Epidemiology of pelvic organ prolapse in rural Gambia, West Africa

Objectives: To investigate the prevalence of pelvic organ prolapse in rural Gambia. Design: Community-based reproductive health survey. Population: 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. Main outcome measures: 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.