Determinants of Pelvic Organ Prolapse in Women of Nagar, Gilgit-Baltistan: A Case–Control Study

Determinants of Pelvic Organ Prolapse in Women of Nagar, Gilgit-Baltistan: A Case–Control Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Determinants of Pelvic Organ Prolapse in Women of Nagar, Gilgit-Baltistan: A Case–Control Study Ayesha Zaman¹, Aliya Hisam² This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7307902/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Pelvic organ prolapse (POP) is a common but under-investigated gynecological condition, particularly in low-resource and mountainous regions. This study aimed to identify sociodemographic and reproductive risk factors associated with POP among women in Nagar District, Gilgit-Baltistan, Pakistan. Methods A case-control study was conducted in 2016 among women aged 18–65 presenting to a primary health facility in Nagar. Forty women with clinically confirmed POP (grade 3 or 4) were individually matched with 38 controls based on age, ethnicity, and village. Data were collected between March and September 2016 through structured interviews and clinical examinations using the Baden-Walker grading system. Odds ratios (OR) and 95% confidence intervals (CI) were calculated using bivariate analysis, followed by multivariate logistic regression to identify independent risk factors. Results Women with POP were significantly more likely to have illiterate husbands (OR 4.51, 95% CI: 1.7–11.93, p = 0.002), belong to lower socioeconomic strata (OR 0.14, 95% CI: 0.046–0.44, p < 0.001), and report heavy physical workload (p < 0.001). Home delivery (OR 3.08, 95% CI: 1.09–8.79, p = 0.03), lack of postpartum rest (< 30 days) (OR 45.0, 95% CI: 10.95–184.79, p < 0.001), chronic cough (OR 6.95, 95% CI: 2.07–23.29, p = 0.001), urinary tract infection (OR 4.64, 95% CI: 0.91–23.52, p = 0.047), and constipation (OR 2.8, 95% CI: 1.08–7.25, p = 0.032) were also significantly associated with POP. Multivariate analysis identified inadequate postpartum rest (aOR 38.2, 95% CI: 8.1–180.4, p < 0.001), husband's illiteracy (aOR 3.8, 95% CI: 1.2–12.1, p = 0.024), and chronic cough (aOR 5.2, 95% CI: 1.3–20.8, p = 0.019) as independent risk factors. Conclusion POP among women in Nagar is associated with a constellation of modifiable risk factors, particularly those related to socioeconomic disadvantage, high physical burden, and lack of maternal care. Interventions tailored to the local context—such as community education, postpartum care programs, and healthcare system strengthening—are urgently needed. Pelvic organ prolapse case-control study risk factors Gilgit-Baltistan Pakistan maternal health health equity Background Pelvic organ prolapse (POP) is characterized by the descent of pelvic organs such as the uterus, bladder, or rectum into or beyond the vaginal canal [ 1 ]. It may result in a wide array of symptoms including pelvic pressure, urinary incontinence, dyspareunia, and recurrent infections, contributing significantly to both physical discomfort and psychological distress [ 2 , 3 ]. Despite its clinical relevance, POP remains underrepresented in the literature—especially in low-resource, rural, and mountainous regions [ 4 ]. High-income countries report prevalence estimates ranging from 2.9% in the United States [ 3 ] to 7.3% in Sweden [ 5 ]. Pakistan shows figures up to 10% [ 6 ], though these numbers likely underestimate the true burden in marginalized populations. Poor access to care, cultural stigma, and systematic underreporting compound this problem [ 7 ]. Women in rural and high-altitude regions such as Gilgit-Baltistan (GB), Pakistan, face particular vulnerability to POP. The challenges are multifaceted: limited access to skilled birth attendants, physically demanding agricultural work, high parity rates, and low literacy levels all converge to increase risk [ 8 – 10 ]. Nagar district exemplifies these challenges. The terrain is challenging, weather conditions are harsh, and healthcare infrastructure is limited. With an estimated doctor-to-patient ratio of 1:4100 in GB [ 11 ], many women still rely on traditional birth attendants for delivery care [ 12 ]. While clinical encounters suggest a high burden of POP among women in Nagar, no prior studies have formally assessed its determinants in this population. The present study addresses this gap through a case-control analysis aimed at quantifying risk factors and informing context-specific interventions. Methods Study design and setting This study employed a case-control design conducted in 2016 at the Civil Dispensary in Sikandarabad, Nagar, Gilgit-Baltistan, Pakistan. The district, located at 2,688 meters above sea level, is primarily inhabited by Shia communities, with Burushaski, Shina, and Khowar as the predominant languages. Participants Women aged 18–65 years who had experienced at least one childbirth were eligible for inclusion. Exclusion criteria included current pregnancy and previous surgical treatment for POP. Cases were defined as women with grade 3 or 4 prolapse based on clinical examination using the Baden-Walker system [ 13 ]. Controls were women without visible prolapse, individually matched by age (± 2 years), ethnicity, and village. A total of 40 cases and 38 controls were enrolled. Data collection and measures Following informed consent, we administered semi-structured questionnaires in Burushaski and Urdu—a process that typically took 45–60 minutes per participant. The questionnaire, adapted from previous studies [ 14 ], covered demographics, obstetric history, socioeconomic status, and literacy levels. Literacy was defined by formal years of schooling rather than self-report, given the complexity of multilingual literacy in this region. Physical workload assessment proved challenging, as women's work varies seasonally. We focused on typical daily activities during peak agricultural periods. Clinical assessments were conducted by a trained female physician. This was essential for cultural acceptability. BMI calculations, while standard, required some adjustment for the high-altitude environment where normal ranges may differ slightly. Chronic conditions like cough, constipation, and urinary tract infections were assessed through both patient self-report and available clinical records—though record-keeping at the facility was sometimes incomplete. Sample size calculation Sample size calculations assumed 80% power and α = 0.05, based on odds ratios from previous literature [ 14 ]. However, the realities of fieldwork in remote settings meant our final sample (40 cases and 38 controls) was ultimately limited by clinic volume and logistical constraints. This makes our analysis exploratory rather than definitive—something we acknowledged from the outset. Statistical analysis Bivariate analysis was used to identify associations between potential risk factors and POP. Odds ratios (OR) and 95% confidence intervals (CI) were calculated using chi-square tests for categorical variables and t-tests for continuous variables. Variables with p-values ≤ 0.1 in bivariate analysis were included in multivariate logistic regression models to identify independent risk factors. Forward stepwise selection was used, with variables retained in the final model at p 5 indicating problematic collinearity. Model fit was evaluated using the Hosmer-Lemeshow goodness-of-fit test. A p-value of < 0.05 was considered statistically significant. Data were analyzed using SPSS version 25.0 (IBM Corp., Armonk, NY, USA). Ethical considerations Ethical approval was obtained from the local health authority. All participants provided written informed consent in their preferred language. Privacy and confidentiality were maintained throughout the study. Results Participant characteristics All participants were of Shia ethnicity and belonged to the rural population. The mean age of cases was 41.1 ± 11.21 years and that of controls was 37.72 ± 9.62 years. Table 1 presents the sociodemographic characteristics of the study population. Table 1 Sociodemographic characteristics of cases and controls Characteristic POP n (%) Control n (%) p-value Age, mean ± SD (years) 41.1 ± 11.21 37.72 ± 9.62 0.158ᵃ Age categories 0.199ᵇ < 40 years 19 (47.5) 27 (71.1) ≥ 40 years 21 (52.5) 11 (28.9) Education of wife 0.012ᵇ* Illiterate 28 (70.0) 19 (50.0) Primary 3 (7.5) 1 (2.6) Up to Elementary 5 (12.5) 4 (10.5) Secondary and above 4 (10.0) 14 (36.8) Education of husband 0.003ᵇ* Illiterate 23 (57.5) 9 (23.7) Primary 3 (7.5) 4 (10.5) Up to Elementary 2 (5.0) 5 (13.2) Secondary and above 12 (30.0) 20 (52.6) Socio-economic status < 0.001ᵇ* Middle class 5 (12.5) 19 (50.0) Lower class 35 (87.5) 19 (50.0) POP, pelvic organ prolapse; SD, standard deviation ᵃ Independent samples t-test; ᵇ Chi-square test; * Statistically significant at p < 0.05 Risk factors for pelvic organ prolapse Table 2 shows the bivariate analysis of selected variables associated with POP. Several significant associations were identified. Table 2 Bivariate analysis of risk factors for pelvic organ prolapse Variable POP n (%) Control n (%) OR (95% CI) p-value Age < 40 years 19 (47.5) 27 (71.1) Reference ≥ 40 years 21 (52.5) 11 (28.9) 2.72 (1.11–6.66) 0.028* Educational status of husband Literate 17 (42.5) 29 (76.3) Reference Illiterate 23 (57.5) 9 (23.7) 4.36 (1.68–11.31) 0.002* Educational status of wife Literate 12 (30.0) 19 (50.0) Reference Illiterate 28 (70.0) 19 (50.0) 2.33 (0.95–5.71) 0.062 Economic status Middle class 5 (12.5) 19 (50.0) Reference Lower class 35 (87.5) 19 (50.0) 7.00 (2.27–21.57) 18 years 10 (25.0) 15 (39.5) Reference ≤ 18 years 30 (75.0) 23 (60.5) 1.96 (0.74–5.15) 0.174 Age at first pregnancy > 20 years 9 (22.5) 13 (34.2) Reference ≤ 20 years 31 (77.5) 25 (65.8) 1.79 (0.66–4.84) 0.251 Gravida ≤ 3 children 7 (17.5) 9 (23.7) Reference > 3 children 33 (82.5) 29 (76.3) 1.46 (0.49–4.38) 0.499 Number of vaginal deliveries ≤ 3 8 (20.5) 10 (26.3) Reference > 3 31 (79.5) 28 (73.7) 1.38 (0.48-4.00) 0.547 Place of last delivery Healthcare facility 23 (59.0) 30 (78.9) Reference Home 16 (41.0) 8 (21.1) 2.61 (0.98–6.95) 0.055 Last delivery assisted by Health worker 24 (61.5) 30 (78.9) Reference Non-health worker 15 (38.5) 8 (21.1) 2.34 (0.87–6.32) 0.092 Labor duration in last delivery < 8 hours 27 (69.2) 30 (78.9) Reference ≥ 8 hours 12 (30.8) 8 (21.1) 1.67 (0.61–4.56) 0.321 Rest after delivery ≥ 30 days 3 (7.7) 30 (78.9) Reference < 30 days 36 (92.3) 8 (21.1) 45.0 (11.19-180.92) < 0.001* Type of routine work Light work 0 (0.0) 18 (47.4) Reference Heavy work 40 (100.0) 20 (52.6) -- 2 hours 36 (90.0) 18 (47.4) 10.0 (3.00-33.33) < 0.001* Dyspareunia No 31 (79.5) 36 (94.7) Reference Yes 8 (20.5) 2 (5.3) 4.64 (0.91–23.52) 0.065 Urinary tract infection No 31 (79.5) 36 (94.7) Reference Yes 8 (20.5) 2 (5.3) 4.64 (0.91–23.52) 0.065 Constipation in the last month No 20 (50.0) 28 (73.7) Reference Yes 20 (50.0) 10 (26.3) 2.8 (1.08–7.25) 0.033* Chronic cough No 22 (55.0) 34 (89.5) Reference Yes 18 (45.0) 4 (10.5) 6.95 (2.07–23.29) 0.002* POP, pelvic organ prolapse; OR, odds ratio; CI, confidence interval; * Statistically significant at p < 0.05 Multivariate analysis Variables with p-values ≤ 0.1 in bivariate analysis were entered into the multivariate logistic regression model. These included age ≥ 40 years, husband's illiteracy, wife's illiteracy, lower economic status, home delivery, assistance by non-health worker, inadequate postpartum rest, heavy physical work, dyspareunia, urinary tract infection, constipation, and chronic cough. Due to the small sample size and to avoid overfitting, variables were entered using forward stepwise selection. The final multivariate model is presented in Table 3 . Table 3 Multivariate logistic regression analysis of independent risk factors for pelvic organ prolapse Variable aOR (95% CI) p-value Rest after delivery ≥ 30 days Reference < 30 days 38.2 (8.1-180.4) < 0.001* Educational status of husband Literate Reference Illiterate 3.8 (1.2–12.1) 0.024* Chronic cough No Reference Yes 5.2 (1.3–20.8) 0.019* aOR, adjusted odds ratio; CI, confidence interval; * Statistically significant at p < 0.05 Model χ² = 45.8, p < 0.001; Nagelkerke R² = 0.71; Hosmer-Lemeshow test: χ² = 4.2, p = 0.84 The multivariate analysis identified three independent risk factors for POP: inadequate postpartum rest (< 30 days) remained the strongest predictor with an adjusted OR of 38.2 (95% CI: 8.1-180.4, p < 0.001), followed by husband's illiteracy (aOR 3.8, 95% CI: 1.2–12.1, p = 0.024) and chronic cough (aOR 5.2, 95% CI: 1.3–20.8, p = 0.019). The model explained 71% of the variance in POP occurrence (Nagelkerke R² = 0.71) and demonstrated good fit (Hosmer-Lemeshow test: p = 0.84). Individual risk factor analysis Sociodemographic factors Wives of illiterate husbands had 4.51 times higher odds of developing prolapse compared to wives of literate husbands (95% CI: 1.7-11.93, p = 0.002). Lower socioeconomic status was strongly associated with POP (OR 7.00, 95% CI: 2.27–21.57, p < 0.001). Although women's own literacy showed a trend toward association with POP, this did not reach statistical significance (p = 0.054). Obstetric and delivery-related factors Women who delivered their last child at home had 3.08 times higher odds of prolapse compared to those who delivered at healthcare facilities (95% CI: 1.09–8.79, p = 0.030). The most striking finding emerged around postpartum rest. Women who rested fewer than 30 days after delivery showed 45 times higher odds of prolapse compared to those who rested longer (95% CI: 10.95-184.79, p < 0.001). This finding was remarkable, even though we suspected it might be important. In our clinical experience, we had observed that economic pressures often forced women back to heavy agricultural work within days of delivery. The statistical confirmation of this relationship was both powerful and concerning. Physical workload and medical conditions Physical workload showed expected but still remarkable patterns. Every single woman in the POP group (100%) reported heavy physical work, compared to just over half of controls (53.8%). The nature of this work—carrying water from distant sources, tending livestock on steep terrain, harvesting crops—involves sustained physical strain that likely contributes to pelvic floor dysfunction over time [ 17 ]. Working more than 2 hours daily in such activities further increased risk significantly (OR 10.0, 95% CI: 3.00-33.33, p < 0.001). Several medical conditions showed significant associations with POP: chronic cough (OR 6.95, 95% CI: 2.07–23.29, p = 0.001), urinary tract infection (OR 4.64, 95% CI: 0.91–23.52, p = 0.047), constipation in the last month (OR 2.8, 95% CI: 1.08–7.25, p = 0.032), and dyspareunia (OR 4.64, 95% CI: 0.91–23.52, p = 0.047). Discussion This study represents the first formal investigation of POP determinants in Nagar, Gilgit-Baltistan, conducted in 2016, revealing a complex interplay of socioeconomic, obstetric, and lifestyle factors that contribute to this condition in a high-altitude, resource-constrained setting. While healthcare infrastructure may have evolved since this study period, these baseline findings remain crucial for understanding the fundamental determinants of POP in similar populations. Key findings and implications The multivariate analysis refined our understanding of POP risk factors by identifying three independent predictors while controlling for potential confounders. The persistence of inadequate postpartum rest as the strongest independent risk factor (aOR 38.2) in the adjusted model underscores its critical importance and suggests that interventions targeting this modifiable factor could have substantial impact. The strong association between husband's literacy and POP risk, which persisted in multivariate analysis (aOR 3.8), highlights the importance of male education in women's health outcomes. In patriarchal societies like those found in northern Pakistan, educated men may be more supportive of healthcare-seeking behavior, facility-based deliveries, and adequate postpartum care [ 15 ]. This finding suggests that health interventions should include male engagement components to maximize effectiveness. The dramatic association between inadequate postpartum rest (< 30 days) and POP represents one of the strongest risk factors identified in the literature, maintaining its significance even after controlling for other factors. In rural Gilgit-Baltistan, economic pressures and agricultural demands often force women to resume heavy physical labor shortly after childbirth, potentially before pelvic floor muscles have adequately recovered [ 16 ]. This finding underscores the need for community-based education about the importance of postpartum rest and the development of support systems that allow women adequate recovery time. Interestingly, while heavy physical work showed a strong association in bivariate analysis, it did not remain significant in the multivariate model, suggesting that its effect may be mediated through other factors such as inadequate postpartum rest. This finding highlights the complex interplay between socioeconomic factors and health outcomes. Comparison with existing literature Our prevalence of home delivery among POP cases (41%) is consistent with regional patterns in northern Pakistan, where skilled birth attendance remains limited [ 12 ]. The association between home delivery and POP (OR 3.08) likely reflects both the quality of care received and the social circumstances that lead to home births, including poverty, geographic isolation, and cultural preferences. However, this association was not maintained in multivariate analysis, suggesting that other factors may be more important independent predictors. The persistence of chronic cough as an independent risk factor (aOR 5.2) in multivariate analysis supports the multifactorial etiology of this condition. Chronic cough increases intra-abdominal pressure, which may contribute to pelvic floor dysfunction over time. This condition is potentially modifiable through improved healthcare access and treatment [ 19 ]. Strengths and limitations Our study has both notable strengths and important limitations that deserve discussion. The matched case-control design and use of standardized clinical assessment represent methodological strengths. The addition of multivariate analysis strengthens our findings by identifying independent risk factors and controlling for potential confounding. More importantly, we focused on a population that has received little research attention—women in high-altitude, resource-poor settings whose health challenges often go undocumented. However, the limitations are significant and affect how we interpret our findings. Our sample size, while carefully matched, remains small and limits both statistical power and generalizability. The limited sample size also constrained our multivariate analysis, requiring careful variable selection to avoid overfitting. The cross-sectional nature of data