The burden of urinary incontinence among African diabetic and non-diabetic women seeking care at the Aga Khan University Hospital, Nairobi

Date of Award


Document Type


Degree Name

Master of Medicine (MMed)

First Supervisor/Advisor

Dr. Johnstone Miheso

Second Supervisor/Advisor

Dr Nancy Kunyiha

Third Supervisor/Advisor

Dr Abraham Mukaindo


Obstetrics and Gynaecology (East Africa)


Introduction: Female urinary incontinence is a common and chronic condition with devastating psychosocial effects. It can occur at any age and is specifically more common in older women. It has a prevalence of up to 55% depending on the age-group and the target population studied. About 9% of adults globally have diabetes and a greater number live in LMICs. Diabetes is twice as prevalent in blacks and three to four times higher in South-Asian populations compared to Caucasian populations. In women with Type 2 DM, urinary incontinence is 30% to 70% more common than among women with normal glucose levels. Despite studies showing higher prevalence and incidence of urinary incontinence among Caucasian women with diabetes, there is limited data on the prevalence of urinary incontinence among other racial groups with diabetes.

Objectives: The primary objective was to compare the prevalence of urinary incontinence among diabetic and non-diabetic women of native African origin seeking outpatient services at the Aga Khan University Hospital, Nairobi. It secondarily determined the factors associated with urinary incontinence in these two groups.

Methods: The study was cross-sectional in design. Eligible women aged 35 years and above on follow up at the Diabetes outpatient clinic and other outpatient clinics were consented, requested to fill in a general demographic tool containing personal data and the Michigan Incontinence Symptom Index Questionnaire (M-ISI) further administered. The Total M-ISI Domain score ranges from 0 to 32. Patients who achieved a score of ≥ 7 out of 32 were considered as having clinically significant urinary incontinence. Univariate and multivariate analysis was done to compare clinical variables between women with urinary incontinence in the diabetic and non-diabetic control groups in order to delineate potential associations.

Results: We established that there was a statistically significant difference in prevalence between the two study groups. The prevalence of UI was 23.8% (95% CI 18.4% – 29.1%) for diabetics and 8.4% (95% CI 4.9% - 12%) for non-diabetics (p<0.0001). The two groups were comparable with respect to UI types. The most predominant type was urge urinary incontinence in both study groups. There was no significant difference in severity scores across the groups. However, non-diabetic study participants reported significantly higher bother scores compared to their diabetic counterparts. We identified diabetic status, age, parity, menopausal status and education level as possible interacting factors on performing univariate analysis for the entire study population. Diabetic women still had significant odds of developing UI even after adjusting for potential confounders; AOR 2.5 (95% CI 1.3 – 4.9).

Conclusion: Our study findings demonstrate a strong association between DM and UI even after adjusting for potential confounders in native African women. There is a need for a public health strategy to address prevention and treatment of UI and non-communicable diseases from a primary care level by active case-finding.

This document is available in the relevant AKU library