Quality of life and associated factors among women with pelvic organ prolapse in Ethiopia: A systematic review and meta-analysis

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Despite the poor quality of life, there is a lack of comprehensive reviews in the existing literature. This review aims to address this gap by systematically evaluating the overall quality of life and identifying the factors among women suffering from pelvic organ prolapse in Ethiopia. Methods: PubMed, Scopus, Web of Science, ScienceDirect, African Journals Online, and the Wiley Online Library, and a Google Scholar were searched from January 1, 2024, to February 10, 2024. Data extractions were performed using Excel, and the analyses were conducted with Stata 11 software. Pooled effect sizes were determined based on the percentages, and pooled odds ratios with 95% CI were used to pool the effect measure. To evaluate statistical heterogeneity, the Cochrane Q test and I² statistic were employed. A sub group analysis, Meta-regression, and sensitivity analysis were done. Small study effect was assessed. The quality of the studies was assessed using the Newcastle-Ottawa Scale. Results: The pooled prevalence of poor quality of life among women with pelvic organ prolapse was found to be 42.40% (95% CI: 43.22, 57.61). Key factors significantly associated with a poor quality of life included uneducated women (POR=2.52, 95% CI: 1.79, 3.53), lack of regular physical exercise (POR=3.39; 95% CI: 2.20–5.22), the presence of urge urinary incontinence (POR=4.08, 95% CI: 3.10, 5.36), and having pelvic organ prolapse stages ≥ 3 (POR = 2.91; 95% CI: 2.06–4.11). Conclusions : This review highlights that 42.4% of Ethiopian women with pelvic organ prolapse experience a poor quality of life. This issue is particularly pronounced among women who have not received formal education, those with stage III or IV pelvic organ prolapse, individuals suffering from urge urinary incontinence, and those who do not participate in regular physical exercise. To enhance the quality of life for these women, it is essential to ensure access to early interventions, psychosocial support, and counseling that addresses their physical, mental, and social health. We recommended that healthcare providers play a vital role in identifying cases within communities and linking these services to health extension workers for effective support and management. Poor quality of life pelvic organ prolapse Ethiopia Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Introduction Pelvic organ prolapse, which involves the descent of the uterus, cervix, bladder, rectum, and small intestine into the vaginal canal, has a profound impact on women's quality of life ( 1 , 2 ). Women who experience pelvic floor disorders face a variety of symptoms such as pain during intercourse, vaginal discharge, and a feeling of heaviness in the pelvis ( 3 , 4 ). Other symptoms include burning sensations, urgency, poor urine flow, and difficulties with bladder emptying, which can manifest as delays or incomplete voiding ( 5 ). The extent of the impact on quality of life can range from mild to severe, with approximately 19.7% of women reporting significant issues related to this condition ( 6 ). The adverse effects of a diminished quality of life can heavily compromise a woman's physical, social, psychological, and sexual well-being, leading to discomfort and distress ( 7 ). This issue is particularly pronounced in developing countries like Ethiopia, where the implications of pelvic floor dysfunction are frequently overlooked in public health discussions ( 8 , 9 ). As a result, women's health-related quality of life may continue to deteriorate without adequate recognition of the seriousness of pelvic organ prolapse ( 10 , 11 ). These findings underline the urgency of addressing poor quality of life among women with this condition as a significant public health concern. Globally, between 3.3 and 4.9 million women with pelvic organ prolapse (POP) live in poor quality of life ( 12 ). In developed countries, the quality of life and associated factors for women with POP are typically assessed using specific tools designed to measure this, which serve as a baseline strategy for treatment( 13 ). By 2030, complications related to poor quality of life among these women are predicted to be the second leading cause of disease burden in developing countries and the third in low-income countries ( 6 ). POP is a major cause of disability among women worldwide, significantly impacting the quality of life for expectant women. Poor quality of life accounts for about 6.2% of years lived with disability in both developed and developing nations ( 14 ). Over a woman's lifetime, these issues can negatively affect not only herself but also her child and family. Researchers have identified poor quality of life as a risk factor for suicide attempts, divorce, and poor economic status ( 15 , 16 ). However, there are currently no systematic reviews and meta-analyses that comprehensively synthesize the available evidence on this topic. The quality of life among women with pelvic organ prolapse (POP) is often undiagnosed in low- and middle-income countries, leading to adverse outcomes for local communities ( 17 ). Programs like PRIME (Program for Improving Quality of Life) and Emerald (Emerging Mental Health System in Low- and Middle-Income Countries) are making strides to enhance maternal quality of life by integrating POP health services into primary healthcare systems ( 18 ). Despite these efforts, the quality of life for women facing POP remains a significant public health issue in developing nations, particularly in Ethiopia ( 19 , 20 ). The challenges in effectively addressing this condition are ongoing and continue to hinder progress ( 21 ). Recent studies in Ethiopia have shown varying prevalence rates of poor quality of life among affected women, ranging from 37.7% ( 22 ), to 58.2%, ( 23 ), along with differing quality scores. These studies have also pointed out several factors that can impact a woman's quality of life in relation to POP. Factors such as economic status, lifestyle choices, age especially for women over 40 educational attainment, health-seeking behaviors, and cultural attitudes have been identified as influential ( 23 – 26 ). To date, there have been ten primary studies ( 22 , 27 – 35 ) conducted on the prevalence of poor quality of life quality of life among women with POP in Ethiopia. However, these studies have revealed inconsistent findings, with prevalence rates ranging from 37.7% ( 22 ), to 58.2% ( 28 ), and varying degrees of quality scores. Furthermore, the impact of various socio-demographic, socioeconomic, cultural, health-seeking behaviors, and psychosocial factors on womens' poor quality of life remains inconclusive ( 36 , 37 ). This systematic review and meta-analysis was conducted in response to a prior methodological study in Ethiopia ( 35 ), which highlighted the need for additional research in this field. The main goal of this review was to summarize the findings from the ten primary studies on poor quality of life. By consolidating these reviews, it becomes easier to compare their results. This was the first systematic review and meta-analysis focusing on quality of life and its associated factors among women with POP in Ethiopia. The review aims to synthesize the pooled quality of life and its determinants among women with POP in Ethiopia through a comprehensive analysis. The findings will help healthcare providers and policymakers design targeted interventions to improve womens' health and overall well-being. By identifying the overall poor quality of life and related factors, this research can inform the development of preventive strategies and effective management of pelvic floor disorders. Additionally, it will provide health planners with essential statistics to design targeted programs aimed at reducing the incidence of POP. Methods This review was conducted using the Preferred Reporting Items for the Systematic Reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (S 1 PRISMA_2020 checklist.docx). This review was registered as a protocol in the International Prospective Register of Systematic Reviews (PROSPERO ID: CRD42024572231). Search strategy and data sources Three authors (AGM, GAT, and WCT) conducted a comprehensive literature search using Scopus, Web of Science, PubMed/Medline, Science Direct, African Journal Online, and the Wiley Online Library from January 1, 2024, to February, 2024. Additionally, a Google Scholar search was performed as a confirmatory measure to ensure that no primary studies were overlooked. The focus of this research was specifically on the prevalence of poor quality of life among women with POP in Ethiopia, allowing for a targeted analysis. We used the following keywords during our search: (quality of life) OR (Life Quality) OR (prevalence of quality of life) OR (magnitude of quality of life) OR (depressed quality of life) AND (associated factors) OR (determinants) OR (predictors) AND (pelvic organ prolapse in women) AND (Ethiopia). All identified articles were imported into Endnote version 7, where duplicates were removed electronically. Following the removal of duplicate articles, the titles and abstracts of all collected records were screened. Any disagreements were resolved through discussion, and reasons for exclusion were documented according to the eligibility criteria. Study inclusion and exclusion criteria In this review, which focused on cross-sectional studies conducted in Ethiopia that reported on women’s quality of life and its associated factors among women with pelvic organ prolapse (POP), articles published until January 2024 were included. Only free articles and publications in the English language were considered for our review. Eligible studies that specifically addressed the quality of life among women with POP in Ethiopia were included. However, studies that did not clearly report on quality of life and its associated factors among women with POP were excluded. Additionally, studies that focused on specific case reports, case series, letters to the editor, and commentaries were excluded. The inclusion criteria for this review were established using the modified condition, context, and population (CoCoPop) framework (see Table 1 ). Table 1 Framework for determining the eligibility of studies (CoCoPop) in Ethiopia Population Outcome Comparison Contest Women with pelvic organ prolapse Women quality of life Women with