The Traditionally Amputated Uvula amongst Nigerians: Still an Ongoing Practice

Traditional uvulectomy; practice and belief among Sudanese children in Khartoum hospitals: A multi-center cross-sectional study

BACKGROUND

Traditional healing practices are common in Sub-Saharan Africa. Traditional uvulectomy (TU) is the removal of the uvula with a sharp curved knife and is often practised in children under five years old. This practice is believed to have a therapeutic effect on children suffering from sore throat, vomiting or difficulty breastfeeding.

OBJECTIVES

This study aimed to describe the practice of traditional uvulectomy and Sudanese mothers' perception of it.

METHODS

A cross-sectional study was conducted in seven teaching hospitals across Khartoum State. We interviewed 385 mothers of children who presented to pediatric units using a semi-structured questionnaire. The study period spanned from July 2022-February 2023.

RESULTS

A total of 385 mothers of children under five participated in this study. 33 % of mothers believed in the practice of traditional uvulectomy, yet only 17.9 % of children under five years had undergone TU. Reasons for performing TU included persistent cough (36.9 %), vomiting (33 %), difficulty in breastfeeding (22.6 %) and TU being a family tradition (25.7 %). Factors significantly associated with these practices were the mother's age, her level of education and the family's regional origin. Mothers reported that no major complications to the children were perceived as a result of the TU procedure.

CONCLUSION

The practice of TU is prevalent among children who present to hospitals seeking medical advice. More than one-third of mothers had misconceptions regarding the uvula. Health education campaigns targeting females of childbearing age, and health practitioners at primary health centres and hospitals must raise awareness related to this practice.

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.

Uvula infections and traditional uvulectomy: Beliefs and practices in Luwero district, central Uganda

Uvulitis is the inflammation and swelling of the uvula, usually associated with infection of nearby structures. Uvulitis can be treated symptomatically, using medication or in some cases with uvulectomy, the uvula surgical removal or shortening. Traditional uvulectomy by traditional practitioners has been practiced in Africa for ages, associated with adverse outcomes. Although there is no empirical evidence for the association between adverse outcomes and traditional uvulectomy in Uganda, anecdotal findings showed incidents of uvula infections following uvulectomy in central Uganda. While these findings also indicate that traditional uvulectomy is common, the community understanding of uvulitis, the beliefs and practices are not well understood. This qualitative study sought to understand beliefs and practices using interviews with community health workers, traditional uvulectomy clients, and traditional surgeons, and focus group discussions with community members. Transcribed data were analysed in Atlas.ti 9 using thematic analysis steps. The findings show that uvula infection, locally known as "Akamiro" and the associated traditional uvulectomy are common in Luwero and beyond. "Akamiro" was described as larger than the normal, the size of a chicken heart or a big pimple, visible when a child cries, with unknown causes. Symptoms included persistent cough, diarrhoea, vomiting, loss of appetite, inability to swallow and ultimately weight loss, swollen stomach, saliva overflow, fever, breathing and speech difficulty. Diagnosis was confirmed after seeking care from health workers or in consultation with significant others and finally the traditional surgeon; in a hierarchical pattern. Uvulectomy was conducted by traditional surgeons, with surgery lasting a few minutes, in the morning or after sun-set. Tools used were razor blades, reeds, strings, wires, sickle knives and spoons. Payment was flexible; cash or in-kind. Surgeons had immense community trust, including community health workers. Interventions to support persons with uvula infections need to address the health system weaknesses, and health education.

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.

The burden of traditional neonatal uvulectomy among admissions to neonatal intensive care units, North Central Ethiopia, 2019: A triangulated crossectional study

Background

Traditional neonatal uvulectomy is unsupervised, unscientific and potentially dangerous cultural malpractice. It is often accompanied with life threatening neonatal morbidities such as infection, septicemia, anemia, aspiration and oropharyngeal injury. However, there is no current regional and even national data of its public health importance in the health care system. Therefore, this study was aimed at assessing the burden, associated factors and reasons of traditional uvulectomy among neonatal admissions at Debre Tabor General Hospital, North Central Ethiopia, from September 2018 to August 2019.

Methods

A quantitative cross sectional study supplemented with phenomenological study was employed on 422 mother-neonate pairs. Eight mothers who were not included in the quantitative part were involved as key informants of the qualitative study. Systematic and purposive sampling techniques were used to select study participants for the quantitative and qualitative parts of the study respectively. Multivariable logistic regressions were fitted to investigate significant predictors of traditional neonatal uvulectomy at p-value ≤ 0.05 and 95% CI. Moreover, the qualitative data were carefully transcribed, coded, screened, thematized, synthesized and then triangulated with the quantitative results.

