Incontinence in Zambia: Lessons Learned Pre-departure

by Claire Scott

 

 

As I write this I have less than one week before I leave for Zambia. As a ‘newbie’ to the world of incontinence, the last month or so has been a steep learning curve which was kick-started by the ‘What’s New in Pelvic Floor’ event organised by the NIHR Colorectal Therapies Healthcare Technology Co-operative. I have since googled, read, and spoken about incontinence on almost a daily basis in preparation for my trip. Now that the ethical approval applications have been submitted and the travel arrangements confirmed, I finally have time to reflect on what I have learned so far, and to share some of my key findings:

·        Estimating the prevalence of incontinence is challenging due to variable definitions and the dynamic nature of the condition, but studies tend to report a prevalence of any urinary incontinence in females in the range of 25% to 45%, and in men from 1% to 30%. The prevalence of faecal incontinence in adults tends to be lower than 15%[1];

·        Incontinence in men is usually related to disability, injury or surgery. Incontinence in women is typically related to reproductive history: in Zambia the total fertility rate is 5.7 children per woman versus a global average of 3.0 years[2];

·        There are a number of possible interventions to improve the prevention and management of incontinence including products and aids, behavioural changes, pharmacological interventions and also surgery, but only a minority of sufferers ever ask for help[3].

Although little is known about the implications of living with incontinence in lower-income settings, much of the literature suggests that the personal consequences are often more severe than for those with similar symptoms in high-income settings. This is due to limited opportunities to keep clean (as a result of restricted access to water, soap, pads and/or spare clothes), to disclose (often related to a fear of discrimination), and to access health education and/or facilities.

These barriers to improving the quality of life for incontinence sufferers and carers are circling in my mind as I start to pack for my trip to Zambia. My bag is filling up with various incontinence products and aids to use in my discussions, and my hope is that the conversations I have will provide a little more understanding about what could make a positive difference to many.

 

[1] Abrams, P., Cardozo, L., Khoury, S. and Wein, A. (eds) (2013) Incontinence (5th edition). Paris: ICUD-EAU Available at: https://www.ics.org/Publications/ICI_5/INCONTINENCE.pdf (Accessed on 1 June 2017).
[2] World Health Organisation (WHO) (2017c) Global Health Observatory indicator views: Total fertility rate (per woman) (Demographic and socioeconomic statistics) Available at: http://apps.who.int/gho/data/node.imr.WHS9_95?lang=en (Accessed on 24 May 2017).
[3] Minassian, V.A., Drutz, H.P., and Al-Badr, A. (2003) ‘Urinary incontinence as a worldwide problem’, International Journal of Gynaecology and Obstetrics, 82, pp. 327-338.