The prevalence of gallstone disease and associated factors among patients who visited the surgical department of Debre Birhan Comprehensive Specialized Hospital, Debre Birhan, Ethiopia: an institution-based cross-sectional study

Abstract

Background

The gallstone disease is gradually becoming a burden of healthcare systems throughout world. The frequency of gallstone disease in Ethiopia has been the subject of few investigations and to the best of our knowledge, limited evidence of published research has examined the risk factors linked with gallstone disease. The main objective of the current study was to assess the prevalence of gallstone disease and associated factors among patients who visited the surgical department of Debre Birhan Comprehensive Specialization Hospital.

Methods

This retrospective institution-based cross-sectional study was conducted at Debre Birhan Comprehensive Specialized Hospital's Surgical Department. A total of 169 patients, aged 18 and above years, were selected between January 2020 and December 2022 using a simple random sampling method. The collected data were analyzed by using SPSS version 25. Descriptive statistics were done, and binary and multiple logistic regression analyses were performed. Risk variables were found using multivariable logistic regression.

Results

The study included 165 participants, 86 (52.1%) males and 79 (47.9%) females. The mean age of the participants was 41.58 ± 16.185 years. The overall prevalence of gallstone disease was 7.9%, with a greater prevalence observed in women (15.2%) than in men (1.2%). The prevalence of gallstone disease was found to be highest (61.3%) among participants aged between 26 and 45 years, with a Decrease in prevalence after the age of 65 years. Multiple logistic regression analysis revealed that female sex (OR = 6.88), alcohol intake for more than five years (OR = 4.27), and history of gastrointestinal surgery (OR = 6.5) were significantly associated with gallstone disease. Further subgroup multiple logistic regression analysis in females revealed that parity (OR = 8.5) and, after adjusting for alcohol intake, diabetes (OR = 4.6) and hypertension (OR = 1.37) were significantly associated with gallstone disease.

Conclusion

In conclusion, the prevalence of gallstone disease was 7.9%, and the disease was fairly common in our study area. Female sex, alcohol intake for more than five years, and a history of gastrointestinal surgery were strongly associated with the occurrence of gallstone disease.

Background

Gallstones (GS) are deposits of bile salt, that form in the gallbladder (cholelithiasis) or bile ducts (choledocholithiasis). GS are formed from calcium ions, bile pigments, and excess concentrations of cholesterol [1]. The majority of asymptomatic stones are discovered incidentally on ultrasound taken during routine medical examinations or while testing for an existing medical condition. Others are palpated during laparotomies, and some are exposed on oral cholecystograms [2, 3]. According to their primary chemical components, gallstones can be generally classified as cholesterol, pigment stones or mixed cholesterol GS. Each form of GS may have a unique pathophysiology and etiology, which are poorly understood. The complex interplay of genetic and environmental factors leads to GS [4].

The gallstone disease (GSD) is increasingly burdening healthcare systems worldwide. Due to rapid urbanization and changes to a westernized diet, its prevalence has steadily increased globally [5]. Currently, GSD is a widespread issue in developed nations and appears to be increasing in developing countries. In addition, the condition poses a significant health burden that drives up the frequency of hospital admissions, surgeries, and health care costs [6, 7].

Cholecystolithiasis has a mean prevalence rate of 10–12% in European populations, while 3–4% in Asian people. In larger sonographic epidemiologic surveys conducted in Europe, the median gallstone prevalence rate ranged from 5.9% to 21.9% [8]. Gallstones, which are the most prevalent form of biliary system disease in adults and the main reason for hospital admissions for gastro intestinal tract (GIT) issues, are thought to affect 20–25 million adults in the United States of America (USA) [9]. The number of cholecystectomies carried out annually in the USA ranges between 650,000 to 700,000 [7]. There have been a few studies published in Africa. The range of prevalence was 4% to 10% [8]. In the past, cholelithiasis was thought to be uncommon in sub-Saharan Africa. However, the frequency of cholecystectomy appears to be increasing over time [10, 11].

