Urinary incontinence (UI) in older women in low- and middle-income countries: a rapid review and case study from Burkina Faso

Arthi Kozhumam; Mamadou Bountogo; Dina Goodman Palmer; Carolyn Grieg; Maxime Inghels; Sandra Agyapong-Badu; Cristina Osborne; Guy Harling; Till Bärnighausen; David Rapp; Molly Beestrum; Justine Davies; Lisa R. Hirschhorn

doi:10.3389/fgwh.2024.1511444

Urinary incontinence (UI) in older women in low- and middle-income countries: a rapid review and case study from Burkina Faso

Arthi Kozhumam^*, Mamadou Bountogo, Dina Goodman Palmer, Carolyn Grieg, Maxime Inghels, Sandra Agyapong-Badu, Cristina Osborne, Guy Harling, Till Bärnighausen, David Rapp, Molly Beestrum, Justine Davies, Lisa R. Hirschhorn

^*Corresponding author for this work

Medical Social Sciences

Research output: Contribution to journal › Article › peer-review

Abstract

The prevalence of urinary incontinence (UI) in older women in low- and middle-income countries (LMICs) is not well understood. We conducted a rapid literature review to assess the burden of UI in this population and contextualize findings from a household survey of women aged 40 and older in Nouna, in northwestern Burkina Faso. The rapid review included 21 survey articles. UI prevalence for LMIC women 40 or older varied greatly (6%–80%), with differences by socio-demographics, gynecological factors (menopausal status, birth outcomes), comorbidities (age, education, obesity, diabetes, hypertension, arthritis), behaviors (smoking status) and survey location. The studies used validated tools—the International Consultation on Incontinence Urinary Incontinence Short Form (ICIQ UI-SF) was most common (n = 4, 19%)—and bespoke tools that have not yet been validated. In Nouna, 983 (64.5%) of 1,524 women, completed the ICIQ UI-SF. Overall UI prevalence, defined as reporting leakage at least 2–3 times a week, was 2.6% (95% CI 1.73%–3.85%), descriptively increased with age from 0.5% in 40–49 year-olds to 6.6% in those 70 and over. Of those with UI, 88.5% experienced leakage daily, and 50% reported moderate or greater interference with daily life, yet most (88.5%) had not spoken to a healthcare provider. Multivariable analysis revealed that UI was more common among women who were not currently married and decreased with higher education levels. Both the rapid review and survey highlight the burden of UI among older women in LMICs, particularly as they age beyond 60. Given UI's association with physical and mental health, it is crucial to raise awareness of its burden, improve healthcare access, and integrate routine screening into basic healthcare services. Additionally, training healthcare providers and developing culturally appropriate interventions will help address stigma and ensure effective management of UI in this vulnerable population.

Original language	English (US)
Article number	1511444
Journal	Frontiers in Global Women's Health
Volume	5
DOIs	https://doi.org/10.3389/fgwh.2024.1511444
State	Published - 2024

Funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. Support for the CRSN Heidelberg Aging Study and for TB was provided by the Alexander von Humboldt Foundation through the Alexander von Humboldt Professor award to Till B\u00E4rnighausen, funded by the German Federal Ministry of Education and Research. Data collection for the Nouna survey is supported by the German Research Foundation (DFG) under research grant SFB 544. GH is supported by a fellowship from the Wellcome Trust and Royal Society [grant number 210479/Z/18/Z]. The author(s) declare financial support was received for the research, authorship, and/or publication of this article. Support for the CRSN Heidelberg Aging Study and for TB was provided by the Alexander von Humboldt Foundation through the Alexander von Humboldt Professor award to Till B\u00E4rnighausen, funded by the German Federal Ministry of Education and Research. Data collection for the Nouna survey is supported by the German Research Foundation (DFG) under research grant SFB 544. GH is supported by a fellowship from the Wellcome Trust and Royal Society [grant number 210479/Z/18/Z]. Acknowledgments This research was funded in whole, or in part, by the Wellcome Trust [Grant numbers 210479/Z/18/Z]. For the purpose of open access, the authors have applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission. We would like to acknowledge the contributions of Dr. Ali Sie and Fiona Walsh in the development of this manuscript, as well as the individuals of the Nouna HDSS for their participation.

