title: Feasibility of using pessaries for treatment of pelvic organ prolapse in rural Nepal.
abstract: OBJECTIVE
  To evaluate the acceptability, feasibility, and outcomes of pessary fitting in rural Nepali communities.
  
  
  METHODS
  A 1-year prospective cohort study was conducted in the Ramechhap district of Nepal in January 2013-January 2014 among women attending a free gynecology health camp. All women with symptomatic pelvic organ prolapse (POP) were offered ring pessaries. Demographic information was collected and questionnaires on POP were completed. A urogynecologic examination was performed. At the 1-year follow-up, women were questioned on pessary use and underwent an examination. Logistic regression was used to identify associations.
  
  
  RESULTS
  In total, 411 women attended the health camps, of whom 142 presented with symptomatic POP. Initial fitting was accomplished for 134 (94.4%) of the women. At the 1-year follow-up, 130 (97.0%) women in the cohort were evaluated, and 72 (55.4%) were still using the pessary. The primary reason for discontinuation was the pessary falling out (35/58, 60.3%). The most common complication was vaginal erosion (18/130, 13.8%), observed exclusively among postmenopausal women. Postmenopausal status was a predictor of continued use (odds ratio 3.12, 95% confidence interval 1.45-6.72; P=0.004).
  
  
  CONCLUSIONS
  Pessaries were found to be an acceptable and feasible option with minimal complications for treating POP in rural Nepal.
authors.affiliation: Department of Obstetrics and Gynecology, Section of Urogrynecology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
authors.forename: Magali
authors.initials: M
authors.lastname: Robert
authors.affiliation: Independent Consultant, Calgary, AB, Canada.
authors.forename: A Jane
authors.initials: AJ
authors.lastname: Govan
authors.affiliation: Rural Health and Education Service Trust, Kathmandu, Nepal.
authors.forename: Uma
authors.initials: U
authors.lastname: Lohani
authors.affiliation: Rural Health and Education Service Trust, Kathmandu, Nepal.
authors.forename: Aruna
authors.initials: A
authors.lastname: Uprety
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D009390:Nepal; D056887:Pelvic Organ Prolapse / Q000628:therapy*; D010570:Pessaries; D011446:Prospective Studies; D012424:Rural Population; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D014621:Vagina / Q000601:surgery*; D016585:Vaginosis, Bacterial / Q000453:epidemiology; D055815:Young Adult
keywords: Low-income country; Nepal; Outcome; Pessary; Prolapse