Ethiopia, like many other African nations, is rapidly urbanizing, and there has been a gradual move toward a westernized diet characterized by high-calorie diet and high in carbohydrates, which has led to an increase in the prevalence of GSD in recent years. The statistics revealed that 56 GSD cases were reported annually at Ayder Referral Hospital in Mekelle [12], while the Ras Desta Damtew Memorial Hospital conducts a total of 71 cholecystectomies each year [13]. Moreover, five-year GSD research conducted at Tikur Anbessa Specialized Hospital (TASH) revealed 78 GSD cases annually [14], which is indicative of a changing pattern in GSD. Cholelithiasis or cholecystitis were among the top ten disorders of surgical inpatient care, comprising 10.3% of the study conducted on the pattern of admission to TASH's surgical ward [15]. The total prevalence of GSD is 10.2% among patients who were admitted to the St. Paul Hospital Millennium Medical College (SPHMC), Addis Ababa [16], and 5.2% among patients who visited the radiology department of Gondar University Hospital [17].

To the best of our knowledge, studies on the prevalence and associated factors for GSD in Ethiopian populations are scarce. Moreover, most of the studies provided insufficient information because they focused only on the prevalence of GSD; as a result, it is important to recognize the prevalence and associated factors. Due to the lack of community-based research and the fact that the majority of patients are asymptomatic at the time of diagnosis, it is still challenging to diagnose GSD early, which increases the likelihood of missed diagnoses and leaves the true prevalence of the condition unknown. Overall, this research serves as a foundation for further investigations by other researchers in the field.

Methods

Study area and period

The study was conducted at the Debre Birhan Comprehensive Specialized Hospital (DBCSH), located 130 km north of Addis Ababa in the Amhara region, the northern Shewa zone of the Debre Birhan district. It is the largest public referral hospital in the northern Shewa zone. It offers services for more than 3 million individuals within its catchment region. A total of 25,004 patients visited the DBCSH surgical Department during the study period between January 2020 and December 2022.

Study design, sampling methods and analysis

This single-center retrospective cross-sectional study analyzed data from 169 randomly selected patients who visited the surgical Department of DBCSH during the study period. The sample size calculation accounted for a 20% non-response rate and incomplete medical records. The minimum required sample size was determined using the single population proportion formula: , Where: Z = 1.96 (Z-score for 95% confidence level), P = 0.102 (The 10.2% prevalence rate was adopted from a comparable study at SPHMC, which provided a 13-year trend analysis of gallstone cases in a similar institutional setting [16]), and E = 0.05 (5% margin of error).

The sampling frame was the hospital's health management information system HMIS records. A total of 169 patients were chosen using a computer-generated simple random sampling (SRS) method. All patients who visited the surgical Department of DBCSH, and recorded on HMIS from January, 2020 to December, 2022 were included in the study. Incomplete patient records (if more than 20% of the information critical for the study's objectives was missed.), subsequent visit to the surgical Department with the same diagnosis and patients under 18 years of age [18, 19] since GSD is uncommon at a younger age were excluded from the study.

Each filled-out form was reviewed for completeness following data collection by ODK before being exported to SPSS version 25 for analysis. To identify determinants of GSD, binary logistic regression analyses with two or more variables were performed. Based on the value of p < 0.2 in the binary logistic regression, independent variables were selected as candidates for multiple logistic regression analysis. Forward stepwise multiple logistic regression analysis was subsequently performed. The adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used to estimate the strength of the association. A 5% level of significance was considered statistically significant. In the end, text, tables, and charts were used to present the results.

The studied parameters include: Sociodemographic Factors (like Age, Sex, Educational level, Occupation, and Residence); Genetic and Behavioral Characteristics (History of GSD in first-degree relatives, Alcohol intake, Physical activity, and Drug use for more than 6 months); Pathologic Conditions (Hypertension, Diabetes, Liver cirrhosis, Hemolytic anemia, HCV/HBV infection, SCI); and Factors Related to Bile Stasis (Pregnancy, Exogenous estrogen, Prolonged parenteral nutrition, History of GI (gastrointestinal) surgery, Parity (number of pregnancies), and Previous history of abortion).

