WfWF data

From 2003 onwards, WfWF organised, in collaboration with District Health Officers and local NGO’s, gyno-camps in various districts in Nepal like Sindhupalchowk, Dhading, Parbat and Sunsari. The selection of districts was based on anticipated POP burden, lack in health care and at the request of the local health care authorities. Women living in the surrounding VDC’s and experiencing relevant symptoms were encouraged to attend the gynocamp. At the camp each woman could present her symptoms/complaints and a clinical examination was performed. In case of POP staging, counselling and appropriate treatment was arranged. To evaluate the value of these gynocamps for screening and treatment initiation for POP, WfWF collected systematically data regarding the prevalence, severity/stage and treatment of women with POP.

In Dhading district, WfWF organized several gynocamps in 2011-2014.6 Of the 74.173 women in 30.380 households living in the surrounding VDC’s, a total of 3.350 women (4.5% of all women; 11% of all households) attended a gynocamp at least once. Although most women with POP (1.813) had stage I or II (78%), a substantial number had stage III or higher (22%). The remaining group of women (1.537) had either no POP or refused examination.

In Parbat district, several gyno-camps were organised by WfWF in 2014-2017.7 Of the 39.535 women living in the relevant VDC’s, a total of 3.992 women (10%) attended a camp. This may be relevantly higher than in Dhading. POP has been diagnosed in 2012 women (50.5% of women attending camps). Although most women with POP had stage I or II (78%), a substantial number had stage III or higher (22 %). The remaining group of women (1.979) had either no POP or refused examination. The results demonstrate the high unmet need for a clinical screening for POP in women with symptoms in these districts in Nepal. The specific POP results are very similar for the two districts. In conclusion: these results further confirm that POP is a major common morbidity in Nepal, with many women suffering in silence, unaware that it can be prevented and treated. By organising gynocamps, substantial numbers of patients can be identified and treatment initiated.

WfWF recognised that the impact of POP is much more than the burden due to the physical symptoms alone, eg social and psychological impacts are important elements as well. To understand the needs and impact of diagnosing and treating women with POP in gynocamps WfWF supported a qualitative study on the quality of life of women with POP with a research grant and additional data.8 The study was conducted by Dushala Adhikari at the Department of Community Medicine and Family Health Maharajgunj Medical Campus, Institute of Medicine Tribhuvan University, Nepal,. In this qualitative study, in-depth interviews were taken from 32 women, diagnosed with POP (18 women stage III) and treated (21 women with pessary, 9 with surgery) during a gynocamp in 2011. The aim was to obtain information about women’s experiences of having POP and its effects on physical, psychological and social dimensions of quality of life before and after treatment.

The result shows that POP affects all three dimensions of women’s quality of life negatively. Treatment has a positive effect on quality of life in many cases by reducing physical symptoms but the psychosocial impacts of POP were not addressed adequately.

In conclusion: comprehensive and quality management of POP by addressing all physical, psychological and social effects is imperative.

Factors influencing the severity of POP were studied in a cohort of 529 women who visited a gynocamp in a hill region.11 The factors analysed specifically were: age, age at first pregnancy, number of pregnancies, number of deliveries, help during delivery, postmenopausal status and level of education. Of these older age, higher age of first pregnancy and a higher number of pregnancies and deliveries were associated with higher stage of prolapse. The study is limited as no information was obtained when the prolapse occurred and about genetic factors, smoking, carrying heavy loads and nutritional condition.