Factors associated with delay in seeking treatment among women with pelvic organ prolapse at selected general and referral hospitals of Southern Ethiopia, 2020.

BACKGROUND: Pelvic organ prolapse (POP) is the descent of the vaginal wall, cervix, uterus, bladder, and rectum downward into the vaginal canal. Its prevalence is higher among women in developing countries because women are more prone to risk factors. In Ethiopia, women with prolapse seek treatments at advanced stages of prolapse; hence, surgical management has been widely practicing. Therefore, it was found to be very important to conduct research that assesses factors hindering early treatments in Southern Ethiopia. This study aimed to find out factors associated with the delay in seeking treatment of pelvic organ prolapse among patients at selected general and referral hospitals of Southern Ethiopia. METHODS: Cross-sectional study design was employed in 123 participants of seven randomly selected General and Referral Hospitals of Southern Ethiopia from February 01 to April 30, 2020, by using a structured questionnaire. Pre-trained two midwives in each center were deployed to collect data. Physicians performed diagnosis and physical examination. Data were entered and coded using EPI INFO version 7 and exported into SPSS version 25 for analysis. Bivariate and multivariable logistic regression analyses were performed. The goodness of fit was assessed by using the Hosmer and Lemeshow goodness test. RESULTS: In this study, out of 123 clinically diagnosed POP cases, nearly half of them were stage III, and over one-third were stage IV. Therefore, 84.6% (104 participants) of the respondents were delayed for the treatment of POP. The mean length of delay for POP treatments was 36.41 ± 3.95 months. After adjusting for covariates, lack of supports [AOR (Adjusted Odds Ratio) = 5.2 (95% CI 1.4-19.5)], low-income [AOR = 5.8 (95% CI 1.1-19.66)], and fear of social stigma [AOR = 4.7 (95% CI 1.2-18.59)] were significant factors for delayed treatments. CONCLUSIONS: Most of the POP patients were delayed for POP treatments. Factors like lack of support, low-income, and fear of losing social value/stigma were associated with treatment delay. Screening for the POP cases, educating (making awareness) the community about this devastating disease to facilitate early treatment and to avoid social stigma, and raising access to treatment by making the nearby hospitals equipped with facilities to treat POP are recommended.

Sociodemographic Factors Predicting Exclusive Breastfeeding in Ethiopia: Evidence from a Meta-analysis of Studies Conducted in the Past 10 Years.

OBJECTIVES: To investigate the association between EBF and educational status, household income, marital status, media exposure, and parity in Ethiopia. METHODS: PubMed, EMBASE, Web of Science, SCOPUS, CINAHL and WHO Global health library databases were searched using key terms for all studies published in English between September 2009 and March 2019. The methodological quality of studies was examined using the Newcastle-Ottawa Scale (NOS) for cross-sectional studies. To obtain the pooled odds ratio (OR), extracted data were fitted in a random-effects meta-analysis model. Statistical heterogeneity was quantified using Cochran's Q test, τ2, and I2 statistics. In addition, Jackknife sensitivity analysis, cumulative meta-analysis, and meta-regression analysis were conducted. RESULTS: Out of 553 studies retrieved, 31 studies fulfilled our inclusion criteria. Almost all included studies were conducted among mothers with newborn less than 23 months old. Maternal primary school education (OR 1.39; 95% CI 1.03-1.89; I2 = 86.11%), medium household income (OR 1.27; 95% CI 1.05-1.55; I2 = 60.9%) and being married (OR 1.39; 95% CI 1.05-1.83; I2 = 76.96%) were found to be significantly associated with EBF. We also observed an inverse dose-response relationship of EBF with educational status and income. However, EBF was not significantly associated with parity, media exposure, and paternal educational status. CONCLUSIONS: In this meta-analysis, we showed the relevant effect of maternal education, income, and marital status on EBF. Therefore, multifaceted, effective, and evidence-based efforts are needed to increase the national level of exclusive breastfeeding in Ethiopia.

Prediction of Number of Casts and Need of Tenotomy Using Pirani Score in the Management of Clubfoot.

