A systematic review and meta-analysis were conducted following the PRISMA 2020 guidelines. The protocol was developed based on the Cochrane Handbook, though it was registered on PROSPERO (CRD420251082146). Comprehensive searches were performed in PubMed, Google Scholar, HINARI, and African Journals Online (AJOL) for studies published between January 2010 and May 2025, using a combination of MeSH and free-text terms related to urinary incontinence, pelvic organ prolapse, Africa, prevalence, and hospital-based studies. No restrictions were applied during the initial search phase, but only studies available in English or with English translations were included for full review. Search results were imported into Zotero for deduplication. Two reviewers independently screened titles and abstracts, with full-text assessments resolving discrepancies through consensus. The study selection process was documented in a PRISMA 2020 flow diagram ( Figure 1).

The review question was framed using the PICO framework, appropriate for observational prevalence studies:

Population (P): Women diagnosed with pelvic organ prolapse in African health facilities.

Intervention (I): None (observational focus on prevalence).

Comparison (C): Subgroups (e.g., regional comparisons, study design, or facility level).

Outcome (O): Prevalence of urinary incontinence among women with pelvic organ prolapse.

The Primary research question was: “What is the pooled prevalence of urinary incontinence among women with pelvic organ prolapse in Africa?”

Search terms were built using Boolean operators and included both MeSH and free-text terms such as “urinary incontinence”, “pelvic organ prolapse”, “prevalence”, “Africa”, and “hospital”. Filters were applied to include only human studies. No language restrictions were applied in the search phase, but only studies in English were retained.

Following deduplication in Zotero, 1,068 unique records were screened by two independent reviewers using Rayyan. Full-text articles were assessed against eligibility criteria, and disagreements were resolved through discussion. A total of 12 studies were included. The process is shown in the PRISMA 2020 flow diagram.

Included studies were observational (cross-sectional, cohort, retrospective), those Reported primary data on the prevalence of urinary incontinence among women with POP, conducted in African hospital settings, published in English.

Studies were excluded if they were Reviews, case reports, editorials, or RCTs, Conducted in non-hospital or non-African settings, Focused on non-POP-related UI or community-based estimates.

Two reviewers independently extracted data using a standardized Excel template developed using the PICO framework. Extracted data included, First author and publication year, Country and study setting, Study design and sample size, Diagnostic criteria and prevalence estimates,

Definitions and classification of urinary incontinence.

Quality assessment was conducted using the Joanna Briggs Institute (JBI) critical appraisal tool for prevalence studies. Studies scoring 6 or above out of 9 were considered high quality. All included studies underwent quality grading.

Statistical analyses were performed using Jamovi software version 2.6.44 with the MAJOR module. Prevalence rates were logit-transformed to stabilize variance and ensure normality, then back-transformed for pooled interpretation. A random-effects model using Restricted Maximum Likelihood (REML) was employed to estimate the overall prevalence, accounting for anticipated clinical and methodological heterogeneity.

Heterogeneity was evaluated using the I ², Tau ², H ², and Cochran’s Q statistics.

Publication bias was assessed using Egger’s regression, Kendall’s Tau, Fail-Safe N, and visualized using funnel plots ( Figure 3).

Substantial heterogeneity was found across studies (I ² = 78.5%, Tau ² = 0.729, H ² = 4.66, Q = 51.2, p < 0.001), suggesting meaningful variability due to factors like geographic region, healthcare access, and diagnostic criteria ( Table 3).

No significant publication bias was identified: Fail-Safe N = 8,956, Kendall’s Tau = 0.343 (p = 0.152), and Egger’s regression = 1.98 (p = 0.374) ( Table 3). Visual inspection of the funnel plot supported this ( Figure 3).

From 1,324 records (636 PubMed, 413 Google Scholar, 104 HINARI, and 167 AJOL), 256 duplicates were removed, and 1,068 articles were screened. After full-text review of 90 studies, 12 met the inclusion criteria, involving 11,149 women with pelvic organ prolapse from Ethiopia, Uganda, Tanzania, Nigeria, Ghana, South Africa, Sierra Leone, Kenya, and Cameroon ( Table 1). Study designs included cross-sectional (11) and one community-based survey, with sample sizes ranging from 250 ( Nwaeze et al., 2011) to 1,000 ( Madombwe et al., 2023).

PRISMA 2020 Flow Diagram showing that 12 studies were included in your final review.

This plot shows the prevalence of urinary incontinence across the 12 included studies, the pooled prevalence of urinary incontinence among women with pelvic organ prolapse across included studies was 33.1% (95% CI: 29.9–36.2%).

As illustrated in Figure 2 (forest plot), the individual study estimates and the pooled prevalence are presented for clarity.

The random-effects meta-analysis yielded a pooled logit-transformed prevalence of -0.704 (SE = 0.100, 95% CI: -0.900 to -0.508), translating to a prevalence of 33.1% (95% CI: 29.9%–36.2%) ( Table 2). This indicates that approximately 1 in 3 women with pelvic organ prolapse in African settings experience urinary incontinence.

Publication bias and heterogeneity assessment

No significant publication bias was detected (Fail-Safe N = 8,378, Kendall’s Tau = 0.073, p = 0.737, Egger’s Regression = 0.222, p = 0.304) ( Table 3). The high Fail-Safe N suggests that the results are robust and unlikely to be overturned by unpublished studies.

Prevalence varied across African regions: East Africa (31.0%–42.1%, average 36.5%), West Africa (28.0%–34.8%, average 31.2%), Southern Africa (25.0%–39.0%, average 32.0%), and Central Africa (33.5%).

Using the GRADE approach, the overall quality of evidence was rated as moderate. Although the studies included a large total sample size and demonstrated consistent methodologies, the high degree of heterogeneity downgraded the confidence level despite the absence of publication bias.

This review shows a heavy burden of urinary incontinence in African women with pelvic organ prolapse, prevalence of 33.1% necessitating urgent clinical and health policy intervention. At the clinical level, routine screening for UI as part of gynecological care is required, with frontline clinical personnel having the capacity to detect and treat pelvic floor disorders early. Non-surgical treatments like pelvic floor rehabilitation must be emphasized, especially in low-resource settings.

At a policy level, national reproductive health guidelines must include pelvic floor health, public education to reduce stigma, and the allocation of resources for training and treatment. Community-based, multidisciplinary care will enhance early detection, quality of life, and more equitable access to care.

According to the findings and limitations, the following are suggested for future research: Standardization of UI and POP diagnostic tools in research, Multi-country longitudinal studies to establish incidence and progression, Inclusion of community samples, particularly in rural communities where access is most limited, Capacity building among nurses and midwives to early identify and treat UI, Integration of pelvic floor health into maternal and reproductive health policy agendas.