Operational definition

Symptomatic stones, defined as gallstones that have positive ultrasonography, produced biliary pain expressed as abdominal pain in the hypochondrium and/or epigastrium lasting longer than a half-hour and makes them to lie down or take painkillers and/or cause consequences in the last 5 years as it was already confirmed by previous physicians [2]. The ultrasonographic findings that were used to indicate the presence of stones in the gallbladder are one or more echogenic, distantly shadowing, potentially movable structures within the gallbladder; one or more echogenic, movable, but not shadowing, structures within the gallbladder; and echogenic structures with persistent shadowing in the area of the gallbladder fossa, with little to no visualization of the gallbladder [2].

The following final gallbladder status was noted to determine the prevalence of gallstone disease: Ultrasonography results could be: normal, gallstone-positive, biliary sludge-positive, previous cholecystectomy, or inconclusive or uncertain. Gallstone positive and a history of cholecystectomy were used to define gallstone disease. Those with no gallbladder lumen on ultrasonography, a confirmed history of cholecystectomy, and a pertinent abdominal scar on physical examination were considered cases of cholecystectomy [2]. A history of GI surgery included upper GI surgeries with or without vagotomy, which was performed for trauma and chronic tumors. These include esophagectomy, gastrectomy and hiatal hernia repair.

The diagnosis of metabolic disorders, such as obesity, hypertension, and diabetes, was made under the accepted guidelines as it was already confirmed by previous physicians [2]. For people who smoked for five years or longer, smoking was defined as the number of cigarettes smoked per day. Drinkers are individuals who have consumed much alcohol per day at least for five years. Those who didn't use tobacco or alcohol for at least the last three years were categorized as nonusers [2]. A high-calorie diet low in dietary fiber and high in carbohydrates can be characterized as a Western diet [20].

Results

Sociodemographic characteristics

Eighty-six (52.1%) of the 165 patients were men, and 79 (47.9%) were women; the male-to-female ratio was 1.17 to 1. The participants'average age was 41.58 ± 16.185 years. The upper age limit was 84 years, and the minimum age was 18 years. A total of 106 (64.2%) participants were between the ages of 18 and 45, and 46 (27.9%) were between 46 and 65. Rural dwellers made up 92 patients (55.8%), while urban dwellers made up 73 (44.2%), as shown in Table 1.

Table 1.

Sociodemographic characteristics of participants who visited the surgical department of the DBSCH

Variables		Total Frequency	Percentage %
Age	18–25	30	18.2
	26–35	41	24.8
	36–45	35	21.2
	46–55	19	11.5
	56–65	27	16.4
	> 65	13	7.9
Sex	Female	79	47.9
	Male	86	52.1
Educational level	Illiterate	63	38.2
	Primary education	28	17
	Secondary education	39	23.6
	College diploma & above	35	21.2
Occupation	Farmer	53	32.1
	Governmental	28	17.0
	Private work	36	21.8
	House wife	39	23.6
	Others (students…)	9	5.5
Residency	Rural	92	55.8
	Urban	73	44.2

The age and sex distribution of respondents among different age categories are shown in Fig. 1.

Fig. 1.

The relationship between age and sex of respondents who visited the surgical department of DBSCH

Gallstone-related characteristics

In the present study, the overall prevalence of GSD among individuals who visited the DBCSH surgical Department was 7.9% (12 patients had a GSD, and 1 patient had a history of cholecystectomy).

Among the patients diagnosed with GSD, 92.3% were female, while only 7.7% were male. Around 66.7 percent of females with GSD had more than four pregnancies, compared to 25% who had two to four pregnancies and 8.3% who were nulliparous.

Thirty-six patients (21.8%) who visited the DBCSH surgical Department had previously undergone an ultrasound scan for RUQ, while 129 patients (78.2%) did not. Of the patients who had previously undergone an ultrasound scan for RUQ, 58.3% had normal results, 33.3% had gallstone-positive results, 5.6% had unclear or inconclusive results, and 2.8% had a prior cholecystectomy. All verified GSD patients underwent RUQ ultrasound scanning, which showed positive results for GS and previous cholecystectomies.