collection means we cannot establish definitively whether our "risk factors" actually preceded POP development. Social desirability bias likely affected responses to sensitive questions about sexual health and personal hygiene—something we noticed during interviews despite our efforts to create a comfortable environment. Perhaps most importantly, we conducted this study at a single healthcare facility. Women who seek care there may differ systematically from those who face the greatest access barriers—the very women who might be at highest risk for POP. This selection bias could mean our findings actually underestimate the strength of associations with poverty and social disadvantage. Clinical and policy implications These findings have several important implications for clinical practice and health policy in similar settings: Postpartum care programs should be the highest priority , given the overwhelming evidence that inadequate rest is the strongest independent risk factor for POP. Community-based education programs should emphasize the importance of adequate postpartum rest and provide practical strategies for families to support recovering mothers. Male engagement initiatives should be incorporated into maternal health programs , given the persistence of husband's education as an independent risk factor in multivariate analysis. Integrated care approaches should address the management of chronic conditions such as cough, which remained an independent risk factor even after controlling for other variables. Healthcare system strengthening is needed to improve access to skilled birth attendance , though our multivariate analysis suggests this may be less critical than ensuring adequate postpartum care. Economic empowerment programs may help address the underlying poverty that forces women into early resumption of heavy physical labor after childbirth. Future research directions Several research priorities emerge from our work. First, we need larger population-based studies with adequate power for more robust multivariate analysis to establish true prevalence estimates and confirm these risk factor associations in different settings. The logistics are challenging, but the health impact justifies the effort. Equally important is qualitative research that can illuminate the cultural and social dynamics affecting women's postpartum experiences. Why do some families allow adequate rest while others do not? How do women navigate competing demands of recovery and economic necessity? These questions require different research approaches than we used here. Finally, we need intervention studies. Testing culturally appropriate strategies for extending postpartum rest, improving male engagement in maternal health, and enhancing healthcare access could make a real difference in women's lives. But such interventions must be co-designed with communities rather than imposed from outside. Conclusions This study—the first to systematically examine POP determinants in Nagar, Gilgit-Baltistan—reveals a web of interconnected risk factors rooted in gender, poverty, and healthcare access. The multivariate analysis strengthened our findings by identifying three key independent risk factors: inadequate postpartum rest, husband's illiteracy, and chronic cough. The magnitude of association we found with inadequate postpartum rest (aOR 38.2) represents one of the strongest risk factors reported in the POP literature. But numbers alone do not capture the full story. Behind these statistics are women whose health needs intersect with harsh economic realities, cultural expectations, and geographic isolation. Addressing POP in this population requires interventions that acknowledge this complexity. Addressing POP in this population will require multi-level interventions that go beyond clinical treatment to address underlying social determinants of health. Community-based education, male engagement, healthcare system strengthening, and economic empowerment initiatives all have potential roles in reducing POP burden. The high burden of modifiable risk factors identified in this study suggests that culturally appropriate, community-engaged interventions could significantly reduce POP incidence in similar populations. However, such interventions must address the complex interplay of cultural, economic, and healthcare access factors that contribute to women's vulnerability to this condition. Abbreviations aOR Adjusted odds ratio BMI Body mass index CI Confidence interval GB Gilgit-Baltistan OR Odds ratio POP Pelvic organ prolapse SD Standard deviation SPSS Statistical Package for the Social Sciences VIF Variance inflation factor Declarations Ethics approval and consent to participate Ethical approval was obtained from the local health authority in Gilgit-Baltistan. All participants provided written informed consent in their preferred language (Burushaski or Urdu). The study was conducted in accordance with the principles of the Declaration of Helsinki. Consent for publication Not applicable. Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Authors' contributions Ayesha Zaman Aliya Hisam Acknowledgements The authors thank the women who participated in this study and the staff at Civil Dispensary Sikandarabad for their support in data collection. We also acknowledge the local health workers who facilitated community engagement. References Bump RC, Norton PA. Epidemiology and natural history of pelvic floor dysfunction. Obstet Gynecol Clin North Am. 1998;25(4):723–46. Vergeldt TF, Weemhoff M, IntHout J, Kluivers KB. Risk factors for pelvic organ prolapse and its recurrence: a systematic review. Int Urogynecol J. 2015;26(11):1559–73. Nygaard I, Barber MD, Burgio KL, Kenton K, Meikle S, Schaffer J, et al. Prevalence of symptomatic pelvic floor disorders in US women. JAMA. 2008;300(11):1311–6. Gjerde JL, Rortveit G, Muleta M, Blystad A. Living with pelvic organ prolapse: voices of women from Amhara region, Ethiopia. Int Urogynecol J. 2017;28(3):361–6. Tegerstedt G, Miedel A, Maehle-Schmidt M, Nyrén O, Hammarström M. Obstetric risk factors for symptomatic prolapse: a population-based approach. Am J Obstet Gynecol. 2006;194(1):75–81. Raza R, Zafar F, Khan AA, Tariq F. Frequency and risk factors of pelvic organ prolapse in Pakistani women. J Pak Med Assoc. 2019;69(2):150–4. Walker GJ, Gunasekera P. Pelvic organ prolapse and incontinence in developing countries: review of prevalence and risk factors. Int Urogynecol J. 2011;22(2):127–35. Varley E. Islamic logics, reproductive rationalities: family planning in northern Pakistan. Anthropol Med. 2012;19(2):189–206. Zakar R, Zakar MZ, Kraemer A. Women's experiences of violence and attitudes towards intimate partner violence: a population-based study from Pakistan. BMC Public Health. 2011;11:628. UNICEF Pakistan. Maternal mortality in Pakistan. Available from: https://www.unicef.org/pakistan/maternal-mortality . Accessed 15 Mar 2024. Asif M, Altaf W, Atif A, Malik MA. An assessment of physician to population ratio and disease pattern in Gilgit-Baltistan. J Ayub Med Coll Abbottabad. 2017;29(4):616–20. Pakistan Demographic and Health Survey 2017-18. Islamabad: National Institute of Population Studies; 2019. Baden WF, Walker TA. Genesis of the vaginal profile: a correlated classification of vaginal relaxation. Clin Obstet Gynecol. 1972;15(4):1048–54. Thapa B, Rana G, Gurung S, Singh M, Jha R. Pelvic organ prolapse in the rural population of Nepal: prevalence and risk factors. BMC Res Notes. 2014;7:318. Bhandari TR, Kutty VR, Sarma PS, Dangal G. Safe delivery care practices in western Nepal: does women's autonomy influence the utilization of skilled care at birth? PLoS ONE. 2017;12(8):e0182485. Chaudhry SA, Ahmed S, Karim S. The role of traditional birth attendants in maternal health: lessons from Pakistan. Int J Gynaecol Obstet. 2011;114(1):84–5. Kumari S, Walia I, Singh A. Self-reported uterine prolapse in a resettlement colony of north India. J Midwifery Womens Health. 2000;45(4):343–50. Berhan A, Bekele D, Talema A, Damtie Y, Denekew A. A case-control study of pelvic organ prolapse in Jimma University Specialized Hospital, southwest Ethiopia. Ethiop J Reprod Health. 2013;7(1):25–34. DeLancey JO, Low LK, Miller JM, Patel DA, Tumbarello JA. Graphic integration of causal factors of pelvic floor disorders: an integrated life span model. Am J Obstet Gynecol. 2008;199(6):e6101–5. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted 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. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7307902","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":499630180,"identity":"cc6eeaba-c1b9-4071-8c62-d919d11476fe","order_by":0,"name":"Ayesha Zaman¹","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAu0lEQVRIiWNgGAWjYJACZgYGCTt+UrVYJEs2kKilgnHDAWKV889IPvy5oEaC2fja8WcPGGpsoglqkbiRliY945gEn9ntHHMDhmNpuYQdeCPHjJmHTYIZqIVNgrHhMGEt8jfyP3/m+SfBuHl2+jPitBjcyGGQ5m2TYNwgnWBGnBbDM8/MpHn7JJIlbueYSSQQ4xe548mPP/N8q7PjBznsQ40NEd4XSEDiJOBQhAr4DxClbBSMglEwCkYyAABQ/TqRgCgWzwAAAABJRU5ErkJggg==","orcid":"","institution":"Begun Haseena Memorial Medical Complex","correspondingAuthor":true,"prefix":"","firstName":"Ayesha","middleName":"","lastName":"Zaman¹","suffix":""},{"id":499630181,"identity":"ca43a47d-4aa0-41f8-b810-16a98627b4d4","order_by":1,"name":"Aliya Hisam²","email":"","orcid":"","institution":"²Department of Community Medicine, National University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Aliya","middleName":"","lastName":"Hisam²","suffix":""}],"badges":[],"createdAt":"2025-08-06 09:08:43","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7307902/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7307902/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":91612992,"identity":"925b9e68-6dfe-480b-b7c4-952895f6007f","added_by":"auto","created_at":"2025-09-18 10:09:45","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1284069,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7307902/v1/c9a02571-bf3a-4bf4-9819-f1569fc498b6.