1. Chronic Obstetric Morbidities and Validation of Self-reports by Women
Samina Sultana1 and Charles P. Larson2
1SUZY Project, Health Systems and Infectious Diseases Division and 2Health Systems and
Infectious Diseases Division, ICDDR,B, GPO Box 128, Dhaka 1000, Bangladesh
Background: Chronic obstetric morbidities (COM) are long-term sequelae of obstetric origin,
which include genital prolapse, genital fistulas, old perineal tears, haemorrhoids, dyspareunia,
and urinary incontinence. In most developing countries, the only feasible technique for
estimating the prevalence or incidence of obstetric morbidities is by self-reports. Studies report
that women may either under- or over-report morbidities. A study conducted by BIRPERHT has
shown the prevalence of self-reported COM in Bangladesh, but did not mention anything wheth-
er the reports of morbidities were assessed by observation or examination to identify morbidities.
Objective: To describe the pattern of self-reported COM and validate the accuracy of self-
reports.
Methodology: This cross-sectional study was conducted in the urban slum of Mirpur, Dhaka,
Bangladesh. The source population was women whose infants or young children were enrolled in
an ongoing study of ICDDR,B. One hundred and ninety-six women who had delivered between
12 and 24 months prior to the date of interview were identified; of these, 183 were examined for
confirmation of morbidity status.
Results: Eighty-nine (48.6%) of the respondents reported at least one COM during the interview.
The reported morbidities Bangladesh included genital prolapse (3.8%), old perineal tear (1.6%),
stress incontinence (13.7%), and dyspareunia (14.4%). Twenty (14.8%) respondents reported
more than one morbidity. The physical examination identified at least one COM in 105 (57.4%)
women; these included genital prolapse (12%), old perineal tear (13.7%), stress incontinence
(2.7%), dyspareunia (9.8%), and multiple morbidities (19.1%). Genital fistula was neither re-
ported by the respondents nor identified on physical examination. Sensitivity, specificity,
positive predictive value, and negative predictive value for COM were 63%, 70%, 74%, and 41%
respectively. No significant differences were observed in identifying morbidities by the
respondents in relation to their age, education, occupation, socioeconomic status, education of
husband, and occupation of husband. The multipara respondents could identify their status of
presence of COM significantly more than primipara (p<0.05).
Conclusion: The results suggest that there are substantial amount of COM among the study
population. Estimating the prevalence of chronic obstetric morbidities by self-reports is not a
reliable method.
Acknowledgements: The financial support of Swiss Agency for Development and Cooperation
is acknowledged.
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