College of Health Sciences

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    Joint modeling of onset of microvascular complications and longitudinal fasting blood sugar among type 2 diabetes patients at Ayder and Mekelle hospitals, 2025
    (Mekelle University, 2025-06-28) TETEMKE MEKONEN
    Introduction: Type 2 diabetes mellitus is a major cause of microvascular complications that impact patients' quality of life and contribute to long-term health issues. Worldwide, 18.8% of individuals with diabetes experience these complications, rising to 37.9% in Ethiopia. Fasting blood sugar levels are vital for managing Type 2 diabetes and are linked to the onset of microvascular complications; however, no studies have examined the relationship between fasting blood sugar progression and the onset of these complications in the Tigray region. Objective: To jointly model the longitudinal pattern of fasting blood sugar and the time to onset of microvascular complications among type 2 diabetes mellitus patients at Ayder and Mekelle hospitals using a joint modeling approach, January 2018 - March 2024 Methods: A retrospective longitudinal study was conducted among 447 type 2 diabetes patients at Ayder and Mekelle hospitals from May 25 to July 10, 2024. Data were collected from patients' medical records using Kobo Toolbox, with training and supervision provided to data collectors. The adequacy of the random effects assumption was assessed and proportional hazards assumptions were validated. Joint modeling of Cox-PH with random intercept and random slope was fitted. Akaike Information Criteria and Bayesian information criterion were used for model comparison. Variables were interpreted via hazard ratios and 95% confidence intervals. Result: The incidence rate of microvascular complications was 6 per 1000 person-months (95% CI: 5–7) with estimated restricted mean of 62 months. For one unit increased in longitudinal mean log (FBS), the hazard of complications was 18.92 (CI: 6.050, 54.598) times higher. For one unit increase in body mass index the hazard of complications was 6.1% more likely higher. A one-unit increase in the triglyceride level, the hazard of complications was 0.3% more likely higher. Patients on injection plus oral medications had a 2.45 times higher hazard of complications compared to those on single oral medications (AHR = 2.455, CI: 1.118, 5.302). Conclusion: fasting blood sugar trajectory, baseline fasting blood sugar, Body mass index, Triglycerides level, proteinuria, and type of medication intake were significant predictors of time to onset of microvascular complications. These findings emphasize the importance of continuous monitoring and tight control of blood glucose levels in diabetes management to prolong the onset of microvascular complications.
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    JOINT MODELING OF TIME TO DEVELOP TUBERCULOSIS AND CHANGE IN CD4 COUNT AMONG HIV PATIENTS UNDER ART IN MEKELLE, ETHIOPIA, 2024
    (Mekelle University, 2025-06-28) TEKLEBRHAN KINFE
    Background: In patients with HIV, tuberculosis remains the leading cause of mortality and morbidity. Little is known about the predictors and the median time to develop tuberculosis while considering for the effect of the variation of longitudinal CD4 cell count. Objective: To investigate the time to develop tuberculosis accounting for longitudinal CD4 cell count change and its predictors among HIV patients who are under ART follow-up at Mekelle General Hospital and Ayder Comprehensive Specialized Hospital, Mekelle, Ethiopia, 2024. Methodology: A facility-based retrospective follow-up study was conducted among 449 adult PLHIV under ART follow-up from March 2018 to May 2024. The study participant were selected via a simple random sampling. The secondary data were collected from the patients’ medical records via Kobocollect version 2021.2.4 and exported to STATA version 17.0. The final model was a joint random intercept Cox-proportional hazard model. A model with the lowest Akaike information criterion and Bayesian information criterion was selected. Results: The incidence density of TB disease was 6.77 cases/100 person-years with a restricted mean survival time of 60 months. The joint analysis provided an association parameter alpha with AHR=0.854; 95% CI(0.8-0.91), indicating that for a unit increase in the average √CD4 cell count , the hazard of TB infection decreased by 14.6%, keeping other variables constant. The study also revealed that advanced WHO clinical stage (AHR = 1.024, 95% CI: 1.017–1.033), sex (AHR= 1.62, 95% CI: 1.09,2.4), CPT intake (AHR= 0.55, 95% CI: 0.35,0.89), and adherence (AHR= 0.38, 95% CI: 0.28,0.52) were significantly associated with the time to develop tuberculosis. The random intercept model indicated that greater variation in CD4 counts at baseline contributed strongly to the hazard of tuberculosis. Conclusion and Recommendation: This research highlights that PLHIV with a decreasing trajectory of CD4 count, advanced WHO clinical stage, female sex, history of CPT intake, and poor adherence have a higher risk of tuberculosis. On the basis of these findings, it is strongly recommended that the government and relevant health actors working on TB/HIV should intensify activities that improve patient adherence and a regular CD4 cell measurement.
