Dépistage des lésions précancéreuses du col utérin et micro-organismes associés dans trois communes de Nouakchott

Introduction : Le cancer du col de l'utérus emporte plus de 266.000 femmes chaque année dans le monde et 70% des victimes de cette affection vivent dans des pays à revenu faible ou intermédiaire. Cette maladie peut être prévenue grâce à un test de frottis cervico-vaginal. Les objectifs de cette étude était de déterminer la prévalence des lésions précancéreuses du col utérin et des micro-organismes associés dans la population étudiée et d'aider à une meilleure prise en charge de la maladie aussi bien dans la prévention que dans le traitement à l'échelle nationale. Patientes et méthodes : Cet article porte sur un échantillon de 500 femmes venant de 3 communes de Nouakchott (Arafat, Riad et Sebkha). Il ressort de notre étude que les infections spécifiques étaient prédominées par celles au Gardnerella vaginalis (58,44%). Elles étaient suivies respectivement par celles au Candida albicans (16,25%), Trichomonas vaginalis (14,29%) et HPV (12,98%). Les lésions pré-cancéreuses représentaient 14,29% des lésions spécifiques avec une forte association du HPV (95,4%).Conclusion : Il importe de vulgariser le test de FCV, en passant par la formation de cyto-techniciens capables de réaliser des FCV et multiplier les sites de dépistage à l'intérieur du pays

Impact of Introduction of a Colposcopy Service in a Rural South African Sub-District on Uptake of Colposcopy

Objective.To describe the establishment of a colposcopy service at a district hospital in a rural sub-district of the Western Cape; South Africa; and assess its impact on colposcopy uptake. Design. A retrospective double-group cohort study using a laboratory database of cervical cytology results; clinical records and colposcopy clinic registers.Setting. The Overstrand sub-district; where 80 000 people are served by seven clinics and a district hospital in Hermanus; 120 km from its referral hospitals in Cape Town and Worcester. A colposcopy service was established at Hermanus Hospital in 2008.Subjects. All women in the sub-district who required colposcopy on the basis of cervical smears done in 2007 and 2009.Outcome measures. Numbers of women booked for colposcopy at distant referral hospitals in 2007 and at the district hospital in 2009; the proportions who attended colposcopy; the time from cervical smear to colposcopy; and comparison between the two years.Results. Uptake of colposcopy booked at distant referral hospitals was 67 in 2007. Uptake improved by 18 to 79 for the district hospital colposcopy service in 2009 (p=0.06). When patients from an area with no public transport to the district hospital were excluded from analysis; the improvement was more marked at 22 (p=0.02). The delay from cervical smear to colposcopy improved significantly from 170 to 141 days (p=0.02).Conclusion. Establishment of a colposcopy service in a rural sub-district increased uptake of colposcopy and decreased the delay from cervical smear to colposcopy. The service removed 202 booked patients in one year from the colposcopy load of the referral hospitals

Educational needs and causes of false diagnosis of atypical squamous cells of unknown significance at a university hospital

The entity of atypical squamous cells of undetermined significance (ASCUS) in The Bethesda System 2001 for reporting cervical cytology is characterized by equivocal diagnosis, poor reproducibility and debatable management. This retrospective study was done to analyse the causes of false ASCUS if any and identify the educational needs as part of quality assurance programme. Cervical smears of all ASCUS cases reported over the one-year period were reviewed by the Cytopathologist. Relevant clinical data was retrieved. ASCUS was the most common type of abnormality representing 43.0 % cases among 294 abnormal smears reported during study period. 16.0% cases were found to be non ASCUS on review. The main four causes of over use of ASCUS diagnosis were poor quality smears and cellular atypia associated with Candida infection, atrophy and squamous metaplasia. Educational measures are being undertaken to avoid over diagnosis and improve the patient management (Afr J Reprod Health 2011; 15[1]: 111-114)

Knowledge, attitude and practice of cervical cancer screening - Papanicolaou test (Pap smear) among female health care providers in Port Harcourt

Background: Cervical cancer is the second most common malignancy affecting women globally and the commonest female genital cancer in Nigeria. It can be prevented through regular cytologic screening by Pap smear. The general public sees health care providers as models; therefore; their attitudes and actions would predictably influence societal health behaviour. Aim: To assess the knowledge; attitude and practices of female health workers in Port Harcourt; towards cervical cancer screening. Methods: A questionnaire-based survey of 133 female health care providers at the Braithwaite Memorial Specialist Hospital and the University of Port Harcourt Teaching Hospital; Port Harcourt; which evaluated the socio-demographic characteristics of respondents; knowledge of cervical cancer; attitude and utilization of cervical cancer screening service was carried out. The data were entered into SPSS version 11.0 which was used for analysis and results are presented as Frequency tables; percentages and means. The level of significance was set at p-value 0.05. Results: Up to 123 (92.2) respondents had knowledge of Pap smear as a screening tool for cervical cancer; and 96 (72.2) respondents recognized early sexual debut as a risk factor. Nine-three (70) respondents would be willing to have Pap smear. Only 17(12.8) had done a Pap smear previously. Conclusion: The high knowledge of cervical cancer screening and their positive attitudes towards it did not translate to service utilization by female health professionals in Port Harcourt.There is therefore need to improve uptake of Pap smear by health professionals in order to improve their effectiveness in encouraging the public to utilize this service

