Heavy Load Carrying and Symptoms of Pelvic Organ Prolapse among Women in Tanzania and Nepal: An Exploratory Study

Aybüke Koyuncu, Jillian L Kadota, Agatha Mnyippembe, Prosper F Njau, Tula Ram Sijali, Sandra I McCoy, Michael N Bates, Carisa Harris-Adamson, Ndola Prata, Aybüke Koyuncu, Jillian L Kadota, Agatha Mnyippembe, Prosper F Njau, Tula Ram Sijali, Sandra I McCoy, Michael N Bates, Carisa Harris-Adamson, Ndola Prata

Abstract

Heavy load carrying of water, firewood, and sand/stones is a ubiquitous activity for women living in developing countries. Although the intra-abdominal pressure associated with heavy load carrying is hypothesized to increase the risk of pelvic organ prolapse (POP) among women, relevant epidemiologic data are lacking. We conducted a comparative study involving two exploratory cross-sectional studies among convenience samples of women carrying heavy loads, with different characteristics: (1) as part of their activities for daily living, in Shinyanga region, Tanzania; and (2) working as sand miners in Pokhara, Nepal. Women were categorized has having "low" or "high" load-carrying exposures based on the measured weights of the loads being carried at the time of the survey, as well as on self-reported duration and frequency of load carrying. A summary score for lower abdominal discomfort suggestive of POP was generated using questions from the Pelvic Organ Prolapse Distress Inventory (POPDI-6). Women with higher load carrying exposures had on average higher discomfort scores in both Tanzania (adjusted prevalence difference (PDa) = 3.7; 95% CI: -3.8-11.3; p = 0.33) and Nepal (PDa = 9.3; 95% CI: -4.9-23.6; p = 0.18). We identified trends suggestive of an association between increasing heavy load carrying exposures and symptoms of lower abdominal discomfort. Our findings underscore the need for larger epidemiologic studies of the potential adverse reproductive health effects of heavy load carrying activities on women in developing countries.

Keywords: heavy load carrying; pelvic organ prolapse (POP); uterine prolapse.

Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
A female carrying a load of wood in Shinyanga region, Tanzania, July–August 2016.
Figure 2
Figure 2
A female sand-miner carrying a load of sand using a doko and namlo at a sand mining site at the Seti River in Pokhara, Kaski district, Nepal, December 2016–January 2017.
Figure 3
Figure 3
Predicted probability of high discomfort with load-carrying exposures (continuous), Tanzania, July–August 2016.
Figure 4
Figure 4
Predicted probability of lower abdominal discomfort with load-carrying exposures (continuous), Nepal, December–January 2017.

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