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Mismatch Between Arab Women's Preferences and Options Offered For EMHJ • Vol. 18 No. 10 • 2012 Eastern Mediterranean Health Journal La Revue de Santé de la Méditerranée orientale Mismatch between Arab women’s preferences and options offered for treatment of stress urinary incontinence in the United Arab Emirates S. George,1 M.J. Hashim,2 M.H.S. Al Belooshi,3 R.S. Al Hebsi,3 A.A. Bloushi,3 S.A. Balfaqeeh 3 and A. Al Midfa 3 عدم التطابق بني ما تفضله النساء العربيات واﻻختيارات املقدمة هلن ملعاجلة َس َلس البول َالك ْريب يف اﻹمارات العربية املتحدة سامي جورج، حممد جواد هاشم، مريم هندي شاكر البلويش، ريم سيف احلبيس، أمل عيل البلويش، ساره عيل بلفقيه، عاليه املدفع اخلﻻصة: ُي ُّعد َس َلس البول الكريب من احلاﻻت الشائعة ًنسبيا، ويشكل ًعبئا ًثقيﻻ من املعاناة مع أنه يمكن معاجلته بفعالية وبالقليل من اجلراحات غري الباضعة. ولكن ما تفضله النساء العربيات ملعاجلة هذا املرض غري معروف، وﻻسيام من حيث رغبتهن يف إجراء اجلراحة. ويف هذا املسح الذي شمل 404 امرأة يف اﻹمارات العربية املتحدة، أبلغت 99 امرأة عن سلسل البول الكريب، وأقرت 51% منهن عىل موافقتهن عىل إجراء اجلراحة. هذه 5 24 التفضيﻻت مل ترتبط بالعمر، أو عدد مرات الوﻻدة، أو التعليم، أو شدة َّالس َلس. إﻻ أنه من بني امرأة التمسن اﻻستشارة الطبية، ذكرت سيدات 38 29 فقط أن اﻷطباء قد َع َر ْض َن عليهن املعاجلة باجلراحة. وشملت عروض العﻻج اﻷخرى العﻻج باﻷدوية ) %(، ومتارين للحوض ) %(، ومتارين للمثانة )25 (. ومع% أن نصف النساء من اﻹمارات العربية املصابات بالسلسل البويل الكريب يف هذه الدراسة رغبن يف إجراء اجلراحة، إﻻ أن هذا النوع من املعاجلة مل يقدم إليهن عىل نحو روتيني. ABSTRACT Stress urinary incontinence is a relatively common condition with a high burden of suffering that can be treated effectively with minimally invasive surgery. Treatment preferences for this condition in Arab women are not known, especially in regard to willingness to undergo surgery. In this survey of 404 women across the United Arab Emirates, 99 had self-reported stress urinary incontinence and 51% of these stated they would undergo surgery. This preference was not related to age, parity, education or severity of incontinence. However, of the 24 women who sought medical advice, only 5 recalled being offered surgical management by their physicians. Other treatments offered included medication (29%), pelvic exercise (38%) and bladder training (25%). Even though half of the Arab Emirati women with stress urinary incontinence in our study were willing to undergo surgery, this treatment is not being offered routinely. Décalage entre les préférences des femmes arabes et les options thérapeutiques proposées pour traiter l'incontinence urinaire à l'effort aux Émirats arabes unis RÉSUMÉ L'incontinence urinaire à l'effort est une affection relativement fréquente entraînant une souffrance importante qui peut être traitée efficacement par une intervention chirurgicale minimalement invasive. Les préférences thérapeutiques des femmes arabes affectées restent à élucider, en particulier par rapport à leur volonté de se soumettre à une chirurgie. Dans la présente étude portant sur 404 femmes des Émirats arabes unis, 99 souffraient d'une incontinence urinaire à l'effort autodéclarée et parmi celles-ci, 51 % affirmaient être volontaires pour choisir la chirurgie. Cette préférence n'était liée ni à l'âge, ni à la parité , ni au niveau d'études, ni à la sévérité de l'incontinence. Toutefois, sur les 24 femmes qui avaient consulté un médecin, seules 5 se sont souvenues avoir été informées par ce dernier de la possibilité d'une prise en charge chirurgicale. Des médicaments (29 %), des exercices du plancher pelvien (38 %) et une rééducation de la vessie (25 %) étaient les autres traitements proposés. La moitié des femmes émiraties de notre étude souffrant d'incontinence urinaire à l'effort étaient volontaires pour la chirurgie, mais ce type de traitement n'a pas été proposé systématiquement. 1Department of Obstetrics and Gynaecology; 2Department of Family Medicine; 3Faculty of Medicine & Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates (Correspondence to M.J. Hashim: [email protected]). Received: 03/08/11; accepted: 04/10/11 1060 املجلة الصحية لرشق املتوسط املجلد الثامن عرش العدد العارش Introduction (risk ratio 1.03 in 8 trials involving 599 interviewed in hospitals, primary health women) [5]. Minimally invasive sur- care clinics and local communities Although the prevalence of stress gery was associated with shorter op- based on non-random convenience urinary incontinence (SUI) and erating times and fewer postoperative sampling: any potential participants the burden of suffering caused by urinary complications. Furthermore, who were present were approached this condition among women has these operations can be performed as and invited to take part in the survey . been studied extensively, the treat- outpatient procedures under local an- The inclusion criteria were: wom- ment preference of these patients aesthesia with conscious sedation [6]. en age 30 years and above (since SUI has received minimal attention. It The quality of life has been shown to is generally related to childbearing is sometimes assumed that women improve with the