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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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    Sero-prevalence of hepatitis B virus and human immunodeficiency virus, and associated factors among pregnant women attending antenatal care in selected general hospitals of Mekelle and Eastern zone of Tigray region, Northern Ethiopia
    (Mekelle University, 2025-06-28) SENAIT KEBEDE
    Background: Hepatitis B virus (HBV) and Human Immunodeficiency Virus (HIV) share common transmission risk factors and represent significant global public health challenges. They are major contributors to morbidity and mortality among pregnant women, especially in low and middle-income countries. However, there is limited local data on the burden of these infections among pregnant women in the study area collectively. Hence, this study was aimed to assess the sero-prevalence of hepatitis B viruses (HBV) and human immunodeficiency viruses (HIV), and associated factors among pregnant women attending antenatal care in selected general hospitals of Mekelle and Eastern Zone of Tigray, Northern Ethiopia. Method: A hospital based cross sectional study was conducted from December 2024 to April 2025 in selected general hospitals of Mekelle and Eastern zones of Tigray. Socio-demographic risk factors data and blood sample were collected from the 238 pregnant women. Rapid diagnostic tests were used to detect HBV and HIV. HBV confirmation with Enzyme linked immune sorbent assay (ELISA) was also performed. Data was entered and analyzed using SPSS version 27. Descriptive and Logistic regression analysis was used to assess associations between variables. A p-value of ≤0.05 was considered as statistical significant. Result: The overall seroprevalence of HBV and HIV were 9.7% and 4.2% respectively. However, no cases of HBV/HIV co-infection were identified. Among the three sites the seroprevalence of HBV and HIV were 8.9% & 3.7%, 8% & 2.7% and 11.9% & 6% in Adigrat, Wukro and Mekelle respectively. Variables like older age (AOR = 3.10, 95% CI: 1.01–9.46, P = 0.047), history of liver disease (AOR = 23.67, 95% CI: 3.55–158.01, P = 0.001), history of abortion (AOR: 0.23, 95% CI: 0.05-0.96; p=0.043), nose piercing (AOR: 4.01, 95% CI: 1.35, 11.92; p=0.013) and history of sexually transmitted infection(AOR: 5.94, 95% CI: 1.41-24.99; p=0.015) were revealed significant association with seroprevalence of HBV while knowledge about transmission of HIV (Exact OR = 0.10, 95% CI: 0.02–0.72, p = 0.0219) was the only variable significantly associated with of HIV infection. Conclusion: The overall seroprevalence of HBV among pregnant women attending antenatal care was high according to WHO classification. The current HIV prevalence lies within the range of the pooled HIV prevalence among pregnant women in Ethiopia
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    Bacterial Urinary Tract Infections, Antimicrobial Susceptibility Patterns and Associated Risk factors Among Fistula patients at Hamlin Fistula Hospital, Mekelle, Tigray, North of Ethiopia
    (Mekelle University, 2025-06-28) KASECH FITSUM TEDLA
    Background: Urinary tract infections (UTIs) are one of the most common bacterial infections in humans, both in the community and hospital. UTIs are a significant cause of hospital admissions, a widespread concern, affecting millions of people worldwide and causing significant morbidity, mortality, and serious healthcare costs. Patients with obstetric fistula usually suffer from urinary and stool incontinence that can predispose them to frequent infections with urinary tract infection. Despite this fact, there is lack of data on the prevalence, causative pathogens, and antimicrobial susceptibility patterns of UTIs, particularly in lower resource settings like Tigray, Ethiopia. Objective: The study aimed to assess the prevalence of bacterial urinary tract infection, evaluate antimicrobial susceptibility patterns and identify associated risk factors among fistula patients at Hamlin Fistula Hospital in Mekelle, Tigray, Ethiopia. Method: A cross-sectional study was conducted from January to May 2025 at Hamlin Fistula Hospital in Mekelle, Tigray. Socio-demographic characteristics and other urinary tract infection related risk factors were collected from study participants using