Reproductive morbidity: a neglected issue? Report of a clinic-based study in Far-Western Nepal

Reproductive morbidity: a neglected issue? Report of a clinic-based study in Far-Western Nepal

Maternal morbidity issues facing women in Western Nepal

This paper describes the results of a study of reproductive morbidity in Nepal. The study obtained information and proxy indicators on the prevalence of reproductive morbidity of women in Doti and Achham districts.

Findings include:

  • general health status of women: is strongly influenced by socio-cultural habits. Food restrictions were widely observed in the study area, with 61.2% in the case of a death of a relative, followed by menstruation (47.5%) and the postpartum period (42.6%). Regarding domestic violence, more than 18% of the women reported to have been verbally abused, while 5.1% indicated to have been physically abused. Husbands were cited as the most frequent abusers, child-related issues the most frequent reason
  • pelvic organ prolapse (POP): ¼ women were diagnosed with POP. There was a strong correlation between self-reported and diagnosed POP. 1/5 of women reported the onset of prolapse before the age of 20 years, 44.2% were between 20-29 years. The mean number of years suffering from POP was 10. Approximately 40% of the women reported only one completed pregnancy at the onset of POP, while 58% had only completed two pregnancies. Of those self-reporting POP, 87% had no rest before delivery and 21% reported to have had less than 7 days rest after delivery. The impact of POP on the daily life is dramatic: 88.6% of women reported difficulty lifting, 82% difficulty sitting, 79% difficulty walking, 65.5% difficulty standing. Other complaints included backache (55%), burning upon urination (49%), and painful intercourse (41.1%). The data also suggest a potential association between prolapse and nutrition
  • infertility: there was a marked correlation between self-reported and diagnosed infertility. Out of 89 semen tests carried out among husband of women complaining of infertility, 68.6% had oligospermia (deficiency in sperm and semen) and 18.1% azoospermia (absence of sperm)
  • reproductive tract and STIs: in contrast to the high number of self-reported RTI/STI symptoms (33.6%), the number of cases diagnosed was much lower (20%). The laboratory findings were even lower, and ranged from trichomonas (3.8%), hepatitis B (1.8%), syphilis (1.5%) to candidiasis (0.6%), neisseria gonorrhoea (0.6%) and bacterial vaginosis (0.1%). There was no association between women who were clinically diagnosed with a RTI/STI and those with a positive laboratory result
  • menstrual disorders: 12.3% of the patient population was clinically diagnosed with some type of menstrual disorder: functional uterine bleeding, DUB (3.6%), Depo-induced DUB (3.4%), lactational amenorrhoea (2.3%) and dysmenorrhoea (2.1%)

Recommendations:

  • establish regular gynaecological training and services
  • introduce reproductive morbidity checklists
  • advocate a focus on non-life threatening reproductive illnesses
  • increase counselling services
  • continue to support social development
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