Assessing The Burden, Risk Factors And Perceived Impact Of Uterine Fibroid Among Pregnant

Women attending ANC At The Laquintinie Hospital Douala

CHAPTER ONE

INTRODUCTION

1.1 BACKGROUND

Uterine fibroids are benign tumors of the smooth muscle of the uterus and their burden across

populations varies widely – with rates ranging from 4.5 to 68.6%.(1). Uterine fibroids are the

most common pelvic tumor in women. Despite the high prevalence, the pathogenesis,

incidence, natural history, and risk factors are far from being completely understood.

Nevertheless, fibroids are a significant health care burden on women's health: among

15–54 year-old-women, fibroids accounts for 29% of gynecologic hospitalizations(2).

Globally, the age-standardized incidence of uterine fibroids has been increasing in recent years.

In contrast, age-standardized DALY rates have exhibited a decreasing trend. Eastern Europe,

Tropical Latin America, Brazil and India experience the greatest uterine fibroid burden.

Globally, women aged 35–39 years and older have an increased risk of uterine fibroids, as

reflected in the higher incidence rates among these age groups(3). These tumors, commonly

known as fibroid, affect women mainly during their reproductive years and are diagnosed in up

to 70% of white women and more than 80% of women of African ancestry during their lifetime.

This disease has a profound impact on health care delivery and costs worldwide(4).

This study is out to study the burden, risk factors and perceived impact of uterine fibroid among

pregnant women attending ANC at the Laquintinie Hospital Douala.

Presented by Nsaikila Raisa Kinyuy 1

Assessing The Burden, Risk Factors And Perceived Impact Of Uterine Fibroid Among Pregnant
Women attending ANC At The Laquintinie Hospital Douala

1.2 STATEMENT OF PROBLEM

Fibroids are the most common gynaecological tumors and are present in 30% of women of

reproductive age(5), most often in women aged 30–50. The main symptoms are a heavy

menstrual flow, abnormal uterine bleeding, pelvic pain, frequent urination and constipation.

Several studies have shown that uterine fibroids can lead to infertility and are an independent

risk factor for adverse perinatal outcomes, including preterm birth, obstructed labor,

intrauterine growth restriction, low birth weight (< 2500 g), placenta previa, placental

abruption, cesarean section, postpartum hemorrhage and postpartum maternal anemia.

Uterine fibroids are the most common benign female gynecologic tumors. There are multiple

risk factors, including age and reduced fertility. There is however a paucity of data on disease

burden and risk factors among African populations(4)

Even though, uterine fibroid is crucial in reducing maternal and infant mortality which are

the target area in achieving millennium development goal, no study has been conducted on

the burden, risk factors and perceived impact of uterine fibroid within the study area, there is

lack of comprehensive information regarding the burden, risk factors and perceived impact of

uterine fibroid within the study area. This research will help to create awareness and increase

the burden, risk factors and perceived impact of uterine fibroid in the study area.

1.3 RESEARCH QUESTION

1.3.1 GENERAL RESEARCH QUESTION

What is the burden, risk factor and perceived impact of uterine fibroid among pregnant women at

the laquintini hospital?

1.3.2 SPECIFIC RESEARCH QUESTION

Presented by Nsaikila Raisa Kinyuy 2

Assessing The Burden, Risk Factors And Perceived Impact Of Uterine Fibroid Among Pregnant
Women attending ANC At The Laquintinie Hospital Douala

 What is the prevalence of uterine fibroid among women at the Laquintini Hospital

Douala?

What are the risk factors associated to uterine fibroid among women at the Laquintini Hospital

Douala?

1.4 RESEARCH HYPOTHESIS

1.4.1 NULL HYPOTHESIS

There is an increased burden, risk factor and perceived impact among pregnant women attending

ANC at the Laquintini Hospital Douala

1.4.2 ALTERNATIVE HYPOTHESIS

There is a decreased burden, risk factor and perceived impact among pregnant women attending

ANC at the Laquintini Hospital Douala

1.5 RESEARCH OBJECTIVES

1.5.1 GENERAL OBJECTIVES

To determine the burden, risk factor and perceived impact among pregnant women attending

ANC at the Laquintini Hospital Douala

1.5.2 SPECIFIC OBJECTIVES

 To determine the burden of uterine fibroid among women at the Laquintini Hospital

Douala

 To determine the associating factors of uterine fibroid among women at the Laquintini

Hospital Douala

1.6 SCOPE OF STUDY

It will last for two months the from the 1st of April to the 31st of May 2024

1.7 SIGNIFICANCE OF THE STUDY

Presented by Nsaikila Raisa Kinyuy 3

Assessing The Burden, Risk Factors And Perceived Impact Of Uterine Fibroid Among Pregnant
Women attending ANC At The Laquintinie Hospital Douala