Keywords

Burkina Faso
LMIC (low and middle income countries)
UI
older women
urinary incontinence

ASJC Scopus subject areas

General Medicine

Access to Document

10.3389/fgwh.2024.1511444

Cite this

Kozhumam, A., Bountogo, M., Palmer, D. G., Grieg, C., Inghels, M., Agyapong-Badu, S., Osborne, C., Harling, G., Bärnighausen, T., Rapp, D., Beestrum, M., Davies, J., & Hirschhorn, L. R. (2024). Urinary incontinence (UI) in older women in low- and middle-income countries: a rapid review and case study from Burkina Faso. Frontiers in Global Women's Health, 5, Article 1511444. https://doi.org/10.3389/fgwh.2024.1511444

@article{4c345fe57eab4cea8c0ad04339118fdf,

title = "Urinary incontinence (UI) in older women in low- and middle-income countries: a rapid review and case study from Burkina Faso",

abstract = "The prevalence of urinary incontinence (UI) in older women in low- and middle-income countries (LMICs) is not well understood. We conducted a rapid literature review to assess the burden of UI in this population and contextualize findings from a household survey of women aged 40 and older in Nouna, in northwestern Burkina Faso. The rapid review included 21 survey articles. UI prevalence for LMIC women 40 or older varied greatly (6%–80%), with differences by socio-demographics, gynecological factors (menopausal status, birth outcomes), comorbidities (age, education, obesity, diabetes, hypertension, arthritis), behaviors (smoking status) and survey location. The studies used validated tools—the International Consultation on Incontinence Urinary Incontinence Short Form (ICIQ UI-SF) was most common (n = 4, 19%)—and bespoke tools that have not yet been validated. In Nouna, 983 (64.5%) of 1,524 women, completed the ICIQ UI-SF. Overall UI prevalence, defined as reporting leakage at least 2–3 times a week, was 2.6% (95% CI 1.73%–3.85%), descriptively increased with age from 0.5% in 40–49 year-olds to 6.6% in those 70 and over. Of those with UI, 88.5% experienced leakage daily, and 50% reported moderate or greater interference with daily life, yet most (88.5%) had not spoken to a healthcare provider. Multivariable analysis revealed that UI was more common among women who were not currently married and decreased with higher education levels. Both the rapid review and survey highlight the burden of UI among older women in LMICs, particularly as they age beyond 60. Given UI's association with physical and mental health, it is crucial to raise awareness of its burden, improve healthcare access, and integrate routine screening into basic healthcare services. Additionally, training healthcare providers and developing culturally appropriate interventions will help address stigma and ensure effective management of UI in this vulnerable population.",

keywords = "Burkina Faso, LMIC (low and middle income countries), UI, older women, urinary incontinence",

author = "Arthi Kozhumam and Mamadou Bountogo and Palmer, {Dina Goodman} and Carolyn Grieg and Maxime Inghels and Sandra Agyapong-Badu and Cristina Osborne and Guy Harling and Till B{\"a}rnighausen and David Rapp and Molly Beestrum and Justine Davies and Hirschhorn, {Lisa R.}",

note = "Publisher Copyright: 2025 Kozhumam, Bountogo, Palmer, Greig, Inghels, Agyapong-Badu, Osborne, Harling, B{\"a}rnighausen, Rapp, Beestrum, Davies and Hirschhorn.",

year = "2024",

doi = "10.3389/fgwh.2024.1511444",

language = "English (US)",

volume = "5",

journal = "Frontiers in Global Women's Health",

issn = "2673-5059",

publisher = "Frontiers Media SA",

}

Kozhumam, A, Bountogo, M, Palmer, DG, Grieg, C, Inghels, M, Agyapong-Badu, S, Osborne, C, Harling, G, Bärnighausen, T, Rapp, D, Beestrum, M, Davies, J & Hirschhorn, LR 2024, 'Urinary incontinence (UI) in older women in low- and middle-income countries: a rapid review and case study from Burkina Faso', Frontiers in Global Women's Health, vol. 5, 1511444. https://doi.org/10.3389/fgwh.2024.1511444

TY - JOUR

T1 - Urinary incontinence (UI) in older women in low- and middle-income countries

T2 - a rapid review and case study from Burkina Faso

AU - Kozhumam, Arthi

AU - Bountogo, Mamadou

AU - Palmer, Dina Goodman

AU - Grieg, Carolyn

AU - Inghels, Maxime

AU - Agyapong-Badu, Sandra

AU - Osborne, Cristina

AU - Harling, Guy

AU - Bärnighausen, Till

AU - Rapp, David

AU - Beestrum, Molly

AU - Davies, Justine

AU - Hirschhorn, Lisa R.