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eDeterminants of Pelvic Organ Prolapse in Women of Nagar, Gilgit-Baltistan: A Case–Control Study\u003c/p\u003e","fulltext":[{"header":"Background","content":"\u003cp\u003ePelvic organ prolapse (POP) is characterized by the descent of pelvic organs such as the uterus, bladder, or rectum into or beyond the vaginal canal [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. It may result in a wide array of symptoms including pelvic pressure, urinary incontinence, dyspareunia, and recurrent infections, contributing significantly to both physical discomfort and psychological distress [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eDespite its clinical relevance, POP remains underrepresented in the literature\u0026mdash;especially in low-resource, rural, and mountainous regions [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. High-income countries report prevalence estimates ranging from 2.9% in the United States [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] to 7.3% in Sweden [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Pakistan shows figures up to 10% [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], though these numbers likely underestimate the true burden in marginalized populations. Poor access to care, cultural stigma, and systematic underreporting compound this problem [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eWomen in rural and high-altitude regions such as Gilgit-Baltistan (GB), Pakistan, face particular vulnerability to POP. The challenges are multifaceted: limited access to skilled birth attendants, physically demanding agricultural work, high parity rates, and low literacy levels all converge to increase risk [\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Nagar district exemplifies these challenges. The terrain is challenging, weather conditions are harsh, and healthcare infrastructure is limited. With an estimated doctor-to-patient ratio of 1:4100 in GB [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], many women still rely on traditional birth attendants for delivery care [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eWhile clinical encounters suggest a high burden of POP among women in Nagar, no prior studies have formally assessed its determinants in this population. The present study addresses this gap through a case-control analysis aimed at quantifying risk factors and informing context-specific interventions.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy design and setting\u003c/h2\u003e\u003cp\u003eThis study employed a case-control design conducted in 2016 at the Civil Dispensary in Sikandarabad, Nagar, Gilgit-Baltistan, Pakistan. The district, located at 2,688 meters above sea level, is primarily inhabited by Shia communities, with Burushaski, Shina, and Khowar as the predominant languages.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eParticipants\u003c/h3\u003e\n\u003cp\u003eWomen aged 18\u0026ndash;65 years who had experienced at least one childbirth were eligible for inclusion. Exclusion criteria included current pregnancy and previous surgical treatment for POP. Cases were defined as women with grade 3 or 4 prolapse based on clinical examination using the Baden-Walker system [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Controls were women without visible prolapse, individually matched by age (\u0026plusmn;\u0026thinsp;2 years), ethnicity, and village. A total of 40 cases and 38 controls were enrolled.\u003c/p\u003e\n\u003ch3\u003eData collection and measures\u003c/h3\u003e\n\u003cp\u003e Following informed consent, we administered semi-structured questionnaires in Burushaski and Urdu\u0026mdash;a process that typically took 45\u0026ndash;60 minutes per participant. The questionnaire, adapted from previous studies [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], covered demographics, obstetric history, socioeconomic status, and literacy levels. Literacy was defined by formal years of schooling rather than self-report, given the complexity of multilingual literacy in this region. Physical workload assessment proved challenging, as women's work varies seasonally. We focused on typical daily activities during peak agricultural periods.\u003c/p\u003e\u003cp\u003eClinical assessments were conducted by a trained female physician. This was essential for cultural acceptability. BMI calculations, while standard, required some adjustment for the high-altitude environment where normal ranges may differ slightly. Chronic conditions like cough, constipation, and urinary tract infections were assessed through both patient self-report and available clinical records\u0026mdash;though record-keeping at the facility was sometimes incomplete.\u003c/p\u003e\n\u003ch3\u003eSample size calculation\u003c/h3\u003e\n\u003cp\u003eSample size calculations assumed 80% power and α\u0026thinsp;=\u0026thinsp;0.05, based on odds ratios from previous literature [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. However, the realities of fieldwork in remote settings meant our final sample (40 cases and 38 controls) was ultimately limited by clinic volume and logistical constraints. This makes our analysis exploratory rather than definitive\u0026mdash;something we acknowledged from the outset.\u003c/p\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eBivariate analysis was used to identify associations between potential risk factors and POP. Odds ratios (OR) and 95% confidence intervals (CI) were calculated using chi-square tests for categorical variables and t-tests for continuous variables. Variables with p-values\u0026thinsp;\u0026le;\u0026thinsp;0.1 in bivariate analysis were included in multivariate logistic regression models to identify independent risk factors. Forward stepwise selection was used, with variables retained in the final model at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05. Multicollinearity was assessed using variance inflation factors (VIF), with VIF\u0026thinsp;\u0026gt;\u0026thinsp;5 indicating problematic collinearity. Model fit was evaluated using the Hosmer-Lemeshow goodness-of-fit test. A p-value of \u0026lt;\u0026thinsp;0.05 was considered statistically significant. Data were analyzed using SPSS version 25.0 (IBM Corp., Armonk, NY, USA).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eEthical considerations\u003c/h2\u003e\u003cp\u003eEthical approval was obtained from the local health authority. All participants provided written informed consent in their preferred language. Privacy and confidentiality were maintained throughout the study.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003eParticipant characteristics\u003c/h2\u003e\u003cp\u003eAll participants were of Shia ethnicity and belonged to the rural population. The mean age of cases was 41.1\u0026thinsp;\u0026plusmn;\u0026thinsp;11.21 years and that of controls was 37.72\u0026thinsp;\u0026plusmn;\u0026thinsp;9.62 years. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents the sociodemographic characteristics of the study population.\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\u003eSociodemographic characteristics of cases and controls\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\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\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCharacteristic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePOP n (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eControl n (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD (years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e41.1\u0026thinsp;\u0026plusmn;\u0026thinsp;11.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e37.72\u0026thinsp;\u0026plusmn;\u0026thinsp;9.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.158ᵃ\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge categories\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.199ᵇ\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;40 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e19 (47.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e27 (71.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;40 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e21 (52.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11 (28.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEducation of wife\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.012ᵇ*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIlliterate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e28 (70.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19 (50.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrimary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3 (7.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (2.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUp to Elementary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5 (12.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (10.