This study will take approximately 2months with the identification of research place

interest and submission of research form provided by the institution. It will end by data

collection, write up and presentation of result. This work will involve all the women at

Laquintini Hospital during the study period based on the prevalence and associating factors

uterine fibroid

1.8 CONTEXTUAL DEFINITION OF TERM

Uterine fibroid

Uterine myoma is a benign neoplasm composed of uterine smooth muscle and connective tissue

that supports it and is often referred to as fibromyoma, leiomyoma, fibroids. Can be single or

multiple and reach large sizes (100 pounds). It has a tough consistency, with a clear cap

boundary so that it can be removed from the surroundings. Uterine myoma, also known as

leiomyoma or fibroid is a benign tumor that is often found in women of reproductive age(6).

Presented by Nsaikila Raisa Kinyuy 4

Assessing The Burden, Risk Factors And Perceived Impact Of Uterine Fibroid Among Pregnant
Women attending ANC At The Laquintinie Hospital Douala

CHAPTER TWO

LITERATURE

1.1 historical background review

Fibroids can develop within 3 anatomical parts of the uterus and are classified as

subserosal, intramural, and submucosal fibroids. Myomas have been found to

originate from the plasticity of myometrial cells during tissue development and

maintenance; the cells undergo cellular reprogramming and mutations

2.2 conceptual background review and frame work

2.3 contextual background review

Definition

The main symptoms are a heavy menstrual flow, abnormal uterine bleeding, pelvic pain, frequent

urination and constipation

Causes

The cause of leiomyomas is not clearly known, but studies have shown evidence of

factors that drive the development or exacerbation of the disease. Evidence has

linked risk factors such as lifestyle, age, environment, family history of uterine

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Assessing The Burden, Risk Factors And Perceived Impact Of Uterine Fibroid Among Pregnant
Women attending ANC At The Laquintinie Hospital Douala

fibroids, and vitamin D deficiencies to an increased risk of uterine fibroids, which

impact women of African descent at higher rates. Treatments may be invasive,

such as hysterectomy and myomectomy, or noninvasive, such as hormonal or non-

hormonal therapies. These treatments are costly and tend to burden women who

have the disease.(7)

Diagnosis

Typically, to diagnose a fibroid, a woman must come to a hospital or health facility equipped

with an ultrasound system (Sarkodie et al., 2016). The combined use of a physical examination

and ultrasound helps physicians identify the presence of fibroids (Sarkodie et al., 2016; Igboeli et

al., 2019). The determination can also be made using patient history and laboratory investigation.

Further testing to detect specific fibroids, such as hysterosalpingography and hysterosonography,

can be performed.(7)

Management

Current treatments for fibroids are mainly surgical and expensive, so alternatives need to be

found. It is, therefore, vital to develop and evaluate alternatives to surgical procedures, especially

when fertility preservation is the goal. Selective progesterone receptor modulators (SPRMs) are

synthetic compounds that have either an agonistic or antagonistic impact on target tissues

determined by their binding to progesterone receptors. Their mixed activity depends on

recruitment of cofactors that regulate transcription along so-called genomic pathways, as well as

nongenomic interactions with other signaling pathways. There is no doubt that surgery remains

indicated in some instances, but we must now establish whether use of SPRMs (notably ulipristal

acetate) allows less invasive surgery or even complete avoidance of surgery(8).

Presented by Nsaikila Raisa Kinyuy 6

Assessing The Burden, Risk Factors And Perceived Impact Of Uterine Fibroid Among Pregnant
Women attending ANC At The Laquintinie Hospital Douala

1.4 the burden of uterine fibroid Globally, the incident cases of URs had an obvious increase

from 5,769,658 (95%UI, 7,634,3995–4,274,824) incidences in 1990 to 9,643,336 (95%UI,

7,178,053–12,714,741) incidences in 2019 (Table 1). Contrary to the 67.14% increase in the

incidence rate over the past 30 years, the ASIR was steady with 225.67/100,000 persons (95%UI,

167.33–298.87) in 1990 and 241.18/100,000 persons (95%UI, 179,45–318.02) in 2019(9)

1.5 the risks factors of uterine fibroid

Studies has revealed that the 49 – 60 years old age group had the highest fibroid prevalence,

whereas the 13 – 24 years old age group had the lowest prevalence. Age was significantly

associated with the uterine fibroid (X2 = 35.3, P ˂ 0.001). Similarly, the women who were

overweight and obese had more frequent uterine fibroid than those with normal BMI. This

indicated a significant association between BMI and uterine fibroid (X2 = 11.2, P = 0.011)(10).

study found out that being overweight and obese were highly associated with having uterine

fibroid which is similar to the other studies which showed high body mass index to be associated

with fibroids.3,28,29. This is because fat tissue converts testosterone into estrogen, and obesity

can lead to decreased levels of a protein called sex hormone binding globulin that binds to

estrogen and progesterone, resulting in more unbound hormones. These combined effects result

in more estrogen and progesterone within the uterus, which may lead to fibroid development(11).

