Abstract
BackgroundUterine fibroids, the most common cause of gynecologic surgery, have a reported cumulative incidence of 59% among Black women in the U.S. Uterine fibroids negatively impact the quality of women’s lives. No study has been found 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.MethodsA 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 consecutively a structured questionnaire. In-depth interviews with 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.ResultsOf 193 women analyzed 116 had fibroids (60.1%). The mean age was 41.3. Anemia was the most frequent complication— 61 (52.6%). Compared to women without uterine fibroids, factors associated with uterine fibroids included income decline (AOR = 4.7, 95% CI: 2.1–10.9, p = < 0.001), excessive expenses for transport (AOR = 4.4, 95% CI: 1.6–12.4, p = 0.005), and family history with uterine fibroids (AOR = 4.6, 95% CI: 1.6–13.6, p = 0.005). In contrast, higher level of education and micro polycystic ovarian syndrome were associated with lower prevalence (AOR = 0.3, 95% CI: 0.1–0.9, p = 0.021) and (AOR = 0.2, 95% CI: 0.1–0.97, p = 0.044), respectively. The qualitative findings delineate how contextual factors such as health system failures, long wait times, gender inequality and poverty negatively affect the quality of women’s lives. The poverty cycle of uterine fibroids emerged.ConclusionsA vicious cycle of poverty negatively impacts access to care for uterine fibroids in Haiti. Health insurance, social support, and income generating activities may be keys to promote social justice through access to adequate care for women with uterine fibroids in Haiti.
Highlights
Uterine fibroids, the most common cause of gynecologic surgery, have a reported cumulative incidence of 59% among Black women in the U.S Uterine fibroids negatively impact the quality of women’s lives
A vicious cycle of poverty negatively impacts access to care for uterine fibroids in Haiti
Baird & all’s study indicated that cumulative incidence of premenopausal women with uterine fibroids by ultrasound screening was 59% among Black women compared to 43% among white women in the U.S [2]
Summary
The most common cause of gynecologic surgery, have a reported cumulative incidence of 59% among Black women in the U.S Uterine fibroids negatively impact the quality of women’s lives. 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. Uterine fibroids are benign tumors of the smooth muscle of the uterus and their burden across populations varies widely – with rates ranging from 4.5 to 68.6% [1]. The same study reported rates of uterine fibroids as high as greater than 80 and 70%, among Black and white women, respectively, by the age of fifty [2]. In Haiti as it is the case in other populations the rates of uterine fibroids have not been documented. Studies have identified a variety of risk factors for fibroids including age, race, family history, and comorbid conditions such as diabetes and hypertension [1, 3]. Fibroids – when left untreated – are associated with a number of debilitating complications such as acute or chronic pelvic pain, anemia, pyomyoma, hydronephrosis, and premature delivery as well as fetal intrauterine growth retardation [7,8,9,10,11]
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