Awareness and Uptake of the Pap Smear among Market Women in Lagos; Nigeria

Our study evaluates the effect of an educational programme on awareness and uptake of the cervical cancer screening test (Pap smear) by women in a model market in Lagos Nigeria. This was a quasi-experimental study using a multistage sampling technique. A total of 350 women were divided into two groups. A baseline survey on awareness of the Pap test and screening practices was carried out using pre-tested; interviewer administered; structured questionnaires. Participants in the intervention group received sessions of community based health information on cervical cancer screening tests while participants in the control group received health information on hypertension. Subsequently; participants in both groups were reassessed to evaluate the effect of the educational programme on the Pap test and cervical screening uptake. Data were analysed with the Epi-info version 6.04. Awareness about the Pap test was low at baseline; only 6.9and 12.0of participants in the intervention and control groups; respectively; had heard of Pap smears. Furthermore; less than 10had correct information on the use of the Pap test. Post-intervention; there was a significant and proportional increase in the knowledge of the Pap test in the intervention group (p

Perceived Susceptibility of Cervical Cancer Screening among Women Attending Mahalapye District Hospital; Botswana

Cervical cancer is a significant cause of morbidity and mortality in Botswana. Papanicolaou (Pap) cervical cytology screening has helped to reduce cervical cancer rates dramatically through early detection of premalignant lesions in countries with screening programmes that have been well implemented. The objectives of this cross-sectional study were to describe the women's perceived susceptibility to cervical cancer and the association between socio-demographic characteristics. A total of 300 participants were selected by convenience sampling techniques. Participants' mean age was 37 years (SD=11). Results indicated that cervical cancer screening rates were 39. Most of those that had ever been screened for cervical cancer (64); had been screened in the previous three years. Most of the participants (75) were aware of their perceived susceptibility to cervical cancer. There was a significant association between perceived susceptibility and screening for cervical cancer (c2=20.86; p0.001). Among those with low perceived susceptibility to cervical cancer; 31had screened for cervical cancer as compared to 59screening rates among those with high perceived susceptibility to cervical cancer. Those with high perceived susceptibility were 3.2 times more likely to screen for cervical cancer (OR=3.24; 95CI:1.937-5.43) than those with low perceived susceptibility. High susceptibility rates significantly associated with being married (c2=9.44; p=0.051); employed (c2 = 13.077; p 0.001); monthly income more than $411 (c2

Factors Associated with the Knowledge; Perceptions and Practice of Pap Smear Screening for Cervical Cancer in Southern Nigeria

Background: Cervical cancer persists as a major reproductive health challenge in Nigeria with most cases presenting at advanced stage. Methods: This was an analytical cross-sectional survey of the factors associated with the knowledge; perceptions and practice of Pap smear screening amongst 238 women attending antenatal clinic at Central Hospital; Benin City; South-south Nigeria. Results: The median age of the respondents was 30 years (range = 18-49 years). The median parity was 1 (range = 0-5). Most of the respondents (49.2) had tertiary level of education closely followed by secondary level of education (42.2). Forty-five percent of the respondents were aware of cervical cancer and 22.3were aware of Pap smear screening. The sources were largely from the health personnel (32.1); journals/textbooks (26.4) and electronic media (26.4). Only 2.7of the respondents had ever had Pap smear screening done. The major determinants of utilization of Pap smear screening were knowledge of the test; non-availability of service delivery points; lack of spousal consent; fear that the test will detect cervical cancer and cost; with level of education strongly correlated with awareness of Pap smear screening. Awareness was shown on multiple logistic regression analysis as the only strong predictive factor for the practice of Pap smear screening. Conclusion :The knowledge and practice of Pap smear screening was poor; but the perception of the respondents was favorably excellent. We recommend reproductive health education programmes and advocacy activities; strengthening the existing opportunistic screening and establishing national guidelines for routine Pap smear screening

The Use of Cervical Smear in the Diagnosis of Genital Tract Infections at a University Teaching Hospital

