Systematic review and meta-analysis of prevalence of, and risk factors for, pelvic floor disorders in community-dwelling women in low and middle-income countries:A protocol study

Introduction: Pelvic floor disorders (PFDs) including urinary incontinence, faecal incontinence and pelvic organ prolapse are common debilitating conditions among women in high-income countries. However, PFDs in women in low/middle-income countries (LMICs) have not been studied extensively. We aim to conduct a systematic review and meta-analysis of the available literature to determine the prevalence of, and/or risk factors for, PFDs in women in LMIC. Methods and analysis: We will search electronic databases including MEDLINE, EMBASE, PsycINFO, CINAHL, Maternity & Infant Care and Google Scholar for eligible studies. Inclusion criteria will be observational studies of healthy women, which have collected data using validated or non-validated tools, are published in English and were conducted in community women in LMICs, defined by the World Bank. A standardised data extraction form will be developed and piloted, based on the template of the Cochrane good practice data extraction form. All included studies will be assessed based on a risk-of-bias tool specifically developed for prevalence studies. Pooled prevalence estimates of PFDs will be generated using RevMan V.5.2.1 software. Forest plots will be generated to display the overall random-effects pooled estimates with CIs. A metaregression will be conducted to identify sources of between-study heterogeneity in the pooled prevalence estimates. We will quantify heterogeneity using the I2 measure and its CI. We will use funnel plots to detect potential reporting biases and small-study effects. We will also conduct a sensitivity analysis to verify the robustness of the study conclusions, assessing the impact of methodological quality, study design, sample size and the effect of missing data. Ethics and dissemination: Our review is entirely based on published data. Thus, an ethics committee approval or written informed consent will not be required for this study as primary data will not be collected. The results will be disseminated by publication of the manuscript in a peer-reviewed journal and/or will be presented at relevant conferences.