Closing the gap: addressing delayed healthcare-seeking and improving quality of life for Ethiopian women with pelvic organ prolapse.

BACKGROUND

Pelvic organs prolapse (POP) involves the herniation of pelvic organs, such as the uterus, cervix, vaginal wall, bladder, and rectum, into the vagina. While it is a common gynecologic problem, its impact on quality of life and timely healthcare-seeking remains poorly understood in developing countries. This systematic review and meta-analysis aimed to assess the quality of life, delays in healthcare-seeking, and associated factors among women diagnosed with POP in Ethiopia.

METHODS

A systematic review and meta-analysis were conducted following PRISMA guidelines. Extensive literature searches were performed in PubMed, CINAHL, Google Scholar, ScienceDirect, and Scopus. A restricted maximum likelihood random-effects model was used to estimate pooled proportions. Heterogeneity among studies was assessed using the Cochrane Q-test and I2 statistics. Publication bias was evaluated using funnel plots and Egger's test. Stata 17 software was used for all analyses.

RESULTS

From an initial pool of 421 articles, 10 met the inclusion criteria, encompassing data from 1489 women diagnosed with POP. The pooled proportion of poor quality of life among women with POP in Ethiopia was 52.07 % [95 % C.I.: 48.04 %, 56.09 %]. Moderate heterogeneity was observed across studies. The mean delay between symptom onset and seeking medical care was 50.64 months [95 % C.I: 32.50, 68.79], with an estimated 78.22 % [95 % C.I.: 70.72 %, 85.72 %] of women experiencing delays in seeking healthcare. Postmenopausal status (OR = 2.05, 95 % CI: 1.22-3.45), living with POP for more than 2 years (OR = 4.17, 95 % CI: 1.23-14.10), and having Stage III/IV POP (OR = 4.48, 95 % CI: 1.61-12.44) associated with poor quality of life. In addition, factors associated with delayed healthcare seeking include: fear of disclosure (OR = 4.60, 95 % CI: 4.65-45.71), lack of social support (OR = 4.09, 95 % CI: 1.91-8.74), low income (OR = 4.80, 95 % CI: 2.12-10.86), and experiencing stigma (OR = 5.78, 95 % CI: 1.07-31.36).

CONCLUSION

This review highlights a high prevalence of poor quality of life and significant delays in healthcare-seeking among Ethiopian women with POP, with an average delay of over four years after symptom onset. Stigma, fear of disclosure, low income, and lack of social support were significantly associated with delays in seeking health care. Additionally, longer prolapse duration, menopause, and stage III or IV pelvic organ prolapse (POP) were significantly associated with a reduced quality of life.