pelvic organ prolapse had secondary education or higher Women with pelvic organ prolapse had below primary education level Ethiopia Women with pelvic organ prolapse Women quality of life Women with pelvic organ prolapse did regular exercise Women with pelvic organ prolapse did not regular exercise Ethiopia Women with pelvic organ prolapse Women quality of life Women with pelvic organ prolapse had urinary incontinence Women with pelvic organ prolapse had not urinary incontinence Ethiopia Women with pelvic organ prolapse Women quality of life Women with pelvic organ prolapse had stage III/IV pelvic organ prolapse Women with pelvic organ prolapse had stage one or two pelvic organ prolapse Ethiopia Outcome of interest : In this review and meta-analysis, we examined the quality of life and related factors in women with pelvic organ prolapse (POP) in Ethiopia. The quality of life among these women was assessed using various variables, including nine domains: general health perception, prolapse impact, role limitation, physical limitation, social limitation, personal relationships, emotional well-being, sleep and energy, and severity measures. The quality of life measurement was expressed as either lower or higher. Women who scored above the median score for quality of life were considered to have a good quality of life, while those who scored below the median were considered to have a poor quality of life ( 6 , 28 , 29 , 38 ). Critical appraisal assessment A Newcastle-Ottawa Scale (NOS) specifically designed for studies was employed to assess the quality of each publication ( 39 ). This tool comprises three major components. The first section, which includes five stars, evaluates the methodological quality of each study, focusing on aspects such as the sampling process, sample size, response rate, and determination of exposure or risk factors. The second section assesses the comparability of the studies, with a potential rating of two stars. The final component measures the outcomes and statistical tests of the primary studies, allowing for a maximum of three stars. In total, the quality assessment tool includes ten items related to bias, with each item contributing to a maximum score of 10 and a minimum score of 0. Only high-quality publications that achieved a score of at least 6 out of 10 were included in the meta-analysis. Research synthesis The data extracted using Microsoft Excel were imported into STATA version 11 (Stata Corp LLC, TX, USA) for further analysis. A random effects model employing Der Simonian-Laird weights was utilized to estimate the pooled prevalence and identify predictors of poor quality of life among women with pelvic organ prolapse ( 40 ). To determine the factors associated with poor quality of life in this population, the pooled odds ratio (POR) and 95% confidence interval were computed. Statistical heterogeneity was evaluated using the Cochrane Q test and the I² statistic ( 41 ). Additionally, subgroup analyses by publication year and sample size differences, meta-regression analysis, and sensitivity analysis were conducted to assess the effect of each study on the overall estimate. To investigate the small study effect, a funnel plot and Egger’s test were employed( 24 ). Results Description of the included studies A total of 16,258 articles were identified using electronic searches of PubMed (11,331), Scopus (1321), ScienceDirect (942), Web of Science (1380), National Digital Library (82), African Journals Online (690), and Wiley Online Library (512). Of these, 1,597 were removed due to duplication, and 8,980 were excluded after reviewing the titles and abstracts. From the remaining 5,681 articles, 5,671 were excluded for various reasons, including differences in outcomes of interest, target population disparities, unreported outcomes, and inconsistencies with the inclusion criteria (see Fig. 1). Ultimately, 10 eligible studies ( 27 , 28 , 30 – 35 , 42 ) comprising 3,221 of study participants were included in the systematic review and meta-analysis. The sample sizes of these studies varied from 89( 32 ) to 499( 31 ) participants. In terms of geographical distributions, four studies were conducted in the Amhara ( 27 , 28 , 34 , 35 ), while two were from the southern Region of Ethiopia( 29 , 32 ). All included studies focused on the quality of life among women with pelvic organ prolapse in Ethiopia (see Table 2 ). Table 2 Description of included studies reporting the poor quality of life among women with pelvic organ prolapse in Ethiopia, 2024 First author & year of study Region Study design Sample size Participants Prevalence Quality score Abebe.SA,etal.,2024 ( 27 ) Amhara CSS 367 367 47.1 9 Kindie.W ,etal,2023 ( 28 ) Amhara CSS 253 253 48.35 7 Ayenew. T,2022 ( 29 ) Southern Ethiopia CSS 423 416 53.6 9 Tefera.Z, etal.,2023 ( 30 ) SNNPR CSS 418 399 57.5 10 Hurissa.BF, etal, 2022 ( 31 ) Addis Ababa CSS 499 478 41 8 Ali A, etal ,2022( 22 ) Oromia CSS 408 387 39 9 Belayneh.T, etal.,2021 ( 35 ) Amhara CSS 249 248 42.8 10 Debela.TF,etal, 2021 ( 32 ) Southern Ethiopia CSS 89 78 58.2 10 Matiwos.B,etal.,2021 ( 43 ) Addis Ababa CSS 289 289 37.5 9 Zeleke.BM, etal,2013 ( 34 ) Amhara CSS 306 306 67.7 10 N.b CSS: Cross sectional study Meta-analysis The pooled prevalence of poor quality of life among women with pelvic organ prolapse in Ethiopia was found to be 42.40% (95% CI: 36.34%, 48.51%) (p = 0.000, I² = 93.1%). The I² value of 93.1% indicates the presence of high heterogeneity among the included studies (Fig. 2). Examine the source of heterogeneity To address the high level of heterogeneity,, a random effects model was employed to determine the pooled prevalence of poor quality of life. Nonetheless, significant heterogeneity was observed among the included studies, with a pooled prevalence of 42.40% (95% CI: 34.27%, 50.54%) (p = 0.000, I² = 93.1%). Subgroup analysis was conducted. The analysis based on publication year and sample size differences indicated a higher prevalence of poor quality of life in studies published before 2021 (53.13%, 95% CI: 37.60, 68.66), I 2 = 82.0, p = 0.001 compared to those published in 2021 or after 2021 (48.58%, 95% CI: 42.84, 54.32), I 2 = 0, p = 0.424 among women with pelvic organ prolapse (see Fig. 3 ). There was significant heterogeneity in these subgroup analyses. Additionally, the prevalence of poor quality of life among women with pelvic organ prolapse (POP) was higher in a sample size of ≤ 422 than in a sample size of > 422. There was no evidence of heterogeneity in these subgroup analyses (see Fig. 4 ). Meta-regression We conducted a meta-regression analysis using the random effects model to examine the effects of study participants, sample size, and publication year on the heterogeneity among the studies. According to the univariable meta-regression analysis, the number of participants, sample size, and publication year were not significantly associated with poor quality of life (see Table 3 ). Table 3 Univariable meta-regression analysis results for the poor quality of life among women with pelvic organ prolapse in Ethiopia Logodds Coef. Std. Err. t P > t [95% Conf. Interval] participants − .1076045 .4682705 -0.23 0.827 -1.311332, 1.096123 Pub year .0602613 3.470183 0.02 0.987 -8.860129, 8.980652 Sample size .1074701 .468084 0.23 0.828 -1.095778, 1.310718 _cons -121.7905 7011.595 -0.02 0.987 -18145.67, 17902.09 Sensitivity analysis A sensitivity analysis was conducted using the random effects model to assess the impact of individual studies on the pooled prevalence of poor quality of life among women with pelvic organ prolapse in Ethiopia. The results of the sensitivity analysis indicated that the individual studies did not significantly affect the prevalence of poor quality of life in this population (see (Fig. 6 ). Small study effect The symmetrical appearance of the funnel plot (see Fig. 6 ) suggested that there was no publication bias among the included studies. Similarly, the results of Egger's test (p = 0.909) indicated a statistically insignificant result, suggesting the absence of a small study effect, as shown in (Table 4 ). Table 4 Show that the absence of publication bias Std_Eff Coef. Std. Err. t P>|t| [95% Conf. Interval] Slope .8784661 .8784661 0.83 0.430 -1.559935, 3.316868 Bias − .1090717 − .0128063 -0.12 0.909 − .2643261, .2387136 Factors associated with poor quality of life Figure 7 illustrates the factors associated with a poor quality of life in individuals with pelvic organ prolapse. Key independent factors contributing to poor quality of life among women with pelvic organ prolapse include education level, menopausal status, regular exercise, urinary incontinence, prolapse stage, constipation, dyspareunia, and duration of prolapse. However, only four pooled factors significantly impacted the poor quality of life of affected women at the national level in Ethiopia. This meta-regression analysis revealed that a lack of formal education, failure to engage in regular exercise, urinary incontinence, and having an advanced stage of pelvic organ prolapse are key factors associated with poor quality of life in these women. The association between poor quality of life and lack of formal education was analyzed in seven studies. According to the current meta-analysis of these studies ( 22 , 28 – 30 , 32 – 34 ), women with no formal education were 2.52 times more likely to experience poor quality of life due to pelvic organ prolapse compared to women with secondary education or higher (POR = 2.52, 95% CI: 1.79, 3.53). From five studies ( 27 , 29 , 30 , 34 , 35 ), it was found that those who did not engage in regular physical exercise were 3.39 times more likely to have poor quality of life than those who did (POR = 3.39; 95% CI: 2.20–5.22). Additionally, based on five studies ( 22 , 29 , 30 , 32 , 34 ), ), women experiencing urge urinary incontinence were 4.08 times more likely to report poor quality of life compared to those who did not (POR = 4.08, 95% CI: 3.10, 5.36). Moreover, in six studies ( 22 , 29 , 31 – 34 ), women with pelvic organ prolapse stages three and four were more likely to have poor quality of life than those with stages one and two (POR = 2.91; 95% CI: 2.06, 4.11). The interplay between poor quality of life and experiencing urge urinary incontinence is crucial in understanding the risk of symptomatic prolapse. By focusing on preventive measures surrounding childbirth, healthcare providers can help mitigate the long-term effects on women's pelvic health (Fig. 7 .) Discussion Understanding the latest