Department of Human Anatomy

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    Unveiling the Hidden Burden of Neural Tube Defects Crisis: A Triple-Lens Investigation of Prevalence, Risk Factors and Maternal Folate Deficiency in War-Torn Tigray, Northern Ethiopi
    (Mekelle University, 2025-10-12) Birhane Alem Berihu
    Background: Neural tube defects (NTDs) are among the most severe congenital anomalies globally, with disproportionately high prevalence in low-resource settings. The Tigray regional state in northern Ethiopia, already facing one of the highest NTD burdens in sub-Saharan Africa, has endured an extensive armed conflict for several decades and as recently as in 2020, resulting in the collapse of its healthcare system, widespread famine, and profound maternal health challenges. Despite anecdotal reports of increased birth defects during the conflict, empirical data have been lacking. Objective: This dissertation aimed to assess the prevalence, and associated factors of NTDs in war affected areas of Tigray. It also evaluated maternal red blood cell (RBC) folate levels in NTD high-risk regions to explore biochemical risk factors contributing to these anomalies. Methods: A mixed-methods approach was employed across three interrelated studies. Quantitative data were obtained through hospital-based retrospective chart reviews, prospective observational assessments, and laboratory analyses of RBC folate concentrations in first-trimester pregnant women. Socio demographic, obstetric, nutritional, and biochemical variables were analyzed to identify risk factors associated with NTDs. Results: The findings revealed an alarmingly high prevalence of NTDs (262 per 10, 000 births) in the conflict-affected health facilities of Tigray, significantly exceeding national and regional estimates. Risk factor analysis of our study showed strong links between NTDs and factors such as young maternal age, rural residence, unplanned pregnancy, poor prenatal care, low education, high birth order, and lack of folic acid use. Additional risks included poor folate awareness, food insecurity, low dietary diversity, violence exposure, and limited healthcare access. Biochemical assays showed widespread deficiencies in RBC folate among pregnant women in high-risk areas, with levels frequently falling below WHO recommended thresholds for NTD prevention, with dietary diversity strongly influencing folate status, emphasizing the key role of nutrition in NTD prevention. Conclusion: This study demonstrates an alarming surge in NTDs in war-affected Tigray, primarily driven by widespread folate deficiency, poor dietary diversity, and the collapse of maternal health services. Additional risk was compounded by key socio demographic factors such as low education attainment, rural residence, and limited reproductive autonomy. These findings underscore how conflict magnifies preventable health crises through the convergence of nutritional, medical, and social failures. Hence, efforts should prioritize the restoration of antenatal care services, targeted folic acid supplementation for women of reproductive age, and community-based nutrition education to improve dietary diversity. In the longer term, food fortification with folic acid should be considered once health systems stabilize. These targeted interventions fall within the study’s evidence base and are feasible within conflict-affected and resource-limited contexts.
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    Magnitude and Associated Factors of Oligohydramnios Among Third Trimester Pregnant Women Attending at Mekelle Public Hospitals, Tigray, Ethiopia: Institution-Based Cross Sectional Study
    (Mekelle University, 2025-06-28) SHUSHAY TEKULU
    Background: Oligohydramnios is a condition where amniotic fluid volume is lower than expected for gestational age. It is the most common amniotic fluid disorder and the leading cause of severe fetal and maternal adverse outcomes. Despite the severity of the problem, studies regarding the magnitude and associated factors of oligohydramnios in third-trimester pregnancy were limited in Ethiopia, mainly in the study area. Objective: To assess magnitude and associated factors of oligohydramnios among women in the third trimester of pregnancy at Mekelle public hospitals, Tigray, Ethiopia, 2024/2025. Methods: A cross-sectional study was conducted from December/1/2024 to May/30/2025 in Mekelle city. We included pregnant women using consecutive sampling technique using predefined inclusion criteria. Interview using structured questionnaire was employed to collect socioeconomic and demographic, lifestyle, medical and obstetric related data. The data were analyzed using SPSS version 27. Descriptive statistics were utilized to summarize data. Binary logistic regression analysis was employed to identify factors associated with oligohydramnios in third-trimester of pregnancy. Variables with P<0.05 in multi-variable analysis were declared statistically significant & interpreted using AOR with 95% CI. Hosmer-Lemeshow test was used to assess model fitness & it was insignificant (P=0.956), indicating a good-fitted model for the data. The maximum VIF was 1.12, telling that no Multicolinearity issue among covariates. Results: The mean age of the study participant, 356 with a 100% response rate, was a 28.2±5.06 years. The magnitude of oligohydramnios in third trimester of pregnancy was 7.9% (95% CI: 5.3-11.2%). Women with a history of diabetes mellitus [AOR=4.12 (95% CI: 1.26-13.53)], hypertension [AOR=6.12 (95% CI: 1.82-20.59)], anemia [AOR=4.63 (95% CI: 1.61-13.37)], hyperemesis gravid arum [AOR=4.76 (95% CI: 1.82-12.48)], post-term pregnancy [AOR=7.22 (95% CI: 1.41-36.98)] and fetal factors, including congenital anomalies [AOR=7.60 (95% CI: 1.81-31.94)] and intrauterine growth restriction [AOR=5.87 (95% CI: 1.42-24.32)], were significantly associated with an increased odds of oligohydramnios. Conclusion & Recommendations: 7.9% of pregnant women had sustained oligohydramnios. Maternal diabetes, hypertension, anemia, hyperemesis gravid arum, post-term pregnancy, fetal congenital anomalies and intrauterine growth restriction were identified as significant risk factors for oligohydramnios. We recommend increased surveillance for oligohydramnios focusing on the identified risks, maternal life style modifications & regular antenatal checkups in pregnancy.
