Bloody traditional procedures performed during infancy in the oropharyngeal area among HIV+ children: implication from the perspective of mother-to-child transmission of HIV

The complications of traditional uvulectomy and concurrent occurrences of cultural malpractices in Ethiopia: A systematic review and meta-analysis

Introduction

Despite the establishment of a national strategy and plan to eliminate all harmful traditional practices, traditional uvulectomy remains widely practiced in Ethiopia, and there is a lack of comprehensive summary of national data on uvulectomy complications and associated malpractices. Therefore, this study aimed to assess the pooled complications of uvulectomy and concurrent occurrences of traditional malpractices in Ethiopia.

Methods

The following databases were used to retrieve studies: PubMed, EMBASE, CINAHL, Google Scholar, Web of Science, MEDLINE, Cochrane Library, SCOPUS, and Google Search. Manual searches were also utilized to identify relevant articles. Studies reporting traditional uvulectomy complications and malpractices in Ethiopia were considered. STATA Version 17 was utilized for statistical analyses, while heterogeneity and publication bias were assessed using I2 statistics.

Results

From a total of 259 studies found in electronic databases, 19 studies (23,559 study participants) were incorporated in the analysis. The pooled incidence of complications following traditional uvulectomy in Ethiopia was 29 % (95 % CI: 14%-44 %). Hemorrhage, transmission of communicable infections, and sepsis are the most common complications of traditional uvulectomy. Concurrent to uvulectomy female genital cutting (23 %), milk tooth extraction (29 %), bloodletting ("mebtat" in Amharic) (11 %), eyebrow incision (10 %), and body tattooing (16 %) were found to be widely practiced in Ethiopia.

Conclusions

The overall pooled results of this study revealed that three out of ten children who underwent traditional uvulectomy experienced complications such as hemorrhage, the spread of contagious infections, and sepsis. Children underwent uvulectomy are also victim to other traditional malpractices including milk teeth extraction, bloodletting, eyebrow incision, tonsillectomy, and body tattooing. Efforts should be made to update strategies to avert malpractices through awareness-creation, social mobilization, and controlling traditional practitioners.

Prevalence of traditional uvulectomy and its associated factors among parents who had less than 6 months of infants in Gondar City, north-west Ethiopia: Mixed study design

BACKGROUND

Traditional uvulectomy is widely practiced in Africa especially in sub-Saharan countries including Ethiopia. Limited Studies conducted in different times and areas of the world have shown that the prevalence of uvulectomy and its associated factors are varied from country to country. There is limited evidence to determine the prevalence and reasons of malpractice in Ethiopia. Therefore, this study aimed to assess the prevalence of traditional uvulectomy, and its associated factors among parents who had children aged less than 6 months.

METHODS

A community-based cross-sectional mixed study design was conducted among 630 participants selected by a systematic sampling technique. Data were collected using a pretested interviewer-administered questionnaire. The collected data were entered into Epi-data, and analyzed by using STATA version 14software. Descriptive statistics were computed and presented using tables, figures and texts. Factors associated with the prevalence of uvulectomy were selected for multiple logistic regressions at the probability value (p-value) of less than 0.2 in the X2- analysis. Statistically significant associated factors were identified at the probability value (p-value) less than 0.05 and adjusted OR (AOR) with a 95% CI. A total of 10 individual depth interviewees and 5 key informants were included using purposive sampling techniques. For the qualitative study, and thematic content analysis was employed to analyze the data, which were transcribed, translated, coded, screened, thematized, analyzed, synthesized, and finally supplemented the quantitative finding.

RESULTS

The prevalence of traditional uvulectomy was 84.60% (CI: 81.77%n-87.42%). Being rural residence (adjusted OR = 2.08, CI = 1.06-4.12), mothers aged 30 to 34 years (adjusted OR = 2.9, CI = 1.28-6.60), having no antenatal care visit (adjusted OR = 3.91, CI = 1.33-11.47), having no bad obstetric history (adjusted OR = 2.11, CI = 1.12-3.98), having no postnatal care visit (adjusted OR = 3.88, CI = 1.36-11.12) and mothers' poor attitude (adjusted OR = 3.32, CI = 2.01-5.47) were statistically significant associated factors of traditional uvulectomy. Seeking traditional uvulectomy, lack of information and third-party pressure were the main themes of the qualitative study that support the findings of the quantitative study.