statistics on the quality of life for women with pelvic organ prolapse is crucial for health planners aiming to develop effective programs that mitigate this risk. Identifying the overall pooled prevalence of poor quality of life, along with the associated factors, will facilitate the formulation of preventive strategies and enhance the management of pelvic organ prolapse and its complications. The objective of this review was to examine the pooled prevalence of quality of life and the related factors among women with pelvic organ prolapse. Our findings revealed that the pooled prevalence of poor quality of life in this population is 42.40% (95% CI: 36.34%, 48.51%). This statistic highlights that a significant proportion of women with pelvic organ prolapse experience a diminished quality of life. Our findings align with previous studies conducted in Nigeria (45%) ( 44 ), Uganda (45.5%) ( 26 ), and Iran (48.08%) ( 45 ). However, this review reports lower prevalence values compared to studies in Brazil ( 46 ), Nepal (53.48%) ( 47 ), and rural Pakistan (60.8%) ( 10 ). Additional studies from the United Kingdom, Italy, and China ( 7 , 38 , 48 ) also reflect varying prevalence rates. The variation in the prevalence of poor quality of life across different regions can be attributed to several factors. Firstly, socio-cultural differences play a significant role. Secondly, methodological variations in study design, assessment tools, and sampling techniques can impact prevalence estimates. For instance, a study conducted in a rural area of Pakistan may reflect a potentially lower awareness of the impact of pelvic organ prolapse compared to urban areas. In our review, the domain of general health perception was found to be the most affected. These multifaceted dynamics contribute to the observed discrepancies in prevalence rates worldwide. Further research and cross-cultural comparisons are essential to better understand these variations and inform targeted interventions. A study conducted in Northern England also supports this finding ( 49 ). Women with pelvic organ prolapse may experience feelings of isolation, decreased attractiveness, and distorted health perceptions, which can negatively impact their well-being ( 49 ). This can lead to feelings of shame, embarrassment, and a diminished sense of sexual attractiveness, ultimately affecting their quality of life. Additionally, women without formal education were significantly more likely to experience poor quality of life related to pelvic organ prolapse ( 50 ). This may be because of the misconceptions among uneducated women, who may incorrectly believe that pelvic organ prolapse is a lethal tumor, compounded by aging and cultural beliefs that contribute to their poor quality of life ( 50 ). This finding is consistent with those of a study conducted in Nepal ( 47 ). Based on our findings, women with no formal education were 2.52 times more likely to experience poor quality of life in pelvic organ prolapse compared to those with secondary education or higher. Studies conducted in Nepal ( 44 ), suggest that uneducated women may hold incorrect beliefs about pelvic organ prolapse, linking it to tumors, mortality, and aging, which can adversely impact their quality of life ( 23 ). The long-term effects of childbirth on pelvic organ function can vary widely among women. Awareness, preventive measures, and appropriate treatment can help manage and mitigate these effects. It is essential for women to discuss any concerns with their healthcare providers to receive tailored advice and support ( 51 ). The odds of experiencing poor quality of life were significantly higher among women with advanced stage III/IV pelvic organ prolapse. Specifically, women with advanced stage III/IV pelvic organ prolapse were 2.91 times more likely to report poor quality of life than those with stages I or II (POR = 2.91; 95% CI: 2.06–4.11). This finding is supported by research conducted in Nepal ( 47 ) and Ghana ( 52 ). Symptoms of pelvic organ prolapse tend to increase with advanced stages, leading to a decline in quality of life. This decline may be attributed to the heightened severity of symptoms that affect women's social interactions, emotional well-being, and daily activities such as walking, sitting, and standing. Similar results have been observed in studies conducted in the United Kingdom ( 45 ). A recent study revealed a strong association between urge urinary incontinence and lower quality of life among participants. Previous research in India ( 46 ) and France ( 47 ) supports this finding. Urge incontinence is common among women with pelvic organ prolapse and can negatively impact various aspects of their daily lives, including psychological well-being, social interactions, physical activities, and sexual relationships ( 48 , 49 ). This condition can compromise quality of life by making it difficult to perform household tasks, avoid social events, maintain relationships, and achieve mobility, leading to reduced emotional well-being and feelings of frustration ( 50 ). Finally, women who engaged in regular physical exercise experienced a reduction in the negative impact of prolapse on their quality of life. Studies from the United States ( 51 ) and France ( 47 ) indicate that physical activity can strengthen pelvic floor muscles and alleviate symptoms such as urinary incontinence, frequency, and interference with bladder emptying. These improvements contribute to overall health and well-being. Regular exercise can enhance strength, engage pelvic floor muscles, and promote weight reduction, ultimately leading to a better quality of life ( 46 , 52 ). Strengths and limitations of study Prior to this systematic review, there was no comprehensive examination of poor quality of life and its associated factors among women with pelvic organ prolapse (POP) in Ethiopia. This review is one of the few that specifically focuses on the Ethiopian context, addressing the significant gap in clear and comprehensive data regarding the pooled prevalence of quality of life issues within this population. However, this review has some limitations. All included studies were cross-sectional, which restricts the ability to establish direct cause-and-effect relationships between poor quality of life and its contributing factors. Additionally, some important factors were excluded due to differences in categorization among studies. This review uniquely incorporates ten primary studies, providing up-to-date insights into national quality of life issues related to POP in Ethiopia. While it is recognized that poor quality of life is prevalent and associated with various health challenges, the assessment only covers five of the country's twelve regions, limiting its nationwide relevance. Therefore, conducting scoping reviews in the future is essential for enhancing comparability across study settings and for better understanding the impact of risk factors and protective measures in subsequent research. Conclusions and Recommendations This review highlights that 42.4% of Ethiopian women with pelvic organ prolapse experience a poor quality of life. This issue is particularly pronounced among women who have not received formal education, those with stage III or IV pelvic organ prolapse, individuals suffering from urge urinary incontinence, and those who do not participate in regular physical exercise. To enhance the quality of life for these women, it is essential to ensure access to early interventions, psychosocial support, and counseling that addresses their physical, mental, and social health, including sleep-related concerns. We recommended that healthcare providers play a vital role in identifying cases within communities and linking these services to health extension workers for effective support and management. Abbreviations LMIC: Low- and Middle-Income Countries OR: Odds ratios PECO: Population-Exposed-Comparison-Outcome-Type of study-Area POP: Pelvic organ prolapse PRIME: Program for Improving Quality of Life and Emerald Emerging Mental Health System in Declarations Acknowledgments : The authors would like to express their gratitude to the authors of the included primary studies, which served as valuable sources of information for conducting this systematic review and meta-analysis. Funding The authors received no specific funding for this work. Availability of data and materials All relevant data are within the manuscript and it’s supporting information files. Consent for publication Not applicable. Consent for publication Not applicable. Declaration of conflicting interests The authors have declared that no competing interest exist Authors’ contributions AMZ and WCT: Designed the tests and developed the ideas; performed the data analysis and interpretation; wrote the paper and tools; and authored the paper. WCT and GAT performed the data extraction and YAG and YAF quality assessment. Ethics approval and consent to participate Not applicable Financial Disclosure statement The authors received no specific funding for this work References Patel PD, Amrute KV, Badlani GH. Pelvic organ prolapse and stress urinary incontinence: A review of etiological factors. Indian journal of urology : IJU : journal of the Urological Society of India. 2007;23(2):135-41. Raju R, Linder BJ. Evaluation and Management of Pelvic Organ Prolapse. 