1.6 the perceived impact of uterine fibroid

Presented by Nsaikila Raisa Kinyuy 7

Assessing The Burden, Risk Factors And Perceived Impact Of Uterine Fibroid Among Pregnant
Women attending ANC At The Laquintinie Hospital Douala

CHAPTER THREE

MATERIALS AND METHODS

3.1 STUDY SETTING

This study will be carry out at Laquintini hospital within the period of two months. The

hospital was created in 1931. Laquintinie is a referral Hospital situated at the center of

Akwa (Bonako quarter). It is bounded at the Nord by “La Palais Dika Akwa”, at the South

by the Ngodi Cemetery, in the west by La Salle des Fetes d’Akwa and by east by Akwa

Polyclinic. The purpose of this study is to EVALUATE THE PREVALENCE AND THE

ASSOCIATING FACTORS OF UTERINE FIBROID AMONG WOMEN at the study site.

This design will be used because it is cheap and fast to mananged.

3.2 STUDY AND STUDY DESIGN

A prospective study which will be conducted at the Laquintini Hospital Douala to assessing the

burden, risk factors and perceived impact of uterine fibroid among women. All pregnant women

attending ANC during the period.

3.3 TARGET POPULATION, SAMPLE AND SUBJECTS

All pregnant women attending ANC at the Laquintini hospital Douala during the period of study.

3.4 SAMPLE SIZE CALCULATION, POWER AND VARIABILITY

The following sample size determination formula for finite population (& Lemeshow 1991) will

be used to estimate the sample size.

n2 = NZ2P(1-P)

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Assessing The Burden, Risk Factors And Perceived Impact Of Uterine Fibroid Among Pregnant
Women attending ANC At The Laquintinie Hospital Douala

D2(N-1) + Z2P(1-P)

n2 = sample size with finite population correction

N = size of the target population (20 x 24) (estimated minimal number of uterine fibroid at the

laquintini)

Z = statistic for 95% level of confidence (z =1.96)

P = estimated prevalence of uterine fibroid ~ 24.3%

D = magine of error = 2.1%

n2 = 480 x1.962x 0.0406(1-0.0406)

0.0212(480-1) +1.9620.0406(1-0.0406)

n2 = 200

200 patients (minimal sample size)

3.5 SAMPLING METHOD AND RECRITMENT OF PARTICIPANTS

It will be the random selection of participants and use of questionnaires

3.6 DATA COLLECTION

The date of attendance or hospitalization, age and the patient number will be obtained from the

outpatient attendance and in-patient record book in the gynergoloical unit for all patient with

uterine fibroid. The information will then be used to retrieve files and data will be collected and

entered into the structured questionnaire.

3.8 DATA MANAGEMENT

• The data collected will be entered into Microsoft excel 2010

• Data gathered from the field will be impacted in SPPS (statistics product and service

solution) version 20 and will be analyzed at a confident level of 95% error free.

Presented by Nsaikila Raisa Kinyuy 9

Assessing The Burden, Risk Factors And Perceived Impact Of Uterine Fibroid Among Pregnant
Women attending ANC At The Laquintinie Hospital Douala

Result obtained was presented on tables, bars chart, pie chart and histogram. 32 giga

bytes will be used to store the data and work plan.

• Data collected will be summarized in an abstract and power point

• The findings will be communicated

3.9 ETHICAL ISSUES

In order not to go against participant’s right and to maintain the confidentiality, the following

will be done before the research;

• A research proposal will be submitted to school and to the regional delegation for

authorization

• When Authorization from Regional delegation of public health is done it will now be

submitted to the hospital for authorization

• Permission will be gotten from the study site after submission

• Patients’ confidentiality was strictly observed by coding patiens’s names and

information into the questionnaire and these code will be subsepently used for

reference, analysis and presentation of the findings of the study. The data and

information will only be available to the investigator and the statistician. No patient

will still be on follow up during the study so there will be no contact with any of them.

Only the patient’s records will be used.