Pathologic and metabolic conditions

In the present study, diabetes and hypertension were the most common comorbidities. In this study, 155 individuals (93.9%) did not have diabetes, while 6.1% of patients did. Of the total patients, 4.24% had blood pressure above 140/90 mm Hg, 1.82% had blood pressure below 90/60 mm Hg, and 155 (93.94%) had normal blood pressure.

Genetic and behavioral factors

Of the total patients, 135 (81.8%) did not drink alcohol, while 30 (18.2%) did. Of the patients who consumed alcohol, 40% and 60% had done so for longer or shorter than five years, respectively. It was challenging to evaluate the types and quantities of alcohol consumed each day, as well as the short- and long-term effects on GSD; a more prospective study on the relationships between alcohol and GSD is necessary.

Other factors

Of the female participants, 48.1% had more than four pregnancies. On the other hand, 16.5% of the women had never been pregnant, while 35.4% had two or more pregnancies. Furthermore, 12.12% of the participants had previously undergone gastrointestinal surgery, while the remaining 87.88% had not.

Factors associated with GSD

Based on the p value < 0.2 (20%) in the bivariable logistic regression, independent variables such as sex, DM status, hypertension status, alcohol intake for more than five years, family history of GSD in first-degree relatives, history of GI surgery, parity, history of abortion, residency, history of SCI and use of oral contraceptives were selected as candidates for multivariable logistic regression analysis with confirmed GSD.

Multiple logistic regression revealed that female sex (P = 0.014, OR = 6.88, CI = 2.348–20.2), alcohol intake for more than five years (P = 0.007, OR = 4.27, CI = 2.761–66.83), and gastrointestinal surgery history (P = 0.049, OR = 6.5, CI = 1.011–42.77) were significantly associated with GSD. However, these estimates are unstable due to small sample size. Among females, parity having more than 4 previous pregnancies (P = 0.011, OR = 8.5, CI = 2.745–26.35) and when the effect of alcohol intake was adjusted, diabetes (P = 0.047, OR = 4.6, CI = 1.03–13.7) and hypertension (P = 0.035, OR = 1.37, CI = 1.21–15.1) were significantly associated with GSD as indicated in Table 2.

Table 2.

Results of binary and multiple logistic regressions for patients who visited the surgical department of DBCSH

Independent variables		COR	AOR	P	CI	Remark
Age	≥ 35 years	3.18		0.085	1.33- 21.58
	< 35 years	1.00
Gender	Female	15.2	6.88	0.014*	2.34- 20.2
	Male			1.00
Residency	Urban	3.41
	Rural
Diabetes	Yes	6.21	4.6	0.047*	1.03- 13.7	When alcohol intake was adjusted
	No			1.00
Spinal cord injury	Yes	6.7
	No
Dietary habit		1.00
Family history of GSD	Yes	13.6
	No
Alcohol intake for > 4 years	Yes	4.3	4.27	0.007*	2.76- 66.8
	No			1.00
History of GI surgery	Yes	5.7	6.5	0.049*	1.01–42.7
	No			1.00
Parity	> 4 pregnancies	22.6	8.5	0.011*	2.74–26.35	When sex was adjusted
	2–4 pregnancies	10.2		0.048	1.02–102.4
	Nulliparous			1.00
Abortion history	Yes	10.8
	No
Pregnancy	Yes
	No
OCP uses	Yes	8.8
	No
Hypertension	Yes	10.8	1.37	0.035*	1.21- 15.1	When alcohol intake was adjusted
	No			1.00

COR crude odds ratio, AOR adjusted odds ratio, P level of significance, CI confidence interval