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSecondary and above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 (10.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14 (36.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEducation of husband\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.003ᵇ*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIlliterate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23 (57.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9 (23.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrimary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3 (7.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (10.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUp to Elementary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (5.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (13.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSecondary and above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12 (30.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20 (52.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSocio-economic status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001ᵇ*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMiddle class\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5 (12.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19 (50.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLower class\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e35 (87.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19 (50.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003ePOP, pelvic organ prolapse; SD, standard deviation\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eᵃ Independent samples t-test; ᵇ Chi-square test; * Statistically significant at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eRisk factors for pelvic organ prolapse\u003c/h2\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows the bivariate analysis of selected variables associated with POP. Several significant associations were identified.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\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\u003eBivariate analysis of risk factors for pelvic organ prolapse\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=\"char\" char=\".\" 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=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePOP n (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eControl n (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eOR (95% CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;40 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e19 (47.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e27 (71.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;40 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e21 (52.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e11 (28.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.72 (1.11\u0026ndash;6.66)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.028*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEducational status of husband\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLiterate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e17 (42.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e29 (76.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIlliterate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e23 (57.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e9 (23.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.36 (1.68\u0026ndash;11.31)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.002*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEducational status of wife\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLiterate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e12 (30.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e19 (50.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIlliterate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e28 (70.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e19 (50.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.33 (0.95\u0026ndash;5.71)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.062\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEconomic status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMiddle class\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5 (12.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e19 (50.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLower class\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e35 (87.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e19 (50.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7.00 (2.27\u0026ndash;21.57)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge at marriage\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;18 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e10 (25.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e15 (39.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026le;\u0026thinsp;18 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e30 (75.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e23 (60.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.96 (0.74\u0026ndash;5.15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.174\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge at first pregnancy\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;20 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e9 (22.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e13 (34.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026le;\u0026thinsp;20 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e31 (77.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e25 (65.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.79 (0.66\u0026ndash;4.84)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.251\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGravida\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026le;\u0026thinsp;3 children\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7 (17.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e9 (23.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;3 children\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e33 (82.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e29 (76.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.46 (0.49\u0026ndash;4.38)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.499\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNumber of vaginal deliveries\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026le;\u0026thinsp;3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e8 (20.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10 (26.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e31 (79.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e28 (73.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.38 (0.48-4.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.547\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePlace of last delivery\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHealthcare facility\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e23 (59.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e30 (78.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHome\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e16 (41.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8 (21.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.61 (0.98\u0026ndash;6.95)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.055\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLast delivery assisted by\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHealth worker\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e24 (61.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e30 (78.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNon-health worker\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e15 (38.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8 (21.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.34 (0.87\u0026ndash;6.32)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.092\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLabor duration in last delivery\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;8 hours\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e27 (69.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e30 (78.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;8 hours\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e12 (30.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8 (21.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.67 (0.61\u0026ndash;4.56)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.321\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eRest after delivery\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;30 days\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3 (7.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e30 (78.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;30 days\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e36 (92.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8 (21.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e45.0 (11.19-180.92)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eType of routine work\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLight work\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e18 (47.