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Supplementary Files S1PRISMA2020checklist.docx S 1 PRISMA_2020_checklist.docx S2FileSearchstrategy.docx S2 File Search strategy.docx S3FileDataExtraction.docx S3 File Data Extraction.docx S4Extracteddataset.xlsx S4 Extracted data set.xlsx Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 01 Oct, 2025 Reviewers invited by journal 01 Oct, 2025 Editor assigned by journal 11 Jun, 2025 First submitted to journal 06 May, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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2","display":"","copyAsset":false,"role":"figure","size":50678,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6604414/v1/d47fc62f51e3d7bef2535513.png"},{"id":93530667,"identity":"9167ae55-6650-4cb7-ad00-3e3d3c4319a9","added_by":"auto","created_at":"2025-10-14 20:59:24","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":38231,"visible":true,"origin":"","legend":"\u003cp\u003eThe pooled of estimate of prevalence poor quality of life by publication year subgroup analysis among women with pelvic organ prolapse in Ethiopia\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-6604414/v1/74891d64a25fb35ebd29dda0.png"},{"id":93531042,"identity":"57e76980-36c7-4432-a9cc-750ac6a44ef8","added_by":"auto","created_at":"2025-10-14 21:15:24","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":36919,"visible":true,"origin":"","legend":"\u003cp\u003eThe pooled estimates of the poor quality of life by sample size among women with pelvic organ prolapse in Ethiopia\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-6604414/v1/a379d0552199c0c0ed2e9ba6.png"},{"id":93529876,"identity":"b00cfab1-1073-4751-b85e-0f2d7247fdb9","added_by":"auto","created_at":"2025-10-14 20:51:24","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":17275,"visible":true,"origin":"","legend":"\u003cp\u003eResults of the sensitivity analysis of 10 studies\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-6604414/v1/eb039c00d60c1a4096f4e6ca.png"},{"id":93529882,"identity":"c5e76e33-bba6-4504-a0f5-7a0026b9debf","added_by":"auto","created_at":"2025-10-14 20:51:24","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":11381,"visible":true,"origin":"","legend":"\u003cp\u003eGraphicalrepresentation of publication bias using funnel plots of all included studies, 2024\u003c/p\u003e","description":"","filename":"6.png","url":"https://assets-eu.researchsquare.com/files/rs-6604414/v1/c9756a2c4bf929b51826feda.png"},{"id":93530670,"identity":"fe283bed-7073-496a-afd2-bf795e63bf09","added_by":"auto","created_at":"2025-10-14 20:59:24","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":71888,"visible":true,"origin":"","legend":"\u003cp\u003eForest plot showing the pooled odds ratios of the associations between the poor quality of life among women with pelvic organ prolapse in Ethiopia, 2024\u003c/p\u003e","description":"","filename":"7.png","url":"https://assets-eu.researchsquare.com/files/rs-6604414/v1/44a6391032d5c513afe5bc55.png"},{"id":93531313,"identity":"38406583-f0aa-4bbe-816f-f454677b0bb7","added_by":"auto","created_at":"2025-10-14 21:23:24","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1160165,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6604414/v1/bd18d294-39ed-41a8-ae47-9a5e613cb672.pdf"},{"id":93530675,"identity":"e150babc-30c6-41db-abb9-585165a608e9","added_by":"auto","created_at":"2025-10-14 20:59:24","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":34464,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eS 1 PRISMA_2020_checklist.docx\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"S1PRISMA2020checklist.docx","url":"https://assets-eu.researchsquare.com/files/rs-6604414/v1/dd44c290878d33e2a77cc607.docx"},{"id":93531043,"identity":"79776eaf-11c4-4e50-bf9c-2eecd25ed623","added_by":"auto","created_at":"2025-10-14 21:15:24","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":18338,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eS2 File Search strategy.docx\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"S2FileSearchstrategy.docx","url":"https://assets-eu.researchsquare.com/files/rs-6604414/v1/535c0f553689aeb4f4885086.docx"},{"id":93530859,"identity":"476d6747-e443-40ad-95d7-662496a76af0","added_by":"auto","created_at":"2025-10-14 21:07:24","extension":"docx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":20829,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eS3 File Data Extraction.docx\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"S3FileDataExtraction.docx","url":"https://assets-eu.researchsquare.com/files/rs-6604414/v1/a288f3c97bd26ac3a1fc151a.docx"},{"id":93529862,"identity":"4b31049f-62fc-4232-8eaa-1965254092c1","added_by":"auto","created_at":"2025-10-14 20:51:24","extension":"xlsx","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":15857,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eS4 Extracted data set.xlsx\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"S4Extracteddataset.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-6604414/v1/5198935e1e4d07ea543d5595.xlsx"}],"financialInterests":"","formattedTitle":"Quality of life and associated factors among women with pelvic organ prolapse in Ethiopia: A systematic review and meta-analysis","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePelvic organ prolapse, which involves the descent of the uterus, cervix, bladder, rectum, and small intestine into the vaginal canal, has a profound impact on women's quality of life (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Women who experience pelvic floor disorders face a variety of symptoms such as pain during intercourse, vaginal discharge, and a feeling of heaviness in the pelvis (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Other symptoms include burning sensations, urgency, poor urine flow, and difficulties with bladder emptying, which can manifest as delays or incomplete voiding (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). The extent of the impact on quality of life can range from mild to severe, with approximately 19.7% of women reporting significant issues related to this condition (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). The adverse effects of a diminished quality of life can heavily compromise a woman's physical, social, psychological, and sexual well-being, leading to discomfort and distress (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). This issue is particularly pronounced in developing countries like Ethiopia, where the implications of pelvic floor dysfunction are frequently overlooked in public health discussions (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). As a result, women's health-related quality of life may continue to deteriorate without adequate recognition of the seriousness of pelvic organ prolapse (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). These findings underline the urgency of addressing poor quality of life among women with this condition as a significant public health concern.\u003c/p\u003e\u003cp\u003eGlobally, between 3.3 and 4.9\u0026nbsp;million women with pelvic organ prolapse (POP) live in poor quality of life (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). In developed countries, the quality of life and associated factors for women with POP are typically assessed using specific tools designed to measure this, which serve as a baseline strategy for treatment(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). By 2030, complications related to poor quality of life among these women are predicted to be the second leading cause of disease burden in developing countries and the third in low-income countries (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). POP is a major cause of disability among women worldwide, significantly impacting the quality of life for expectant women. Poor quality of life accounts for about 6.2% of years lived with disability in both developed and developing nations (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Over a woman's lifetime, these issues can negatively affect not only herself but also her child and family. Researchers have identified poor quality of life as a risk factor for suicide attempts, divorce, and poor economic status (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). However, there are currently no systematic reviews and meta-analyses that comprehensively synthesize the available evidence on this topic.\u003c/p\u003e\u003cp\u003eThe quality of life among women with pelvic organ prolapse (POP) is often undiagnosed in low- and middle-income countries, leading to adverse outcomes for local communities (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Programs like PRIME (Program for Improving Quality of Life) and Emerald (Emerging Mental Health System in Low- and Middle-Income Countries) are making strides to enhance maternal quality of life by integrating POP health services into primary healthcare systems (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Despite these efforts, the quality of life for women facing POP remains a significant public health issue in developing nations, particularly in Ethiopia (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). The challenges in effectively addressing this condition are ongoing and continue to hinder progress (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Recent studies in Ethiopia have shown varying prevalence rates of poor quality of life among affected women, ranging from 37.7% (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e), to 58.2%, (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e), along with differing quality scores. These studies have also pointed out several factors that can impact a woman's quality of life in relation to POP. Factors such as economic status, lifestyle choices, age especially for women over 40 educational attainment, health-seeking behaviors, and cultural attitudes have been identified as influential (\u003cspan additionalcitationids=\"CR24 CR25\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eTo date, there have been ten primary studies (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan additionalcitationids=\"CR28 CR29 CR30 CR31 CR32 CR33 CR34\" citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e) conducted on the prevalence of poor quality of life quality of life among women with POP in Ethiopia. However, these studies have revealed inconsistent findings, with prevalence rates ranging from 37.7% (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e), to 58.2% (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e), and varying degrees of quality scores. Furthermore, the impact of various socio-demographic, socioeconomic, cultural, health-seeking behaviors, and psychosocial factors on womens' poor quality of life remains inconclusive (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). This systematic review and meta-analysis was conducted in response to a prior methodological study in Ethiopia (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e), which highlighted the need for additional research in this field. The main goal of this review was to summarize the findings from the ten primary studies on poor quality of life. By consolidating these reviews, it becomes easier to compare their results. This was the first systematic review and meta-analysis focusing on quality of life and its associated factors among women with POP in Ethiopia. The review aims to synthesize the pooled quality of life and its determinants among women with POP in Ethiopia through a comprehensive analysis. The findings will help healthcare providers and policymakers design targeted interventions to improve womens' health and overall well-being. By identifying the overall poor quality of life and related factors, this research can inform the development of preventive strategies and effective management of pelvic floor disorders. Additionally, it will provide health planners with essential statistics to design targeted programs aimed at reducing the incidence of POP.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis review was conducted using the Preferred Reporting Items for the Systematic Reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (S 1 PRISMA_2020 checklist.docx). This review was registered as a protocol in the International Prospective Register of Systematic Reviews (PROSPERO ID: CRD42024572231).\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eSearch strategy and data sources\u003c/h2\u003e\u003cp\u003eThree authors (AGM, GAT, and WCT) conducted a comprehensive literature search using Scopus, Web of Science, PubMed/Medline, Science Direct, African Journal Online, and the Wiley Online Library from January 1, 2024, to February, 2024. Additionally, a Google Scholar search was performed as a confirmatory measure to ensure that no primary studies were overlooked. The focus of this research was specifically on the prevalence of poor quality of life among women with POP in Ethiopia, allowing for a targeted analysis. We used the following keywords during our search: (quality of life) OR (Life Quality) OR (prevalence of quality of life) OR (magnitude of quality of life) OR (depressed quality of life) AND (associated factors) OR (determinants) OR (predictors) AND (pelvic organ prolapse in women) AND (Ethiopia).\u003c/p\u003e\u003cp\u003eAll identified articles were imported into Endnote version 7, where duplicates were removed electronically. Following the removal of duplicate articles, the titles and abstracts of all collected records were screened. Any disagreements were resolved through discussion, and reasons for exclusion were documented according to the eligibility criteria.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eStudy inclusion and exclusion criteria\u003c/h3\u003e\n\u003cp\u003eIn this review, which focused on cross-sectional studies conducted in Ethiopia that reported on women\u0026rsquo;s quality of life and its associated factors among women with pelvic organ prolapse (POP), articles published until January 2024 were included. Only free articles and publications in the English language were considered for our review. Eligible studies that specifically addressed the quality of life among women with POP in Ethiopia were included. However, studies that did not clearly report on quality of life and its associated factors among women with POP were excluded. Additionally, studies that focused on specific case reports, case series, letters to the editor, and commentaries were excluded. The inclusion criteria for this review were established using the modified condition, context, and population (CoCoPop) framework (see Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eFramework for determining the eligibility of studies (CoCoPop) in Ethiopia\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePopulation\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOutcome\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003eComparison\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eContest\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWomen with pelvic organ prolapse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWomen quality of life\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eWomen with pelvic organ prolapse had secondary education or higher\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eWomen with pelvic organ prolapse had below primary education level\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eEthiopia\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWomen with pelvic organ prolapse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWomen quality of life\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eWomen with pelvic organ prolapse did regular exercise\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eWomen with pelvic organ prolapse did not regular exercise\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eEthiopia\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWomen with pelvic organ prolapse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWomen quality of life\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eWomen with pelvic organ prolapse had urinary incontinence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eWomen with pelvic organ prolapse had not urinary incontinence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eEthiopia\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWomen with pelvic organ prolapse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWomen quality of life\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eWomen with pelvic organ prolapse had stage III/IV pelvic organ prolapse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eWomen with pelvic organ prolapse had stage one or two pelvic organ prolapse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eEthiopia\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eOutcome of interest\u003c/b\u003e: In this review and meta-analysis, we examined the quality of life and related factors in women with pelvic organ prolapse (POP) in Ethiopia. The quality of life among these women was assessed using various variables, including nine domains: general health perception, prolapse impact, role limitation, physical limitation, social limitation, personal relationships, emotional well-being, sleep and energy, and severity measures. The quality of life measurement was expressed as either lower or higher. Women who scored above the median score for quality of life were considered to have a good quality of life, while those who scored below the median were considered to have a poor quality of life (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eCritical appraisal assessment\u003c/strong\u003e\u003cp\u003eA Newcastle-Ottawa Scale (NOS) specifically designed for studies was employed to assess the quality of each publication (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). This tool comprises three major components. The first section, which includes five stars, evaluates the methodological quality of each study, focusing on aspects such as the sampling process, sample size, response rate, and determination of exposure or risk factors. The second section assesses the comparability of the studies, with a potential rating of two stars. The final component measures the outcomes and statistical tests of the primary studies, allowing for a maximum of three stars. In total, the quality assessment tool includes ten items related to bias, with each item contributing to a maximum score of 10 and a minimum score of 0. Only high-quality publications that achieved a score of at least 6 out of 10 were included in the meta-analysis.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResearch synthesis\u003c/strong\u003e\u003cp\u003eThe data extracted using Microsoft Excel were imported into STATA version 11 (Stata Corp LLC, TX, USA) for further analysis. A random effects model employing Der Simonian-Laird weights was utilized to estimate the pooled prevalence and identify predictors of poor quality of life among women with pelvic organ prolapse (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e). To determine the factors associated with poor quality of life in this population, the pooled odds ratio (POR) and 95% confidence interval were computed. Statistical heterogeneity was evaluated using the Cochrane Q test and the I\u0026sup2; statistic (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e). Additionally, subgroup analyses by publication year and sample size differences, meta-regression analysis, and sensitivity analysis were conducted to assess the effect of each study on the overall estimate. To investigate the small study effect, a funnel plot and Egger\u0026rsquo;s test were employed(\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e).\u003c/p\u003e\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003eDescription of the included studies\u003c/h2\u003e\u003cp\u003eA total of 16,258 articles were identified using electronic searches of PubMed (11,331), Scopus (1321), ScienceDirect (942), Web of Science (1380), National Digital Library (82), African Journals Online (690), and Wiley Online Library (512). Of these, 1,597 were removed due to duplication, and 8,980 were excluded after reviewing the titles and abstracts. From the remaining 5,681 articles, 5,671 were excluded for various reasons, including differences in outcomes of interest, target population disparities, unreported outcomes, and inconsistencies with the inclusion criteria (see Fig.\u0026nbsp;1).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eUltimately, 10 eligible studies (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan additionalcitationids=\"CR31 CR32 CR33 CR34\" citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e–\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e) comprising 3,221 of study participants were included in the systematic review and meta-analysis. The sample sizes of these studies varied from 89(\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e) to 499(\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e) participants. In terms of geographical distributions, four studies were conducted in the Amhara (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e), while two were from the southern Region of Ethiopia(\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). All included studies focused on the quality of life among women with pelvic organ prolapse in Ethiopia (see Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDescription of included studies reporting the poor quality of life among women with pelvic organ prolapse in Ethiopia, 2024\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFirst author \u0026amp; year of study\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRegion\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStudy design\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSample size\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eParticipants\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003ePrevalence\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eQuality score\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAbebe.SA,etal.,2024 (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAmhara\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCSS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e367\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e367\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e47.