A Study on Selected Reproductive Health Morbidities among Women - - PowerPoint PPT Presentation

A Study on Selected Reproductive Health Morbidities among Women Visiting Reproductive Health Camps in Nepal

Commissioned by Familly Health Division, supported financially and technically by UNFPA and carried out by CMDN

4th National Safe Motherhood Conference 15 Nov 2016

Outline of the presentation

• Objectives of the study
• Study methodology
• Data Collection
• Limitations of the study
• Key findings
• Way Forward
• Acknowledgment

Objectives of the study

• To determine the prevalence of selected RH morbidities

among women of reproductive age groups (15-49 years) in Nepal:

• Pelvic Organ Prolapse (POP)
• Obstetric Fistula (OF)
• Cervical cancer
• Human Papillomavirus (HPV) types 16 and 18.

Specific Objectives:

• To map the selected RH morbidities by urban or rural residence,

developmental regions and ecological zones.

• To determine factors associated with RH morbidities

Methodology

• Cross-sectional, camp-based study carried out from

September 2014 to December 2015 Study Population

• Women of reproductive age group (15-49 years)

Study Sites

• 15 sites; 1 site each in 15 districts
• Representations of 3 ecological regions and 5

development regions

EDR (4) CDR (4) WDR (2) MWDR (3) FWDR (2)

Study Sites

Mountain (2) Hill (7) Terai (6) Baitadi Kailali Dolp a Pyuthan and Dailekh Myagdi Rupandehi Makawanpur and Kavre Parsa and Sarlahi Taplejung Okhaldhunga Morang and Siraha

Data Collection

• Structured Questionnaire
• Clinical Examination
• Visual inspection with Acetic Acid(VIA) and treatment by

Cryotherapy for cervical pre-cancerous lesions

• Cervical swab samples for HPV types (16 & 18)
• Key Informant Interviews
• Secondary Data Collection

Limitations

• Camp based study- cannot be generalized to the national level
• Difficulty in following up with some patients who had been

referred to higher institutions for further management, especially for cervical cancer.

• Low number of OF cases especially due to stigma and isolation.
• Long waiting time in the RH camp leading to drop out for the

clinical examination

• Laboratory investigations quite lengthy
• Geographical constraints and unfavourable weather conditions

contributed to the delay in the completion of study

Key fin indings

1000 2000 3000 4000 5000 6000

Women Visited RH Camp (All age group) Enrolled in the Survey and Interviewed (15 – 49 years)

5555 4277

Number

Participants Enrollment Status

20 40 60 80 100 15-19 20-29 30-39 40-49

3.4 28.2 34.4 34.0 Percent

Age group of the Study Participants (N=4277)

Median Age = 35

Married 95.5% Divorced/S eparated 0.8% Widow 3.5% Unmarried 0.2%

Marital Status of the Study Participants (N=4277)

Below 20 years 80.3% 20 years and above 19.7%

Age at Marriage (N=4268)

Median age (Range) = 17 (8 – 48)

Knowledge on different RH Morbidities (N=4277)

20 40 60 80 100

Pelvic Organ Prolapse Obstretic Fistula Cervical Cancer

79.1 5.4 42.9

Percent

Source of Information about POP (N=3383)

20 40 60 80 100

Radio/Television Newspaper Health Personnel/FCHV Relatives/Friends

45.6 9.3 58.9 79.5

Percent Multiple Responses

Source of Information about Cervical cancer (N=1836)

20 40 60 80 100

Television/Radio Newspaper Doctor/Nurse/Health Camp Relatives/Friends Aama Samuha[1] Books/Training School/Teacher Others

49.8 13.6 56.1 72.3 0.2 1.1 0.5 0.1

Percent

Source of Information about OF (N=229)

20 40 60 80 100

Television/Radio Newspaper Doctor/Nurse/Health Camp Relatives/Friends Books/Training

53.7 20.5 66.8 40.2 2.6

Percent

Prevalence of RH Morbidities

6.4 1.6 5.4

1 2 3 4 5 6 7

POP (N=4031) Cervical pre- cancerous lesions(N=3831) HPV 16/18 (N=3464)

Percent

Key Findings

Pelvic Organ Prolapse

Prevalence of POP by Degrees (N=256)