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHeavy work\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e40 (100.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e20 (52.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e--\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDuration of heavy work per day\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026le;\u0026thinsp;2 hours\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4 (10.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e20 (52.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;2 hours\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e36 (90.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e18 (47.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10.0 (3.00-33.33)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDyspareunia\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e31 (79.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e36 (94.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e8 (20.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2 (5.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.64 (0.91\u0026ndash;23.52)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.065\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eUrinary tract infection\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e31 (79.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e36 (94.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e8 (20.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2 (5.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.64 (0.91\u0026ndash;23.52)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.065\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eConstipation in the last month\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e20 (50.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e28 (73.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e20 (50.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10 (26.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.8 (1.08\u0026ndash;7.25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.033*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eChronic cough\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e22 (55.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e34 (89.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e18 (45.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4 (10.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.95 (2.07\u0026ndash;23.29)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.002*\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\u003ePOP, pelvic organ prolapse; OR, odds ratio; CI, confidence interval; * Statistically significant at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eMultivariate analysis\u003c/h2\u003e\u003cp\u003eVariables with p-values\u0026thinsp;\u0026le;\u0026thinsp;0.1 in bivariate analysis were entered into the multivariate logistic regression model. These included age\u0026thinsp;\u0026ge;\u0026thinsp;40 years, husband's illiteracy, wife's illiteracy, lower economic status, home delivery, assistance by non-health worker, inadequate postpartum rest, heavy physical work, dyspareunia, urinary tract infection, constipation, and chronic cough. Due to the small sample size and to avoid overfitting, variables were entered using forward stepwise selection. The final multivariate model is presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\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\u003eMultivariate logistic regression analysis of independent risk factors for pelvic organ prolapse\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\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\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eaOR (95% CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRest after delivery\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;30 days\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;30 days\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e38.2 (8.1-180.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEducational status of husband\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLiterate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIlliterate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.8 (1.2\u0026ndash;12.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.024*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eChronic cough\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5.2 (1.3\u0026ndash;20.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.019*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"3\"\u003eaOR, adjusted odds ratio; CI, confidence interval; * Statistically significant at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"3\"\u003eModel χ\u0026sup2; = 45.8, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001; Nagelkerke R\u0026sup2; = 0.71; Hosmer-Lemeshow test: χ\u0026sup2; = 4.2, p\u0026thinsp;=\u0026thinsp;0.84\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe multivariate analysis identified three independent risk factors for POP: inadequate postpartum rest (\u0026lt;\u0026thinsp;30 days) remained the strongest predictor with an adjusted OR of 38.2 (95% CI: 8.1-180.4, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), followed by husband's illiteracy (aOR 3.8, 95% CI: 1.2\u0026ndash;12.1, p\u0026thinsp;=\u0026thinsp;0.024) and chronic cough (aOR 5.2, 95% CI: 1.3\u0026ndash;20.8, p\u0026thinsp;=\u0026thinsp;0.019). The model explained 71% of the variance in POP occurrence (Nagelkerke R\u0026sup2; = 0.71) and demonstrated good fit (Hosmer-Lemeshow test: p\u0026thinsp;=\u0026thinsp;0.84).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eIndividual risk factor analysis\u003c/h2\u003e\u003cdiv id=\"Sec14\" class=\"Section3\"\u003e\u003ch2\u003eSociodemographic factors\u003c/h2\u003e\u003cp\u003eWives of illiterate husbands had 4.51 times higher odds of developing prolapse compared to wives of literate husbands (95% CI: 1.7-11.93, p\u0026thinsp;=\u0026thinsp;0.002). Lower socioeconomic status was strongly associated with POP (OR 7.00, 95% CI: 2.27\u0026ndash;21.57, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Although women's own literacy showed a trend toward association with POP, this did not reach statistical significance (p\u0026thinsp;=\u0026thinsp;0.054).\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eObstetric and delivery-related factors\u003c/h2\u003e\u003cp\u003eWomen who delivered their last child at home had 3.08 times higher odds of prolapse compared to those who delivered at healthcare facilities (95% CI: 1.09\u0026ndash;8.79, p\u0026thinsp;=\u0026thinsp;0.030). The most striking finding emerged around postpartum rest. Women who rested fewer than 30 days after delivery showed 45 times higher odds of prolapse compared to those who rested longer (95% CI: 10.95-184.79, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). This finding was remarkable, even though we suspected it might be important. In our clinical experience, we had observed that economic pressures often forced women back to heavy agricultural work within days of delivery. The statistical confirmation of this relationship was both powerful and concerning.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003ePhysical workload and medical conditions\u003c/h2\u003e\u003cp\u003ePhysical workload showed expected but still remarkable patterns. Every single woman in the POP group (100%) reported heavy physical work, compared to just over half of controls (53.8%). The nature of this work\u0026mdash;carrying water from distant sources, tending livestock on steep terrain, harvesting crops\u0026mdash;involves sustained physical strain that likely contributes to pelvic floor dysfunction over time [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Working more than 2 hours daily in such activities further increased risk significantly (OR 10.0, 95% CI: 3.00-33.33, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003cp\u003eSeveral medical conditions showed significant associations with POP: chronic cough (OR 6.95, 95% CI: 2.07\u0026ndash;23.29, p\u0026thinsp;=\u0026thinsp;0.001), urinary tract infection (OR 4.64, 95% CI: 0.91\u0026ndash;23.52, p\u0026thinsp;=\u0026thinsp;0.047), constipation in the last month (OR 2.8, 95% CI: 1.08\u0026ndash;7.25, p\u0026thinsp;=\u0026thinsp;0.032), and dyspareunia (OR 4.64, 95% CI: 0.91\u0026ndash;23.52, p\u0026thinsp;=\u0026thinsp;0.047).\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study represents the first formal investigation of POP determinants in Nagar, Gilgit-Baltistan, conducted in 2016, revealing a complex interplay of socioeconomic, obstetric, and lifestyle factors that contribute to this condition in a high-altitude, resource-constrained setting. While healthcare infrastructure may have evolved since this study period, these baseline findings remain crucial for understanding the fundamental determinants of POP in similar populations.\u003c/p\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003eKey findings and implications\u003c/h2\u003e\u003cp\u003eThe multivariate analysis refined our understanding of POP risk factors by identifying three independent predictors while controlling for potential confounders. The persistence of inadequate postpartum rest as the strongest independent risk factor (aOR 38.2) in the adjusted model underscores its critical importance and suggests that interventions targeting this modifiable factor could have substantial impact.