title: Epidemiology of pelvic organ prolapse in rural Gambia, West Africa.
abstract: OBJECTIVE
  To investigate the prevalence of pelvic organ prolapse in rural Gambia.
  
  
  METHODS
  Community-based reproductive health survey.
  
  
  METHODS
  1348 women residing in 20 villages in rural Gambia.
  
  
  METHODS
  Health questionnaire and standard gynaecological examination to detect symptoms and signs of pelvic organ prolapse and other reproductive diseases. Association between prolapse, socio-demographic data and other morbidities was examined.
  
  
  METHODS
  Presence and degree of pelvic organ prolapse.
  
  
  RESULTS
  Out of 1067 women consenting to speculum examination 488 (46%) were found to have some degree of prolapse. In 152 women (14%) the prolapse was severe enough to warrant surgical intervention. After adjustment for confounders the likelihood of pelvic organ prolapse increased with parity and age and was higher in women of the Wolof tribe, pregnant women, those with insufficient perineum, and moderately and severely anaemic women. Only 13% of women with moderate or severe prolapse reported symptoms on direct questioning.
  
  
  CONCLUSIONS
  Pelvic organ prolapse has a high prevalence in this first community-based study of prolapse in West Africa. Many of those affected did not complain about their problem, thus increasing the large, silent burden of reproductive morbidity in this population. Parity was confirmed to be the strongest risk factor followed by age and anaemia. Ethnic origin was a previously unknown risk factor suggesting possible genetic factors in the pathogenesis of prolapse.
authors.affiliation: Department of Obstetrics and Gynaecology, University of Wales College of Medicine, Cardiff, UK.
authors.forename: Caroline
authors.initials: C
authors.lastname: Scherf
authors.forename: Linda
authors.initials: L
authors.lastname: Morison
authors.forename: Alison
authors.initials: A
authors.lastname: Fiander
authors.forename: Gloria
authors.initials: G
authors.lastname: Ekpo
authors.forename: Gijs
authors.initials: G
authors.lastname: Walraven
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005714:Gambia / Q000453:epidemiology; D005831:Genital Diseases, Female / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery; D006306:Health Surveys; D006801:Humans; D007239:Infections / Q000175:diagnosis; D008875:Middle Aged; D015999:Multivariate Analysis; D010298:Parity; D010388:Pelvis / Q000601:surgery*; D015995:Prevalence; D011391:Prolapse; D012307:Risk Factors; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis