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Pattern and Clinical Presentation of Endometriosis Among the Indigenous Africans

Received: 31 May 2021    Accepted: 15 June 2021    Published: 28 June 2021
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Abstract

Background: Endometriosis is enigmatic clinical entity which is described as the existence of the endometrial tissue external of the uterine cavity. Endometriosis constitutes a serious health issue due to its high affliction of 10% in reproductive age women and its clinical manifestation of infertility and chronic pelvic pain. Despite of years of research, the causative factor and understanding of ambidextrous endometriosis pathology remains elusive, perplex and disconnected. Worldwide, there is clear documentation of prevalence of endometriosis in the development countries, however, the prevalence of endometriosis in most of black Africa is unknown. The current perspective is that indigenous African are rarely affected by endometriosis. Objective: To determine the prevalence, pattern and clinical presentation of endometriosis in indigenous African women with the primary outcome measure being the prevalence of laparoscopic visually diagnosed, histologically confirmed endometriosis and clinical presentation. Methodology: This was a prospective analytical cross-selection study in 2 hospitals in Nairobi city, Kenya. The sample size was 443 women and the duration of the study was from March 2018 to March 2021. The inclusion criteria was women aged at least 18 years up to 49 years undergoing laparoscopic surgery and willing to take part in the study. The patient’s history, clinical and laparoscopic findings and histological diagnosis were recorded and analysed using Social SPSS version 22.0. Results: The mean age of the 443 patients recruited was 33 years. The prevalence of histological confirmed endometriosis in indigenous Africans was 6.8%. Laparoscopic visualization diagnosis had a positive predictive value of 39%. Dysmenorrhoea, chronic pelvic pain scale 8-10 and dyspareunia were significant symptoms of endometriosis P<0.001. Nulliparous patients significantly had a risk of having endometriosis p<0.001. The patients with menarche at 13 years and below had a significant risk of having endometriosis p=0.001. Physical findings on clinical examination of adnexal tenderness and findings of nodules in the pouch of Douglas were significant in relation to endometriosis p<0.001. The most common site of the histological endometriosis implants were on the Pouch of Douglas (30%) and the most common form of endometriosis was superficial (43%). Conclusion: The prevalence of endometriosis in Indigenous Africa is 6.8%. Laparoscopic visualization diagnosis had low a positive predictive value of 39%. Nulliparity, menarche at the age of 13 and below, dysmenorrhoea, chronic pelvic pain scale 8-10 and dyspareunia were significantly associated with endometriosis. The most common site for endometriosis is the of Pouch of Douglas whilst the most common form of endometriosis was superficial.

Published in Journal of Gynecology and Obstetrics (Volume 9, Issue 3)
DOI 10.11648/j.jgo.20210903.17
Page(s) 92-99
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Endometriosis, Prevalence, Clinical Presentation, Laparoscopy, Indigenous Africa