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKindie.W ,etal,2023 (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAmhara\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCSS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e253\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e253\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e48.35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAyenew. T,2022 (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSouthern Ethiopia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCSS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e423\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e416\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e53.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTefera.Z, etal.,2023 (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSNNPR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCSS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e418\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e399\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e57.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHurissa.BF, etal, 2022 (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAddis Ababa\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCSS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e499\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e478\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAli A, etal ,2022(\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOromia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCSS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e408\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e387\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBelayneh.T, etal.,2021 (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAmhara\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCSS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e249\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e248\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e42.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDebela.TF,etal, 2021 (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSouthern Ethiopia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCSS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e58.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMatiwos.B,etal.,2021 (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAddis Ababa\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCSS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e289\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e289\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e37.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eZeleke.BM, etal,2013 (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAmhara\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCSS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e306\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e306\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e67.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003eN.b CSS: Cross sectional study\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eMeta-analysis\u003c/h3\u003e\n\u003cp\u003eThe pooled prevalence of poor quality of life among women with pelvic organ prolapse in Ethiopia was found to be 42.40% (95% CI: 36.34%, 48.51%) (p = 0.000, I² = 93.1%). The I² value of 93.1% indicates the presence of high heterogeneity among the included studies (Fig.\u0026nbsp;2).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eExamine the source of heterogeneity\u003c/h2\u003e\u003cp\u003eTo address the high level of heterogeneity,, a random effects model was employed to determine the pooled prevalence of poor quality of life. Nonetheless, significant heterogeneity was observed among the included studies, with a pooled prevalence of 42.40% (95% CI: 34.27%, 50.54%) (p = 0.000, I² = 93.1%). Subgroup analysis was conducted. The analysis based on publication year and sample size differences indicated a higher prevalence of poor quality of life in studies published before 2021 (53.13%, 95% CI: 37.60, 68.66), I\u003csup\u003e2\u003c/sup\u003e = 82.0, p = 0.001 compared to those published in 2021 or after 2021 (48.58%, 95% CI: 42.84, 54.32), I\u003csup\u003e2\u003c/sup\u003e = 0, p = 0.424 among women with pelvic organ prolapse (see Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e3\u003c/span\u003e). There was significant heterogeneity in these subgroup analyses. Additionally, the prevalence of poor quality of life among women with pelvic organ prolapse (POP) was higher in a sample size of ≤ 422 than in a sample size of \u0026gt; 422. There was no evidence of heterogeneity in these subgroup analyses (see Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eMeta-regression\u003c/h3\u003e\n\u003cp\u003eWe conducted a meta-regression analysis using the random effects model to examine the effects of study participants, sample size, and publication year on the heterogeneity among the studies. According to the univariable meta-regression analysis, the number of participants, sample size, and publication year were not significantly associated with poor quality of life (see Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eUnivariable meta-regression analysis results for the poor quality of life among women with pelvic organ prolapse in Ethiopia\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLogodds\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCoef. Std. Err.\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003et\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP \u0026gt; t\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e[95% Conf. Interval]\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eparticipants\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e− .1076045 .4682705\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e-0.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.827\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e-1.311332, 1.096123\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePub year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.0602613 3.470183\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.987\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e-8.860129, 8.980652\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSample size\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.1074701 .468084\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.828\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e-1.095778, 1.310718\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e_cons\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-121.7905 7011.595\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e-0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.987\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e-18145.67, 17902.09\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\n\u003ch3\u003eSensitivity analysis\u003c/h3\u003e\n\u003cp\u003eA sensitivity analysis was conducted using the random effects model to assess the impact of individual studies on the pooled prevalence of poor quality of life among women with pelvic organ prolapse in Ethiopia. The results of the sensitivity analysis indicated that the individual studies did not significantly affect the prevalence of poor quality of life in this population (see (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eSmall study effect\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eThe symmetrical appearance of the funnel plot (see Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e6\u003c/span\u003e) suggested that there was no publication bias among the included studies. Similarly, the results of Egger's test (p = 0.909) indicated a statistically insignificant result, suggesting the absence of a small study effect, as shown in (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eShow that the absence of publication bias\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStd_Eff\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCoef.\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStd. Err.\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003et\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP\u0026gt;|t|\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e[95% Conf. Interval]\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSlope\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.8784661\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.8784661\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.430\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e-1.559935, 3.316868\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBias\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e− .1090717\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e− .0128063\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-0.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.909\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e− .2643261, .2387136\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eFactors associated with poor quality of life\u003c/h2\u003e\u003cp\u003eFigure\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e7\u003c/span\u003e illustrates the factors associated with a poor quality of life in individuals with pelvic organ prolapse. Key independent factors contributing to poor quality of life among women with pelvic organ prolapse include education level, menopausal status, regular exercise, urinary incontinence, prolapse stage, constipation, dyspareunia, and duration of prolapse. However, only four pooled factors significantly impacted the poor quality of life of affected women at the national level in Ethiopia. This meta-regression analysis revealed that a lack of formal education, failure to engage in regular exercise, urinary incontinence, and having an advanced stage of pelvic organ prolapse are key factors associated with poor quality of life in these women.