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

Transcription

1 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

2 Outline of the presentation Objectives of the study Study methodology Data Collection Limitations of the study Key findings Way Forward Acknowledgment

3 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

4 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

5 Study Sites FWDR (2) Baitadi Kailali MWDR (3) WDR (2) Dolp a Myagdi Pyuthan and Dailekh Rupandehi CDR (4) Makawanpur and Kavre Parsa and Sarlahi EDR (4) Taplejung Okhaldhunga Morang and Siraha Mountain (2) Hill (7) Terai (6)

6 Structured Questionnaire Data Collection 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

7 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

8 Key findings

9 Number Participants Enrollment Status Women Visited RH Camp (All age group) 4277 Enrolled in the Survey and Interviewed (15 49 years)

10 Percent 100 Age group of the Study Participants (N=4277) Median Age =

11 Marital Status of the Study Participants (N=4277) Divorced/S eparated 0.8% Widow 3.5% Unmarried 0.2% Married 95.5%

12 20 years and above 19.7% Age at Marriage (N=4268) Median age (Range) = 17 (8 48) Below 20 years 80.3%

13 Percent Knowledge on different RH Morbidities (N=4277) Pelvic Organ Prolapse Obstretic Fistula Cervical Cancer

14 Source of Information about POP (N=3383) Relatives/Friends 79.5 Health Personnel/FCHV 58.9 Newspaper 9.3 Radio/Television 45.6 Multiple Responses Percent

15 Source of Information about Cervical cancer (N=1836) Others School/Teacher Books/Training Aama Samuha[1] Relatives/Friends Doctor/Nurse/Health Camp Newspaper Television/Radio Percent

16 Source of Information about OF (N=229) Books/Training 2.6 Relatives/Friends 40.2 Doctor/Nurse/Health Camp 66.8 Newspaper 20.5 Television/Radio Percent

17 Percent Prevalence of RH Morbidities POP (N=4031) Cervical precancerous lesions(n=3831) HPV 16/18 (N=3464)

18 Key Findings Pelvic Organ Prolapse

19 Percent Prevalence of POP by Degrees (N=256) 10 Overall Prevalance - 6.4% I Degree II Degree III Degree IV Degree

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) Percent Prevalence of POP by Region and Place of Residence Ecological Region Development Region Place of Residence

21 Below 20 years years 30 and above Not pregnant yet Don't remember/know 1-2 times 3-4 times 5-7 times 8 or more times Percent Fertility Related Information of Women diagnosed with POP Age at First Pregnancy* Number of Pregnancies

22 Percent Health facility Delivery Related Information of Women diagnosed with POP 82.8 At home Yes No 1-3 years years 4.6 More than 5 years Place of Last Delivery* Assisted by Health Worker During Last Delivery* Birth Interval of Last Child (N=241)*

23 Percent 40 Rest after delivery among women with POP Less than 7 days 8-12 days days days More than 30 days

24 Key Findings Cervical Pre-Cancerous screening through VIA

25 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) Percent Prevalence of Cervical Pre-cancerous Lesions Prevalance=1.8% (n=60) Ecological Region Development Region Place of Residence

26 Percent Fertility Related Information of Women with VIA Positive Result Below 20 years 20 years and above Age at Marriage 25

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

28 Findings HPV

29 Percent Prevalence of HPV (N=3464) HPV 16 HPV 18 HPV 16 or HPV Co-infection (HPV 16 & 18)

30 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) Percent Prevalence of HPV 16 / Ecological Region Development Region Place of Residenc

31 15-19 years years years 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 Precent Socio-demographic Characteristics of women with HPV Positive Result Age in Years Educational Status Caste/ethnicity

32 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 OF. women with Strengthen referral mechanisms from peripheral level Health facilities providing RH Morbidity services to higher centers, particularly for cervical cancer