References
[1] Burney R O, Giudice L C. Pathogenesis and pathophysiology of Endometriosis. Fert. Steril. 2012; 98: 511-519.
[2] C. Meuleman, B. Vandenabeele, S. Fieuwsc, C Spiessens, D Tiiermann, T D’Hooghe High prevalence of endometriosis in infertile women with normal ovulation and normaspermic partners. Fertil. Steril. 2009; 92: 68-74.
[3] Kyema CM, Mwenda JW, Machoki J. A Mihalyi, P Simsa, DC Chai, T M D’Hooghe Endometriosis in African women. Women’s Health. 2007; 3: 629-635.
[4] Ozkan S, Murk W, Arici A. Endometriosis and Infertility: Epidemiology and evidence based treatments. Ann. N. Y. Acad. Sci. 2008; 1127: 92-100.
[5] Sasson IE, Taylor HS. Stem cells and the pathogenesis of endometriosis. Ann. N. Y. acad. Sci. 2008; 1127: 106-115.
[6] Harkki P, Tiitnen A, Ylikorkala O. Endometriosis and assisted reproduction techniques. Ann. N. Y. Acad. Sci. 2010; 1205: 207-213.
[7] Osefo J., Okeke B. Endometriosis: Incidence among the Igbos of Nigeria. Int. J. Obstet. Gynaecol. 1989; 30: 349-53.
[8] Ekwempu CC, Harrison KK. Endometriosis among the Hausa/Fulani population of Nigeria. Trop. Geogr. Med. 1979; 31: 201-205.
[9] Fawole AO, Bello FA, Ogubonde O, OduKogbe AO, Nkwocha GC, Nnoham, KE, Zondervan KT, Akintan A, Abdus-Salam RA, Okunlola MA. Endometriosis and associated symptoms among Nigerian women. Int. J. Gynecol Obstet. 2015; 130: 190-194.
[10] Thacher TD, Nwana EJC, Karshima JA. Extrapelvic Endometriosis in Nigeria. Int. J. Gynaecol. Obstet. 1 997; 57: 57-58.
[11] American Society for Reproductive Medicine (ASRM). Revised American Society for reproductive medicine classification of endometriosis. Fertil. Steril. 2006; 67: 817-821.
[12] Eskenazi B, M L Warner. Epidemiology of endometriosis. Obstet. Gynecol. Clin. N. Amer. 1997; 24: 2.
[13] Chatman D. Endometriosis in the Black Woman. Am. J. Obstet. Gynecol. 1976; 125: 987 -989.
[14] Cramer DW, Wilson E, Stillman RJ, Berger MJ, Beslisle S, Sciff I, Albrecht A, Gibson M, Stadel BV, Schoenbaum SC The relation of endometriosis to menstrual characteristics, smoking and exercise. JAMA 986; 355: 1904-1908.
[15] Ajosa S. The Prevalence of Endometriosis in Premenstrual Women Undergoing Gynaecological Surgery. Clin. Exp. Obstet. Gynaecol. 1994; 21: 195-197.
[16] Naegle CM, Bell TA, Purdie DM et al. Relative weight at ages 10 and 16 and risk of endometriosis: a case-controlled analysis. Hum. Reprod. 2009; 24: 1501-1506.
[17] Sourial S, Tempest N, Hapangamana DK. Theories on the pathogenesis of Endometriosis. Int. J. Reprod. Med. 2014; 179515.
[18] Houston DE Incidence of pelvic endometriosis in Rochester, Minonnesota. J. Epidemiol. 1987; 125: 959-969.
[19] Shade GH, Lane M, Diamond MP. Endometriosis in the African –American woman – racially, a different entity? Gyecol. Surg. 2012; 9: 59-62.
[20] Regina F, Pain assessment: the cornerstone to optimal pain management. Proc (Bayl Univ Med) 2000: 13: 236-239.
[21] Brosens I, Donnez J, Benagiodo G. Improving the Classification of Endometriosis. Hum. Reprod. 1993; 8: 1792-1795.
[22] Koninckx PR, Ooster LD, D’Hooghe T, Meulman C. Deeply Infiltrating Endometriosis Is a Disease Whereas Mild Endometriosis Could Be Considered a Non-Disease. Ann. N. Y. Acad. Sci. 1994; 734: 333-341.
[23] Nisolle M, donnez J. Peritoneal Endometriosis, Ovarian Endometriosis and Adenomyotic Nodules of the Rectovaginal Septum and Three Different Entities. Fert Steril 1997; 68: 585-596.
[24] Albea RB, Sinervo K, Fisher DT. Laparoscopic excision of lesion suggestive of endometriosis or otherwise a typical in appearance: relationship between visual findings and final histological diagnosis. J. Minim. Invasive. gynecol 2008; 15: 32-37.
[25] Martin DC, Hubert GD, Vander Z et al. Laparoscopic Appearances of Peritoneal Endometriosis. Fertil. Steril. 1989; 51: 63-67.
[26] Cramer DW, Mismer SA. The epidemiology of endometriosis. Ann. N. Y. Acad. Sci. 2002: 955: 396-406.
[27] Verkauf BS, Incidence, symptoms, and signs of endometriosis in fertile and infertile women. J. Fla. Med. Assoc. 1987; 74: 671-675.
[28] Arumugam K, Lim JM. Menstrual characteristics associated with endometriosis. Br. J. Obstet. Gynecol. 1997; 104: 948-950.
[29] Vercelli P, De Giorgi O, Aime G et al. Menstrual characteristic in women with and without endometriosis. Obstet. Gynecol. 1997; 90: 264-268.
[30] Olive DL. Henderson DY. Endometriosis and Mullerian Anomalies. Obstet Gynaecol 1987; 69, 412.
[31] Motarrass R, Rodiquez F, Pijoun JI. Epidemiology of Endometriosis in Infertile Women. Fertil. Steril. 1995; 63: 34-38.
Cite This Article
  • APA Style

    Joseph Wanyoike Gichuhi, Julius Ogengo, Peter Gichangi. (2021). Pattern and Clinical Presentation of Endometriosis Among the Indigenous Africans. Journal of Gynecology and Obstetrics, 9(3), 92-99. https://doi.org/10.11648/j.jgo.20210903.17

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    ACS Style

    Joseph Wanyoike Gichuhi; Julius Ogengo; Peter Gichangi. Pattern and Clinical Presentation of Endometriosis Among the Indigenous Africans. J. Gynecol. Obstet. 2021, 9(3), 92-99. doi: 10.11648/j.jgo.20210903.17

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    AMA Style

    Joseph Wanyoike Gichuhi, Julius Ogengo, Peter Gichangi. Pattern and Clinical Presentation of Endometriosis Among the Indigenous Africans. J Gynecol Obstet. 2021;9(3):92-99. doi: 10.11648/j.jgo.20210903.17

