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Pelvic organ prolapse in Northwest Ethiopia: a population-based study

  • Original Article
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Abstract

Introduction and hypothesis

Epidemiological studies aimed at pelvic organ prolapse and its risk factors can help to identify women at a higher risk and therefore promote prevention strategies. We aimed to assess the prevalence of and factors associated with symptomatic prolapse.

Methods

A community-based study was conducted in Dabat district, Northwest Ethiopia. Initially, women were interviewed on their prolapse symptoms using validated questionnaires at their home. Subsequently, they were invited for pelvic examination and examined by gynecologists using the simplified pelvic organ prolapse quantification. Symptomatic prolapse was assessed by pelvic examination findings and patient-reported symptoms. Multivariate logistic regression was used to assess the factors associated with symptomatic prolapse.

Results

A total of 880 women were interviewed and invited for pelvic examination, of whom 824 (93.6%) showed up for examination. Of the 824 women examined, 464 (56.3%) had POP stages II–IV and 145 (17.6%) had POP stages III–IV. The overall prevalence of symptomatic prolapse was 46.7% (217 out of 464). Of these, 41.0%, 42.8%, and 3.2% accounted for stage II, III, and IV respectively. Increasing age, multiparity, and heavy lifting/carrying significantly increased the odds of developing symptomatic prolapse.

Conclusions

Symptomatic prolapse affects a substantial proportion of women in the study area and increased with age. Multiparity and carrying heavy objects are associated with prolapse, all of which have the potential to be modified. More attention is needed to improve prevention, diagnosis, and treatment services to mitigate the health burden of these at-risk women.

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Data availability

The raw data supporting the findings presented in the current study are available from the corresponding author upon request.

Abbreviations

CI:

Confidence interval

HDSS:

Health and Demographic Surveillance System

IQR:

Interquartile range

LMICs:

Low and middle income countries

OR:

Odds ratio

POP:

Pelvic organ prolapse

POP-SS:

Pelvic organ prolapse symptom score

QoL:

Quality of life

SPOP-Q:

Simplified Pelvic Organ Prolapse Quantification

sPOP:

Symptomatic pelvic organ prolapse

References

  1. Doaee M, Moradi-Lakeh M, Nourmohammadi A, Razavi-Ratki SK, Nojomi M. Management of pelvic organ prolapse and quality of life: a systematic review and meta-analysis. Int Urogynecol J. 2014;25:153–63. https://doi.org/10.1007/s00192-013-2141-8.

    Article  PubMed  Google Scholar 

  2. Walker GJ, Gunasekera P. Pelvic organ prolapse and incontinence in developing countries: review of prevalence and risk factors. Int Urogynecol J. 2011;22:127–35. https://doi.org/10.1007/s00192-010-1215-0.

    Article  PubMed  Google Scholar 

  3. Rortveit G, Brown JS, Thom DH, Van Den Eeden SK, Creasman JM, Subak LL. Symptomatic pelvic organ prolapse: prevalence and risk factors in a population-based, racially diverse cohort. Obstet Gynecol. 2007;109:1396–403. https://doi.org/10.1097/01.AOG.0000263469.68106.90.

    Article  PubMed  Google Scholar 

  4. Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol. 1997;89(4):501–6.

    CAS  PubMed  Google Scholar 

  5. Barber MD, Maher C. Epidemiology and outcome assessment of pelvic organ prolapse. Int Urogynecol J. 2013;24(11):1783–90.

    PubMed  Google Scholar 

  6. Khadzhieva MB, Kolobkov DS, Kamoeva SV, Salnikova LE. Expression changes in pelvic organ prolapse: a systematic review and in silico study. Sci Rep. 2017;7(1):7668.

    PubMed  PubMed Central  Google Scholar 

  7. Adefris M, Abebe SM, Terefe K, Gelagay AA, Adigo A, Amare S, et al. Reasons for delay in decision making and reaching health facility among obstetric fistula and pelvic organ prolapse patients in Gondar University hospital, Northwest Ethiopia. BMC Womens Health. 2017;17(1):64.

