Female urinary incontinence in sub-Saharan Africa

Area of Science:

• Obstetrics and Gynecology
• Public Health
• Urology

Background:

• Urinary incontinence (UI) is a widespread global health issue disproportionately affecting women.
• In sub-Saharan Africa, UI prevalence is underestimated due to stigma and reporting variations.
• While obstetric fistula-related UI is recognized, non-fistulous UI (stress, urgency, mixed) is increasingly prevalent.

Purpose of the Study:

• To review the prevalence, consequences, and treatment of urinary incontinence in sub-Saharan Africa.
• To highlight the specific challenges and risk factors for both fistulous and non-fistulous UI in the region.
• To identify gaps in specialist capacity and propose strategies for improved management.

Main Methods:

• This study is a review article synthesizing existing literature on UI in sub-Saharan Africa.
• It draws specific examples from Uganda and Malawi to illustrate regional challenges.
• The review analyzes risk factors, social consequences, and treatment barriers.

Main Results:

• Non-fistulous UI is highly prevalent in sub-Saharan Africa, with risk factors similar to high-income countries (e.g., high parity, obesity, ageing).
• UI significantly impacts women's social and emotional well-being, leading to relationship issues, depression, and suicidal ideation.
• A lack of trained specialists and resources hinders effective treatment for non-fistulous UI.

Conclusions:

• Addressing UI in sub-Saharan Africa requires overcoming stigma and improving understanding of its causes.
• Increased specialist training and resource prioritization are crucial for managing the growing burden of non-fistulous UI.
• Enhanced patient education, particularly peri-natal care, may reduce fistula incidence and encourage timely treatment-seeking.