Background: Genital tract infections such as Gardnerella vaginalis vaginosis; trichomoniasis and candidiasis have continued to assume immense importance because of the particular unique features of their main causative organisms - Gardnerella vaginalis; Trichomonas vaginalis and Candida albicans; and myriads of clinical and pathological changes in affected persons. Aim: To investigate the prevalence of Gardnerella vaginalis; Candida albicans and Trichomonas vaginalis in randomly selected sexually active women and the influence of some socioeconomic and demographic factors on the prevalence of these genital infections. Methods: The subjects were 450 randomly selected sexually active women attending antenatal; postnatal; gynaecology and family planning clinics in the Department of Obstetrics and Gynaecology of the University of Maiduguri Teaching Hospital from April 2001 to May 2002. The Pap smear of these patients were examined microscopically for evidence of Candida albicans; Gardnerella vaginalis and Trichomonas vaginalis. A questionnaire assessing sociodemographic characteristics of the patients were administered. Results: Sixty six (66) of the 450 patients studied had specific infections giving a prevalence rate of 14.7. Candida albicans; Gardnerella vaginalis; Trichomonas vaginalis and Candida albicans in conjunction with gardnerella vaginalis contributed 7.1; 5.1; 2.4and 1.8respectively to this overall prevalence. Age range of 15-20 years had the highest prevalence of each of the infections; but this association with age was not statistically significant (P0.05). The prevalence of each of the infections was highest among students and was lowest among housewives and business executives. These differences were statistically significant (P = 0.034). The prevalence of these genital infections increased with increasing educational level; being lowest among those with no formal and primary education and highest in the patients with post-secondary educational qualifications. This difference was statistically significant (P = 0.034; c2 for linear trend = 0.90). About 36.5) of the married women tested had evidence of genital infections compared to 41.6of the women who were not currently married; this difference was not statistically significant (P0.05). Conclusion: This study has shown that cervical cytology is of definite value in the diagnosis of some genital tract infections especially in low resource setting

Etude epidemiologique de 150 cas de neoplasies cervicales depistees par le frottis cervico-vaginal a Bangui

Une etude transversale prospective de 14 mois; portant sur 150 frottis a ete realisee chez des femmes vues en consultation en gynecologie obstetrique a l'hopital communautaire de Bangui. Les prelevements ainsi effectues ont ete colores selon la technique de Harris Schoor et les resultats etaient rendus selon la classification de Bethesda couplee a celle de Richart ou celle de l'OMS. Nous avons enregistre : 71;3 pour cent de lesions de bas grade. 20 pour cent de lesions de haut grade et 8;6 de carcinome invasif. Les lesions condylomateuses virales ont representee 40;7 pour cent. Les facteurs de risque identifies etaient : grossesse multiple rapprochee (p=0;03); antecedents d'infections sexuellement transmissibles (p0;001). Comme cela a deja etait demontre anterieurement l'education sanitaire et le depistage systematique constituent les meilleurs moyens de lutte contre le cancer du col uterin

Diagnostic des dysplasies cervicales associees a l'infection VIH : perte d'efficacite de la cytologie conventionnelle

Problematique : l'absence d'un programme national de depistage du cancer du col uterin en Republique Democratique du Congo ne permet pas de prendre en charge efficacement cette pathologie dont le risque est de surcroit amplifie par l'infection a VIH. Le choix des techniques diagnostiques se pose de facon critique surtout en condition de faibles ressources ou se trouvent la plupart des pays subsahariens. Objectifs de la recherche : Evaluer ; d'une part; les qualites diagnostiques des frottis conventionnels (FC); facilement realisable en conditions de faibles ressources comparativement aux frottis en couche mince (FCM) pris comme reference; et d'autre part; l'influence de l'infection par le VIH sur les performances de ces techniques diagnostiques. Methodologie : Les examens cytopathologiques cervicaux ont ete realises sur 128 patientes VIH et 132 patientes VIH+ consentantes selectionnees dans deux centres de depistage volontaire de VIH a Kinshasa. Le consentement eclaire etait obtenu apres conseil et explication sur l'interet de cet examen pour la femme en activite sexuelle. Resultats : Les lesions dysplasiques de haut grade et les cancers du col uterin (CCU) etaient 10;3 fois plus frequentes chez les sujets VIH+ comparativement aux sujets VIH- (Odds ration=10;3 ; IC95=3;7 a 31;1). La sensibilite; la specificite; les valeurs predilectives positive et negative; et l'efficacite diagnostique des FC etaient respectivement de 66; 7; 98;2; 87;6; 89;4pour les sujets VIH+ contre 80;0; 100; 100;0; 99;2et 99;2pour les sujets VIH-. Le risque de faux negatif comparativement aux risque de faux positifs etait significativement plus eleve chez le sujets VIH+ (x2 de Mc; Nemar = 10;3 ; p = 0;001) que chez les sujets VIH- (x2 de Mc; Nemar = 0 ; p = 1). Conclusion : La sensibilite; l'efficacite diagnostique des FC; d'une part; le taux de concordance (Kappa entre les FC et les FCM; d'autre part; etaient effondrees en presence de l'infection par le VIH; occasionnant un taux eleves de faux negatifs et une faible valeur predilective negative; probablement du fait de l'intensification des reactions inflammatoires. La frequence des examens de controle devrait etre plus rapprochee en cas d'infection a VIH