    PubMed  PubMed Central  Google Scholar 

  8. Gjerde JL, Rortveit G, Muleta M, Adefris M, Blystad A. Living with pelvic organ prolapse: voices of women from Amhara region, Ethiopia. Int Urogynecol J. 2017;28:361–6. https://doi.org/10.1007/s00192-016-3077-6.

    Article  PubMed  Google Scholar 

  9. Islam RM, Oldroyd J, Rana J, Romero L, Karim MN. Prevalence of symptomatic pelvic floor disorders in community-dwelling women in low and middle-income countries: a systematic review and meta-analysis. Int Urogynecol J. 2019;30:2001-11.

    PubMed  Google Scholar 

  10. Vergeldt TFM, Weemhoff M, IntHout J, Kluivers KB. Risk factors for pelvic organ prolapse and its recurrence: a systematic review. Int Urogynecol J. 2015;26(11):1559–73. https://doi.org/10.1007/s00192-015-2695-8.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Giri A, Hartmann KE, Hellwege JN, Velez Edwards DR, Edwards TL. Obesity and pelvic organ prolapse: a systematic review and meta-analysis of observational studies. Am J Obstet Gynecol. 2017;217(1):11–26. https://doi.org/10.1016/j.ajog.2017.01.039.

    Article  PubMed  Google Scholar 

  12. DeLancey JO, Low LK, Miller JM, Patel DA, Tumbarello JA. Graphic integration of causal factors of pelvic floor disorders: an integrated life span model. Am J Obstet Gynecol. 2008;199(6):610.e1–5.

    Google Scholar 

  13. Megabiaw B, Adefris M, Rortveit G, Degu G, Muleta M, Blystad A, et al. Pelvic floor disorders among women in Dabat district, Northwest Ethiopia: a pilot study. Int Urogynecol J. 2013;24(7):1135–43.

    PubMed  Google Scholar 

  14. Dheresa M, Worku A, Oljira L, Mengiste B, Assefa N, Berhane Y. One in five women suffer from pelvic floor disorders in Kersa district eastern Ethiopia: a community-based study. BMC Womens Health. 2018;18(1):95. https://doi.org/10.1186/s12905-018-0585-1.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Ballard K, Ayenachew F, Wright J, Atnafu H. Prevalence of obstetric fistula and symptomatic pelvic organ prolapse in rural Ethiopia. Int Urogynecol J. 2016;27(7):1063–7. https://doi.org/10.1007/s00192-015-2933-0.

    Article  PubMed  Google Scholar 

  16. Ethiopia CSAo (2016) Ethiopia Demographic and Health Survey 2016. Addis Ababa, Ethiopia, and Rockville, Maryland, USA: CSA and ICF. https://dhsprogram.com/pubs/pdf/FR328/FR328.pdf

  17. Assefa Y, Van Damme W, Williams OD, Hill PS. Successes and challenges of the millennium development goals in Ethiopia: lessons for the sustainable development goals. BMJ Glob Health. 2017;2(2):e000318.

    PubMed  PubMed Central  Google Scholar 

  18. Blystad A, Rortveit G, Gjerde JL, Muleta M, Moland KM. Strengthening validity in studies of pelvic floor disorders through qualitative research: an example from Ethiopia. Int Urogynecol J. 2018;29(5):679–84.

    PubMed  Google Scholar 

  19. Hagen S, Glazener C, Sinclair L, Stark D, Bugge C. Psychometric properties of the pelvic organ prolapse symptom score. BJOG. 2009;116:25–31. https://doi.org/10.1111/j.1471-0528.2008.01903.x.

    Article  CAS  PubMed  Google Scholar 

  20. Belayneh T, Gebeyehu A, Adefris M, Rortveit G, Genet T. Validation of the Amharic version of the pelvic organ prolapse symptom score (POP-SS). Int Urogynecol J. 2018;30:149-56. https://doi.org/10.1111/j.1471-0528.2008.01903.x.

