] =3.0 [95% CI: 1.59–5.89]), sphincter damage (AOR =8.1 [95% CI: 1.67–39.7]), family history of POP (AOR =4.9 [95% CI: 1.94–12.63]), parity (≥4) (AOR =4.5 [95% CI: 2.26–9.10]), nonattendance of formal education (AOR =4.3 [95% CI: 1.25–14.8]), carrying heavy objects (AOR =3.1 [95% CI: 1.56–6.30]), body mass index (BMI) <18.5 kg/m2 (AOR =3.1 [95% CI: 1.22–7.82]), and delivery assisted by nonhealth professionals (AOR =2.6 [95% CI: 1.24–5.56]) were significantly associated with POP.ConclusionIn our study, sphincter damage, family history of POP, being uneducated, having ≥4 vaginal deliveries, carrying heavy objects, BMI <18.5 kg/m2, age ≥40 years, and having delivery assisted by nonhealth professional were the independent determinants of POP. Therefore, skilled delivery, further promoting family planning and girls’ education, early pelvic floor assessment, and counseling on avoidance of carrying heavy objects are recommended.

Determinants of Utero-vaginal prolapse in Western Ethiopia

“…Different studies reported that the risk of UVP increases with age [7,13,15,26,28]. This study also revealed that women aged ≥40 years had 10.49 times higher odds of experiencing UVP compared to women aged <40 years.…”

“…Con dence level 95%, power 80%, control to case ratio of 3: 1, the proportion of controls with exposure 6.2%, the proportion of cases with exposure 18.5%, and Odd Ratio of 3.1. It was calculated from the study conducted in Bahir Dar town, North West Ethiopia by taking BMI (< 18.5 kg/m 2 ) as one of the main exposure variables for pelvic organ prolapse that provide the maximum sample size [13]. Therefore, it yields 78 cases and 232 controls.…”

“…Data on socio-demographic, obstetric, gynecologic, and medical history were collected by using a pretested structured interviewer-administered questionnaire which was developed by reviewing different literatures [13,27,30,31,32]. Four BSc nurses and two MSc supervisors were recruited and trained for data collection.…”

“…A review of the literature around the world revealed different factors for the development of uterovaginal prolapse. The most important once are factors that increase intra-abdominal pressure, di cult labor and delivery, malnutrition, old age, connective tissue disorders, heavy exercise, and pelvic trauma [7,[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29].…”

Pelvic Organ Prolapse- A Concern

“…It showed that women in the premenopausal age group opted more commonly for surgical treatment when compared to post-menopausal group and this difference was statistically significant with a p value of <0.05 (Table 5 3 in their unmatched controlled study found that age more than 40 years was independent risk factor for POP. This was consistent with our finding that most of our women belonged to the age group of 40 years and above.…”