Presented by Nsaikila Raisa Kinyuy 10

Assessing The Burden, Risk Factors And Perceived Impact Of Uterine Fibroid Among Pregnant
Women attending ANC At The Laquintinie Hospital Douala

3.10 ACTIVITIES TIMELINE

Monday Tuesday Wednesday Thursday Friday

Week one Presentation Collection Same as Keying of Evaluation of
Of myself and analysis and Tuesday information the work and
obtained assisting in
the time filling of
vaccinations
table questionnaires

Week two Same as Same as Same as Same as Assisting in

Tuesday Tuesday Tuesday Tuesday other activities
in the hospital

Week Same as Same as Same as Evaluation Data

three Tuesday Tuesday Tuesday with staff compilation
and write up

Week Same as Same as Same as Evaluation Data

four Tuesday Tuesday Tuesday with staff compilation
and write up

Week Same as Same as Same as Evaluation Data

five Tuesday Tuesday Tuesday with staff compilation
and write up

Week six Same as Same as Same as Evaluation Data

Tuesday Tuesday Tuesday with staff compilation
and write up

Week Same as Same as Same as Evaluation Data

seven Tuesday Tuesday Tuesday with staff compilation
and write up

Presented by Nsaikila Raisa Kinyuy 11

Assessing The Burden, Risk Factors And Perceived Impact Of Uterine Fibroid Among Pregnant
Women attending ANC At The Laquintinie Hospital Douala

3.11 ITEMIZED BUDGET

Items Quantities Unit price Amount Justification

Pen 1packet 100frs 5000frs To disinfect

Face mask 20 100frs 2000frs protection

Disposable 1packets 5000frs 5000frs prevention

glove

Transportation 40days 500frs 20000frs

Printing of 10 6000frs 60000frs For

research authorization
proposal
Printing of 4copies 5000frs 20000frs For presentation
research project of result

Printing of 200 200 40000frs Collection of

questionnaire data

Total 147,500frs

Presented by Nsaikila Raisa Kinyuy 12

Assessing The Burden, Risk Factors And Perceived Impact Of Uterine Fibroid Among Pregnant
Women attending ANC At The Laquintinie Hospital Douala

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Nigeri. GSC Biological and Pharmaceutical Sciences. 2021;16(2):032–7.

2. Pavone D, Clemenza S, Sorbi F, Fambrini M, Petraglia F. Epidemiology and Risk Factors of

Uterine Fibroids. Best Practice & Research Clinical Obstetrics & Gynaecology. 2018 Jan
1;46:3–11.

3. Li B, Wang F, Chen L, Tong H. Global epidemiological characteristics of uterine fibroids.

Archives of Medical Science : AMS. 2023;19(6):1802.

4. Epidemiology and management of uterine fibroids - Giuliani - 2020 - International Journal of

Gynecology & Obstetrics - Wiley Online Library [Internet]. [cited 2024 Apr 9]. Available
from: https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1002/ijgo.13102

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Assessing The Burden, Risk Factors And Perceived Impact Of Uterine Fibroid Among Pregnant
Women attending ANC At The Laquintinie Hospital Douala

5. Ara I, Sultana F, Najnin R, Afreen S, Tuhin TB. Evaluating the Epidemiological Insights,
Etiology, and Clinical Manifestations, of Uterine Fibroids. Sch Int J Obstet Gynec.
2024;7(1):1–6.

6. Gofur NRP, Gofur AR, Soesilaningtyas GA, Kahdina M, Putri HM. Uterine myoma, risk
factor and pathophysiology: a review article. Clin Onco. 2021;4(3):1–4.

7. Sefah N, Ndebele S, Prince L, Korasare E, Agbleke M, Nkansah A, et al. Uterine fibroids —

Causes, impact, treatment, and lens to the African perspective. Frontiers in Pharmacology
[Internet]. 2023 [cited 2024 Apr 9];13. Available from:
https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2022.1045783

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Reproduction Update. 2016 Nov 20;22(6):665–86.

9. Cheng LC, Li HY, Gong QQ, Huang CY, Zhang C, Yan JZ. Global, regional, and national
burden of uterine fibroids in the last 30 years: Estimates from the 1990 to 2019 Global Burden
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https://www.frontiersin.org/articles/10.3389/fmed.2022.1003605

10. Bizjak T, Bečić A. Prevalence and Risk Factors of Uterine Fibroids in North-East
Slovenia. Gynecol Obstet [Internet]. 2016 [cited 2024 Mar 27];06(01). Available from:
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northeast-slovenia-2161-0932-1000350.php?aid=67241

11. Adawe M, Sezalio M, Kanyesigye H, Kajabwangu R, Okello S, Bajunirwe F, et al.

Prevalence, clinical presentation and factors associated with Uterine fibroids among women
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Uganda. East Africa Science. 2022;4(1):48–53.

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