Study Area Study design, Study area, and period
This study was conducted on three selected governmental hospitals of Hawassa Town, at HUCSH, AGH and yirgalem general hospital using hospital based cross-sectional study design. Both HUCSH and AGH located in Hawassa city which is 273 km south of Addis Ababa, the capital city of Ethiopia. Besides yergalem hospital is also found in sidama region which is 322.5km from Addis abeba and serving mainly the peoples living within a region Currently, both HUCSH and AGH provides health services for more than 25 million people in the Sidamma and Southern Nations, Nationalities and Peoples’ Region (SNNPR) and the neighboring Oromia region(11). The study was conducted at surgical ward of both hospitals from Oct 15 to Nov 15 /2021.
Source population
All male patients age of 30 years and more who were admitted to surgical wards of HUCSH Adare General Hospital and yirgalem general hospital during the data collection period
Study population
All sampled male patients age 30 years of age who were admitted to surgical ward of HUCSH Adare general hospital and yirgalem general hospital during the data collection period.
Study Unit
An individual sampled male patient whose age of 30 years and more and actually participate in the study.
Inclusion Criteria
Sampled male patients with age of 30 years and more who were willing to provide informed consent and admitted at surgical wards of hospitals during study period were included.
Exclusion Criteria
Patients those who were severely ill, unable to communicate throughout the study period, not willing to provide informed consent and patient with known mental illness were excluded from the study.
Sample Size and Sampling Procedure
Sample size
Sample size was determined using a single population proportion formula with a 95% confidence interval and 5% margin of error. we used the proportion of magnitude of BPH is 33.4%(12).
Finally, we will add 10% to compensate for the non-respondent of participants; the final sample size became 143
Where:
n = sample size
p = 33.4%, the maximum estimated proportion taken from previous study of benign prostatic hyperplasia
d = 5% (maximum margin of error the researcher is willing to allow)
Z = 1.96 (standard normal deviation value corresponding to 95% confidence level)
N = (Total surgical male patients admitted to surgical ward to 15 Oct. to 15 Nov.2021)
n = \(\frac{{z}^{2}p\left(1-p\right)}{{d}^{2}}=\frac{1.96\times 1.96\times 0.334(1-0.334)}{{0.05}^{2}}\) =342
But we use correction formula, because the past one months of data shows that an estimated number of patient admitted to surgical ward of three hospitals is 210 that is less than 10,000, therefore use of these correction formula since total study population of less than 10,000
Where: n = sample size = 130, N = Total population = 210
Correction formula = \(\frac{n}{1+n/N}\)=\(\frac{342}{1+\frac{342}{210}}=130\)
Therefore, by adding 10% for possible non-response rate, the final sample size was = 130 + 10% = 143
The final sample size is = 143
Sampling Technique
Purposive sampling technique was applied and three hospitals were selected as a primary sampling unit due to case flow and the surgery had been conducted mainly in these hospitals due to surgeons working there to conduct advanced procedures. Therefore proportionate allocations were done for 3 hospitals to draw the required sample size. Since the patients visiting health institutions were random in their nature, consecutive sampling technique was used to calculate the magnitude of BPH from the individual patients who had been undergone surgery.
Study Variables
Dependent Variable
Benign prostatic hyperplasia (BPH)
Independent Variables include:
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Socio-demographic characteristics: age, occupation, residence, religion, level of education, income and marital status)
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Behavioral and life style factors are as follows: cigarette smoking, alcohol intake, regular physical exercise, khat consumption, coffee and tea intake and daily diet status
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Health-related factors are as follows: family history of BPH, Body Mass Index (BMI) status, Diabetes Mellitus (DM) and disruption in glucose homeostasis, Cardiac disease, pulmonary disease, renal diseases, sexual activity, history of previous surgery and other related diseases
Data Collection and Analysis
Data collection instruments
An interviewer-administered structured questionnaire was used to collect primary data from study participants. Moreover, the chart review checklists were also used to collect secondary data from patient cards. These structured questionnaires were initially prepare in English then translated in to local language Amharic, then translated Back to English independently by language experts. The questionnaire had six parts: (1) Socio demographic (eight items) (2) Behavioral and life style factors (9 items) and (3) Health related factors (12 items)
The weight and height of the study participant was measured using a digital weight scale and stadiometer, respectively, to calculate the body mass index (BMI).
Data collection procedure
Data were collected by face-to-face interviews and reviewing of patient medical cards. Participants were interviewed after getting the surgical or medical service at the surgical ward who had undergone surgery. The weight and height were measured with participants standing without shoes and wearing light clothing. Participants were asked for height measurement and bodyweight (kg). Then BMI was calculated as body weight (kg)/height (m2). Finally, the diagnosis of BPH was confirmed by checking the medical card of the patent.
Data processing and Analysis
Epi-data 3.1 version was used to enter data and then exported to SPSS version 20.0. To determine association between dependent and independent variable binary logistic regression was done. Those variables having p value < 0.25 was built-in and accustomed to calculate in order to identify independent predictors
Data quality control measures
To ensure quality of data, we checked all the collected data daily for the completeness, the accuracy and the consistency. The pre-test were also conducted on 5% of the sample size weeks before the actual data collections were conducted. In addition to this, valid English version of questionnaire was adapted and translated to Amharic language and back to English language by individual experts who speak both languages fluently. We also trained data collectors with the supervisors to maintain data quality.
Operational definitions
Benign prostatic hyperplasia
In this study, the magnitude of benign prostatic hyperplasia and its associated factors will be assessed in patients who had confirmed the presence benign prostatic hyperplasia by a physician based on the information obtained from history, “physical examination,” laboratory investigation, and/or radiographic studies.
Alcohol drinking
In this study, Alcohol drinking is defined as past or current drinking of any alcoholic beverages in regular basis.
Cigarette smoking
In this study, subjects with a history of past or current smoking any amount of cigarette in regular basis were considered as smokers.
Physical activity
Recommended level of physical activity was defined as performing more than 20– 30 min of moderate intensity exercise (for example hurried walking) for at least four times per week
Diet
In this study, subjects who consume an average of 125 ml (400 g) of fruits and vegetables per day were considered as having a recommended level of fruit and vegetable consumption.
BMI Status: Weight status was classified into four categories: underweight (BMI < 18.5), normal weight (BMI: 18.5–24.9 kg/m2), overweight (BMI: 25–29.9 kg/ m2), and obese (BMI ≥ 30 kg/m2)