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    Morphological Variation Of The Umbilical Cord and Its Clinical Significance Among Mothers Delivered at Korem General Hospital, Southern Tigray, Ethiopia: Institution-Based Descriptive CrossSectional Study
    (Mekelle University, 2025-06-28) FANTAHUN BERIHUN
    The umbilical cord is the vital connection between the fetus and the placenta. The umbilical cord plays a vital role in fetal development, supplying oxygen and nutrients from the placenta to the fetus. Different literatures show umbilical cord has morphological variations and it has an impact on birth outcome, despite it is not studied yet in our area which is the reason for the need of the study. OBJECTIVE: The aim of this study is to investigate the morphological variation of the umbilical cord in terms of length, number of vessels, coiling pattern and other abnormalities like cord knot and cord entanglements. METHODOLOGY: Descriptive study design was employed analyzing on 442 umbilical cords collected from Korem General hospital. The data was collected through direct observation and measurement . statistical measures such as mean, range, mode and standard deviation, and frequency distribution were used for analysis. RESULT: The findings reveal that the average length of the umbilical cord was 50 cm, with a range of 35 cm to 78 cm. Most umbilical cord (99.5%) exhibits three vessel patterns, while 0.5% showed variations such as four vessel patterns with no two-vessel pattern. Majority (69%) of the umbilical cords had normal coiling pattern and 17% and 14% were hypocoiled and hypercoiled respectively. Additionally, 88% (392) of the umbilical cord had not had any cord knot whereas the 8% (36) and 3.2% (14) had cord knots and true cord entanglement respectively. CONCLUSION: The study show umbilical cord varies morphologically in length, coiling vasculature, knot and entanglement and has an impact on birth outcome. So, it gives an input for clinical anatomy and embryology. In addition to this the medical students will benefit from this as it will help them in their medical intervention. Further research with a large sample size is recommended to explore the clinical significance of those variations.
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    PREVALENCE OF CONGENITAL ANOMALIES AND ASSOCIATED FACTORS AMONG INFANTS OF DIABETIC MOTHERS DELIVERED IN TERTIARY HOSPITALS OF TIGRAY, ETHIOPIA: A CROSS-SECTIONAL STUDY
    (Mekelle University, 2025-06-28) DAWIT TSEGAY
    Background: Congenital anomalies, or CAs, are structural or functional abnormalities that arise during intrauterine development and can be identified at birth, later in infancy, or throughout fetal life. CAs affects approximately 3% of live births worldwide, and this rised sharply to 5– 14% among infants of diabetic mothers. CAs account for approximately 25% of infant deaths worldwide. Maternal diabetes, particularly when poorly managed during the peri-conceptional period, increases the risk of CAs through mechanisms such as oxidative stress and impaired cellular development. Despite the growing concern of CAs, has been no study on the prevalence and risk factors of congenital anomalies among infants of diabetic mothers in Tigray, Ethiopia. Objective: To assess the prevalence of congenital anomalies and associated factors among infants of diabetic mothers delivered in tertiary hospitals of Tigray, Ethiopia, Nov 2022 to Dec 2024. Methods: An institution- based retrospective cross-sectional study was conducted among 356 infants of diabetic mothers delivered at Ayder and Aksum referral hospitals between November 2022 and December 2024. The minimum sample size was 345, and all eligible infants of diabetic mothers were included. Pretesting, supervision, and training were used to control data quality. Data were collected using Kobo Toolbox and analyzed with STATA version 17. Binary logistic regression model was used and variables with p-values less than 0.25 in bivariate analysis were included in multivariable logistic regression with a 95% confidence interval. Model fitness (p value = 0.95) and Multicollinearity (VIF < 1.78) were assessed. Result: The prevalence of congenital anomalies among infants of diabetic mothers was 5.34% (95% CI: 3.24 - 8.21). Cardiovascular (42.1%) and central nervous system (31.6%) anomalies were the most common. Significant factors associated with congenital anomalies included high maternal blood glucose during pregnancy (AOR = 4.04; 95% CI: 1.36 –12.03), comorbidities in pregnancy (AOR = 3.87; 95% CI: 1.29 –11.58), prior unexplained fetal death (AOR = 3.03; 95% CI: 1.05 –8.74), and a history of macrosomic delivery (AOR = 3.78; 95% CI: 1.24 -11.49). Conclusion and Recommendation: Congenital anomalies (CAs) were present in 5.34% of infants of diabetic mothers. Congenital anomalies were significantly associated with high maternal blood glucose, comorbidities related to diabetes mellitus during pregnancy, previous stillbirth, and macrosomia. These finding emphasize the need for proactive comorbidity management, enhanced glycemic control, and comprehensive prenatal care for mothers with a history of stillbirth or macrosomia in order to decrease CAs in diabetic pregnancies. The study recommends that the underlying modifiable factors be prevented through better glycemic control during preconception and pregnancy, that oral glucose tolerance tests be used to strengthen universal diabetes screening, that special attention be given to DM mothers who have a history of macrosomic babies or stillbirths, and that comorbidities be taken seriously during pregnancy.