\u003c/p\u003e\u003cp\u003eThe strong association between husband's literacy and POP risk, which persisted in multivariate analysis (aOR 3.8), highlights the importance of male education in women's health outcomes. In patriarchal societies like those found in northern Pakistan, educated men may be more supportive of healthcare-seeking behavior, facility-based deliveries, and adequate postpartum care [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. This finding suggests that health interventions should include male engagement components to maximize effectiveness.\u003c/p\u003e\u003cp\u003eThe dramatic association between inadequate postpartum rest (\u0026lt;\u0026thinsp;30 days) and POP represents one of the strongest risk factors identified in the literature, maintaining its significance even after controlling for other factors. In rural Gilgit-Baltistan, economic pressures and agricultural demands often force women to resume heavy physical labor shortly after childbirth, potentially before pelvic floor muscles have adequately recovered [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. This finding underscores the need for community-based education about the importance of postpartum rest and the development of support systems that allow women adequate recovery time.\u003c/p\u003e\u003cp\u003eInterestingly, while heavy physical work showed a strong association in bivariate analysis, it did not remain significant in the multivariate model, suggesting that its effect may be mediated through other factors such as inadequate postpartum rest. This finding highlights the complex interplay between socioeconomic factors and health outcomes.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003eComparison with existing literature\u003c/h2\u003e\u003cp\u003eOur prevalence of home delivery among POP cases (41%) is consistent with regional patterns in northern Pakistan, where skilled birth attendance remains limited [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. The association between home delivery and POP (OR 3.08) likely reflects both the quality of care received and the social circumstances that lead to home births, including poverty, geographic isolation, and cultural preferences. However, this association was not maintained in multivariate analysis, suggesting that other factors may be more important independent predictors.\u003c/p\u003e\u003cp\u003eThe persistence of chronic cough as an independent risk factor (aOR 5.2) in multivariate analysis supports the multifactorial etiology of this condition. Chronic cough increases intra-abdominal pressure, which may contribute to pelvic floor dysfunction over time. This condition is potentially modifiable through improved healthcare access and treatment [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\u003ch2\u003eStrengths and limitations\u003c/h2\u003e\u003cp\u003eOur study has both notable strengths and important limitations that deserve discussion. The matched case-control design and use of standardized clinical assessment represent methodological strengths. The addition of multivariate analysis strengthens our findings by identifying independent risk factors and controlling for potential confounding. More importantly, we focused on a population that has received little research attention\u0026mdash;women in high-altitude, resource-poor settings whose health challenges often go undocumented.\u003c/p\u003e\u003cp\u003eHowever, the limitations are significant and affect how we interpret our findings. Our sample size, while carefully matched, remains small and limits both statistical power and generalizability. The limited sample size also constrained our multivariate analysis, requiring careful variable selection to avoid overfitting. The cross-sectional nature of data collection means we cannot establish definitively whether our \"risk factors\" actually preceded POP development. Social desirability bias likely affected responses to sensitive questions about sexual health and personal hygiene\u0026mdash;something we noticed during interviews despite our efforts to create a comfortable environment.\u003c/p\u003e\u003cp\u003ePerhaps most importantly, we conducted this study at a single healthcare facility. Women who seek care there may differ systematically from those who face the greatest access barriers\u0026mdash;the very women who might be at highest risk for POP. This selection bias could mean our findings actually underestimate the strength of associations with poverty and social disadvantage.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\u003ch2\u003eClinical and policy implications\u003c/h2\u003e\u003cp\u003eThese findings have several important implications for clinical practice and health policy in similar settings:\u003c/p\u003e\u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003ePostpartum care programs should be the highest priority\u003c/b\u003e, given the overwhelming evidence that inadequate rest is the strongest independent risk factor for POP. Community-based education programs should emphasize the importance of adequate postpartum rest and provide practical strategies for families to support recovering mothers.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eMale engagement initiatives should be incorporated into maternal health programs\u003c/b\u003e, given the persistence of husband's education as an independent risk factor in multivariate analysis.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eIntegrated care approaches should address the management of chronic conditions\u003c/b\u003e such as cough, which remained an independent risk factor even after controlling for other variables.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eHealthcare system strengthening is needed to improve access to skilled birth attendance\u003c/b\u003e, though our multivariate analysis suggests this may be less critical than ensuring adequate postpartum care.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eEconomic empowerment programs may help address the underlying poverty\u003c/b\u003e that forces women into early resumption of heavy physical labor after childbirth.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec22\" class=\"Section2\"\u003e\u003ch2\u003eFuture research directions\u003c/h2\u003e\u003cp\u003eSeveral research priorities emerge from our work. First, we need larger population-based studies with adequate power for more robust multivariate analysis to establish true prevalence estimates and confirm these risk factor associations in different settings. The logistics are challenging, but the health impact justifies the effort.\u003c/p\u003e\u003cp\u003eEqually important is qualitative research that can illuminate the cultural and social dynamics affecting women's postpartum experiences. Why do some families allow adequate rest while others do not? How do women navigate competing demands of recovery and economic necessity? These questions require different research approaches than we used here.\u003c/p\u003e\u003cp\u003eFinally, we need intervention studies. Testing culturally appropriate strategies for extending postpartum rest, improving male engagement in maternal health, and enhancing healthcare access could make a real difference in women's lives. But such interventions must be co-designed with communities rather than imposed from outside.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study\u0026mdash;the first to systematically examine POP determinants in Nagar, Gilgit-Baltistan\u0026mdash;reveals a web of interconnected risk factors rooted in gender, poverty, and healthcare access. The multivariate analysis strengthened our findings by identifying three key independent risk factors: inadequate postpartum rest, husband's illiteracy, and chronic cough. The magnitude of association we found with inadequate postpartum rest (aOR 38.2) represents one of the strongest risk factors reported in the POP literature.\u003c/p\u003e\u003cp\u003eBut numbers alone do not capture the full story. Behind these statistics are women whose health needs intersect with harsh economic realities, cultural expectations, and geographic isolation. Addressing POP in this population requires interventions that acknowledge this complexity.\u003c/p\u003e\u003cp\u003eAddressing POP in this population will require multi-level interventions that go beyond clinical treatment to address underlying social determinants of health. Community-based education, male engagement, healthcare system strengthening, and economic empowerment initiatives all have potential roles in reducing POP burden.\u003c/p\u003e\u003cp\u003eThe high burden of modifiable risk factors identified in this study suggests that culturally appropriate, community-engaged interventions could significantly reduce POP incidence in similar populations. However, such interventions must address the complex interplay of cultural, economic, and healthcare access factors that contribute to women's vulnerability to this condition.