Results

The burden of postuvulectomy admission was 67 (15.88%). Most of these admissions had post uvulectomy sepsis [59 (88.1%)] followed by anemia (55.23%). From multivariable analysis, factors that had significant odds of association with traditional neonatal uvulectomy include: having male neonate [AOR = 4.87; 95% CI: 1.10, 21.59], antenatal couple counseling about traditional neonatal uvulectomy [AOR = 0.053; 95% CI: 0.01, 0.35], home delivery [AOR = 6.02; 95% CI: 1.15, 31.61], postnatal couple counseling about traditional neonatal uvulectomy [AOR = 0.101; 95% CI: 0.02, 0.65], prior history of traditional neonatal uvulectomy [AOR = 7.15; 95% CI: 1.18, 43.21] and knowing at least one adverse effect of traditional neonatal uvulectomy [AOR = 0.068; 95% CI: 0.01, 0.44]. Furthermore, maternal perception of “there is no modern medicine to treat elongated and swollen neonatal uvula’ was the most explained reason to practice traditional neonatal uvulectomy.

Conclusion and recommendation

The burden of traditional neonatal uvulectomy was high. Fortunately, its predictors are modifiable. Therefore, several advocacy teams of neonatal health consisting of mainly women health development armies, elders, religious fathers, health professionals and criminal prosecutors should be actively mobilized against traditional neonatal uvulectomy. Besides, parental couple counseling about the adverse effects of traditional neonatal uvulectomy should be properly implemented in the routine antenatal and postnatal continuum of care in South Gondar Zone, North Central Ethiopia.

A cross-sectional study of traditional practices affecting maternal and newborn health in rural Nigeria

Introduction

Certain traditional practices which have negative effects on maternal and child health continue to be practiced in sub-Saharan African countries. A survey was carried out in a rural village in Nigeria to understand the scale and range of these practices.

Methods

This was a cross-sectional study in which trained interviewers administered pre-tested questionnaires on child-bearing women using questionnaires embedded on android devices.

Results

The median age of marriage and pregnancy were 15 and 16 years respectively. Home births were high (90.4%) while non-skilled birth attendant was 87.4%. The community had a son preference index ratio of 1:4.1. Up to 81.5% of mothers responded that one form of unhygienic traditional procedure or the other was performed on their children. Time to initiation of breast feeding was in hours in the majority (76.3%) of mothers, with a high rate of use of prelacteal feeds (85.2%). Being an adolescent mother (AOR 0.403, 95%CI 0.203, 0,797) and utilizing a skilled provider at birth (AOR 0.245, 95%CI 0.088, 0.683) were associated with less likelihood of having an unhygienic procedure performed on children.

Conclusion

The findings of our study suggest that traditional practices which could have negative effects on maternal and child health are still ongoing in the study community. Child protection laws and safeguarding principles could help to reduce these practices and would need to be developed and implemented in these settings where these practices are still prevalent.

A cluster of nosocomial Lassa fever cases in a tertiary health facility in Nigeria: Description and lessons learned, 2018

BACKGROUND

Lassa fever is an acute viral haemorrhagic disease endemic in Nigeria. The 2018 Lassa fever outbreak in Nigeria was unprecedented, with 8% of all cases occurring among healthcare workers (HCWs). A disproportionately high number of these infections occurred in HCWs working in a tertiary health facility in Nigeria. This paper describes the cluster of Lassa fever infections among HCWs in a treatment centre and the lessons learnt.

METHODS

We analysed clinical, epidemiological and laboratory data from surveillance and laboratory records kept during the 2018 outbreak. Interviews were conducted with surviving HCWs using a questionnaire developed specifically for the investigation of Lassa fever infections in HCWs. Descriptive analysis of the data was performed in Microsoft excel.

RESULTS

The index case was a 15-year-old male who presented at the health facility with fever and uncontrolled nasopharyngeal bleeding, following a recent uvulectomy by a traditional healer. Overall, 16 HCWs were affected (15 confirmed and 1 probable) with five deaths (CFR-31.6%). Of the 15 confirmed cases, five (33.3%) were asymptomatic. Nine HCWs were direct contacts of the index case; the remaining six HCWs had no direct contact with the index case. HCW interviews identified a low index of suspicion for Lassa fever leading to inadequate infection prevention and control (IPC) practices as possible contributing factors to nosocomial transmission.

CONCLUSION

Maintaining a high index of suspicion for Lassa fever in all patients, especially in endemic areas, is essential in adhering to adequate IPC practices in health facilities in order to prevent nosocomial transmission of Lassa fever among HCWs. There is a need to continually train and sensitise HCWs on strict adherence to IPC measures while providing care, irrespective of a patient's provisional diagnosis.

