Women’s genital prolapse and incontinence, Gondar, Ethiopia LA Priority Setting Partnership

About the Priority Setting Partnership

The Gondar Priority Setting Partnership (PSP) is an initiative between the University of Gondar, College of medicine, the Department of Health Sciences, University of Leicester, and the College of Medicine and Health, University of Exeter. The three universities are developing a research programme to study the epidemiology and impact of pelvic organ prolapse and urinary incontinence among women living in Northern Ethiopia and to develop and evaluate conservative and surgical interventions for women which can be effectively delivered in community-based health care facilities.

Given the lack of widespread and well-organised primary health care facilities and the low educational attainment of the majority of women in rural Ethiopia, it seems imperative to explore the perceived treatment uncertainties and concerns of women and other stakeholders before planning and implementing major research projects. This PSP has the objective of identifying these uncertainties in partnership with women, their families and communities and professional stakeholder groups.

Some background

Although much is known about the aetiology, impact and treatment of pelvic floor disorders in the developed world, there is less published information regarding epidemiology or prevalence in low and middle income countries (LMIC). Two recent studies in Ethiopia report differing prevalence for women experience symptoms of any pelvic floor disorders of 12% and 20%(1, 2). Despite a majority of women in this Eastern Ethiopian population reporting symptoms of UI and POP to be severely distressing only a third of women had sought help. This is despite growing evidence that UI and POP have significant negative impacts on women’s lives, affecting daily activities and social roles and personal and sexual relationships. UI and POP are often perceived as an inevitable part of aging or result of childbirth and women “silently wait to heal” as reported in a qualitative study from North West Ethiopia(3, 4). Responses to poor knowledge and limited help seeking among women experiencing pelvic floor disorders are to increase education for women. However, the lack of effective care pathways for women in LMICs must also be addressed. Furthermore, access to surgical treatment is very limited given the number of available qualified health professionals and geographical and financial barriers for women(5).

References

  1. 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.
  2. Dheresa M, Worku A, Oljira L, Mengistie B, Assefa N, Berhane Y. Pelvic floor disorders associated with higher-level sexual dysfunction in the Kersa district, Ethiopia. Turkish journal of obstetrics and gynecology. 2018;15(4):210-6.
  3. Gjerde JL, Rortveit G, Muleta M, Blystad A. Silently waiting to heal. Experiences among women living with urinary incontinence in northwest Ethiopia. International Urogynecology Journal. 2013;24:953-8.
  4. Mendes A, Hoga L, Goncalves B, Silva P, Pereira P. Adult women's experiences of urinary incontinence: a systematic review of qualitative evidence. JBI Database System Rev Implement Rep. 2017;15(5):1350-408.
  5. 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.

The James Lind Alliance

The James Lind Alliance is a non-profit making initiative, established in 2004. It brings patients, carers and clinicians together in PSPs. These PSPs identify and prioritise the evidence uncertainties, or ‘unanswered questions’, that they agree are the most important for research in their topic area.

The National Institute for Health Research (NIHR) – coordinates the infrastructure of the JLA to oversee the processes for PSPs, based at the NIHR Evaluation, Trials and Studies Coordinating Centre (NETSCC), University of Southampton.

Further details about the JLA and PSPs are on the NIHR website.

Who we are

Complete the uncertainty questionnaire

If you have received an email from us inviting you to complete the uncertainty questionnaire, it is will be available here

Contact for more information

Prof Doug Tincello: dgt4@le.ac.uk
Dr Zelalem Mengistu: zm102@le.ac.uk