structured questionnaires. The mid-stream urine was collected and cultured on Cysteine lactose electrolyte deficient agar, and MacConkey agar. Bacterial isolates of gram negative and gram positive were characterized using series of biochemical tests. Antimicrobial susceptibility was determined using the disc diffusion method and interpreted according to the Clinical and Laboratory Standards Institute (CLSI2020) guidelines. The data was entered and analyzed using SPSS version 27. Results: Out of the 151 patients sampled, 104 (68.8.6%) were found to have significant bacteria infecting the urinary tract. Isolation of significant bacteriuria was strongly associated with the history of previous UTI and history of catheterization (p=0.01). Eight different species of bacterial uropathogens were identified from the samples. The bacteria isolated were 94.2 % gram negative and 5.8% gram positive. The most predominant bacteria identified were E. coli followed by P.vulgaris. The isolated bacteria had shown the highest resistance rate (72.2%) to Tetracyllin followed by Ampicillin (69.2%) and highest susceptibility to Amikacin (100%) followed by Meropenem (98.1%). Twenty-six of the isolated bacteria (98) were found to be ESBL-producing gram-negative bacteria. Conclusion and recommendation: The overall prevalence of urinary tract infection among fistula patients is high. The predominant pathogen of UTI isolated was E. coli followed by P.vulgaris and K. peumoniae. All the bacterial isolates have shown multiple antibiotic resistance pattern. Based on the findings of the present study, routine screening, urine culture and antimicrobial susceptibility testing are recommended for all fistula patients.
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    Joint Modeling of Longitudinal Blood Pressure and Time to Complications Among Hypertensive Patients: A Retrospective Cohort Study in Mekelle, Ethiopia, 2018-2024
    (Mekelle University, 2025-06-28) MISHO MLAW
    Introduction: Hypertension is one of the 21st century emerging major public health problem, which is a strong risk factor for myocardial infraction, heart failure, ischemic or hemorrhagic stroke, chronic kidney disease, and eye disorder. Despite its significance, limited studies have investigated the association between longitudinal blood pressure measurements and the time to development of complications among hypertensive patients. Objectives: To determine the predictors, association between longitudinal blood pressure measurements and time to develop complications among hypertensive patients in ACSH and Mekelle General Hospital, Tigray, Ethiopia, 2018-2024. Methodology: A retrospective cohort study among 403 adult hypertensive patients with no complications from the beginning of follow up in Ayder Comprehensive Specialized Referral Hospital and Mekelle General Hospital from January 2018 to March 2024 was included. Data from patient’s medical record was collected using Kobo toolbox and exported to Stata version 17 and R 4.4.3 for data management and analysis. A bivariate mixed-effects model, Cox proportional hazards model, and a multivariate joint model linking longitudinal and survival sub-models through shared random effects were fitted. The final interpretation was done by hazard ratio. Result: A multivariate joint modeling analysis was the best fitted model based on the minimum Akaike Information Criterion value with an estimated value of the association parameters of 10.4 (p < 0.001) and 4.9 (p = 0.040), supporting the association between systolic and diastolic blood pressure with time to event was statistically significant. The multivariate joint modeling analysis showed that patients with family history of cardiovascular diseases (Hazard Ratio = 4.31), patient with Diabetes mellitus comorbidity (Hazard Ratio = 3.86), patient who take multiple treatment regimens have higher chance of developing hypertension related complications. Both Systolic and Diastolic blood pressure measurements were found to be critical predictors of hypertension complications. Conclusion and Recommendation - This study highlights the importance of effective blood pressure management and the need for targeted interventions that account for family history, clinical comorbidities, and treatment regimens to reduce the risk of complications in hypertensive patients.