CONCLUSION

The prevalence of traditional uvulectomy was high. Being rural residents, mothers aged 30 to 34 years, having no antenatal care visit, having no complications of obstetric history, having no postnatal care visit and mothers with poor attitude were statistically significant associated factors of traditional uvulectomy. Lack of information about uvulectomy and third-party pressure was the reason for seeking traditional uvulectomy.

The burdens, associated factors, and reasons for traditional uvulectomy in Ethiopia: A systematic review and meta-analysis

INTRODUCTION

Traditional uvulectomy is a harmful procedure in which the entire or a portion of the uvula is removed by traditional practitioners. It causes complications like septicemia, transmission of infectious diseases, anemia, excessive bleeding, infection, tetanus, meningitis, and death. A summary of national data was lacking, thus, the study aimed to determine the pooled national burden and determinants of traditional uvulectomy in Ethiopia.

METHODS

Studies were retrieved from PubMed, EMBASE, CINHAL (EBSCO), Google Scholar, Web of Sciences, MEDLINE, Cochrane Library, SCOPUS, and Google databases. Finally, 19 studies were included. The methodological quality of the included studies was assessed using the JBI checklist. Data synthesis and statistical analysis were conducted using STATA Version 17 software. Heterogeneity and publication bias were assessed. Forest plots were used to present the pooled and summarized with random-effects meta-analysis models.

RESULTS

Totally 19 articles with 23,559 study participants were included in this systematic review and meta-analysis. The overall pooled prevalence of uvulectomy in Ethiopia was 44 % (95 % CI: 31%-57 %). The highest prevalence was observed among studies conducted in the Tigray region (63 % (95 % CI: 34%-94 %), between the year 2011-2014 (58 % (95 % CI: 29%-87 %)) and, community setting (57 % (95 % CI: 36%-78 %). Mothers' educational status (AOR: 1.66, 95 % CI: 1.31-2.01) and residence (AOR: 1.70, 95 % CI: 1.16-2.23) were found to be significantly associated with traditional uvulectomy in Ethiopia. Frequently cited reasons for traditional uvulectomy were to prevent swelling, pus, and rupture of the uvula, for better care, prevention of sore throats and coughs, religion, and culture.

CONCLUSION

The pooled result revealed that almost half of children are still subjected to traditional uvulectomy in Ethiopia. There is a need to intensify awareness creation campaigns against the practice by giving special attention to rural residents and uneducated ones.

Cultural malpractices during pregnancy, child-birth and postnatal period among women of child bearing age in Loma Woreda, Southwest Ethiopia

Background

Every day nearly 810 women died from preventable causes related to pregnancy and childbirth. Sub-Saharan Africa shares two-thirds of the world's maternal mortality ratio. World health organization recommends skilled care to save the lives of women and newborns. However, cultural malpractice is a common practice in developing countries like Ethiopia. So this study intends to determine the prevalence of cultural malpractice during pregnancy, childbirth and postnatal period and associated factors.

Method

A community-based cross-sectional study was conducted in Loma district southwest Ethiopia from February to June 2018. A sample of 387 reproductive-age women who gave birth in the last two years was included using a systematic sampling technique. Data were collected using pretested structured interviewer-administered questionnaire. A multivariable logistic regressions model was used to identify independent predictors of cultural malpractice. Significance association was declared by AOR at 95% confidence and p-value <0.05.

Result

A total of 387 participants were involved in the study yielding a response rate of 100%. The prevalence of cultural malpractice during pregnancy, childbirth, and postnatal period was 68%, 37.5%, and 72.6% respectively. The occupational status of women being students (AOR = 3.198, 95% CI: 1.250, 8.184) was an independent predictor of cultural malpractice during pregnancy. Age less than 30 (AOR = 2.075, 95% CI: 1.282, 3.357), rural residence (AOR = 1.892, 95% CI: 1.014, 3.532), occupation housewife (AOR = 2.841, 95% CI: 1.228, 6.575), merchant (AOR = 3.077, 95% CI: 1.134, 8.346) and number of pregnancy less than five (AOR = 2.707, 95% CI: 1.594, 4.597) were independent predictors of cultural malpractice during childbirth. Occupation housewives (AOR = 0.408, 95% CI: 0.226, 0.736) and a number of pregnancies less than five (AOR = 1.832, 95% CI: 1.035, 3.244) were independent predictors of cultural malpractice during the postnatal period.