BACKGROUND: Clubfoot also called as congenital tailpipes equinovarus is a complex ankle and foot deformity characterized by forefoot adduction and supination, midfoot cavus and hindfoot varus and equinus. It is estimated that more than 100,000 babies are born each year worldwide with clubfoot, and 80% are seen in developing nations. Different scoring systems are used for grading the severity of deformity or monitoring the natural history of clubfoot. The Pirani scoring system is now routinely used in most clubfoot clinics, including Cure Ethiopia, Children's Hospital. METHODS: A facility based retrospective study was conducted on 278 idiopathic club feet successfully treated by the Ponseti method and scored by Pirani system between September 2013/14 to September 2017/2018. Age at presentation, number of casts required, need for percutaneous Achilles tenotomy, casting effects were recorded. RESULTS: A total of 287 clinical folders of children were retrieved (424 feet). The mean (±SD) number of casts required for correction of the deformity was 5.54 ±â€Š1.63. The number of cast required for correction is significantly, and positively correlated with initial severity of Pirani score (r = 0.62 for right foot; r = 0.675 for left foot). There is a significant difference on the overall initial Pirani score between tenotomy and non- tenotomy group (P value < 0.001). CONCLUSION: The study revealed that severity of initial Pirani score can be used to estimate the number of Ponseti cast required for correction of clubfoot deformity and the need for tenotomy. Besides, the number of Ponseti cast required may not be affected by age of a child at the commencement of treatment.

Anatomical Variation in Morphometry and Morphology of the Foramen Magnum and Occipital Condyle in Dried Adult Skulls.

BACKGROUND: The foramen magnum (FM) is the largest opening and is outlet through which medulla oblongata and spinal cord along with meninges, vertebral arteries, anterior and posterior spinal arteries, tectorial membrane, alar ligaments, and spinal branch of the accessory nerve. Occipital condyle (OC) is an important part of craniovertebral or craniocervical junction located anterolaterally on either side of the FM. The objective of the study was to assess variations of FM and OC in Ethiopian dried adult skulls. METHODS: Observation-based descriptive study design was employed. The study was undertaken in 54 FM and 108 OC of 54 adult Ethiopian skulls. The morphometry of FM and OC were determined using a sliding vernier caliper. RESULTS: The mean values of anteroposterior and transverse diameters of the FM were 35.19 and 30.17 mm, respectively, and the mean area of the FM was 853.36 mm. The shapes of FM were determined as round in 22.2%, oval in 18.5%, egg like in 20.4%, triangular in 3.7%, pentagonal in 11.1%, hexagonal in 7.4%, irregular in 13%, and rectangular in 3.7% of the cases. The mean length of right and left OC was 25.69 and 26.96 mm, respectively, and the mean widths of the right and left OC were 12.76 and 13.04 mm, respectively. CONCLUSION: Our study identified various shapes of FM and diameter. The anteroposterior diameter is greater than the transverse diameter. The morphometric study of OC confirmed the length of left side is significantly greater than the right side.

Associated factors of pelvic organ prolapse among patients at Public Hospitals of Southern Ethiopia: A case-control study design.

BACKGROUND: Pelvic organ prolapse (POP) is the descent of the vaginal wall, cervix, uterus, bladder, and rectum downward into the vaginal canal. It occurs owing to the weakness of the structures supporting and keeping pelvic organs in anatomic position. Prolapse occurs due to exposure to risk factors; women in developing countries are highly predisposed to the risk factors of the prolapse. No study assesses POP in Southern Ethiopia. METHODS: A case-control study design was employed in 369 participants (123 cases and 246 controls) of seven randomly selected Public Hospitals of Southern Ethiopia from February-June, 2020, using a structured questionnaire. All patients diagnosed with prolapse (stage I- IV) were included as cases; patients free of prolapse (stage 0) were taken as controls after physicians had performed a diagnosis and vaginal examination. Bivariate and multivariable logistic regression analyses were performed using SPSS. RESULTS: In this study, after adjusting for covariates, age of the women ≥ 45 years (AOR = 5.33, 95% CI: 1.47, 9.05), underweight (AOR= 4.54, 95% CI: 1.4, 15.76), low income (AOR = 2.5, 95% CI:1.14, 5.59), parity ≥5 (AOR = 5.2, 95% CI: 2.2, 12.55), assisted vaginal delivery (AOR= 4, 95% CI: 1.55, 11.63), instrumental delivery (AOR= 3.5, 95% CI:1.45, 84), sphincter damage and vaginal tear (AOR = 3.2, 95% CI:1.44,7.1), carrying heavy loads (AOR= 2.5, 95% CI:1.2, 5.35), and prolonged labor ≥24 hours (AOR = 3.3, 95% CI:1.12, 97) were significant associated factors of prolapse. The odds of developing prolapse is lower among women attended school. Most(84.55%) of the women with prolapse were delayed for the treatments and only surgical interventions were done as treatments. Most of them claimed lack of social support, lack of money, and social stigma as the main reasons for the delay in seeking treatments. CONCLUSIONS: Older age, low educational status, underweight, low income, higher parity, assisted vaginal delivery, prolonged labor, sphincter damage, and carrying heavy loads were significant associated factors of POP. It is better to screen older age women by doing campaigns against the prolapse. Also, responsible bodies should work on raising awareness of women as well as awareness of the community about the prolapse through expanding health education. Moreover, informing women to practice pelvic muscle training daily, raising women's income to empower them, and help of family members to reduce carrying an overload of mothers are recommended.