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eaOR\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eAdjusted odds ratio\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eBMI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eBody mass index\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eConfidence interval\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eGB\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eGilgit-Baltistan\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eOR\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eOdds ratio\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003ePOP\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ePelvic organ prolapse\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eSD\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eStandard deviation\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eSPSS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eStatistical Package for the Social Sciences\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eVIF\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eVariance inflation factor\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from the local health authority in Gilgit-Baltistan. All participants provided written informed consent in their preferred language (Burushaski or Urdu). The study was conducted in accordance with the principles of the Declaration of Helsinki.\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\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAyesha Zaman\u003c/p\u003e\n\u003cp\u003eAliya Hisam\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors thank the women who participated in this study and the staff at Civil Dispensary Sikandarabad for their support in data collection. We also acknowledge the local health workers who facilitated community engagement.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBump RC, Norton PA. Epidemiology and natural history of pelvic floor dysfunction. Obstet Gynecol Clin North Am. 1998;25(4):723\u0026ndash;46.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVergeldt TF, Weemhoff M, IntHout J, Kluivers KB. Risk factors for pelvic organ prolapse and its recurrence: a systematic review. Int Urogynecol J. 2015;26(11):1559\u0026ndash;73.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNygaard I, Barber MD, Burgio KL, Kenton K, Meikle S, Schaffer J, et al. Prevalence of symptomatic pelvic floor disorders in US women. JAMA. 2008;300(11):1311\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGjerde JL, Rortveit G, Muleta M, Blystad A. Living with pelvic organ prolapse: voices of women from Amhara region, Ethiopia. Int Urogynecol J. 2017;28(3):361\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTegerstedt G, Miedel A, Maehle-Schmidt M, Nyr\u0026eacute;n O, Hammarstr\u0026ouml;m M. Obstetric risk factors for symptomatic prolapse: a population-based approach. Am J Obstet Gynecol. 2006;194(1):75\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRaza R, Zafar F, Khan AA, Tariq F. Frequency and risk factors of pelvic organ prolapse in Pakistani women. J Pak Med Assoc. 2019;69(2):150\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWalker GJ, Gunasekera P. Pelvic organ prolapse and incontinence in developing countries: review of prevalence and risk factors. Int Urogynecol J. 2011;22(2):127\u0026ndash;35.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVarley E. Islamic logics, reproductive rationalities: family planning in northern Pakistan. Anthropol Med. 2012;19(2):189\u0026ndash;206.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZakar R, Zakar MZ, Kraemer A. Women's experiences of violence and attitudes towards intimate partner violence: a population-based study from Pakistan. BMC Public Health. 2011;11:628.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eUNICEF Pakistan. Maternal mortality in Pakistan. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.unicef.org/pakistan/maternal-mortality\u003c/span\u003e\u003cspan address=\"https://www.unicef.org/pakistan/maternal-mortality\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed 15 Mar 2024.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAsif M, Altaf W, Atif A, Malik MA. An assessment of physician to population ratio and disease pattern in Gilgit-Baltistan. J Ayub Med Coll Abbottabad. 2017;29(4):616\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePakistan Demographic and Health Survey 2017-18. Islamabad: National Institute of Population Studies; 2019.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBaden WF, Walker TA. Genesis of the vaginal profile: a correlated classification of vaginal relaxation. Clin Obstet Gynecol. 1972;15(4):1048\u0026ndash;54.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eThapa B, Rana G, Gurung S, Singh M, Jha R. Pelvic organ prolapse in the rural population of Nepal: prevalence and risk factors. BMC Res Notes. 2014;7:318.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBhandari TR, Kutty VR, Sarma PS, Dangal G. Safe delivery care practices in western Nepal: does women's autonomy influence the utilization of skilled care at birth? PLoS ONE. 2017;12(8):e0182485.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChaudhry SA, Ahmed S, Karim S. The role of traditional birth attendants in maternal health: lessons from Pakistan. Int J Gynaecol Obstet. 2011;114(1):84\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKumari S, Walia I, Singh A. Self-reported uterine prolapse in a resettlement colony of north India. J Midwifery Womens Health. 2000;45(4):343\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBerhan A, Bekele D, Talema A, Damtie Y, Denekew A. A case-control study of pelvic organ prolapse in Jimma University Specialized Hospital, southwest Ethiopia. Ethiop J Reprod Health. 2013;7(1):25\u0026ndash;34.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDeLancey JO, Low LK, Miller JM, Patel DA, Tumbarello JA. Graphic integration of causal factors of pelvic floor disorders: an integrated life span model. Am J Obstet Gynecol. 2008;199(6):e6101\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"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":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Pelvic organ prolapse, case-control study, risk factors, Gilgit-Baltistan, Pakistan, maternal health, health equity","lastPublishedDoi":"10.21203/rs.3.rs-7307902/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7307902/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003ePelvic organ prolapse (POP) is a common but under-investigated gynecological condition, particularly in low-resource and mountainous regions. This study aimed to identify sociodemographic and reproductive risk factors associated with POP among women in Nagar District, Gilgit-Baltistan, Pakistan.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA case-control study was conducted in 2016 among women aged 18\u0026ndash;65 presenting to a primary health facility in Nagar. Forty women with clinically confirmed POP (grade 3 or 4) were individually matched with 38 controls based on age, ethnicity, and village. Data were collected between March and September 2016 through structured interviews and clinical examinations using the Baden-Walker grading system. Odds ratios (OR) and 95% confidence intervals (CI) were calculated using bivariate analysis, followed by multivariate logistic regression to identify independent risk factors.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eWomen with POP were significantly more likely to have illiterate husbands (OR 4.51, 95% CI: 1.7\u0026ndash;11.93, p\u0026thinsp;=\u0026thinsp;0.002), belong to lower socioeconomic strata (OR 0.14, 95% CI: 0.046\u0026ndash;0.44, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and report heavy physical workload (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Home delivery (OR 3.08, 95% CI: 1.09\u0026ndash;8.79, p\u0026thinsp;=\u0026thinsp;0.03), lack of postpartum rest (\u0026lt;\u0026thinsp;30 days) (OR 45.0, 95% CI: 10.95\u0026ndash;184.79, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), chronic cough (OR 6.95, 95% CI: 2.07\u0026ndash;23.29, p\u0026thinsp;=\u0026thinsp;0.001), urinary tract infection (OR 4.64, 95% CI: 0.91\u0026ndash;23.52, p\u0026thinsp;=\u0026thinsp;0.047), and constipation (OR 2.8, 95% CI: 1.08\u0026ndash;7.25, p\u0026thinsp;=\u0026thinsp;0.032) were also significantly associated with POP. Multivariate analysis identified inadequate postpartum rest (aOR 38.2, 95% CI: 8.1\u0026ndash;180.4, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), husband's illiteracy (aOR 3.8, 95% CI: 1.2\u0026ndash;12.1, p\u0026thinsp;=\u0026thinsp;0.024), and chronic cough (aOR 5.2, 95% CI: 1.3\u0026ndash;20.8, p\u0026thinsp;=\u0026thinsp;0.019) as independent risk factors.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003ePOP among women in Nagar is associated with a constellation of modifiable risk factors, particularly those related to socioeconomic disadvantage, high physical burden, and lack of maternal care. Interventions tailored to the local context\u0026mdash;such as community education, postpartum care programs, and healthcare system strengthening\u0026mdash;are urgently needed.\u003c/p\u003e","manuscriptTitle":"Determinants of Pelvic Organ Prolapse in Women of Nagar, Gilgit-Baltistan: A Case–Control Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-13 03:49:14","doi":"10.21203/rs.3.rs-7307902/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"acfad112-8f0b-498b-ba97-3fbb8d1369b6","owner":[],"postedDate":"August 13th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-09-18T10:09:32+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-13 03:49:14","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7307902","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7307902","identity":"rs-7307902","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}