    Article  PubMed  Google Scholar 

  21. Scherf C, Morison L, Fiander A, Ekpo G, Walraven G. Epidemiology of pelvic organ prolapse in rural Gambia, West Africa. BJOG. 2002;109(4):431–6.

    PubMed  Google Scholar 

  22. Manonai J, Mouritsen L, Palma P, Contreras-Ortiz O, Korte JE, Swift S. The inter-system association between the simplified pelvic organ prolapse quantification system (S-POP) and the standard pelvic organ prolapse quantification system (POPQ) in describing pelvic organ prolapse. Int Urogynecol J. 2011;22:347–52. https://doi.org/10.1007/s00192-010-1286-y.

    Article  PubMed  Google Scholar 

  23. Swift S, Woodman P, O’Boyle A, Kahn M, Valley M, Bland D, et al. Pelvic organ support study (POSST): the distribution, clinical definition, and epidemiologic condition of pelvic organ support defects. Am J Obstet Gynecol. 2005;192(3):795–806. https://doi.org/10.1016/j.ajog.2004.10.602.

    Article  PubMed  Google Scholar 

  24. Gutman RE, Ford DE, Quiroz LH, Shippey SH, Handa VL. Is there a pelvic organ prolapse threshold that predicts pelvic floor symptoms? Am J Obstet Gynecol. 2008;199(6):683.e1–7. https://doi.org/10.1016/j.ajog.2008.07.028.

    Article  Google Scholar 

  25. Barber MD. Pelvic organ prolapse. BMJ. 2016;354:i3853.

    PubMed  Google Scholar 

  26. Masenga GG, Shayo BC, Rasch V. Prevalence and risk factors for pelvic organ prolapse in Kilimanjaro, Tanzania: a population based study in Tanzanian rural community. PLoS One. 2018;13(4):e0195910.

    PubMed  PubMed Central  Google Scholar 

  27. Li Z, Xu T, Li Z, Gong J, Liu Q, Zhu L. An epidemiologic study of pelvic organ prolapse in rural Chinese women: a population-based sample in China. Int Urogynecol J. 2019;30:1925-32.

    PubMed  Google Scholar 

  28. Giday M, Teklehaymanot T, Animut A, Mekonnen Y. Medicinal plants of the Shinasha, Agew-awi and Amhara peoples in Northwest Ethiopia. J Ethnopharmacol. 2007;110(3):516–25.

    PubMed  Google Scholar 

  29. Wusu-Ansah OK, Opare-Addo HS. Pelvic organ prolapse in rural Ghana. Int J Gynaecol Obstet. 2008;103(2):121–4. https://doi.org/10.1016/j.ijgo.2008.06.014.

    Article  PubMed  Google Scholar 

  30. Nygaard I, Barber MD, Burgio KL, Kenton K, Meikle S, Schaffer J, et al. Prevalence of symptomatic pelvic floor disorders in US women. JAMA. 2008;300(11):1311–6. https://doi.org/10.1001/jama.300.11.1311.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Swift SE, Tate SB, Nicholas J. Correlation of symptoms with degree of pelvic organ support in a general population of women: what is pelvic organ prolapse? Am J Obstet Gynecol. 2003;189(2):372–7; discussion 377-379.

    PubMed  Google Scholar 

  32. Ghetti C, Gregory WT, Edwards SR, Otto LN, Clark AL. Pelvic organ descent and symptoms of pelvic floor disorders. Am J Obstet Gynecol. 2005;193(1):53–7.

    PubMed  Google Scholar 

  33. Rortveit G, Hannestad YS. Association between mode of delivery and pelvic floor dysfunction. Tidsskr Nor Laegeforen. 2014;134(19):1848–52. https://doi.org/10.4045/tidsskr.13.0860.

    Article  PubMed  Google Scholar 

  34. Quiroz LH, Muñoz A, Shippey SH, Gutman RE, Handa VL. Vaginal parity and pelvic organ prolapse. J Reprod Med. 2010;55(3–4):93.

