Hypothesis / aims of study
Pelvic floor disorders (PFDs) negatively affect physical, psychosocial, and economic wellbeing of women. In developing countries, less than a quarter of women with PFDs seek health care for their problem. Most often they seek care latterly when they fail to adapt with their problem. Lack of knowledge about PFDs, economic constraints, and cultural taboo attributed for not seeking health care. In Ethiopia, where only one third of women seek maternal health care, and have limited decision making power, health care seeking behaviors for PFDs, deterrents and factors associated to health care seeking is unknown. Therefore, this study aimed to assess health care seeking among women with pelvic floor disorder, identify factors associated with seeking care and explore the barriers against seeking care
Study design, materials and methods
We conducted a community based cross sectional study to identify PFDs and its associated factors among women living in Kersa Health Demography Surveillance System (HDSS) form August 10 to September 4, 2016. Study participants were selected through stratified multi stage sampling procedure and interviewed face to face with pretested questionnaire. To assess PFDs, a standardized data collection tool was customized and adapted from An International Urogynecologic Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female PFD. Socio-demography and obstetrics condition of study participants were also collected using a structured questionnaire adapted from a health related national survey. Seven hundred four participants with PFDs drawn from this large study to assess their care seeking behaviors. Poisson regression model with robust variance was used to investigate the association of the independent variable with health care seeking behaviors. The results are reported in crude and adjusted prevalence ratio with 95% confidence intervals.
Two hundred twenty five (32%; 95% CI: 26.8-35.5) women sought care for their PFDs. Majority 160 (71%) of them seek care from government health facilities. A fourth of women with urinary symptoms, two fifth of women with pelvic organ prolapse, and a tenth of women with anal incontinence sought health care for their problem (Table 1). Nearly half 208 (43.6%) of women who did not seek health care, mentioned lack of knowledge about PFDs treatment as deterrents of care seeking (Fig 1). Middle wealth index (Adjusted Prevalence Ratio (APR=1.4; 95% CI: 1.1, 1.8), autonomous decision making on own health (APR=1.3; 95% CI: 1.1, 1.7), longer existed PFDs (APR=1.5; 95% CI: 1.1, 2.2), and sever impact of PFDs on quality of life (APR=1.4; 95% CI:1.1, 1.9) were identified as associated factors for health care seeking.
Interpretation of results
This study demonstrated that a large number of women with PFDs suffer in silence without seeking help from somewhere else. Subsequently, PFDs impact on women’s wellbeing continued to be a toll on individual women, family members and causes loss of productivity in society. Women’s economic status, decision-making power, duration of PFDs, and PFD’s impact on quality of life were independently associated with health care seeking behaviors. Against Ethiopian national reproductive health strategy target of treating all (100%) women with pelvic floor disorder at hospitals, less than half seek health care, and 15.5% of them visited non-conventional care (traditional medicine) for their PFDs. services were also mentioned as reason not to seek care for PFDs. Women with PFDs in this setting are challenged with social taboos, lack of information about treatability of the symptoms, and their economic burden.