An Updated Systematic Review and Meta‐Analysis on the Prevalence of Female Urinary Incontinence in Developing Countries—A Collaborative Report by the International Continence Society (Developing World Committee) and the Iranian Research Center for Evidence‐Based Medicine

Abstract

HYPOTHESIS/AIMS OF STUDY: Urinary incontinence (UI) remains a substantial public health issue, particularly for women residing in developing nations, significantly impacting their economic stability and overall quality of life. Despite its considerable burden, a thorough understanding of the current prevalence of UI and its various subtypes across these regions is still not fully clear. This updated systematic review and meta-analysis aims to build upon previous research. Our primary objective is to determine the pooled prevalence of both overall UI and its specific subtypes among adult women in developing countries, utilizing data from population-based studies. STUDY DESIGN, MATERIALS, AND METHODS: This study involved an updated systematic review and meta-analysis. A comprehensive search was conducted across several electronic databases, including PubMed, Medline, Web of Science, Scopus, and Google Scholar, to identify relevant population-based studies published from January 2018 through October 2024. To ensure the breadth of coverage, data from our prior project, which encompassed studies up to 2020, were also integrated. Studies were considered for inclusion if they reported the prevalence of UI or its subtypes in adult women (generally aged 18 years or older, with exceptions justified by the original study) residing in developing countries and employed population-based research methodologies. Conversely, studies that focused on specific demographic cohorts (e.g., pregnant or recently postpartum women, or individuals with particular medical conditions) were systematically excluded. The methodological quality of each selected study was rigorously assessed using the Joanna Briggs Institute Meta-Analysis of Statistics, Evaluation, and Review Instrument (JBI MASTARI), a standardized tool for critical appraisal. For the meta-analysis, a random-effects model was employed to appropriately account for the expected variability and heterogeneity among the included studies. Furthermore, subgroup analyses were performed to investigate the influence of various factors on the reported prevalence rates, including the recall period (e.g., past 3 months, past 12 months), the overall quality of the studies, and whether validated or nonvalidated questionnaires were utilized. RESULTS: Our meta-analysis incorporated 83 population-based studies. These studies collectively included data from 252 698 women, ranging in age from 10 to 90 years, across numerous developing countries, all meeting the predefined inclusion criteria. The reported prevalence of overall UI exhibited substantial heterogeneity, ranging from a low of 2.8% in Nigeria to a high of 64.1% in Jordan. The pooled prevalence of overall UI in adult women residing in developing countries was estimated to be 27.4% (95% confidence interval [CI]: 24.5-30.5). Subtype-specific analyses revealed pooled prevalence rates of 20.1% (95% CI: 17.7-22.7) for stress UI, 11.4% (95% CI: 8.3-15.3) for urgency UI, and 13.7% (95% CI: 11.3-16.4) for mixed UI. Subgroup analysis based on the recall period demonstrated a significant impact on prevalence estimates, with higher rates reported for shorter recall periods (e.g., 46.8% for UI in the past 3 months) compared to longer periods (e.g., 15.8% for UI in the past 12 months). Furthermore, the study quality and the utilization of validated questionnaires appeared to have a modest influence on the reported prevalence rates, with studies of higher quality and those employing validated questionnaires tending to report slightly higher (31.9%) prevalence compared to those of lower quality or using nonvalidated questionnaires (20.5%). CONCLUSION: The high pooled prevalence of UI (27.4%) underscores its significant burden among adult women in developing countries. The substantial variation across countries suggests the influence of diverse factors. Higher prevalence with shorter recall periods indicates potential recall bias. The modest impact of study quality and questionnaire validation highlights the need for methodological rigor. The considerable prevalence of all UI subtypes necessitates targeted interventions.

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