Conclusion

and recommendation: cultural malpractice among reproductive-age women was high. Therefore, concerned bodies should strengthen the promotion of skilled birth attendance and community sensitization on the cultural malpractice consequences.

Practice and associated factors of traditional uvulectomy among caregivers having children less than 5 years old in South Gondar Zone, Amhara Region, Ethiopia, 2020

INTRODUCTION

Traditional uvulectomy is widely practiced in Africa especially in sub-Saharan countries including Ethiopia. Studies conducted in different times and areas of the world have shown that the level of practice of uvulectomy and its associated factors were varied from country to country. Therefore, this study was carried out to assess the practice and associated factors of traditional uvulectomy among caregivers having children less than 5 years old in the South Gondar Zone.

OBJECTIVE

This study aimed to assess practice and associated factors of traditional uvulectomy among caregivers having children less than 5 years old in South Gondar Zone, Amhara Region, Ethiopia, 2020.

METHOD

A community-based cross-sectional study was conducted on 634 participants who were selected using a multistage with a simple random sampling method. Data were collected using a structured interviewer-administered Amharic version questionnaire; it was entered into Epi Data and analyzed using SPSS. Descriptive statistics were calculated and logistic regressions were fitted to declare statistical significance at p-value < 0.05 and 95% CI.

RESULT

The prevalence of traditional uvulectomy in this study was 52.5% (95% CI, 48.6-56.3%). Moreover, lack of information [AOR = 2.975 (1.677-5.277)], perceived as uvula causes illness [AOR = 4.888 (2.954-8.086)], future intention or will perform [AOR = 4.188 (2.584-6.788)], perceived as traditional uvulectomy should not be eradicated [AOR = 1.893 (1.172-3.057)]), saw the previous good result [AOR = 9.396 (5.512-16.016)], health personnel hospitality problem [AOR = 5.922 (2.392-14.664)] and did not get cured by pharmacologic treatment [AOR = 3.918 (2.073, 7.405)] were significantly associated with traditional uvulectomy.

CONCLUSION AND RECOMMENDATION

The prevalence of traditional uvulectomy was high. Lack of information, perceived as uvula causes illness, future intention to uvulectomy, perceived as traditional uvulectomy should not be eradicated, saw the previous good result, health personnel hospitality problem and did not get cured by pharmacologic treatment were the factors significantly associated with traditional uvula cutting. Therefore, special attention will be given to creating further awareness to the community at large and setting controlling mechanisms for the health care delivery system.

The folk illness kimeo and "traditional" uvulectomy: an ethnomedical study of care seeking for children with cough and weakness in Dar es Salaam

BACKGROUND

Amputation of the uvula by lay providers, so-called "traditional uvulectomy", is common in parts of Sub-Saharan Africa. In Tanzania, the procedure is a treatment of persistent cough, and in some areas of the country, one in three children have been cut. Previous research from Sub-Saharan Africa suggest that uvulectomy by lay providers can increase morbidity and mortality in children, but few studies have examined the cultural ideas and practices that are linked to this form of lay surgery.

METHODS

This ethnomedical study took place in Dar es Salaam. Ten focus group discussions with a total of 43 caregivers in three different administrative districts were carried out, focusing on their perceptions of uvulectomy, the folk illness kimeo, and their experiences with taking a child for cutting. Four folk practitioners who carry out uvulectomies were interviewed individually, with a special focus on their background, and their perceptions of kimeo and uvulectomy.

RESULTS

Caregivers in Dar es Salaam typically take children who suffer from cough, vomiting and weakness to a professional health provider as a first recourse. If the child does not get well relatively quickly, some start fearing that their child may suffer from the folk illness kimeo. Kimeo is perceived by some to be an acute, life-threatening illness that professional health providers are incapable of treating. Folk practitioners treat kimeo by amputating the uvula using forceps. The four interviewed practitioners had learned their skill in apprenticeship, and two of them were third generation uvula cutters. Caregivers regard the folk practitioners as experts who offer a service that is perceived as both efficient and safe.