Discussion

Prevalence of GSD

In the present study, the overall prevalence of GSD among patients who had visited the surgical Department of DBCSH was 7.9% [CI = 6.2–10.7]. This figure is nearly in agreement with several studies including the 10.2% reported from SPHMC, Addis Ababa. A study conducted at Saint Paul’s Hospital reported 7% of patients had stones in the bile duct, with similar findings in other regions: 10% in South Africa, 6.83% in Shanghai, China, 8.6% in another study from Southwest China, 6.2% in northern India, 9.7% in Guadalajara, Spain's adult population, and 8.03% in Linkoping, Sweden [8, 16, 18, 21–25]. The prevalence of GSD is slightly higher than 5.0% in central Taiwan, while dietary practices and environmental factors can alter the pigment types and composition of stones, and a population-based study Described the slightly lower prevalence of GSD. Similarly, the total prevalence of GSD in the current study was slightly higher than 5.53% in Sana, Yemen; 5.9% in Kumasi, Ghana; and 5.2% in the radiology department of Gondar University Hospital. The differences in methodology may have contributed to the variation in prevalence rates [17, 26–28]. This percentage is slightly lower than the 11.7% of the Saudi high-altitude population. The cluster sampling method, combined with the use of couples who share similar environmental risk factors as the study unit, might have contributed to a slightly higher prevalence of GSD [29].

The total prevalence of GSD in the current study was much lower compared to the other studies. For instance, GSD was found to be prevalent in 24.8% of diabetic individuals in northern Italy, 17.7% of type 2 DM patients in North India, and 17.5% of diabetic individuals in Ibadan, Nigeria,. It has been suggested that impaired glucose metabolism raises the chance of getting GS, which could explain the higher prevalence of GSD among individuals with diabetes [30–32]. According to a Taiwanese study, there was a greater overall incidence of GSD in the type 2 diabetes cohort than in the nondiabetic cohort, but there was a lower total incidence of GSD in the type 1 DM cohort [33].

The prevalence of GSD in the present study was much lower than that in an American study in which 31% of SCI patients had gallstones. Similarly, among Chilean male patients with SCI, the prevalence was 25%. The study also revealed that a higher incidence of GSD in patients with SCI is linked to impaired gallbladder relaxation, which was usually limited to patients with SCI at or above T10 [34, 35].

A Japanese study discovered that the prevalence of GSD among individuals who underwent esophagectomy was 23%, which is not consistent with the present study. The study concluded that gallbladder hypomotility and biliary stasis due to truncal vagotomy could increase the risk of gallstone development in all forms after esophagectomy [36, 37].

The prevalence of GSD found in the current study was significantly lower than that reported by Italian researchers. According to their study, the prevalence of GD was much higher in first-degree relatives of individuals with gallstones (28.6%) compared to those without gallstones (12.4%), indicating a possible genetic connection. Similarly the prevalence of GSD found in the current study was significantly lower than 20.5% in Rosario, Argentina, because a larger percentage of the population there were immigrants from Europe and 19.2% in rural Morocco as a result of a greater (89%) western-style diet consumption [20, 38, 39].

The total prevalence of GSD in the current study was higher than 2.4% in southeastern Iran due to the small sample size, 4.4% in the sonographic study on adult Igbo individuals in southeastern Nigeria. The lower prevalence of GSD in Nnewi, Nigeria, was explained by the protective effects of the hereditary, environmental, and high fiber dietary habits of the Igbo population [40, 41].

Determinants of GSD

Female gender

In the present study it was founded that women were 6.88 more likely than men to have GS, which is consistent with findings from other studies conducted in various regions, such as Igbo in southeast Nigeria, rural Morocco, Saudi's high-altitude population, Sana in Yemen, Rosario in Argentina, and Italy, where researchers have found that mothers and sisters had the highest relative risks for GD [16, 19, 20, 28, 29, 38–41]. Considerably higher rate of GSD in women is due to conception, the impact of sex hormones and the disease is passed down through dominant sex-linked features [38–40].

According to the present research, female gender was significantly associated with GSD. The study found that women have a 6.88 times higher risk of developing GSD than men. This finding is consistent with several other studies, including the Gonder University Hospital study, a sonographic study carried out in Nigeria, a survey conducted in northern India, and a high-altitude population study in Saudi Arabia [17, 18, 29, 40]. The reason behind this gender difference could be due to early marriages, longer reproductive periods, and the effects of sex hormones, which make females more prone to GS.