    PubMed  PubMed Central  Google Scholar 

  35. Asresie A, Admassu E, Setegn T. Determinants of pelvic organ prolapse among gynecologic patients in Bahir Dar, north West Ethiopia: a case-control study. Int J Womens Health. 2016;8:713–9. https://doi.org/10.2147/IJWH.S122459.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Akmel M, Segni H. Pelvic organ prolapse in Jimma university specialized hospital, Southwest Ethiopia. Ethiop J Health Sci. 2012;22:85–92.

    PubMed  PubMed Central  Google Scholar 

  37. Fantahun M, Berhane Y, Högberg U, Wall S, Byass P. Ageing of a rural Ethiopian population: who are the survivors? Public Health. 2009;123(4):326–30.

    CAS  PubMed  Google Scholar 

  38. Moges AG, Tamiya N, Yamamoto H. Emerging population ageing challenges in Africa: a case of Ethiopia. J Int Health. 2014;29(1):11–5.

    Google Scholar 

  39. Beard JR, Officer A, De Carvalho IA, Sadana R, Pot AM, Michel J-P, et al. The world report on ageing and health: a policy framework for healthy ageing. Lancet. 2016;387(10033):2145–54.

    PubMed  Google Scholar 

  40. Rahmanou P, Caudwell-Hall J, Kamisan Atan I, Dietz HP. The association between maternal age at first delivery and risk of obstetric trauma. Am J Obstet Gynecol. 2016;215(4):451 e451–7. https://doi.org/10.1016/j.ajog.2016.04.032.

    Article  Google Scholar 

  41. Woodman PJ, Swift SE, O’Boyle AL, Valley MT, Bland DR, Kahn MA, et al. Prevalence of severe pelvic organ prolapse in relation to job description and socioeconomic status: a multicenter cross-sectional study. Int Urogynecol J Pelvic Floor Dysfunct. 2006;17(4):340–5. https://doi.org/10.1007/s00192-005-0009-2.

    Article  PubMed  Google Scholar 

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Acknowledgements

We would like to thank all women in the Dabat HDSS site for participating in this study. We gratefully acknowledge all data collectors, supervisors, and data clerks for their contribution. We would also acknowledge Dr Tamiru Minwyelet for performing pelvic examinations; Women and Health Alliance International for covering the treatment costs of participants; the staff of the Department of Obstetrics and Gynecology for treating the participants at the UoG hospital and the staff of the Dabat HDSS site for their contribution in obtaining the sampling frame.

Funding

This study was funded by the Uuiversity of Gondar with the grant, reference number: O/VP/RCS/05/216/2017. The funding agency played no role in the study design, data collection, analysis, interpretation, or writing up of the manuscript.

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Authors and Affiliations

  1. Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, 196, Gondar, Ethiopia

    Tadesse Belayneh, Abebaw Gebeyehu & Tadesse Awoke

  2. Department of Gynecology and Obstetrics, School of Medicine, University of Gondar, Gondar, Ethiopia

    Mulat Adefris

  3. Research Group for General Practice, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway

    Guri Rortveit

  4. Research Unit for General Practice, Uni Research Health, Bergen, Norway

    Guri Rortveit

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  1. Tadesse Belayneh
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Contributions

T. Belayneh: project development, data collection, and analysis, manuscript writing; A. Gebeyehu: project development, data analysis, manuscript editing; M. Adefris: project development, data analysis, manuscript editing; G. Rortveit: project development, data analysis, manuscript editing; T. Awoke: project development, data analysis, manuscript editing. All authors contributed to the intellectual content of the manuscript.

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Correspondence to Tadesse Belayneh.

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The study was conducted in Gondar, Dabat District, Ethiopia

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Belayneh, T., Gebeyehu, A., Adefris, M. et al. Pelvic organ prolapse in Northwest Ethiopia: a population-based study. Int Urogynecol J 31, 1873–1881 (2020). https://doi.org/10.1007/s00192-019-04196-1

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  • DOI: https://doi.org/10.1007/s00192-019-04196-1

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