Depistage du cancer du col de l'uterus: pourquoi et comment ? (1ere partie)

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Depistage du cancer du col de l'uterus pourquoi et comment ? (2eme partie)

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A Comparison Of Cervical Smear Adequacy Using Either The Cytobrush Or The Ayre Spatula: A Practice Audit

Background: To obtain an adequate cervical (Papanicolaou) smear; the transformation zone; including the squamo-columnar junction; should be sampled as carcinoma develops preferentially in this transformation zone. The Ayre spatula has been widely used but is not very effective. Other sampling devices have been developed to improve efficiency; including the cytobrush. The purpose of this study was to compare the adequacy of cervical smears taken with the Ayre spatula as opposed to the cytobrush. MethodsThis was a retrospective analytical study. One sampler; an experienced general practitioner; took the smears in the period 1990 to 2004. Initially; the Ayre spatula was used to consecutively sample the cervix and thereafter; a cytobrush alone was used. Two groups were thus formed for comparison. The presence of endocervical cells was accepted as an indicator of an adequate smear. A Cusco speculum was used to visualize the cervix. The sample was smeared onto a slide and fixated with an alcohol aerosol spray. ResultsA total of 4561 smears were taken and 247 had no endocervical cells. A further 34 smears were classified as unsatisfactory due to the presence of degeneration (19); insufficient squamous cells (7); inflammatory exudate (4); excess blood (3) and/or a thick slide (1).The cytobrush group was similar demographically to the Ayre spatula group: 1981 (99) and 2490 (98) respectively were non pregnant; 67 (3) and 110 (4) were nulliparous; 1008 (50) and 1370 (54) were para 1 - 5; and 931 (46) and 1075 (42) were para 6 or more; 0 (0) and 2 (0.1) were aged between 10 - 19 years; 1496 (75) and 2012 (78) between 20 - 49; and 510 (25) and 541 (21) were aged 50 years or more. Of 2006 smears taken with a cytobrush; 1955 (97.5) contained endocervical cells compared with 2325 (91) of 2555 smears taken with an Ayre spatula. The difference was significant with an Odds Ratio of 4.56 (95Confidence Interval 3.42-6.42). ConclusionThe cytobrush is significantly more efficacious than the Ayre spatula in obtaining adequate cervical smears. Use of the cytobrush will ensure less repeat smears with a consequent reduction in workload for samplers and laboratories. Although very few smears lacked sufficient squamous cells (an indicator of adequate ectocervical sampling); current best practice is that the cytobrush be used together with a wooden spatula to ensure adequate sampling of both the endocervical and ectocervical components of the transformation zone

A Comparison of Cervical Smear Adequacy Using either the Cytobrush or the Ayre Spatula: a Practice Audit

Background: The study aimed to i) investigate the smoking habits of students attending tertiary institutions of learning in the Eastern Cape Province (ECP) and ii) determine the knowledge of the students about the health hazards of smoking and their attitude towards current government anti-smoking legislation.Methods: This was a questionnaire-based study involving all seven tertiary institutions of learning in the ECP; viz. the Universities of Transkei; Fort Hare; Port Elizabeth and Rhodes University; and the Border; Eastern Cape and Port Elizabeth technikons. A total of 1 728 students were interviewed out of a student population of 30;080. Stratified random sampling was used to select the students. Two-way tables were used to test the independence of the variables and chi-square tests were applied. A 'p' value of below 5 was used as a test of significance. Results : A total of 1 480 students completed the questionnaires (86). The racial classification of the respondents was 79 Black; 13 White; 7 Coloured and 2 Indian. Twenty-six per cent of the students were smokers; of which 37 were male and 15 were female. Forty-five per cent of the Coloured students smoked; while the figures for Whites and Blacks were 26 and 25 respectively. Seventy per cent of the students smoked less than 10 cigarettes a day. Fifty-two per cent of the smokers said they wanted to stop smoking. Sixty-one per cent had been influenced to start smoking by their friends and only 13 were influenced by advertisements. Ninety-four percent agreed that smoking was dangerous to the smoker's health; while 73 responded that there was a relationship between mothers who smoke and low birth weight. Thirteen per cent thought the legislation was too tough; while 30 said it was good as it was. On measures to reduce smoking; 86 favoured restricting smoking in public places.Conclusion: This study has demonstrated that smoking is prevalent in tertiary institutions of learning in the Eastern Cape Province. The demographic profile of the smokers reflects the national picture. The knowledge of the harmful effects of smoking is generally good