Prevalence of palmar crease patterns and associated factors among students at University of Gondar, Northwest Ethiopia.

Palmar creases are unique, permanent, and genetically controlled morphological variables. Recognizing palmar crease types are important for personal identification, criminal investigations, and diagnosis of congenital diseases. This study aimed to reveal the anthropological characteristics as well as contribute to the diagnosing of congenital disease of Ethiopian people. In this study, a cross-sectional study design with a multistage sampling technique were used. Chi-square test, bivariable, and multivariable multinomial logistic regression models were employed. At bivariable analysis variables with a P-value of ≤0.2 were selected for multivariable analysis and at multivariable analysis variables with a P-value of ≤0.05 were considered as statistically significant factors. Most of study participants had normal palmar crease patterns (90.8%), followed by simian crease patterns (5.0%), whereas sydney crease patterns was the least (1.92%). Being male was more likely to have simian crease and sydney crease than normal crease. Right-handed subjects were less likely to have simian crease and suwon crease than normal crease. The simian crease was more common among students whose fathers were from Gurage ethnicity than normal creases. Students who have one point of origin of the primary palmar creases were more likely to have simian crease, sydney crease, and suwon crease than normal crease. In this study, the normal type of palmar crease patterns was the most prevalent. Whereas the simian crease pattern was the commonest type among the variant palmar creases. Palmar crease patterns are affected by sex, ethnicity, handedness, and points of origin of the primary palmar crease.

Risk Factors of Anomalous Cord Insertion Among Singleton Births at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia: An Institution-Based Cross-Sectional Study.

INTRODUCTION: Anomalous cord insertion causes bad pregnancy outcomes. Therefore, knowledge on the prevalence and risk factors of anomalous cord insertion will reinforce the prenatal care by health providers in addressing the adverse outcome caused by this abnormality. METHODS AND MATERIALS: An institution-based cross-sectional study design was conducted among 421 singleton births at the University of Gondar comprehensive specialized hospital. A systematic random sampling technique was used to select study participants. Data were collected by using a structured questionnaire and checklist and was entered into epi-data version 3.1 and then exported to SPSS version 20 for data cleansing and analysis. Bi-variable and multivariable logistic regression was employed to identify factors associated with anomalous cord insertions. Crude and adjusted odds ratio with a 95% confidence interval was calculated to identify the independent risk factors for anomalous cord insertions. RESULTS: The prevalence of anomalous cord insertion was 9.0% in singleton pregnancies. Independent risk factors for ACI were advanced maternal age (AOR= 4.77), primiparity (AOR=3.87), maternal chronic hypertension (AOR=3.23), previous caesarian delivery (AOR=3.28), and use of IUCD before pregnancy (AOR=3.91). CONCLUSION: Anomalous cord insertion was reported in approximately one-tenth of singleton deliveries in the representative Ethiopian population. Advanced age, primiparity, hypertensive disorder, history of caesarian section, and IUCD usage before pregnancy were associated with increased risk of anomalous cord insertion.