Examining neglected health problems in women at mid-life in Bangladesh

Although women’s reproductive health has improved remarkably in Bangladesh since her independence in 1971, other aspects of women’s health remain neglected. The overall aim of this thesis was to determine the awareness of, and barriers to, cervical cancer (CCa) and breast cancer (BCa) screening, the prevalence and severity of menopausal symptoms, and pelvic floor disorders (PFDs) in Bangladeshi women. A nationally representative, cross-sectional survey of women aged 30-59 years was conducted in Bangladesh, using a multistage cluster sampling technique, between September 2013 and March 2014. Factors associated with all outcomes were investigated separately, using simple and multivariable logistic regression. Of 1590 participants, mean age 42.3 (± 8.0) years, 81.3% and 48.6% had ever heard of CCa and CCa screening respectively, while 81.9% and 64.2% had ever heard of BCa and BCa screening, respectively. 8.3% of those who had ever heard of CCa, had been screened for CCa and 8.0% of those who had ever heard of BCa, reported clinical breast examination (CBE). Awareness of CCa was inversely associated with living in a rural area compared with an urban setting and having no education compared with women having education beyond secondary school, while being positively associated with being aged 40–49 years compared with being aged 30-39 years, and being obese. Awareness of BCa was positively associated with being aged 40–49 years and 50–59 years compared with being aged 30–39 years, being overweight and obese, while being inversely associated with rural dwelling, having primary or no education compared with women having education beyond secondary school, and having at least three children compared with ≤2 children. The leading barrier to both CCa and BCa screening uptake was lack of understanding of the concept of screening healthy women for disease. Having been screened for CCa was associated with being aged 40–49 years compared with 30-39 years and employed outside the home, and inversely associated with rural dwelling and having no education. Women with no education were less likely to have undergone CBE compared with women having education beyond secondary school. Of the study participants, 59.4% were premenopausal, 8.4% perimenopausal and 32.3% postmenopausal. Nearly all of the women had reached menopause by the age of 50 years. The prevalence of moderate-severely bothersome vasomotor symptoms (VMS) was 4.1% in premenopausal, 33.3% in perimenopausal, and 28.2% in postmenopausal women. Factors associated with moderate-severely bothersome VMS were being perimenopausal or postmenopausal compared with premenopausal and obesity. The prevalence of moderate-severely bothersome joint pain was 40.3% in postmenopausal, 36.2% in perimenopausal, and 15.3% in premenopausal women. Moderate-severely bothersome joint pain was more likely both in perimenopausal and postmenopausal women compared with premenopausal women, and in women with no education compared with women having education beyond secondary school. No women reported prescription therapy for menopausal symptoms. The weighted prevalence of at least one PFD was 35.3%, urinary incontinence (UI) 23.7% faecal incontinence (FI) 5.3%, and pelvic organ prolapse (POP) 16.2%. Compared with women aged 30-39 years, at least one PFD was more likely for women aged 40-49 years and 50-59 years. Having at least one PFD was significantly associated with having ≥3 compared with fewer children, being in the middle, second lowest or lowest wealth quintiles compared with the highest wealth quintile, and being a self-reported diabetic. With continued ageing of the population in Bangladesh, the health issues of women at mid-life investigated in this study need to be given a higher priority. Efforts to screen for CCa and downstage BCa need to be accompanied by community-based education. The impact of menopause requires greater recognition as do the prevention and treatment of PFDs.