Uterine Prolapse in Nepal

Abstract

BACKGROUND: Uterine prolapse is a significant public health problem in Nepal. The United Nations Population Fund reported a global prevalence between 2% to 20% in 2006 and approximately 10% for Nepali women. The aim of this study is to explore the prevalence of self-reported uterine prolapse in Nepal currently and determine the unmet surgical need. METHODS: A countrywide survey was done in Nepal using the Surgeons OverSeas Assessment of Surgical Need in May to June 2014. The two-stage cluster sampling was done randomly and population-weighted. χ2 tests and logistic regression assessed the associations. RESULTS: A total of 2,695 individuals (1,259 female) were surveyed, with a response rate of 97%; 957 (76%) women older than 18 years of age were used for this analysis. Fifty women stated they had experienced “something coming out of their vagina” (5.2%, 95% confidence interval [CI] 3.9–6.8%). The average parity and average age of first childbirth were 3.18 years (standard deviation [SD] 1.49) and 20.2 (SD 4.13) years, respectively. Of the 50 respondents, 20 (40%) reported urinary incontinence and 14 (28%) reported a chronic cough. Medical consultation occurred for 21 (42%) women with a prolapse, and two of those underwent major surgery, whereas 29 (58%) sought no health care at all. In adjusted regression analysis, the odds of prolapse in women with incontinence was 10.88 (P<.001, CI 5.10–23.23) and 3.52 in women with a history of chronic cough (P=.017, CI 1.24–9.93). CONCLUSION: Our estimation of uterine prolapse is 5.2%; these patients have high unmet need for evaluation and possible surgery.