Arthi S. Kozhumam ^1,2* Mamadou Bountogo ³ Dina Goodman Palmer ⁴ Carolyn Greig ^5,6,7,8 Maxime Inghels ^10,9 Sandra Agyapong-Badu ^5,6,7,8 Cristina Osborne ⁴ Guy Harling ^11,12,13,9 Till Bärnighausen ^10,11,14 David Rapp ^15,16 Molly Beestrum ¹⁷ Justine Davies ^13,18,4 Lisa R Hirschhorn ¹⁷

• ¹ Northwestern Medicine, Chicago, United States
• ² Institute for Global Health, Northwestern University, Chicago, Illinois, United States
• ³ Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
• ⁴ Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
• ⁵ School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, England, United Kingdom
• ⁶ NIHR Birmingham Biomedical Research Centre, Birmingham, United Kingdom
• ⁷ University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
• ⁸ MRC Arthritis Research UK Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, England, United Kingdom
• ⁹ Lincoln International Institute for Rural Health, Lincoln, United Kingdom
• ¹⁰ School of Public Health, Harvard University, Boston, Massachusetts, United States
• ¹¹ Africa Health Research Institute, KwaZulu-Natal, South Africa
• ¹² School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
• ¹³ MRC/Wits Rural Public Health & Health Transitions Research Unit, University of the Witwatersrand, Johannesburb, South Africa
• ¹⁴ Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Baden-Württemberg, Germany
• ¹⁵ Global Surgical Expedition, Glen Allen, Virginia, United States
• ¹⁶ Department of Urology, School of Medicine, University of Virginia, Charlottesville, Virginia, United States
• ¹⁷ Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States
• ¹⁸ Department of Global Health, Centre for Global Surgery, Stellenbosch University, Cape Town, South Africa

The prevalence of urinary incontinence (UI) in older women in low- and middle-income countries (LMICs) is not well understood. We conducted a rapid literature review to assess the burden of UI in this population and contextualize findings from a household survey of women aged 40 and older in Nouna, in northwestern Burkina Faso. UI prevalence for LMIC women 40 or older varied greatly (6-80%), with differences by socio-demographics, gynecological factors, comorbidities, behaviors and survey location. The studies used validated tools -- the International Consultation on Incontinence Urinary Incontinence Short Form (ICIQ UI-SF) was most common (n=4, 19%) – and bespoke tools that have not yet been validated. In Nouna, 983 (64.5%) of 1524 women, completed the ICIQ UI-SF. Overall UI prevalence, defined as reporting leakage at least 2-3 times a week, was 2.6% (95% CI 1.73-3.85%), descriptively increased with age from 0.5% in 40-49 year-olds to 6.6% in those 70 and over. Of those with UI, 88.5% experienced leakage daily, and 50% reported moderate or greater interference with daily life, yet most (88.5%) had not spoken to a healthcare provider. Multivariable analysis revealed that UI was more common among women who were not currently married and decreased with higher education levels. Both the rapid review and survey highlight the burden of UI among older women in LMICs, particularly as they age beyond 60. Given UI’s association with physical and mental health, it is crucial to raise awareness of burden, improve healthcare access, and integrate routine screening into basic healthcare services.