Urinary incontinence (UI) represents a significant health concern, particularly for women in developing countries, impacting their economic well-being and quality of life. Despite its importance, a comprehensive understanding of UI prevalence and its subtypes across these regions remains limited. The recent systematic review and meta-analysis reported that the total prevalence of UI was 25.7% (95% CI: 22.3-29.5) and the prevalence rates for stress, urgency, and mixed UI were 12.6% (95% CI: 10.3-15.4), 5.3% (95% CI: 3.4-8.3), and 9.1% (95% CI: 7.0-11.8), respectively. The primary aim of this updated systematic review and meta-analysis study is to determine the pooled prevalence of overall UI and its subtypes in adult women living in developing countries based on population-based studies.

A comprehensive search strategy was executed across electronic databases, including PubMed, Medline, Web of Science, Scopus, and Google Scholar, to identify relevant population-based studies. To ensure comprehensiveness, we also incorporated data from our previous project conducted up to 2020. The inclusion criteria were studies reporting the prevalence of UI or its subtypes in adult women (aged ≥18 years, unless specified otherwise in the original study and justified) residing in developing countries, utilizing population-based methodologies. Studies focusing on specific populations (e.g., pregnant women, postpartum women with recent delivery, or those with specific medical conditions) were excluded. The methodological quality of included studies was critically appraised using the standardized Joanna Briggs Institute Meta‐Analysis of Statistics, Evaluation, and Review Instrument (JBI MASTARI). Meta-analysis was performed using a random-effects model to account for potential heterogeneity across studies. Subgroup analyses were conducted to explore the influence of factors such as recall period (e.g., past 3 months, past 12 months), study quality, and the use of validated versus non-validated questionnaires on the reported prevalence rates.

A total of 153 population-based studies, encompassing data from 306582 women aged 10 to 90 years across various developing countries, met the inclusion criteria for this meta-analysis. The reported prevalence of overall UI exhibited substantial heterogeneity, ranging from a low of 11.9% in Indonesia to a high of 64.1% in Jordan. The pooled prevalence of overall UI in adult women residing in developing countries was estimated to be 31.2% (95% Confidence Interval [CI]: 29 -33.4). Subtype-specific analyses revealed pooled prevalence rates of 20.7% (95% CI: 18.6-23.1) for stress UI, 13.1% (95% CI: 10.5-16.2) for urgency UI, and 17.8% (95% CI: 14.9-21) for mixed UI. Subgroup analysis based on the recall period demonstrated a significant impact on prevalence estimates, with higher rates reported for shorter recall periods (e.g., 46.8% for UI in the past 3 months) compared to longer periods (e.g., 25.6% for UI in the past 12 months). Furthermore, the study quality and the utilization of validated questionnaires appeared to have a modest influence on the reported prevalence rates, with studies of higher quality and those employing validated questionnaires tending to report slightly higher (34%) prevalence compared to those of lower quality or using non-validated questionnaires (27%).

The high pooled prevalence of UI underscores its significant burden among adult women in developing countries. The substantial variation across countries suggests the influence of diverse factors. Higher prevalence with shorter recall periods indicates potential recall bias. The modest impact of study quality and questionnaire validation highlights the need for methodological rigor. The considerable prevalence of all UI subtypes necessitates targeted interventions.

This meta-analysis reveals a substantial public health issue of UI among women in developing countries, with significant heterogeneity. Standardized, large-scale international population-based studies with validated methodologies and consistent recall periods are crucial for accurate prevalence estimation. These studies are essential to inform effective preventive healthcare programs and improve the quality of life for affected women.

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