Trends in cervical pap smear cytology in a tertiary hospital: implications for cervical cancer screening in low-income countries

Introduction: An estimated 99% of largely preventable maternal deaths occur across developing regions characterized by a cascade of well-established delays at all levels. Data on community deaths remains scanty hence a wide reliance on institutional data. Target 3.1 of the SDG aims to attain a global reduction of less than 70/100000 live births by 2030. Ghana's MMR of 350/100000 live births is accounted for by commensurately high MMR across its 10 administrative regions. The MMR of the Eastern region, ranked among the top 5 by MMR, has exceeded the national average since 2011. Studies are largely cross sectional, not computing individual risk. This study aimed to (1) identify trends of institutional maternal deaths, (2) estimate magnitudes of individual risk with exposure to specific factors and (3) recommend preventive strategies. Methodology: Records on 479 maternal deaths were compared with 616 records on obstetric clients over the same period that did not die from 2011 - 2016 using an unmatched case control study design. Data were analyzed with epi info 3.5.4. Results: Maternal deaths were mainly direct. Controls were largely urban residents, with traceable addresses, engaged in formal occupations, of higher educational backgrounds and ANC attendants. Leading cause of death was obstetric hemorrhage. Most abortions, mainly cases, were unsafe. Mean maternal age was higher for cases. Maternal age of 11 - 20 and ≥ 35, rural residence, underlying medical conditions, informal occupations, multi- and grand multiparity increased risk of maternal deaths, while, ≥ SHS education and ANC ≥ 4 reduced risk of death. Recommendations: Health policies to address concerns of fertility control for adolescents and clients ≥ 35, inequitable access to CEmONC services, quality ANC, low literacy and awareness on the abortion law should be prioritized

Correlation between colposcopic impression and histologic diagnosis of premalignant lesions of the cervix

Background: Cervical cancer is the commonest cancer in sub-Saharan African with majority of the women presenting with an advanced disease stage. This is largely due to the unavailability of an established cervical cancer screening programme in most countries. This also includes the use of colposcopy which is still not available to many gynaecologists practicing in Nigeria. Aim: To review reports of colposcopy carried out at the University of Abuja Teaching Hospital, Abuja, Nigeria and to determine the degree of concurrence between colposcopic impression and histologic diagnosis. Methods: A retrospective analysis of the colposcopic findings of 84 patients was done. Subsequent correlation with histopathology report was carried out in 53 patients who had colposcopically directed biopsies between March 2012 and February 2014. Results: The commonest impression made on colposcopy was high grade CIN in 40(47.6%) patients. The concurrence rate between colposcopic findings and histology diagnosis was 64.2% (34/53) {K =0.302, 95%CI= -0.010-0.436}. The concurrence rate was higher for high grade CIN 29/40(72.5%) than for low grade CIN 5/12 (41.7 %). There was an overestimation of colposcopic diagnosis in 13(24.5%) patients and an underestimation in 6(11.3%) patients. The sensitivity of colposcopy for detecting high grade lesions or more was 32/36(88.9%) while the specificity was 8/17(47.1%). False positive rate for high grade lesions was 9/17(52.9%) and false negative rates for low grade lesions was 4/36(11.1%). Positive predictive value (PPV) of high grade colposcopic diagnosis or more was 32/41(78.04%) while the negative predictive value (NPV) was 8/12(66.73%). Conclusion: The strength of agreement between colposcopic diagnosis and cervical pathology was fair and colposcopy performs better in the detection of high grade lesions