\u003c/p\u003e\u003cp\u003eThe association between poor quality of life and lack of formal education was analyzed in seven studies. According to the current meta-analysis of these studies (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan additionalcitationids=\"CR29\" citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e–\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan additionalcitationids=\"CR33\" citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e–\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e), women with no formal education were 2.52 times more likely to experience poor quality of life due to pelvic organ prolapse compared to women with secondary education or higher (POR = 2.52, 95% CI: 1.79, 3.53). From five studies (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e), it was found that those who did not engage in regular physical exercise were 3.39 times more likely to have poor quality of life than those who did (POR = 3.39; 95% CI: 2.20–5.22). Additionally, based on five studies (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e), ), women experiencing urge urinary incontinence were 4.08 times more likely to report poor quality of life compared to those who did not (POR = 4.08, 95% CI: 3.10, 5.36). Moreover, in six studies (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan additionalcitationids=\"CR32 CR33\" citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e–\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e), women with pelvic organ prolapse stages three and four were more likely to have poor quality of life than those with stages one and two (POR = 2.91; 95% CI: 2.06, 4.11). The interplay between poor quality of life and experiencing urge urinary incontinence is crucial in understanding the risk of symptomatic prolapse. By focusing on preventive measures surrounding childbirth, healthcare providers can help mitigate the long-term effects on women's pelvic health (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e7\u003c/span\u003e.)\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eUnderstanding the latest statistics on the quality of life for women with pelvic organ prolapse is crucial for health planners aiming to develop effective programs that mitigate this risk. Identifying the overall pooled prevalence of poor quality of life, along with the associated factors, will facilitate the formulation of preventive strategies and enhance the management of pelvic organ prolapse and its complications.\u003c/p\u003e\u003cp\u003eThe objective of this review was to examine the pooled prevalence of quality of life and the related factors among women with pelvic organ prolapse. Our findings revealed that the pooled prevalence of poor quality of life in this population is 42.40% (95% CI: 36.34%, 48.51%). This statistic highlights that a significant proportion of women with pelvic organ prolapse experience a diminished quality of life. Our findings align with previous studies conducted in Nigeria (45%) (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e), Uganda (45.5%) (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e), and Iran (48.08%) (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e). However, this review reports lower prevalence values compared to studies in Brazil (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e), Nepal (53.48%) (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e), and rural Pakistan (60.8%) (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Additional studies from the United Kingdom, Italy, and China (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e) also reflect varying prevalence rates. The variation in the prevalence of poor quality of life across different regions can be attributed to several factors. Firstly, socio-cultural differences play a significant role. Secondly, methodological variations in study design, assessment tools, and sampling techniques can impact prevalence estimates. For instance, a study conducted in a rural area of Pakistan may reflect a potentially lower awareness of the impact of pelvic organ prolapse compared to urban areas. In our review, the domain of general health perception was found to be the most affected. These multifaceted dynamics contribute to the observed discrepancies in prevalence rates worldwide. Further research and cross-cultural comparisons are essential to better understand these variations and inform targeted interventions. A study conducted in Northern England also supports this finding (\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e). Women with pelvic organ prolapse may experience feelings of isolation, decreased attractiveness, and distorted health perceptions, which can negatively impact their well-being (\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e). This can lead to feelings of shame, embarrassment, and a diminished sense of sexual attractiveness, ultimately affecting their quality of life. Additionally, women without formal education were significantly more likely to experience poor quality of life related to pelvic organ prolapse (\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e). This may be because of the misconceptions among uneducated women, who may incorrectly believe that pelvic organ prolapse is a lethal tumor, compounded by aging and cultural beliefs that contribute to their poor quality of life (\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e). This finding is consistent with those of a study conducted in Nepal (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eBased on our findings, women with no formal education were 2.52 times more likely to experience poor quality of life in pelvic organ prolapse compared to those with secondary education or higher. Studies conducted in Nepal (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e), suggest that uneducated women may hold incorrect beliefs about pelvic organ prolapse, linking it to tumors, mortality, and aging, which can adversely impact their quality of life (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). The long-term effects of childbirth on pelvic organ function can vary widely among women. Awareness, preventive measures, and appropriate treatment can help manage and mitigate these effects. It is essential for women to discuss any concerns with their healthcare providers to receive tailored advice and support (\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe odds of experiencing poor quality of life were significantly higher among women with advanced stage III/IV pelvic organ prolapse. Specifically, women with advanced stage III/IV pelvic organ prolapse were 2.91 times more likely to report poor quality of life than those with stages I or II (POR = 2.91; 95% CI: 2.06–4.11). This finding is supported by research conducted in Nepal (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e) and Ghana (\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e). Symptoms of pelvic organ prolapse tend to increase with advanced stages, leading to a decline in quality of life. This decline may be attributed to the heightened severity of symptoms that affect women's social interactions, emotional well-being, and daily activities such as walking, sitting, and standing. Similar results have been observed in studies conducted in the United Kingdom (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eA recent study revealed a strong association between urge urinary incontinence and lower quality of life among participants. Previous research in India (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e) and France (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e) supports this finding. Urge incontinence is common among women with pelvic organ prolapse and can negatively impact various aspects of their daily lives, including psychological well-being, social interactions, physical activities, and sexual relationships (\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e). This condition can compromise quality of life by making it difficult to perform household tasks, avoid social events, maintain relationships, and achieve mobility, leading to reduced emotional well-being and feelings of frustration (\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eFinally, women who engaged in regular physical exercise experienced a reduction in the negative impact of prolapse on their quality of life. Studies from the United States (\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e) and France (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e) indicate that physical activity can strengthen pelvic floor muscles and alleviate symptoms such as urinary incontinence, frequency, and interference with bladder emptying. These improvements contribute to overall health and well-being. Regular exercise can enhance strength, engage pelvic floor muscles, and promote weight reduction, ultimately leading to a better quality of life (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e).\u003c/p\u003e\u003ch2\u003eStrengths and limitations of study\u003c/h2\u003e\u003cp\u003ePrior to this systematic review, there was no comprehensive examination of poor quality of life and its associated factors among women with pelvic organ prolapse (POP) in Ethiopia. This review is one of the few that specifically focuses on the Ethiopian context, addressing the significant gap in clear and comprehensive data regarding the pooled prevalence of quality of life issues within this population.\u003c/p\u003e\u003cp\u003eHowever, this review has some limitations. All included studies were cross-sectional, which restricts the ability to establish direct cause-and-effect relationships between poor quality of life and its contributing factors. Additionally, some important factors were excluded due to differences in categorization among studies. This review uniquely incorporates ten primary studies, providing up-to-date insights into national quality of life issues related to POP in Ethiopia.\u003c/p\u003e\u003cp\u003eWhile it is recognized that poor quality of life is prevalent and associated with various health challenges, the assessment only covers five of the country's twelve regions, limiting its nationwide relevance. Therefore, conducting scoping reviews in the future is essential for enhancing comparability across study settings and for better understanding the impact of risk factors and protective measures in subsequent research.\u003c/p\u003e"},{"header":"Conclusions and Recommendations","content":"\u003cp\u003eThis review highlights that 42.4% of Ethiopian women with pelvic organ prolapse experience a poor quality of life. This issue is particularly pronounced among women who have not received formal education, those with stage III or IV pelvic organ prolapse, individuals suffering from urge urinary incontinence, and those who do not participate in regular physical exercise.