However, the present study finding’s was in contrast to the screening studies conducted in central Taiwan and Shanghai, China, where sex did not show statistical significance, which was explained by the pigment types of stones common in Asian populations [23, 26].

Parity

The present study showed that parity was significantly associated with GSD, with women who had four or more pregnancies having an 8.5 times higher risk of GSD than nulliparous women. These findings are consistent with a study in Rosario, Argentina, northern India, as well as a sonographic study in the Igbo region of Nigeria [18, 39, 40].

Alcohol intake

The present study has shown that individuals who consumed alcohol for more than five years were at a significantly higher risk of Developing GSD, with a 4.27 times higher risk than nondrinkers, but the majority of patients with GSD were women who consumed less alcohol than men. However, the available literature on the effect of alcohol intake for more than 5 years is inconsistent and conflicting. The present study was consistent with a study conducted in Guadalajara, Spain, and Swedish forward cohort researches revealed that weekly alcohol use was linked to the growth and formation of GS [22, 24]. The present study was inconsistent with a study conducted in a rural area of Morocco, and Mexico showed that a history of alcohol abuse is preventative of gallstone disease. Possibly explained by alcohol decreases the saturation of bile cholesterol, which reduces cholesterol calculi, and the fact that females consume small amounts of alcohol inconsistently [20, 42].

History of gastrointestinal surgery

In the present study, individuals with a previous history of gastrointestinal surgery were significantly at a higher risk of Developing GSD. The study reports that such individuals had a 6.5-fold greater risk of developing GSD. Similarly, studies conducted in Hungary after vagotomy, Japanese men after gastrectomy, central Taiwan, Shanghai, China and northern India have also found a correlation between a history of gastrointestinal surgery and the prevalence of GSD [18, 23, 26, 43, 44]. The possible scientific justification might be, even in cases where a vagotomy is not done, the surgical process of a gastrectomy may cause damage to the vagal nerves, which might lead to biliary stasis as a result of gallbladder dilatation and incomplete emptying [43]. The cholecystograms following surgery showed gross dilatation. There were very few and obviously compromised contractual responses. Following a total vagotomy, gallbladder hypotonia and increased gallstone production occur [44].

Diabetes

The present study found a strong link between diabetes and GSD. The study shows that individuals with diabetes have a 4.6 times greater risk of developing GSD than those without diabetes. The findings of this study are consistent with previous research conducted in various regions, including Addis Ababa, Ethiopia, on the association between DM and GSD, SPHMC on the patterns of stone disease, central Taiwan, Shanghai, China, Mexico, and other parts of the world. These studies have also found a significant association between GSD and DM, highlighting the importance of diabetes management in preventing the development of GSD [16, 23, 26, 32, 42, 45–47]. There are probably several contributing factors to the higher frequency of GS in individuals with T2D. Patients with diabetes have larger fasting gallbladder volumes than controls, which may indicate that the hypotonicity of the gallbladder results in bile stasis. In diabetics, cholecystokinin's impact on bile ejection is also decreased. By lowering GB motility, diabetic neuropathy also contributes. Changes in the metabolism of glucose also impact [32].

Hypertension

According to the present study, when the effect of alcohol intake was adjusted hypertension was found to be significantly associated with GSD. The risk of GSD was also observed to increase by 1.37 times among hypertensive individuals than among non-hypertensive individuals. There is evidence linking hypertension to an increased risk of gallstone disease, which is supported by Japanese population-based cohort study in which high blood pressure and treatment for hypertension were associated with a higher risk of cholelithiasis. Similarly, in Southwest China [21, 45]. A study conducted at two Addis Ababa referral hospitals on the surgical outcomes of choledocholithiasis patients with symptoms revealed the presence of chronic illnesses like diabetes, high blood pressure, and RVI [48]. In a study on the clinical presentation and pathogenesis of biliary tree blockage outside the liver at TASH, diabetes and high blood pressure were common comorbidities [49]. In Southwest China, a study revealed that hypertension (21.8%) is the most common comorbidity [21].

