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.

Management of Patent Vitellointestinal Duct in Infants

Objectives This study was undertaken to investigate and review the clinical presentation, surgical procedures executed, and the final outcome of infants managed for the patent vitellointestinal duct. Materials and Methods This is a single-institution, retrospective study and included infants who were operated for the patent vitellointestinal duct. This study was conducted at author’s Department of Paediatric Surgery during the last 20 years; from January 1, 2000 to December 31, 2019. Results A total of 24 infants were operated for the patent vitellointestinal duct during the study period and comprised 20 (83.3%) boys and 4 (16.6%) girls. The age of infants ranged from 7 days to 10 months, with a mean of 88.41 ± 64.9 days. Twenty-three (95.8%) infants were operated within 6 months of the age, 17 (70.8%) of them were operated within 3 months of the age. Only one (4.1%) infant was operated at the age of 10 months. Among 24 infants, 13 (54.1%) were presented with features suggestive of acute intestinal obstruction and remaining 11 (45.8%) were presented with fecal discharges through the umbilicus without intestinal obstruction. Among 13 infants who presented with acute intestinal obstruction, 12 had prolapsed bowel and 6 of them also had gangrenous bowel. Operative procedures were executed (n = 24) in the following order of frequency: (1) resection of patent vitellointestinal duct, wide wedge resection of ileum,and ileal repair (n = 13, 54.1%); (2) resection of patent vitellointestinal duct, small segment of ileum, and ileoileal anastomosis (n = 9, 37.5%); and (3) resection of patent vitellointestinal duct, segment of ileum, and an ileostomy (n = 2, 8.33%). Postoperatively, two (8.3%) infants developed anastomotic leak and peritonitis one each, later on, both of them died. Conclusion Patent vitellointestinal duct not only present with fecal discharges through the umbilicus but half of the infants presented with prolapsed bowel and with features of acute small bowel obstruction. Delay in seeking treatment for such cases was associated with considerable morbidity and mortality and therefore the patent vitellointestinal duct should be excised at the earliest.

Factors Associated with SARS-CoV2 Infection and Care Pathways Among the Most Vulnerable Populations Living in Marseille: A Case Control Study

Background: Mainland France has been seriously affected by the Covid-19 epidemic, which has brought significant and unexpected morbidity and mortality. Precarious people cared for in accommodation centers are particularly at risk of infection because of collective housing, their dependence on the support system and therefore their difficulty in applying barrier measures. These populations are also subject to a risk of more severe infections or a delay in seeking treatment. This study aims to identify the factors associated with SARS-CoV2 infection in the most vulnerable populations in Marseille.Methods: The sample on which the study was carried out consists of association users, whether or not presenting a symptomatology suggestive of Covid-19, and routinely treated between March 2020 and May 2020. Through univariate and multivariate analyzes, we studied the influence of several variables on morbidity attributable to SARS-CoV2. Results: 64 participants were enrolled in the study with 29 cases and 35 control subject. Median age was 21.16 years old with a younger age in the case group (p < 0.005). Sex ratio was 7. Risk factors of SARS-CoV2 in multivariate analysis were living in a shared apartment and a low compliance for distancing measure. Participants presented frequent mental health problems such as anxiety. Conclusions: The allocation of housing to structures involved with the most precarious people appears to be a decisive factor in the fight against the spread of SARS-CoV2 and therefore deserves more attention from public authorities.

Perceived Stigma as a Risk Factor for Delay in Seeking Treatment of Leprosy Patients: A Cross-Sectional Study in Tuban Regency

Tuban Regency is a leprosy endemic area. Leprosy prevalence in 2018 was 1.5 per 10,000 population with 177 new cases, about 87% of new leprosy cases are MB type and 11% have grade II disability. The high number of MB type and grade II disability leads to the low awareness of treatment-seeking behavior, as early as immediately after symptoms appear. This study aimed to prove that perceived stigma is a risk factor for delay in seeking treatment for leprosy patients. Cross-sectional study design was used in this study and the subject consisted of 112 leprosy patients, selected by proportional random sampling. Data were collected using a structured questionnaire. This study showed most of the subjects ranged from 15-60 years, more than half were male, most had low levels of education with low income. Most subjects suffered from the MB type of leprosy. More than half experienced delays in seeking treatment and did not experience disabilities. The variables such as knowledge, attitude, perceived susceptibility and severity of leprosy, and perceived stigma associated with the delay in seeking treatment, and only perceived stigma was proven as a risk factor for delay in seeking treatment of leprosy patients (p = 0.002; OR 4.458 (95% CI; 1,700-11,690)

Delay in treatment seeking and associated factors among suspected pulmonary tuberculosis patients in public health facilities of Adama town, eastern Ethiopia

Background In low-income countries, delays in treatment seeking among tuberculosis patients contribute to easy transmission and high prevalence of tuberculosis. Objective The aim of this study was to determine the magnitude of delays in treatment-seeking and risk factors among pulmonary tuberculosis suspected patients in health facilities located in Adama, Ethiopia. Method A health-facility based cross-sectional study was conducted at Adama from December 20, 2015, to March 1, 2016, among 598 tuberculosis suspected patients. Data was collected from all study participants on the same day of tuberculosis diagnosis using a structured questionnaire. Epi-Info 3.5.3 and Statistical package for the social sciences (SPSS) version 16.0 were used for data entry and analysis respectively. A bivariate and multivariable regression model was used to investigate the association between delay in seeking-treatment and various factors. Odds ratio with 95% CI and P-value < 0.05 were considered as cut off point to measure the strength and significance of the association. Results Among 598 pulmonary tuberculosis suspected patients, 79 (13.2%) were smear-positive. Among smear-positive participants, 61(77.2%) delayed seeking treatment and 275 (46%) patients delayed seeking treatment for > 30 days. The following factors were significantly associated with a delay in seeking treatment: female sex OR = 1.57, 95% CI (1.14, 2.18), low monthly income OR = 1.45, 95% CI (1.05, 2.01), lack of knowledge regarding tuberculosis OR = 1.67, 95% CI (1.13, 2.48), and cure rate of tuberculosis OR = 1.836, 95% CI (1.25, 2.69). Conclusion Nearly half of pulmonary tuberculosis suspected patients delayed seeking treatment in our study area. Female sex, low income, family size of five and greater, no knowledge about tuberculosis and cure rate were factors contributing to delay in treatment-seeking among suspected tuberculosis patients.

Challenges in Assessing and Treating Patients with Body Dysmorphic Disorder and Recommended Approaches

Clinicians commonly encounter multiple challenges when assessing and treating individuals with body dysmorphic disorder (BDD). Some of the major challenges include poor insight and low motivation for appropriate treatment, delay in seeking treatment, desire for usually ineffective cosmetic treatment (e.g., surgery or dermatologic treatment) instead of mental health treatment, co-occurring substance use disorders, and frequent and sometimes severe suicidality. This chapter discusses recommended approaches to these challenges that clinicians can implement when assessing and treating patients with BDD. Strategies for engaging patients in cognitive-behavioral treatment and pharmacotherapy, and for disengaging patients from cosmetic treatment, are reviewed. Suggestions for treating patients with comorbid substance use disorders and suicidal patients are offered.