Economic impact of urinary incontinence and pelvic organ prolapse in women in Belize

Abstract

Introduction: Urinary incontinence (UI) and pelvic organ prolapse (POP) are prevalent in low-income and middle-income countries (LMIC). Although the significant clinical and social impacts of UI/POP are well-described, less is known regarding their microeconomic impacts. This study aimed to assess the microeconomic impact of UI/POP in the LMIC country of Belize. Methods: The authors performed a prospective survey-based assessment of patients with urologic disease during surgical trips to Belize in 2019–2021 by the charity Global Surgical Expedition. This study is a post-hoc analysis focused on a subset with urogynecologic disorders. Patients completed a 17-item survey focused on disease impact on work, caretaker responsibilities, and finances. The primary study outcome was income loss resulting from work impairment or absence related to UI/POP, calculated using the validated work productivity and activity impairment questionnaire. Results: Forty-nine women with UI (n=15) and POP (n=34) completed surveys. The majority (73% UI; 88% POP) reported their condition negatively impacted their lives. In the analysis of 21 patients able to provide financial data, 6 (29%) patients reported missing work and 10 (48%) reported impairment at work due to UI/POP. This resulted in a loss of 6.7% (UI) and 8.5% (POP) in total income per capita. When also accounting for direct treatment costs, the total cost attributable to UI/POP was 28% (2%, 51%) of weekly income. Conclusions: In Belize, UI and POP significantly impair work and caretaking responsibilities, resulting in considerable lost income and cost. Efforts are thus necessary to provide surgical care for UI/POP in LMIC to address not only the quality of life but also the financial health of individuals and families.