CONCLUSIONS

Efforts should be made to improve the quality of professional health services for children presenting with cough, including more open communication with caregivers about the folk illness kimeo. More research is needed to establish the clinical conditions that children who are taken for uvulectomy suffer from, to what degree the practice delays professional health care for underlying illnesses like pneumonia, and the negative effects of the cutting itself.

Cultural and Personal Practices with Unusual Oral Findings: Three Case Reports and a Literature Review

Due to increased migration, dentists are encountering patients with varied cultural practices. The main aim of this study was to report three cases in which cultural/individual oral practices appeared to be suggestive of disease, leading to initial misdiagnoses. We describe the case findings of three individuals treated at the Oral Diagnosis Clinic at the College of Dentistry at King Saud University in Riyadh, Saudi Arabia. In two cases, the patients presented with a missing uvula and dark maxillary gingiva. The initial diagnoses in both cases were incorrect. Further questioning revealed that the individuals had gingival tattoos and uvulectomies performed for traditional reasons. The patient in the third case presented with a diffuse red and white bilateral lesion on the buccal mucosa. The initial diagnosis was possible speckled leukoplakia. Upon further questioning, a definitive diagnosis of a chemical burn from a coarse salt mouth rinse due to personal oral practices was made. A literature review of these cultural practices is included. Our case report findings and the literature review highlight the need to consider cultural practices that can affect oral health and cause unusual oral findings when recording medical histories. Increasing awareness regarding these practices may help dentists provide appropriate treatment plans and reduce misdiagnoses. Furthermore, by understanding cultural practices, dentists may educate their patients about the harmful effects of some of these traditions.

An Evidence-Based Practical Approach to Pediatric Otolaryngology in the Developing World

Despite humanitarian otolaryngology groups traveling in record numbers to resource-limited areas treating pediatric otolaryngology disease processes and training local providers, there remains a large burden of unmet needs. There is a meager amount of published information that comes from the developing world from an otolaryngology standpoint. As would be expected, the little information that does comes involves some of the most common pediatric otolaryngology diseases and surgical burdens including childhood hearing loss, otitis media, adenotonsillectomies, airway obstructions requiring tracheostomies, foreign body aspirations, and craniomaxillofacial surgeries, including cleft lip and palate.

Reasons for persistently high maternal and perinatal mortalities in Ethiopia: Part II-Socio-economic and cultural factors

BACKGROUND

The major causes of maternal and perinatal deaths are mostly pregnancy related. However, there are several predisposing factors for the increased risk of pregnancy related complications and deaths in developing countries. The objective of this review was to grossly estimate the effect of selected socioeconomic and cultural factors on maternal mortality, stillbirths and neonatal mortality in Ethiopia.

METHODS

A comprehensive literature review was conducted focusing on the effect of total fertility rate (TFR), modern contraceptive use, harmful traditional practice, adult literacy rate and level of income on maternal and perinatal mortalities. For the majority of the data, regression analysis and Pearson correlation coefficient were used as a proxy indicator for the association of variables with maternal, fetal and neonatal mortality.

RESULTS

Although there were variations in the methods for estimation, the TFR of women in Ethiopia declined from 5.9 to 4.8 in the last fifteen years, which was in the middle as compared with that of other African countries. The preference of injectable contraceptive method has increased by 7-fold, but the unmet contraceptive need was among the highest in Africa. About 50% reduction in female genital cutting (FGC) was reported although some women's attitude was positive towards the practice of FGC. The regression analysis demonstrated increased risk of stillbirths, neonatal and maternal mortality with increased TFR. The increased adult literacy rate was associated with increased antenatal care and skilled person attended delivery. Low adult literacy was also found to have a negative association with stillbirths and neonatal and maternal mortality. A similar trend was also observed with income.

CONCLUSION

Maternal mortality ratio, stillbirth rate and neonatal mortality rate had inverse relations with income and adult education. In Ethiopia, the high total fertility rate, low utilization of contraceptive methods, low adult literacy rate, low income and prevalent harmful traditional practices have probably contributed to the high maternal mortality ratio, stillbirth and neonatal mortality rates.