An exploration into the quality of life of women treated for cervical cancer

Background: Cervical cancer mainly occurs among women from the developing world, and women face unique challenges in terms of their disease and treatment. Most women present with advanced cervical cancer and receive the standard curative treatment with external beam radiotherapy and brachytherapy with or without chemotherapy. Objectives: To describe the quality of life (QOL) of women treated for cervical cancer during treatment (M0), at 6 months after completing treatment (M6) and at 12 months after treatment (M12).Methods: A cross-sectional design, calculated sample size (n = 153) and convenience sampling were used. Data were collected through structured interviews, and the EORTC QLQ-C30 and EORTC QLQ CX24 served as data collection instruments. Descriptive statistics were used to analyse the data, and the Kruskal­Wallis H test was used to compare the mean responses across the groups (p ≤ 0.05).Results: The mean age of the respondents was 50.6 years (standard deviation [SD] 11.9). The global health status improved significantly in contrast with the functional scores. Financial difficulties were rampant, especially during the treatment phase. Insomnia and urinary frequency were the most cumbersome problems and remained so even after treatment.Conclusions: Despite an improvement in the global health, cervical cancer and its treatment had a negative influence on the QOL in all domains of lives of these women. Assessing the QOL of patients during treatment and follow-up visits would allow nurses to develop interventions to address distressing problems timeously. In addition, Africa's nurses should assess social functioning and develop programmes to prevent social dysfunction

Epidémiologie de l'infection à HPV en Région semi-urbaine du Cameroun: l'expérience du District de Santé de Baham, Ouest-Cameroun

Introduction. Les vaccins contre le HPV ciblent de façon privilégiée les papillomavirus humains 16 et 18. La distribution géographique de ces génotypes reste peu connue au Cameroun, ce qui a justifié notre étude. Méthodologie. Nous avons réalisé une étude transversale descriptive et analytique auprès de 157 femmes à l'hôpital de District de Baham-Ouest Cameroun. La détection et le typage des génotypes ont été obtenus par PCR à temps réel. Les analyses statistiques ont été réalisées à partir du logiciel Epi Info 3.5.1. Le test de Khi2 et de Fisher ont été utilisés pour la comparaison des taux. Une différence était considérée comme statistiquement significative lorsque p < 0.05. Résultats. Parmi les 157 prélèvements que nous avons analysés, nous avons eu 26 (16.6%) cas de positivité au HPV de haut risque, [IC à 95% (11.1-23.3%)]. Les génotypes vaccinaux (HPV 16 et, HPV 18) représentaient 30,8% de l'effectif. Le risque d'être infecté au HPV était doublé en cas d'analphabétisme [OR : 1,84(0,57-5,90) ; p=0,25], de premiers rapports sexuels pendant la jeune adolescence [OR : 2,18(0,79-6,01) ; et de recours à la contraception injectable [OR : 1,84(0,41-7,79), p=0,46].Comparées aux femmes négatives au HPV, les femmes avec infection à HPV avaient souvent une anomalie cytologique (23,5 vs 5,1 ; p=0.01). Conclusion. Dans le district de santé de Baham, les génotypes vaccinaux sont minoritaires. Le risque d'être infecté au HPV est doublé en cas d'analphabétisme, de début de rapports sexuels pendant la jeune adolescence et de recours à la contraception injectable

Screening for cervical cancer in Senegal: Contributing factors

Context: Cervical cancer is first cancer in women in Africa. The disease is often diagnosed at a late stage. Aims: The purpose of this survey is to study the factors of cervical cancer screening. Settings and Design: This is a descriptive and analytical cross-sectional survey carried out in the health district of Thiès in Senegal. Subjects and Methods: Sampling was in two-stage clusters. The data were collected during an individual interview at home. The collection focused on knowledge, attitudes, and practices on cervical cancer. Statistical Analysis Used: Logistic regression was used for data analysis. Results: A total of 498 women were interviewed; 77% of them lived in urban areas, 38% have not been to school, and 82% were married. Nearly, 82.7% of them have already heard about the disease. Infection was the most reported risk factor (55.8%). The screening practice was 35.5% in our sample. Nonschooling reduced screening, while women living in urban areas were seven times more likely to be screened. Screening increased from the poorest quartile to the richest quartile. The knowledge of risk factors and the possibility of recovery increased by 4.80 and 2.34, respectively, the chance of being screened. Conclusions: Improved screening requires multiple strategies that target particularly poor uneducated people living in rural areas but also the strengthening of the capacity of health-care providers