Profile of pediatric traditional uvulectomy in North-West Nigeria: The need for caution and education

OBJECTIVES

The study assessed the prevalence of complications associated with traditional uvulectomy and identified factors associated with favorable outcome after management in a pediatric population in North-Western Nigeria.

STUDY DESIGN AND SETTING

This cross-sectional descriptive study was carried out at the accident and emergency section as well as at the otolaryngology out-patient clinic of the Federal Medical Centre, Birnin-Kebbi, Nigeria.

METHODS

Patients with traditional uvulectomy complications were recruited on consecutive basis and sample size was dependent on the patients seen over the study period. This was done over a 6 month study period (January 2014-June 2014).

RESULTS

A total of forty one participants, all within the paediatric age group (<15 years) participated in this study. The age of the participants ranged from 2 to 13 years while the mean age was 6.17 years ± 2.47. The ≤5 year age group constituted about 44% of the children studied. Gender distribution noted a slight male preponderance (Male: Female ratio = 1.05: 1). A total of 58.8% of the participants were fully immunized, while the Haemoglobin concentration status (packed cell volume) at hospital presentation of <10 g/dl (<30%) occurred in 34.1% of the participants of the study. The duration of hospital stay in pediatric patients with post-traditional uvulectomy complications was significantly associated with the maternal immunization status (p = 0.007). Also, subjects with completed maternal immunization status had about 0.1 times odds (CI = 0.19-0.64) likelihood to have a prolonged hospital stay when compared with subjects whose mothers were partially immunized or not immunized at all.

CONCLUSION/SIGNIFICANCE

In conclusion, this study found that favorable outcome post-traditional uvulectomy is related to early presentation and maternal immunization status, but adversely affected by anemia. Traditional uvulectomy remains a cultural practice that should be discouraged using both advocacy and legislative measures.

Morbidity and Mortality following Traditional Uvulectomy among Children Presenting to the Muhimbili National Hospital Emergency Department in Dar es Salaam, Tanzania

Background. Traditional uvulectomy is performed as a cultural ritual or purported medical remedy. We describe the associated emergency department (ED) presentations and outcomes. Methods. This was a subgroup analysis of a retrospective review of all pediatric visits to our ED in 2012. Trained abstracters recorded demographics, clinical presentations, and outcomes. Results. Complete data were available for 5540/5774 (96%) visits and 56 (1.0%, 95% CI: 0.7–1.3%) were related to recent uvulectomy, median age 1.3 years (interquartile range: 7 months–2 years) and 30 (54%) were male. Presenting complaints included cough (82%), fever (46%), and hematemesis (38%). Clinical findings included fever (54%), tachypnea (30%), and tachycardia (25%). 35 patients (63%, 95% CI: 49–75%) received intravenous antibiotics, 11 (20%, 95% CI: 10–32%) required blood transfusion, and 3 (5%, 95% CI: 1–15%) had surgical intervention. All were admitted to the hospital and 12 (21%, 95% CI: 12–34%) died. By comparison, 498 (9.1%, 95% CI: 8–10%) of the 5484 children presenting for reasons unrelated to uvulectomy died (p = 0.003). Conclusion. In our cohort, traditional uvulectomy was associated with significant morbidity and mortality. Emergency care providers should advocate for legal and public health interventions to eliminate this dangerous practice.

Magnitude and Reasons for Harmful Traditional Practices among Children Less Than 5 Years of Age in Axum Town, North Ethiopia, 2013

Background. In addition to beneficial traditional practices, there are around 140 harmful traditional practices affecting mothers and children in almost all ethnic groups of Ethiopia. Therefore this study might give a clue about their practice and associated factors. The objective of this study was to assess magnitude of harmful traditional practices among children less than 5 years of age in Axum Town, North Ethiopia. Methods. Community based cross-sectional study was conducted on 752 participants who were selected using multistage sampling. Simple random sampling method was used to select ketenas from all kebelles of Axum Town. After proportional allocation of sample size to eachketena, systematic random sampling method was used to get the study participants. Data was collected using interviewer administered questionnaire; it was entered and analyzed using SPSS version 16 and descriptive statistics was calculated. Results. Majority of the respondents (81.2%) were Orthodox, 78.2% of the mothers had no work, and majority of mothers had no formal education. Among the harmful traditional practices performed on children, uvula cutting alone was performed on 72.8% of children followed by milk teeth extraction and uvula cutting with eyebrow incision. Conclusion. The leading harmful traditional practice performed on children in this study was uvula cutting.