title: Non-surgical interventions for pelvic organ prolapse in rural Nepal: a prospective monitoring and evaluation study.
abstract: OBJECTIVE
  Pelvic organ prolapse (POP) is a major cause of morbidity in Nepal, particularly affecting women in the rural communities. Women with POP in Nepal may suffer from symptoms for decades. At present, the Government of Nepal advocates surgical intervention but access to surgical care is inadequate. This report evaluated the feasibility of a non-surgical public health programme in rural Nepal, and describes risk factors associated with POP in this setting.
  
  
  METHODS
  Prospective monitoring and evaluation study of a new public health programme.
  
  
  METHODS
  Baglung district, rural Nepal.
  
  
  METHODS
  Women with gynaecological symptoms of POP.
  
  
  METHODS
  Risk factors for disease progression were assessed using Fisher's exact test, Pearson's χ(2)-test and logistic regression analysis.
  
  
  RESULTS
  Of the 74 women included in this analysis, 70.8% were diagnosed with stage 2 POP or greater. The majority of women did not have any further children following the onset of POP symptoms (63.5%). Duration of symptoms ranged from 2 months to 60 years, with 73.4% of women suffering for over 5 years and 28.4% suffering for over 20 years. Univariate analyses identified age at screening, age at onset of symptoms, the duration of symptoms and an associated rectocele as factors associated with increasing POP severity (p < 0.05). Kegel exercises were taught to 25 (33.8%) women with POP and ring pessaries were offered to 47 (63.5%) women with POP.
  
  
  CONCLUSIONS
  Non-surgical interventions may provide an opportunity to address the significant burden of POP in rural Nepal.
authors.affiliation: Harvard T. H. Chan School of Public Health, Boston MA 02115, USA ; Department of Infection and Population Health, University College London, London, NW3 2PF, UK.
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Fitchett
authors.affiliation: One Heart World-Wide Nepal, Kathmandu 44616, Nepal.
authors.forename: Surya
authors.initials: S
authors.lastname: Bhatta
authors.affiliation: One Heart World-Wide Nepal, Kathmandu 44616, Nepal.
authors.forename: Tenzing Y
authors.initials: TY
authors.lastname: Sherpa
authors.affiliation: One Heart World-Wide Nepal, Kathmandu 44616, Nepal.
authors.forename: Bishwo S
authors.initials: BS
authors.lastname: Malla
authors.affiliation: Harvard T. H. Chan School of Public Health, Boston MA 02115, USA.
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: A Fitchett
authors.affiliation: One Heart World-Wide, San Francisco, CA 94116, USA.
authors.forename: Arlene
authors.initials: A
authors.lastname: Samen
authors.affiliation: One Heart World-Wide Nepal, Kathmandu 44616, Nepal ; One Heart World-Wide, San Francisco, CA 94116, USA.
authors.forename: Sibylle
authors.initials: S
authors.lastname: Kristensen
keywords: Kegel exercises; Nepal; Pelvic organ prolapse; cystocele; maternal health; primary prevention; rectocele; ring pessary; secondary prevention; uterine prolapse; vault prolapse