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    Predictors of clinical severity , immunological failure and magnitude of intestinal parasitic infections among HIV Patients on ART in Mekelle General Hospital, Tigray, Ethiopia.
    (Mekelle University, 2025-06-28) GIRMAY ALEMSEGED
    Background: Untreated intestinal parasitic co-infections appeared to hasten the progression of HIV-1 disease. However, there had been few studies to ascertain the interference and their induced severity of intestinal parasitic infections among on ART HIV/AIDS patients in resource-limited settings such as Ethiopia, where HIV/AIDS management largely depended on CD4+ T cells counts, viral load, and WHO clinical staging. Objective: To assess predictors of clinical severity, immunological failure and magnitude of intestinal parasitic infections in HIV Patients on ART in Mekelle General Hospital, Tigray, Ethiopia. Methods: A health facility based cross-sectional study was carried out from December 2024 to March 2025 among adult HIV/AIDS patients on ART. Data on socio-demographic, clinical and risk factors were gathered using a pre-tested structured questionnaire. Intestinal parasite were detected using direct microscopic examination, the formal ether concentration methods, and the Modified Ziehl–Neelsen technique, CD4 cell quantification was performed using the BD FACS Count System, while viral load measurement was conducted with the 2000rt Abbott machine. Multivariable logistic regression analysis determined the association between predictors and outcomes. P-value ≤ 0.05 was considered statistically significant. Results: The prevalence of intestinal parasites among HIV/AIDS patients was found to be 31.5% (100/318), of these 92.0 % (92/100) protozoans and 8.0% (8/100) helminthes. Among the identified parasites, Entamoeba histolytica/dispar had the highest prevalence 13.8% (44/318), followed by Giardia lamblia 10.4% (33/318) and Isospora belli was detected in 3.5% (11/318). The overall magnitude of clinical severity and immunological failure were 33.3% (106/318) among on ART patients, of these 26.7% (85/318) clinical severity and 29.3% (93/318) immunological failure. Among these, 72.3% (64 /85) had disclosed their HIV status, while 69.4% (59/85) demonstrated fair or poor adherence to antiretroviral therapy (ART). The prevalence of clinical and immunological failure among patients with parasitic infections was 53% (53/100). Significant association was observed between parasite infection and CD4+ T cell counts below 200/µl (AOR: 3.4, 95% CI: 1.5-8.5, p=0.005) as well as viral load levels equal to or greater than 1000 copies/ml (AOR: 3.2, 95% CI: 1.7-5.9, p=0.000). Several factors were associated with an increased likelihood of clinical severity and immunological failure, including smoking habits, occupational status, low BMI and an ambulatory or bedridden functional status at the last ART visit. Conclusions: The prevalence of intestinal parasites was higher among HIV patients on ART of these, E. histolytica, G.lambelia and Isospora belli were the leading causes of clinical severity and immunological failure on those individuals who were their CD4 count less than 200 cells/mm3, viral load greater than 1000 copies/µl. The overall severity of clinical conditions and immunological failure was significantly high among patients on ART who had smoking habits, occupational status, low body mass index, and an ambulatory or bedridden functional status.
