Currently with Acasus, Karachi, Pakistan.
Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom.
PLoS One. 2022 Jul 15;17(7):e0271617. doi: 10.1371/journal.pone.0271617. eCollection 2022.
Incontinence is a complex health and social issue, which involves the involuntary loss of urine or faeces or both. Individuals with disabilities are particularly vulnerable to incontinence. The management of incontinence has largely been overlooked in low and middle-income settings (LMICs). This study aimed to explore the incontinence management strategies employed by disabled people with severe incontinence and their caregivers in Sindh Province, Pakistan.
Incontinence management was explored through in-depth interviews with people with incontinence (PWI) and their caregivers, photovoice, and a market survey and product attribute assessment. Data was analysed thematically through inductive coding and evaluated against existing disability and caregiver frameworks.
Incontinence management affected all aspects of daily life for PWI and caregivers. Effective management of incontinence was prioritised because caregivers viewed it to be part of their familial duty and a requirement for the household to remain pure in the eyes of God. Coping strategies included strict adherence to routines, reducing food and drink intake, creative uses of locally available natural resources, and a heavy reliance on soap and water for maintaining hygiene. Products such as adult diapers were largely unavailable, costly and were not deemed suitable for regular use. There were no social or medical interventions in the region to support incontinence management. The main impacts of incontinence on the household were social isolation, stigma, role shifts within the family, the development of physical ailments among caregivers, and decreased income.
The complex health, psychological, social, economic, and cultural impacts of incontinence are exacerbated in LMICs due a lack of recognition of the condition, the absence of social or medical interventions and limited access to basic WASH infrastructure, and assistive devices or products. Appropriate solutions need to be developed in partnership with PWI and caregivers and need to be contextualised, affordable and sustainable.
尿失禁是一个复杂的健康和社会问题，涉及到尿液或粪便或两者的无意识流失。残疾人尤其容易受到尿失禁的影响。在中低收入国家（LMICs），尿失禁的管理在很大程度上被忽视了。本研究旨在探讨巴基斯坦信德省严重尿失禁的残疾人和他们的照顾者所采用的尿失禁管理策略。
通过对尿失禁者（PWI）及其照顾者进行深入访谈、摄影和市场调查以及产品属性评估，探讨了尿失禁管理策略。通过归纳编码对数据进行分析，并根据现有的残疾人和照顾者框架进行评估。
尿失禁管理影响了 PWI 和照顾者日常生活的方方面面。有效的尿失禁管理被优先考虑，因为照顾者认为这是他们家庭责任的一部分，也是家庭在上帝眼中保持纯洁的要求。应对策略包括严格遵守日常生活规律、减少食物和饮料的摄入、创造性地利用当地可获得的自然资源，以及大量使用肥皂和水来保持卫生。产品，如成人尿布，在该地区基本上无法获得、昂贵，并且不被认为适合经常使用。该地区没有社会或医疗干预措施来支持尿失禁管理。尿失禁对家庭的主要影响是社会孤立、耻辱感、家庭角色转变、照顾者身体不适以及收入减少。
由于对该疾病缺乏认识、缺乏社会或医疗干预以及基本的 WASH 基础设施、辅助设备或产品的获取有限，中低收入国家的尿失禁的复杂的健康、心理、社会、经济和文化影响更加严重。需要与 PWI 和照顾者合作制定适当的解决方案，并使其具有针对性、负担得起和可持续性。