\u003c/p\u003e\u003cp\u003eTo enhance the quality of life for these women, it is essential to ensure access to early interventions, psychosocial support, and counseling that addresses their physical, mental, and social health, including sleep-related concerns. We recommended that healthcare providers play a vital role in identifying cases within communities and linking these services to health extension workers for effective support and management.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eLMIC: Low- and Middle-Income Countries\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOR: Odds ratios\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePECO: Population-Exposed-Comparison-Outcome-Type of study-Area\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePOP: Pelvic organ prolapse\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePRIME: Program for Improving Quality of Life and Emerald Emerging Mental Health System in\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003eThe authors would like to express their gratitude to the authors of the included primary studies, which served as valuable sources of information for conducting this systematic review and meta-analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors received no specific funding for this work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;All relevant data are within the manuscript and it\u0026rsquo;s supporting information files.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of conflicting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have declared that no competing interest exist\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eAuthors\u0026rsquo; contributions\u003c/h2\u003e\n\u003cp\u003eAMZ and WCT: Designed the tests and developed the ideas; performed the data analysis and interpretation; wrote the paper and tools; and authored the paper. WCT and GAT performed the data extraction and YAG and YAF quality assessment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFinancial Disclosure statement\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors received no specific funding for this work\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003ePatel PD, Amrute KV, Badlani GH. Pelvic organ prolapse and stress urinary incontinence: A review of etiological factors. Indian journal of urology : IJU : journal of the Urological Society of India. 2007;23(2):135-41.\u003c/li\u003e\n \u003cli\u003eRaju R, Linder BJ. Evaluation and Management of Pelvic Organ Prolapse. Mayo Clinic proceedings. 2021;96(12):3122-9.\u003c/li\u003e\n \u003cli\u003eChan SSC, Cheung RYK, Yiu KW, Lee LL, Pang AWL, Chung TKH. 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BMC Womens Health. 2021;21(1):258.\u003c/li\u003e\n \u003cli\u003eOjifinni OO, Munyewende PO, Ibisomi L. Exploring the perception of and attitude towards preconception care service provision and utilisation in a South Western Nigerian community\u0026ndash;a qualitative study. African Population Studies. 2021;35(1).\u003c/li\u003e\n \u003cli\u003eAbebe SA, Gashaw ZM, Ayichew Z, Angaw DA, Kindie EA. Prevalence and associated factors of depression among women with advanced pelvic organ prolapse in Northwest Ethiopia: cross-sectional study. BMC Womens Health. 2024;24(1):313.\u003c/li\u003e\n \u003cli\u003eKindie W, Yiheyis A, Aragaw A, Wudineh KG, Miskir D. Quality of life among women with a diagnosis of pelvic organ prolapse at Felege Hiwot Comprehensive Specialized Hospital, Bahir Dar, Northwest Ethiopia: an institutional based cross-sectional study. Int Urogynecol J. 2023;34(1):225-30.\u003c/li\u003e\n \u003cli\u003eAyenew T. 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Multimorbidity of Chronic Noncommunicable Diseases: Burden, Care Provision and Outcomes over Time Among Patients Attending Chronic Outpatient Medical Care in Health Facilities in Bahir Dar City Ethiopia: A Mixed Methods Study 2023.\u003c/li\u003e\n \u003cli\u003eFritel X, Varnoux N, Zins M, Breart G, Ringa V. Symptomatic pelvic organ prolapse at midlife, quality of life, and risk factors. Obstetrics \u0026amp; Gynecology. 2009;113(3):609-16.\u003c/li\u003e\n \u003cli\u003eDigesu GA, Chaliha C, Salvatore S, Hutchings A, Khullar V. The relationship of vaginal prolapse severity to symptoms and quality of life. BJOG : an international journal of obstetrics and gynaecology. 2005;112(7):971-6.\u003c/li\u003e\n \u003cli\u003eWells GA SB, O\u0026rsquo;Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses http://wwwohrica/programs/clinicalepidemiology/oxfordasp.\u003c/li\u003e\n \u003cli\u003eDerSimonianR L. 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Clinical obstetrics and gynecology. 2005;48(3):648-61.\u003c/li\u003e\n \u003cli\u003eBurrows LJ, Meyn LA, Walters MD, Weber AM. Pelvic symptoms in women with pelvic organ prolapse. Obstetrics and gynecology. 2004;104(5 Pt 1):982-8.\u003c/li\u003e\n \u003cli\u003eOuchi M, Kato K, Gotoh M, Suzuki S. Physical activity and pelvic floor muscle training in patients with pelvic organ prolapse: a pilot study. Int Urogynecol J. 2017;28(12):1807-15.\u003c/li\u003e\n \u003cli\u003eBradley CS, Brown HW, Shippey SS, Gutman RE, Andy UU, Yurteri-Kaplan LA, et al. Generic Health-Related Quality of Life in Patients Seeking Care for Pelvic Organ Prolapse. Female pelvic medicine \u0026amp; reconstructive surgery. 2021;27(6):337-43.\u003c/li\u003e\n \u003cli\u003ePanman CM, Wiegersma M, Kollen BJ, Berger MY, Lisman-van Leeuwen Y, Vermeulen KM, et al. Effectiveness and cost-effectiveness of pessary treatment compared with pelvic floor muscle training in older women with pelvic organ prolapse: 2-year follow-up of a randomized controlled trial in primary care. Menopause (New York, NY). 2016;23(12):1307-18.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"systematic-reviews","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"sysr","sideBox":"Learn more about [Systematic Reviews](http://systematicreviewsjournal.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/sysr/default.aspx","title":"Systematic Reviews","twitterHandle":"@MedicalEvidence","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Poor quality of life, pelvic organ prolapse, Ethiopia","lastPublishedDoi":"10.21203/rs.3.rs-6604414/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6604414/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction: \u003c/strong\u003eThe poor quality of life for women with pelvic organ prolapse is significantly impacted by physical discomfort and emotional distress. Despite the poor quality of life, there is a lack of comprehensive reviews in the existing literature. This review aims to address this gap by systematically evaluating the overall quality of life and identifying the factors among women suffering from pelvic organ prolapse in Ethiopia.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003ePubMed, Scopus, Web of Science, ScienceDirect, African Journals Online, and the Wiley Online Library, and a Google Scholar were searched from January 1, 2024, to February 10, 2024. Data extractions were performed using Excel, and the analyses were conducted with Stata 11 software. Pooled effect sizes were determined based on the percentages, and pooled odds ratios with 95% CI were used to pool the effect measure. To evaluate statistical heterogeneity, the Cochrane Q test and I² statistic were employed. A sub group analysis, Meta-regression, and sensitivity analysis were done. Small study effect was assessed.\u003cstrong\u003e \u003c/strong\u003eThe quality of the studies was assessed using the Newcastle-Ottawa Scale.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e \u0026nbsp;The pooled prevalence of poor quality of life among women with pelvic organ prolapse was found to be 42.40% (95% CI: 43.22, 57.61). Key factors significantly associated with a poor quality of life included uneducated women (POR=2.52, 95% CI: 1.79, 3.53), lack of regular physical exercise (POR=3.39; 95% CI: 2.20–5.22), the presence of urge urinary incontinence (POR=4.08, 95% CI: 3.10, 5.36), and having pelvic organ prolapse stages ≥ 3 (POR = 2.91; 95% CI: 2.06–4.11).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e: This review highlights that 42.4% of Ethiopian women with pelvic organ prolapse experience a poor quality of life. This issue is particularly pronounced among women who have not received formal education, those with stage III or IV pelvic organ prolapse, individuals suffering from urge urinary incontinence, and those who do not participate in regular physical exercise. To enhance the quality of life for these women, it is essential to ensure access to early interventions, psychosocial support, and counseling that addresses their physical, mental, and social health. We recommended that healthcare providers play a vital role in identifying cases within communities and linking these services to health extension workers for effective support and management.\u003c/p\u003e","manuscriptTitle":"Quality of life and associated factors among women with pelvic organ prolapse in Ethiopia: A systematic review and meta-analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-14 20:51:18","doi":"10.21203/rs.3.rs-6604414/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"","date":"2025-10-01T14:31:47+00:00","index":0,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-01T04:15:10+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-06-12T03:01:12+00:00","index":"","fulltext":""},{"type":"submitted","content":"Systematic Reviews","date":"2025-05-06T11:00:27+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"systematic-reviews","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"sysr","sideBox":"Learn more about [Systematic Reviews](http://systematicreviewsjournal.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/sysr/default.aspx","title":"Systematic Reviews","twitterHandle":"@MedicalEvidence","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ab75a762-212e-4bd7-a77f-f4e0a115eb9a","owner":[],"postedDate":"October 14th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-10-14T20:51:19+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-14 20:51:18","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6604414","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6604414","identity":"rs-6604414","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}