2 4 6 8 10

I Degree II Degree III Degree IV Degree

3.7 1.4 0.8 0.3

Percent

Overall Prevalance - 6.4%

5 10 15 20

Mountain (N=516) Hill (N=1797) Terai (N=1718) Eastern Development Region (N=1094) Central Development Region (N=1134) Western Development Region (N=581) Mid-Western Development Region (N=719) Far Western Development Region (N=503) Rural (N=2457) Urban (N=1574) Ecological Region Development Region Place of Residence

4.8 6.5 6.6 4.6 8 3.4 5.3 11.3 5.9 7.1

Percent

Prevalence of POP by Region and Place of Residence

Fertility Related Information of Women diagnosed with POP

20 40 60 80 100

Below 20 years 20 - 29 years 30 and above Not pregnant yet Don't remember/know 1- 2 times 3-4 times 5-7 times 8 or more times Age at First Pregnancy* Number of Pregnancies

57.8 39.8 0.4 2 16 41.8 32.4 9.8

Percent

Delivery Related Information of Women diagnosed with POP

20 40 60 80 100

Health facility At home Yes No 1-3 years 3-5 years More than 5 years Place of Last Delivery* Assisted by Health Worker During Last Delivery* Birth Interval of Last Child (N=241)*

17.2 82.8 30.9 69.1 83 12.4 4.6

Percent

Rest after delivery among women with POP

10 20 30 40

Less than 7 days 8 - 12 days 13 - 15 days 16 - 30 days More than 30 days 16.1 17.7 12.9 35.5 17.7

Percent

Key Findings

Cervical Pre-Cancerous screening through VIA

Prevalence of Cervical Pre-cancerous Lesions

1 2 3 4 5

Mountain (N=490) Hill (N=1715) Terai (N=1626) Eastern Development Region (N=1038) Central Development Region (N=1057) Western Development Region (N=561) Mid-Western Development Region (N=689) Far Western Development Region (N=486) Urban (N=2329) Rural (N=1502) Ecological Region Development Region Place of Residence

2 0.8 2.2 2.2 1.1 1.6 1.6 1 1.4 1.8

Percent

Prevalance=1.8% (n=60)

Fertility Related Information of Women with VIA Positive Result

20 40 60 80 100

Below 20 years 20 years and above Age at Marriage

75 25

Percent

Screening for Cervical Cancer

20 40 60 80 100

Yes No Biopsy Pap smear test Unable to mention proper method Self Doctor/Nurse Husband/family member/neighbor Health worker/FCHV Ever screened for Cervical Method of Screening (n=63) Advised/Referred for Cervical Cancer Screening (n=63)

1.5 98.5 9.5 50.8 42.9 44.4 34.9 15.9 4.8

Percent

Findings

HPV

Prevalence of HPV (N=3464)

1 2 3 4 5 6

HPV 16 HPV 18 HPV 16 or HPV 18 Co-infection (HPV 16 & 18)

3.6 2 5.4 0.2

Percent

Prevalence of HPV 16 /18

1 2 3 4 5 6 7

Mountain (N=435) Hill (N=1540) Terai (N=1489) Eastern Development Region (N=927) Central Development Region (N=918) Western Development Region (N=516) Mid-Western Development Region (n=643) Far Western Development Region (N=460) Rural (2092) Urban (N=1372) Ecological Region Development Region Place of Residence

3.2 5.3 6.2 4.2 5.9 6.8 6.7 3.7 5.3 5.6

Percent

Socio-demographic Characteristics

• f women with HPV Positive Result

20 40 60

15-19 years 20-29 years 30-39 years 40-49 years Illiterate Literate but no schooling Primary Secondary SLC and above Dalit Disadvantaged Janajati Disadvantaged non-dalit Terai… Religious Minorities Relatively advantaged Janajatis Upper caste groups Age in Years Educational Status Caste/ethnicity

0.5 35.637.8 26.1 36.7 19.7 13.3 28.2 2.1 17.614.417.6 2.7 2.1 45.7

Precent

Way Forward

• Support SRHR, including for the most marginalized, focusing on delaying

early marriage and pregnancy, access to contraceptive choices, access to skilled birth attendants and promote gender equality across sectors.

• Focused programmes to increase awareness on different morbidities,

including available treatment and treatment sites.

• Expand and strengthen RH Morbidity related services to different level of

Health facilities to increase access, including availability of trained human resources

• POP prevalence decreased from 10% in 2006 to 6.4% Still very high.

Conservative management of POP needs to be prioritized equally to surgical management.

• Need for focused strategy to increase awareness and identify women with

OF.

• Strengthen referral mechanisms from peripheral level Health facilities

providing RH Morbidity services to higher centers, particularly for cervical cancer