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      Uterine prolapse and its impact on quality of life in the Jhaukhel–Duwakot Health Demographic Surveillance Site, Bhaktapur, Nepal

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          Abstract

          Background

          Uterine prolapse (UP) is a reproductive health problem and public health issue in low-income countries including Nepal.

          Objective

          We aimed to identify the contributing factors and stages of UP and its impact on quality of life in the Jhaukhel–Duwakot Health Demographic Surveillance Site of Bhaktapur, Nepal.

          Design

          Our three-phase study used descriptive cross-sectional analysis to assess quality of life and stages of UP and case–control analysis to identify contributing factors. First, a household survey explored the prevalence of self-reported UP (Phase 1). Second, we used a standardized tool in a 5-day screening camp to determine quality of life among UP-affected women (Phase 2). Finally, a 1-month community survey traced self-reported cases from Phase 1 (Phase 3). To validate UP diagnoses, we reviewed participants’ clinical records, and we used screening camp records to trace women without UP.

          Results

          Among 48 affected women in Phase 1, 32 had Stage II UP and 16 had either Stage I or Stage III UP. Compared with Stage I women (4.62%), almost all women with Stage III UP reported reduced quality of life. Decreased quality of life correlated significantly with Stages I–III. Self-reported UP prevalence (8.7%) included all treated and non-treated cases. In Phase 3, 277 of 402 respondents reported being affected by UP and 125 were unaffected. The odds of having UP were threefold higher among illiterate women compared with literate women (OR=3.02, 95% CI 1.76–5.17), 50% lower among women from nuclear families compared with extended families (OR=0.56, 95% CI 0.35–0.90) and lower among women with 1–2 parity compared to >5 parity (OR=0.33, 95% CI 0.14–0.75).

          Conclusions

          The stages of UP correlated with quality of life resulting from varied perceptions regarding physical health, emotional stress, and social limitation. Parity, education, age, and family type associated with UP. Our results suggest the importance of developing policies and programs that are focused on early health care for UP. Through family planning and health education programs targeting women, as well as women empowerment programs for prevention of UP, it will be possible to restore quality of life related to UP.

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          Purposeful selection of variables in logistic regression

          Zoran Bursac, C Gauss, David Williams … (2008)
          Background The main problem in many model-building situations is to choose from a large set of covariates those that should be included in the "best" model. A decision to keep a variable in the model might be based on the clinical or statistical significance. There are several variable selection algorithms in existence. Those methods are mechanical and as such carry some limitations. Hosmer and Lemeshow describe a purposeful selection of covariates within which an analyst makes a variable selection decision at each step of the modeling process. Methods In this paper we introduce an algorithm which automates that process. We conduct a simulation study to compare the performance of this algorithm with three well documented variable selection procedures in SAS PROC LOGISTIC: FORWARD, BACKWARD, and STEPWISE. Results We show that the advantage of this approach is when the analyst is interested in risk factor modeling and not just prediction. In addition to significant covariates, this variable selection procedure has the capability of retaining important confounding variables, resulting potentially in a slightly richer model. Application of the macro is further illustrated with the Hosmer and Lemeshow Worchester Heart Attack Study (WHAS) data. Conclusion If an analyst is in need of an algorithm that will help guide the retention of significant covariates as well as confounding ones they should consider this macro as an alternative tool.
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            Pelvic organ prolapse and incontinence in developing countries: review of prevalence and risk factors.

            P Gunasekera, Godfrey J A Walker (2011)
            Information on the prevalence, risk factors and social consequences of pelvic floor dysfunction (PFD) affecting women in 16 low-income and lower middle-income countries is reviewed. Medline searches were performed for articles dealing with prevalence of PFD. Thirty studies were identified. The mean prevalence for pelvic organ prolapse was 19.7% (range 3.4-56.4%), urinary incontinence (UI) was 28.7% (range 5.2-70.8%) and faecal incontinence (FI) was 6.9% (range 5.3-41.0%). Risk factors for PFD are similar to those in more affluent countries particularly increased age and parity, but additionally, PFD is associated with other factors including poor nutrition and heavy work. The social consequences of PFD conditions can be devastating. Pelvic organ prolapse and urinary and faecal incontinence are significant problems in developing countries. Access to health care to manage these conditions is often limited, and women usually have to live with the consequences for the rest of their lives.
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              Nepal Demographic and Health Survey, 2011

              ERAN MoHP (2011)
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                Author and article information

                Journal
                Journal ID (nlm-ta): Glob Health Action
                Journal ID (iso-abbrev): Glob Health Action
                Journal ID (publisher-id): GHA
                Title: Global Health Action
                Publisher: Co-Action Publishing
                ISSN (Print): 1654-9716
                ISSN (Electronic): 1654-9880
                Publication date (Electronic): 10 August 2015
                Publication date Collection: 2015
                Volume: 8
                Electronic Location Identifier: 10.3402/gha.v8.28771
                Affiliations
                [1 ]Department of Community Medicine and Public Health, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
                [2 ]Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
                [3 ]Health Metrics, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
                [4 ]School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
                [5 ]Department of Biomedicine and Public Health, School of Health and Education, University of Skövde, Skövde, Sweden
                [6 ]Department of Community Medicine, Faculty of Health Sciences, The Arctic University of Norway, Tromsø, Norway
                Author notes
                [* ]Correspondence to: Binjwala Shrestha, Department of Community Medicine and Public Health, Institute of Medicine, Tribhuvan University, Maharajgunj Medical Campus, Maharajgunj, Kathmandu 44600, Nepal, Email: binjwala.shrestha@ 123456gu.se

                Responsible Editor: Stig Wall, Umeå University, Sweden.

                Article
                Publisher ID: 28771
                DOI: 10.3402/gha.v8.28771
                PMC ID: 4532727
                PubMed ID: 26265389
                SO-VID: 1933bf5e-2a38-4b94-a70c-67f232fe10ec
                Copyright © © 2015 Binjwala Shrestha et al.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 International License, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for any purpose, even commercially, provided the original work is properly cited and states its license.

                History
                Date received : 05 June 2015
                Date revision received : 13 July 2015
                Date accepted : 13 July 2015
                Categories
                Subject: Original Article

                ScienceOpen disciplines: Health & Social care
                Keywords: uterine prolapse,quality of life,health demographic surveillance site,nepal
                Data availability:
                ScienceOpen disciplines: Health & Social care
                Keywords: uterine prolapse, quality of life, health demographic surveillance site, nepal

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