The aim of this study was to assess the proportion of women with POP or OF who delayed seeking treatment and to identify factors associated with the delays (delay to decide to seek care and treatment (first delay) and delay to reach treatment center (second delay). In this institution- based study, we found a high proportionof delay in seeking treatment for both POP and OF participants. Factors associated with the in seeking treatment for POP were fear of disclosure and lack of money, and for OF marital status and age.
In this study, it was noted that the proportion of women who delayed seeking treatment for POP (82.6%), and OF (63%) was high. Similarly, the mean length of delay for POP was 85.8 months (SD± 80.2), which is higher than the report from Israel (41.2 months with SD ± 39.5) [19]. However, the mean length of delay for OF (48.3 months) was in line with a similar study done in Israel (47.6 months) [19]. Due to social stigma attached to these problems, women with POP and OF usually feel embarrassed, isolate themselves,and this in turn results in different social and psychological consequences. These also make women not to disclose their problems to their relatives and keep them secret and thereby delay seeking treatment [20, 21]. In this study, it was noted that women who had fear of disclosure were two times more likely to delay seeking treatment for POP compared to those who had no fear of disclosure.
Financial constraint was one of the reasons for delaying seeking treatment for POP. In this finding, women who mentioned lack of money as a reason for the delay were nearly two times more likely to delay seeking treatment for POP as compared to those who didn’t mentionlack of money as the reason for the delay. Women with low or no income were not able to cover the health service expenses (medical and surgical), transport, foodand other indirect costs. Most women, especially rural women in Ethiopia are not economically empowered [22]A systematic review also indicated that financial problem was the most frequently mentioned reason for delaying to seeking treatment [23]. As POP is not a lifethreatening condition, many patients don’t want to seek treatment even if they are symptomatic. However, early treatment improves patient quality of life by improving the social, psychological, physical and sexual life of the women.
In this study, it is identified that fistula patients who were divorced were more likely to delay seeking treatment for OF than unmarried ones. Most fistula patients experienced stigma from their husbands, families and the community. A systematic review identified that socio- cultural factors were the second most frequent barriers to early treatment seeking. Different studies noted that more than 50% of women with OF were divorced [16, 23]. This implies that social problems, including social stigma and divorce can prevent women from getting early treatment [24].
In our work, age was found to have a significant association with delays to seek treatment for OF. The older the women the longer the delay to seek treatment for OF. Older women may believe that the symptom or the problem is a part of aging and tend to become reluctant to seek medical help.
The limitation of our study is that, some of the information was based on self-report which make it subject to recall bias. Hence, a longitudinal research is needed to assess the relationship amongvariables over time. Even though all patients were getting treatment during data collection, the sample size, especially the number of fistula cases was too small for us to do a rigorous and detailed analysis on the various risk factors.This study can be regarded as an eye opener for studies on POP and OF in Ethiopia and has clearly indicated the need for further detailed research with sufficiently large sample size. Another limitation of this study is its across-sectional design which might not show temporal relationships and thus making the observed associations not necessarily causal.