Introduction

Uterine leiomyoma commonly or uterine fibroid is the most common of all pelvic tumours in women. It is composed essentially of muscle tissue although there is a variable amount of fibrous connective tissue as well. The incidence of uterine fibroid depends on age and race, It is quite high in africa-ugandan women with over 80% of those above 25 years of age having fibroids if only of the size of a seedling. The vast majority of these fibroids are not symptomatic. Fibroids are more common in Negroes, 3–9 times more than in Caucasians. They occur after menarche and the majority would undergo atrophy at menopause.

The precise aetiology of uterine fibroids is still unknown, but genetic determinants in addition to hormonal factors-oestrogen, growth hormone and epidermal growth factor, play a synergistic or facilitative role in their growth. The predisposing factors for clinically significant fibroids are nulliparity, obesity, and a positive family history. Women of known contraceptive methods are said to be at high risk of development of uterine fibroid in users.

The clinical symptoms and signs of uterine fibroid are variable with less than 50% being asymptomatic, one-third having abnormal uterine bleeding, and another one-third having pelvic pain usually acute, sequel to degenerative changes, torsion haemorrhage, or infection, other clinical features include abdominal swelling, pelvic pressure, urinary frequency, compressive bowel symptoms, and subfertility. In Kampalaand also in other parts ofUganda, women with uterine fibroids present late to the hospital with large tumours (uterus greater than 20-week size gestation) which cause increased morbidity and mortality) and other go for herbalists in fear of hysterectomy as can result into barrenness.

Diagnosis of these tumours may be clinically elicited from the history and examination or incidentally during abdominal palpation in pregnancy. Ultrasonography, hysterosalpingography, laparoscopy, and laparotomy are other diagnostic procedures for uterine fibroids. In addition, magnetic resonance imaging, computerized tomography, and endoscopic diagnostic methods can also be used of which such services are limited in easy to reach health government facilities like health centerIV downwards that can affect early diagnosis.

The treatment options for uterine leiomyoma include medication, surgery, myolysis, and uterine artery embolization. Surgery for removal of fibroids can be by either myomectomy or hysterectomy depending on the age and parity of the women and this could be performed by the abdominal or vaginal route. There is an increasing trend for minimal access surgery (endoscopic surgery) for treatment of uterine fibroid in developing countries like Uganda.
Palliative treatment is also advocated to temporarily control abnormal uterine bleeding (menorrhagia) and this includes administration of danazol or norethisterone acetate, oestrogen-progesterone preparation such as in combined oral contraception, and gonadotrophin releasing hormone (GnRH) agonist. Uterine fibroid could also be treated by embolization.

Main Objective
• The aim of the project is to provide knowledge, perception, and attitude of women of reproductive age on the cause, prevention, sign and symptoms and where to address the condition and provide treatment for uterine fibroids in order to minimize infertility cases due to uterine liomayoma in Ugandans.

Specific Objectives
• To determine the factors responsible for late presentation to the health facilities for early diagnosis among women.

• To increase awareness and to bring in intervention to reduce late presentation by the affected women

• To reduce the prevalence of acquiring fibroids and minimize infertility due to uterine fibroids.

Target Group and Beneficiaries

The target group is the marginalized women with disabilities and local women leaders in the 5 divisions of Kampala City where the project will be implemented. A total of 30 women councilors, 6 in each division will be targeted. At least 60% will be women councilors representing marginalized Women with disabilities (MWDs).

Expected Results
• Created awareness on prevention of infertility due to uterine fibroids among women of reproductive age with Disabilities.
• It reduced the incident rate of developing infertility due to uterine fibroids.
• It reduced the prevalence of acquiring fibroids and minimized infertility due to uterine fibroids.

Main Activities
• To Sensitize Marginalized women with disabilities on prevention of infertility caused by uterine fibroids.
• Training Marginalized women with disabilities on prevention of infertility caused by uterine fibroids.
• Train health workers on infertility caused by uterine fibroids and needs of Marginalized Persons with disabilities.

Strategy

This will be achieved through a wide range of sensitization and networking initiatives, by which FRENDA will strengthen the knowledge of Marginalized women with disabilities on prevention of infertility caused by uterine fibroids in the local communities such as slams. Best practice exchanges complemented with a set of tools and mechanisms to provide the grounds for increased awareness will be established.