Extension du depistage du cancer du col uterin par inspection visuelle aux centres de sante communautaire du District de Bamako

Le cancer du col de l'uterus demeure un probleme de sante publique dans les pays en developpement. Le present travail constitue un bilan d'une etude multicentrique basee sur l'inspection visuelle du col apres application d'acide acetique (IVA) et de lugol (IVL). L'objectif assigne a ce travail est de determiner la faisabilite et l'impact de ce depistage au niveau des centres de sante communautaires du district de Bamako. Il s'agissait d'une etude prospective multicentrique a travers 8 CSCOM; 3 Centres de Sante de Reference (CSRef); l'Hopital Gabriel Toure (HGT) et l'Institut National de Recherche en Sante Publique (INRSP) de Bamako. Sur une periode de 28 mois; 5016 femmes agees de 25 a 49 ans ont ete depistees. Apres un consentement eclaire; la fiche d'enquete est remplie. La patiente etait confortablement installee sur une table gynecologique pour le depistage. La repartition des femmes depistees selon le niveau de la pyramide sanitaire se fait comme suit : CSCOM (19;24: 965/5016); CSRef (48;64: 2440/5016); HGT (32;12: 1611/5016). De facon generale; la positivite des tests etait la suivante : 5;2pour l'IVA et 6;8pour l'IVL. Les femmes positives au niveau des CSCOM etaient orientees vers un CSRef ou l'HGT pour la colposcopie; une biopsie eventuelle et la prise en charge. Sur 177 biopsies effectuees; les diagnostics suivants ont ete observes : 67 dysplasies; 3 carcinomes micro-invasifs; 69 carcinomes invasifs et 38 lesions inflammatoires; metaplasiques ou non concluantes. Les patientes presentant des lesions dysplasiques ou tumorales ont ete traitees par cryotherapie; conisation; resection a l'anse diathermique ou par la chirurgie. Ce travail montre que le depistage du cancer du col par les methodes visuelles est realisable au niveau des CSCOM. Nous recommandons une large diffusion de la methode sur tout le territoire national

Experience : à propos de dix ans de dépistage cytologique systématique des lésions précancereuses du col uterin au CHU de Dakar

Le cancer du col de l'uterus est l'un des cancers pour lesquels il y a eu dans les pays du Nord; les plus grandes modifications au cours des 20 dernieres annees. Il en est autrement en Afrique intertropicale ou le test de papanicolaou est d'introduction recente et ou l'accumulation des facteurs ethiopathogeniques defavorables potentialise le risque de cancer du col

Exfoliative cytology in the detection of cervical cancer in Uganda

Walshe in 1851 observed fragments of malignant tissue in sputum; and duggeon and Patrick examined scrapings of tissues for malignant cells. In 1928; Papanicolaou used a similar wet fixation technique for diagnosing cancer of the female genital tract; although his classic paper with Traut was not published until 1943. Exfoliative cytology can now be applied to the study of sputum; stomach washings; pleural; ascitic and cerebrospinal fluids; aspirates; breast secretion and rectal and colonic specimens but it is in the cervix uteri that it is still of maximum value and most frequently used. Cervical cytology may be investigated to determine the hormonal status of the patient and thus serve as a guide to therapy. A second use is as an adjunct to other conventional diagnostic aids where there is an somiasis or tuberculosis. A third and more important use is in the detection of cancer in the population at large. It is this latter application that holds the greatest possibilities; has excited the greatest interest and is the subject of this paper. A group of women who would not otherwise be suspected of having cancer may be identified at a stage before the malignant process has become invasive; when it has an excellent prognosis and when it is treatable by limited surgery which is not mutilating; leaving the patient free incertain cases to have further children