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    Prevalence and Antimicrobial Susceptibility Pattern of Extended Spectrum Betalactamase Producing Bacterial Species From Catheterized Pat Ayder Comprehensive Specialized Hospital and Mekelle General Hospitals,Northen Ethiopia
    (Mekelle University, 2025-06-28) GEBREGIORGIS ASSEFA
    Background: Extended spectrum beta –lactamase (ESBL) producing bacteria are a public health problem globally, more than700000 deaths occur every year by multi-drug resistance. Patients catheter associated urinary tract infection and among the most affected by ESBL producing bacteria which results in increases the cost of medical care, extend hospital stay and mortality which needs to undergo regular surveillance and intervention. Objectives: To determine the prevalence of extended spectrum beta –lactamase producing bacteria and their antimicrobial susceptibility pattern among catheterized patients at Ayder compressive specialist Hospital and Mekelle General Hospital. Methods:A hospital based cross-sectional study was conducted on 310catheterized patients from October1/2023 to February30, 2024.Urine specimen (5-10mL) from patients catheterized with indwelling urinary catheters were collected in to a sterile labeled container. Urine specimens were delivered to the laboratory immediately and processed within 2hours.Each urine sample was inoculated onto MacConnkey agar and incubated at 37°C for 24 hours. Extend spectrum beta lactamace producing bacteria detection were done using biochemical and culture characteristics method and antimicrobial susceptibility tests to isolated bacterial pathogens was done using the disc diffusion technique. The data was entered and analyzed using Epidata version 3 and SPSS version 20, Chi-square was used to assess association between variables and then logistic regression was used to measure strengths of association, p-values less than 0.05 was considered statistically significant. RESULT: The results show that 37/310(11.9%) of the participants had bacteria. Of these,Escherichia Coli 32/37 (86.5%), K.pnuemoniae 3/37(8.1%) and mixed (E.coli and K.pnuemoniae) 2/37(5.4%). ESBL was seen in 13/37(35.1%) of the bacterial isolated and was all seen on Escherichia coli, 13/13 (100%) isolates. Altogether 100% (n=37) isolates were sensitive to meropnem, 83.8% (n=31) to nitrofurantoin, and 59.5% (n=22) to gentamicin. 64.8% (n=24) isolates were resistant to antibiotic ampicillin while 29.7% (n=11) were found as multidrug resistant (MDR). Conclusion:Most ESBL-producing bacteria were E.coli, The prevalence of ESBL producing bacteria were on patients who admitted at medical ward. Microbiological-based therapy for patients with UTIs is essential at my study site due to high rates of ESBL production with concomitant high rates of drug resistance to several antibiotics.
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    PREVALENCE AND ASSOCIATED RISK FACTORS OF PLUMONARY TUBERCULOSIS AMONG PRISONERS IN SHIRE, AXUM AND ADWA PRISON CENTRS
    (Mekelle University, 2025-06-28) GIRMASLASIE FISEHA
    Background: Pulmonary Tuberculosis is a contagious airborne disease caused by Mycobacterium tuberculosis and remains a significant global public health problem. Prisons, due to overcrowding, poor ventilation, and limited healthcare services, present a high-risk environment for TB transmission and progression. In the Tigray region of Ethiopia, challenges such as inadequate diagnostic capacity and insufficient data hinder effective TB control among incarcerated populations. Objective: This study was aimed to determine the prevalence of pulmonary tuberculosis and identify its associated risk factors among prisoners in Shire, Axum, and Adwa correctional facilities in Tigray, Ethiopia, over the period from December, 2024 to May, 2025. Methodology: An institutional-based cross-sectional design was employed to enroll 265 prisoners presenting with TB symptoms. Structured questionnaires were collected socio-demographic and clinical information, including HIV status, history of smoking, and incarceration-related exposures. Sputum samples were collected and analyzed using Ziehl-Neelsen staining and the Gen-expert MTB/RIF assay. Results: A total of 265 prisoners were enrolled in this study, drawn from a total incarcerated population of 3,180 inmates across the three prison centers in Shire, Axum, and Adwa, located in northern Ethiopia. The study identified 5 bacteriologically confirmed TB cases, yielding a point prevalence of 1.9% (95% CI: 0.6%–4.3%) among the study participants. Occupation prior to imprisonment was significantly related to TB status: prisoners who had been governmentemployed or self-employed had significantly lower odds of TB infection compared to those who had been daily laborers or unemployed (exact AOR = 0.119, 95% CI: 0.000–0.946, p = 0.0432). Prisoners who were HIV-negative or whose HIV status was unknown had significantly lower odds of TB compared to HIV-positive individuals (exact AOR = 0.033, 95% CI: 0.001–0.722, p = 0.0281). Conclusions and Recommendations: The prevalence of PTB was high in these prison centers. There should be an intensified implementation of TB screening among high-risk inmates, particularly those with a history of unemployment, HIV infection, smoking, or TB symptoms.
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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.