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Suwal S1, Mareschal G1, Retis C2, Shah MB3
1Humanity and Inclusion (Formerly Handicap International), Kathmandu, Nepal, 2Humanity and Inclusion (Formerly Handicap International), Phnom Penh, Cambodia, 3Humanity & Inclusion (Formerly Handicap International), Kathmanudu, Nepal
Background: It is estimated that in Nepal 6.4 % of women of reproductive age have Pelvic Organ Prolapse (POP). Insertion of ring pessary and verbal instructions for pelvic floor muscle (Kegel) exercise are provided by community health workers and midwives as part of the conservative management strategy based on the national Reproductive Health Policy. Low coverage of health services, geographical and gender barriers greatly limit the access to appropriate care for women at risk of or with POP , especially in remote areas. In order to reach these underserved communities, Women Reproductive Health camps are carried out, however little is known about their effectiveness. Until now, Nepali physiotherapists have not been involved in prevention nor rehabilitation interventions for POP, since physiotherapy has been only recently integrated into the Nepal essential package of health care.
Purpose: We aimed to look at the effectiveness of conservative management of POP by community health workers and midwives in one remote district of Nepal and to evaluate the relevance and feasibility of integrating physiotherapy in the current programmes.
Methods: Four Women Reproductive Health and Physiotherapy mobile camps of two days each were organized by Humanity & Inclusion and the Ministry of Health in the remote district of Gorkha . The intervention included (i) assessment by a gynecologist to identify women with or at risk of POP ; insertion of ring pessary if needed and referral to a physiotherapist; (ii) assessment by the physiotherapist , collection of information on knowledge on Kegel exercises among referred women, and education on pelvic floor muscle and ergonomic exercises; (iii) provision of medicines for vaginal infection and hygiene counselling by a midwife; (iv) further referral to the physiotherapy unit at the district hospital in Gorkha for long term follow up.
Results: A total of 345 women were assessed by the gynecologist; among them, 66 had POP and 99 were considered at risk of POP. Both women with and at risk of POP (165 in total) were seen by the physiotherapist during the 4 camps and received pelvic floor and ergonomic training; among them, only 1 woman knew about Kegel exercises. Ring pessary was inserted to 14 women ; for 2 of them it was a renewal. 165 women were further referred to the physiotherapy unit at the district hospital for follow up, however none of them used the referral service .
Conclusion(s): The provision of POP conservative management by health workers in remote areas of Nepal has limitations in providing information and education on Kegel exercises. Integrated mobile camps that include physiotherapy are effective in reaching women in need, however further information on causes of low utilization of follow up services are required to develop sustainable strategies for a better access to quality care.
Implications: Physiotherapy interventions should be integrated into both POP prevention and management programs in Nepal. Multidisciplinary models of care that involve physiotherapists and health workers in the communities should be promoted. A review of rehabilitation service delivery in remote areas should take into account barriers of service utilization by women.
Keywords: Pelvic organ prolapse, pelvic floor muscle exercise, physiotherapy
Funding acknowledgements: The Ministry of Foreign Affairs- Luxembourg
Purpose: We aimed to look at the effectiveness of conservative management of POP by community health workers and midwives in one remote district of Nepal and to evaluate the relevance and feasibility of integrating physiotherapy in the current programmes.
Methods: Four Women Reproductive Health and Physiotherapy mobile camps of two days each were organized by Humanity & Inclusion and the Ministry of Health in the remote district of Gorkha . The intervention included (i) assessment by a gynecologist to identify women with or at risk of POP ; insertion of ring pessary if needed and referral to a physiotherapist; (ii) assessment by the physiotherapist , collection of information on knowledge on Kegel exercises among referred women, and education on pelvic floor muscle and ergonomic exercises; (iii) provision of medicines for vaginal infection and hygiene counselling by a midwife; (iv) further referral to the physiotherapy unit at the district hospital in Gorkha for long term follow up.
Results: A total of 345 women were assessed by the gynecologist; among them, 66 had POP and 99 were considered at risk of POP. Both women with and at risk of POP (165 in total) were seen by the physiotherapist during the 4 camps and received pelvic floor and ergonomic training; among them, only 1 woman knew about Kegel exercises. Ring pessary was inserted to 14 women ; for 2 of them it was a renewal. 165 women were further referred to the physiotherapy unit at the district hospital for follow up, however none of them used the referral service .
Conclusion(s): The provision of POP conservative management by health workers in remote areas of Nepal has limitations in providing information and education on Kegel exercises. Integrated mobile camps that include physiotherapy are effective in reaching women in need, however further information on causes of low utilization of follow up services are required to develop sustainable strategies for a better access to quality care.
Implications: Physiotherapy interventions should be integrated into both POP prevention and management programs in Nepal. Multidisciplinary models of care that involve physiotherapists and health workers in the communities should be promoted. A review of rehabilitation service delivery in remote areas should take into account barriers of service utilization by women.
Keywords: Pelvic organ prolapse, pelvic floor muscle exercise, physiotherapy
Funding acknowledgements: The Ministry of Foreign Affairs- Luxembourg
Topic: Women's & men's pelvic health; Women's & men's pelvic health
Ethics approval required: No
Institution: N/A
Ethics committee: N/A
Reason not required: This work addresses a new practice in clinical management and in education of health workers. The contents of this work are based on secondary data provided by Humanity& Inclusion. This organisation gave consent for the utilisation of these data
All authors, affiliations and abstracts have been published as submitted.