minimally invasive and prevalence in younger women is from less-developed countries and tension-free vaginal tape procedure at much lower) and United Arab Emir- non-Western backgrounds may not 12 months follow-up, with a cure rate ates nationality. Due to the unique be aware that surgical treatment is of 87% [7].Treatment of SUI has ad- needs of our study and the lack of an option, or may not be willing to vanced significantly in terms of tech- a validated instrument in Arabic, a have surgery for this condition. Con- nique, success rate, non-invasiveness new questionnaire was developed via sequently, physicians may not be of- and safety [8]. multiple iterations and pilot tested in fering the full range of management Unfortunately, these remarkable Al Ain to assess the suitability of the options, especially to less-educated or advances in treatment do not appear questionnaire. The questions covered older women of certain ethnic origins. to have improved the community bur- demographic data, childbearing and Recent research in the Arabic- den of suffering from SUI. Whether medical conditions as well as specific speaking Middle East region has shown this is because of women’s reluctance questions about urine incontinence, that prevalence and morbidity of urinary to have surgery or to not being offered treatment options, attitudes and incontinence is comparable to that in this safe and effective option is un- healthcare-seeking behaviour. Most other parts of the world. The prevalence clear. For clinicians and public health questions were closed-ended with pre- reported in this region is over 20% in professionals, knowledge of women’s specified options. adult women [1]. awareness and preferences for man- In this study SUI was defined agement options are important in Arab Muslim women are particu- as “involuntary or accidental leak- discussing treatment choices and for larly distressed by SUI as it impacts age of urine with any increase in health education campaigns. As treat- on their ability to pray on a daily basis. intra-abdominal pressure such as with ment preferences and awareness of Embarrassment and misconceptions coughing, sneezing, laughing, exercise, effective operative management are about this condition prevents a large carrying heavy objects and bending, not known among Arab women, we number of women from seeking treat- regardless of its severity or social con- conducted this cross-sectional survey ment. A community-based survey in sequences”. among Emirati women. the United Arab Emirates found that Ethical approval was obtained from 69% of women did not seek medical Al Ain District Medical Research Eth- advice for urine leakage, leading to de- Methods ics Committee at Tawam Hospital, Al bilitating physical, psychological and Ain and the Faculty of Medicine and social burdens [1]. Women’s beliefs We developed a questionnaire and Health Sciences, United Arab Emirates about treatment options for inconti- conducted a cross-sectional survey to University, Al Ain. nence have been noted to affect help- assess the treatment preferences for seeking behaviour, including the fear SUI among women in the United Arab Statistical analysis of surgery and a perception of lack of Emirates. The survey was conducted Our study was powered to detect a effective treatments [2,3]. from June 2009 to March 2010 in 4 difference of at least 15% from the pref- However, the effectiveness of cities across the United Arab Emirates, erence for surgical treatment of 50% minimally invasive surgical techniques Abu Dhabi, Al Ain, Dubai and Sharjah. (minimum sample size 100 subjects; is fairly well established in urogynae- The cities were selected on the basis alpha 0.05; achieved power 82%; for a cology trials [4]. A systematic review of accessibility. After initial training 2-tailed, binomial, one-sample calcu- comparing minimally-invasive syn- sessions and a pilot phase, 6 medical lation). Data analysis was carried out thetic suburethral sling operations students from the United Arab Emir- using SPSS, version 18. We used 1-way with traditional suburethral slings ates University administered the ques- analysis of variance and nonparametric found them to be equally effective tionnaire. A total of 404 women were tests where appropriate. Two-tailed 1061 EMHJ • Vol. 18 No. 10 • 2012 Eastern Mediterranean Health Journal La Revue de Santé de la Méditerranée orientale significance testing was used with sig- 99 had SUI as judged by self-reported with SUI said that the condition inter- nificance level 0.05. loss of urine with physical activity: 69 fered with performing their daily prayers women had leakage with coughing and and 41% said it caused them embarrass- 11 reported leakage with sexual inter- ment (Table 2). Severity of interference Results course (Table 2). with daily living varied from mild 32% Although 51% (50/99) of those (32/99) to moderate 25% (25/99) to Generalizability of the findings can with SUI indicated that they would severe 5% (5/99) (data missing for 4 be assessed from the background undergo surgery, only 20.8% (5/24) women).
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