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  • @article{10.11648/j.jgo.20210903.17,
      author = {Joseph Wanyoike Gichuhi and Julius Ogengo and Peter Gichangi},
      title = {Pattern and Clinical Presentation of Endometriosis Among the Indigenous Africans},
      journal = {Journal of Gynecology and Obstetrics},
      volume = {9},
      number = {3},
      pages = {92-99},
      doi = {10.11648/j.jgo.20210903.17},
      url = {https://doi.org/10.11648/j.jgo.20210903.17},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.jgo.20210903.17},
      abstract = {Background: Endometriosis is enigmatic clinical entity which is described as the existence of the endometrial tissue external of the uterine cavity. Endometriosis constitutes a serious health issue due to its high affliction of 10% in reproductive age women and its clinical manifestation of infertility and chronic pelvic pain. Despite of years of research, the causative factor and understanding of ambidextrous endometriosis pathology remains elusive, perplex and disconnected. Worldwide, there is clear documentation of prevalence of endometriosis in the development countries, however, the prevalence of endometriosis in most of black Africa is unknown. The current perspective is that indigenous African are rarely affected by endometriosis. Objective: To determine the prevalence, pattern and clinical presentation of endometriosis in indigenous African women with the primary outcome measure being the prevalence of laparoscopic visually diagnosed, histologically confirmed endometriosis and clinical presentation. Methodology: This was a prospective analytical cross-selection study in 2 hospitals in Nairobi city, Kenya. The sample size was 443 women and the duration of the study was from March 2018 to March 2021. The inclusion criteria was women aged at least 18 years up to 49 years undergoing laparoscopic surgery and willing to take part in the study. The patient’s history, clinical and laparoscopic findings and histological diagnosis were recorded and analysed using Social SPSS version 22.0. Results: The mean age of the 443 patients recruited was 33 years. The prevalence of histological confirmed endometriosis in indigenous Africans was 6.8%. Laparoscopic visualization diagnosis had a positive predictive value of 39%. Dysmenorrhoea, chronic pelvic pain scale 8-10 and dyspareunia were significant symptoms of endometriosis PConclusion: The prevalence of endometriosis in Indigenous Africa is 6.8%. Laparoscopic visualization diagnosis had low a positive predictive value of 39%. Nulliparity, menarche at the age of 13 and below, dysmenorrhoea, chronic pelvic pain scale 8-10 and dyspareunia were significantly associated with endometriosis. The most common site for endometriosis is the of Pouch of Douglas whilst the most common form of endometriosis was superficial.},
     year = {2021}
    }
    

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  • TY  - JOUR
    T1  - Pattern and Clinical Presentation of Endometriosis Among the Indigenous Africans
    AU  - Joseph Wanyoike Gichuhi
    AU  - Julius Ogengo
    AU  - Peter Gichangi
    Y1  - 2021/06/28
    PY  - 2021
    N1  - https://doi.org/10.11648/j.jgo.20210903.17
    DO  - 10.11648/j.jgo.20210903.17
    T2  - Journal of Gynecology and Obstetrics
    JF  - Journal of Gynecology and Obstetrics
    JO  - Journal of Gynecology and Obstetrics
    SP  - 92
    EP  - 99
    PB  - Science Publishing Group
    SN  - 2376-7820
    UR  - https://doi.org/10.11648/j.jgo.20210903.17
    AB  - Background: Endometriosis is enigmatic clinical entity which is described as the existence of the endometrial tissue external of the uterine cavity. Endometriosis constitutes a serious health issue due to its high affliction of 10% in reproductive age women and its clinical manifestation of infertility and chronic pelvic pain. Despite of years of research, the causative factor and understanding of ambidextrous endometriosis pathology remains elusive, perplex and disconnected. Worldwide, there is clear documentation of prevalence of endometriosis in the development countries, however, the prevalence of endometriosis in most of black Africa is unknown. The current perspective is that indigenous African are rarely affected by endometriosis. Objective: To determine the prevalence, pattern and clinical presentation of endometriosis in indigenous African women with the primary outcome measure being the prevalence of laparoscopic visually diagnosed, histologically confirmed endometriosis and clinical presentation. Methodology: This was a prospective analytical cross-selection study in 2 hospitals in Nairobi city, Kenya. The sample size was 443 women and the duration of the study was from March 2018 to March 2021. The inclusion criteria was women aged at least 18 years up to 49 years undergoing laparoscopic surgery and willing to take part in the study. The patient’s history, clinical and laparoscopic findings and histological diagnosis were recorded and analysed using Social SPSS version 22.0. Results: The mean age of the 443 patients recruited was 33 years. The prevalence of histological confirmed endometriosis in indigenous Africans was 6.8%. Laparoscopic visualization diagnosis had a positive predictive value of 39%. Dysmenorrhoea, chronic pelvic pain scale 8-10 and dyspareunia were significant symptoms of endometriosis PConclusion: The prevalence of endometriosis in Indigenous Africa is 6.8%. Laparoscopic visualization diagnosis had low a positive predictive value of 39%. Nulliparity, menarche at the age of 13 and below, dysmenorrhoea, chronic pelvic pain scale 8-10 and dyspareunia were significantly associated with endometriosis. The most common site for endometriosis is the of Pouch of Douglas whilst the most common form of endometriosis was superficial.
    VL  - 9
    IS  - 3
    ER  - 

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Author Information
  • Department of Obstetrics & Gynaecology, University of Nairobi, Nairobi, Kenya

  • Department of Anatomy, University of Nairobi, Nairobi, Kenya

  • Department of Anatomy, University of Nairobi, Nairobi, Kenya

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