Limitations of the study

Firstly, Strong inferences regarding prevalence at the population level cannot be drawn due to the limited sample size, which probably exaggerates genuine effects. Secondly, a 3-year span may miss long-term or seasonal trends in the incidence of GSD. The cases may be impacted by temporary interruptions in medical care. Thirdly, the absence of variables like BMI, physical activity, or comprehensive dietary information compromises regression model adjustment and leads to underestimated correlations. Lastly, the hospital-based retrospective study may not record asymptomatic GSD cases the study only included symptomatic or diagnosed cases, which understates the actual burden of disease in the community in the absence of widespread radiography. Inaccurate diagnosis could cause prevalence estimates to be exaggerated or understated.

Conclusion

Our study shows that the prevalence of GSD was 7.9%, which was greater in females than in males. Gallstone diseases were more common in individuals between 26 and 45 years of age. The majority of patients with gallstones were asymptomatic. Abdominal pain and vomiting were the leading symptoms present in all patients with symptomatic GSD. The most common comorbidities identified were diabetes and hypertension. Female gender, alcohol intake for more than five years and gastrointestinal surgery were significantly associated with GSD. For female’s parity and when alcohol intake was adjusted, diabetes and hypertension were significantly associated with GSD. Although the prevalence of GSD (7.9%; 95% CI: 6.2–10.7%) was consistent with some research from Ethiopia and other underdeveloped nations, firm inferences on population level prevalence are not possible due to the small number of cases (n = 13) and the wide confidence interval. Bigger, population-based investigations are required to confirm these findings and assess generalizability, even if the majority of relationships with important risk factors (such as female sex and parity) are in line with earlier research.

Recommendations

This study identifies three key areas that require more investigation: (1) community-based screening to ascertain the actual population-level prevalence of GSD; (2) mechanistic studies of hormonal and metabolic pathways (such as diabetes and parity); and (3) detailed studies of alcohol consumption patterns. By concentrating on these areas, we can better understand Ethiopia's GSD burden and direct targeted preventative initiatives.

Abbreviations

AOR

Adjusted odds ratio

CI

Confidence interval

COR

Crude odds ratio

DBCSH

Debre Birhan Comprehensive Specialized Hospital

DM

Diabetes mellitus

GIT

Gastrointestinal Tract

GS

Gallstone

GSD

Gallstone Disease

HMIS

Health Management Information System

LUQ

Left upper quadrant

ODK

Open data kit

RUQ

Right upper quadrant

SRS

Simple random sampling

SCI

Spinal cord injury

SD

Standard deviation

SPHMC

St. Paul Hospital Millennium Medical College

SPSS

Statistical Package for the Social Science

TASH

Tikur Anbessa Specialized Hospital

USA

United States of America

Authors’ contributions

All authors reviewed the manuscript. Natnael Yikeber Haile silassie, who is the first author, principal investigator and wrote the main manuscript text. Soressa Abebe Geneti (assistant professor of anatomy at Addis Abeba University)(principal advisor), advised the principal investigator during the whole work. Balkew Agonafir (surgeon at Debre Birhan Specialized Hospital) (co-advisor), advised the principal investigator during the whole work and prepared Fig. 1.

Funding

The total cost of the current study was funded by Addis Ababa University, College of Health Science, in collaboration with Dilla University, College of Health Science.

Data availability

No datasets were generated or analysed during the current study.

Declarations

Ethics approval and consent to participate

Ethical approval was received from Research Ethics Review Committee of the Anatomy Department, School of Medicine, College of Health Sciences, Addis Ababa University with reference number of DRERC/011/23, dated on March 16, 2023. Debrebrehan hospital research board reviewed the proposal. The hospital's surgical department and card room received a formal letter of support and ethical clearance from the hospital's research ethics review board. After obtaining hospital consent, the study ensured confidentiality at all stages, and only the medical records of the study participants were utilized without stating their names. The ethical committees waived the requirement for individual informed consent because this was a retrospective cross-sectional study that used anonymized data taken from hospital health management information systems (HMIS). The information gathered was kept in a secure location. There was no direct benefit or harm from participation in the study.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.