N1 - Publisher Copyright: 2025 Kozhumam, Bountogo, Palmer, Greig, Inghels, Agyapong-Badu, Osborne, Harling, Bärnighausen, Rapp, Beestrum, Davies and Hirschhorn.

PY - 2024

Y1 - 2024

N2 - The prevalence of urinary incontinence (UI) in older women in low- and middle-income countries (LMICs) is not well understood. We conducted a rapid literature review to assess the burden of UI in this population and contextualize findings from a household survey of women aged 40 and older in Nouna, in northwestern Burkina Faso. The rapid review included 21 survey articles. UI prevalence for LMIC women 40 or older varied greatly (6%–80%), with differences by socio-demographics, gynecological factors (menopausal status, birth outcomes), comorbidities (age, education, obesity, diabetes, hypertension, arthritis), behaviors (smoking status) and survey location. The studies used validated tools—the International Consultation on Incontinence Urinary Incontinence Short Form (ICIQ UI-SF) was most common (n = 4, 19%)—and bespoke tools that have not yet been validated. In Nouna, 983 (64.5%) of 1,524 women, completed the ICIQ UI-SF. Overall UI prevalence, defined as reporting leakage at least 2–3 times a week, was 2.6% (95% CI 1.73%–3.85%), descriptively increased with age from 0.5% in 40–49 year-olds to 6.6% in those 70 and over. Of those with UI, 88.5% experienced leakage daily, and 50% reported moderate or greater interference with daily life, yet most (88.5%) had not spoken to a healthcare provider. Multivariable analysis revealed that UI was more common among women who were not currently married and decreased with higher education levels. Both the rapid review and survey highlight the burden of UI among older women in LMICs, particularly as they age beyond 60. Given UI's association with physical and mental health, it is crucial to raise awareness of its burden, improve healthcare access, and integrate routine screening into basic healthcare services. Additionally, training healthcare providers and developing culturally appropriate interventions will help address stigma and ensure effective management of UI in this vulnerable population.

AB - The prevalence of urinary incontinence (UI) in older women in low- and middle-income countries (LMICs) is not well understood. We conducted a rapid literature review to assess the burden of UI in this population and contextualize findings from a household survey of women aged 40 and older in Nouna, in northwestern Burkina Faso. The rapid review included 21 survey articles. UI prevalence for LMIC women 40 or older varied greatly (6%–80%), with differences by socio-demographics, gynecological factors (menopausal status, birth outcomes), comorbidities (age, education, obesity, diabetes, hypertension, arthritis), behaviors (smoking status) and survey location. The studies used validated tools—the International Consultation on Incontinence Urinary Incontinence Short Form (ICIQ UI-SF) was most common (n = 4, 19%)—and bespoke tools that have not yet been validated. In Nouna, 983 (64.5%) of 1,524 women, completed the ICIQ UI-SF. Overall UI prevalence, defined as reporting leakage at least 2–3 times a week, was 2.6% (95% CI 1.73%–3.85%), descriptively increased with age from 0.5% in 40–49 year-olds to 6.6% in those 70 and over. Of those with UI, 88.5% experienced leakage daily, and 50% reported moderate or greater interference with daily life, yet most (88.5%) had not spoken to a healthcare provider. Multivariable analysis revealed that UI was more common among women who were not currently married and decreased with higher education levels. Both the rapid review and survey highlight the burden of UI among older women in LMICs, particularly as they age beyond 60. Given UI's association with physical and mental health, it is crucial to raise awareness of its burden, improve healthcare access, and integrate routine screening into basic healthcare services. Additionally, training healthcare providers and developing culturally appropriate interventions will help address stigma and ensure effective management of UI in this vulnerable population.

KW - Burkina Faso

KW - LMIC (low and middle income countries)

KW - UI

KW - older women

KW - urinary incontinence

UR - http://www.scopus.com/inward/record.url?scp=85215624158&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85215624158&partnerID=8YFLogxK

U2 - 10.3389/fgwh.2024.1511444

DO - 10.3389/fgwh.2024.1511444

M3 - Article

C2 - 39834525

AN - SCOPUS:85215624158

SN - 2673-5059

VL - 5

JO - Frontiers in Global Women's Health

JF - Frontiers in Global Women's Health

M1 - 1511444

ER -

Urinary incontinence (UI) in older women in low- and middle-income countries: a rapid review and case study from Burkina Faso

Abstract

Funding

Keywords

ASJC Scopus subject areas

Access to Document

Other files and links

Fingerprint

Cite this