Prevalence and risk factors for pelvic organ prolapse in Kilimanjaro, Tanzania: A population based study in Tanzanian rural community

Abstract

IntroductionThe prevalence and risk-factors of pelvic organ prolapse (POP) in Tanzania are unknown. To help elucidate the problem, we assessed POP and associated risk-factors among Tanzanian women by deploying the POP-Q classification system.MethodA cross sectional community based study conducted in Hai, Rombo and Same Districts, Kilimanjaro Region, Tanzania. Women aged 18–90 were recruited through multi-stage random sampling from January to May 2015. Home-based questionnaire interviews were performed and the women were subsequently invited to the nearest health clinic for pelvic examination. Trained physicians used the POP-Q classification system to assess the POP stage.ResultsA total of 1195 women were interviewed and invited for pelvic examination; 1063(89%) women presented at the clinic of whom 1047(88%) accepted a clinical examination. Of 1047 examined women, 64.6% had an anatomical POP stage II–IV and 6.7% had a severe POP that descended 1 cm or more below the hymen. POP stage II–IV was associated with being aged 35+ years, being a farmer, doing petty trading and having delivered 3 times or more. Severe POP was associated with carrying heavy objects for ≥ 5 hours (OR 4.70;1.67–13.2), having delivered 5 times or more (OR 10.2;2.22–48.6) and having delivered at home (OR 2.40;1.36–4.22).ConclusionPOP is a common condition among rural Tanzanian women where 64.6% are having POP grade II-IV and 6.7% are having a severe POP descending 1 cm or more below the hymen. Risk-factors are increasing age, heavy lifting, high parity and home-delivery.

Prevalence of pelvic organ prolapse in women, associated factors and impact on quality of life in rural Pakistan: population-based study.

“…The mean age of the women with POP in this study was 37.6 years with a mean parity of 5.5 births. Increasing age and parity were identified as risk factors for POP in our study and this is consistent with other studies in LMICs 11,14,[16][17][18] as well as in developed countries 1,[19][20] .…”

“…However, a community based survey of 1034 women in rural Gambia, reported a much higher rate of 46% 16 . A much higher prevalence of POP 64.6% was reported from the most recent study on this topic in LMICs from rural Tanzania 10 . Two other recent studies both from Ethiopia reported differing prevalence .One included 395 women who completed a questionnaire and 294 of these women had a clinical examination in the questionnaire symptomatic pelvic organ prolapse (do you have a feeling of bulging/pressure or something seems to be coming down through the vagina or do you have a visible mass protruding via the vagina) was 6.3% but when women were examined 55.1% had anatomical prolapse stage II-IV 8 .…”

“…Well established risk factors for POP, mainly based on data from HICs are older age 1 , pregnancy and vaginal delivery, high parity and obesity 8 , with others less consistently demonstrated including, early age at first delivery, forceps delivery, prolonged second stage of labour 10 , carrying heavy objects or doing heavy work and high infant birthweight 11 . The distribution of these various risk factors differs in low and middle relative to high income countries, for example, high parity and younger age at first delivery being generally more common, whilst forceps delivery and caesarean section are less common.…”

Uterine prolapse and associated factors among reproductive age women in Dawro zone, southwest Ethiopia: a community based cross sectional study

“…Since ethnicity and anemia were the main risk factors reported in Gambia the higher prevalence of UP compared with this study might be because of the socio-cultural and ethnicity variation between the ethnic groups of the two different countries. In addition, the study in Tanzania reports 64.6% prevalence of anatomical prolapse which is substantially higher when compared to the reports of this study with 5.9% anatomical prolapse [12]. However, both studies share home delivery as a strongest risk factor in common.…”

“…The burden of UP in low-income countries is expected to be worse than that of developed countries given the low level of awareness of women in developing countries. [10][11][12].…”