Education efforts may contribute to wider acceptance of human papillomavirus self-sampling.

BACKGROUND: Information about women's acceptance of new screening methods in Sub-Saharan Africa is limited. The aim of this study was to report on women's acceptance of human papillomavirus (HPV) self-sampling following an educational intervention on cervical cancer and HPV. METHODS: Women were recruited from the city of Tiko and a low-income neighborhood of Yaoundé, both in Cameroon. Written and oral instructions about how to perform an unsupervised HPV self-sample were given to participants, who performed the test in a private room. Acceptability of HPV self-sampling was evaluated by questionnaire. Participants previously screened for cervical cancer by a physician were asked additional questions to assess their personal preferences about HPV self-sampling. RESULTS: A sample of 540 women were prospectively enrolled in the study; median age was 43 years old (range 30-65 years). Participants expressed a high level of acceptance of HPV self-sampling as a screening method following information sessions about cervical cancer and HPV. Most expressed no embarrassment, pain, anxiety, or discomfort (95.6%, 87.8%, 91.3%, and 85.0%, respectively) during the information sessions. Acceptance of the method had no correlation with education, knowledge, age, or socio-professional class. Eighty-six women (16%) had a history of previous screening; they also reported high acceptance of HPV self-sampling. CONCLUSION: Educational interventions on cancer and HPV were associated with high acceptability of HPV self-testing by Cameroonian women. Further evaluation of the intervention in a larger sample and using a control group is recommended.

Impact of an educational intervention on women's knowledge and acceptability of human papillomavirus self-sampling: a randomized controlled trial in Cameroon.

OBJECTIVE: Human papillomavirus (HPV) self-sampling (Self-HPV) may be used as a primary cervical cancer screening method in a low resource setting. Our aim was to evaluate whether an educational intervention would improve women's knowledge and confidence in the Self-HPV method. METHOD: Women aged between 25 and 65 years old, eligible for cervical cancer screening, were randomly chosen to receive standard information (control group) or standard information followed by educational intervention (interventional group). Standard information included explanations about what the test detects (HPV), the link between HPV and cervical cancer and how to perform HPV self-sampling. The educational intervention consisted of a culturally tailored video about HPV, cervical cancer, Self-HPV and its relevancy as a screening test. All participants completed a questionnaire that assessed sociodemographic data, women's knowledge about cervical cancer and acceptability of Self-HPV. RESULTS: A total of 302 women were enrolled in 4 health care centers in Yaoundé and the surrounding countryside. 301 women (149 in the "control group" and 152 in the "intervention group") completed the full process and were included into the analysis. Participants who received the educational intervention had a significantly higher knowledge about HPV and cervical cancer than the control group (p<0.05), but no significant difference on Self-HPV acceptability and confidence in the method was noticed between the two groups. CONCLUSION: Educational intervention promotes an increase in knowledge about HPV and cervical cancer. Further investigation should be conducted to determine if this intervention can be sustained beyond the short term and influences screening behavior. TRIALS REGISTRATION: International Standard Randomised Controlled Trial Number (ISRCTN) Register ISRCTN78123709.

HPV self-sampling as primary screening test in sub-Saharan Africa: implication for a triaging strategy.

Our objective was (i) to assess if a self-collected test for human papillomavirus (HPV) may serve as a primary cervical cancer screening method in a low-resource setting, (ii) to evaluate its implication in a screen and treat approach and (iii) to identify the most eligible age group in a screening program. Women were recruited through a cervical cancer screening campaign conducted in Cameroon. Written and oral instructions were given to participants by a health-care professional to carry out an unsupervised self-collected HPV-test (Self-HPV), followed by a physician-collected cervical sample for HPV testing (Physician-HPV) and cytology. Differences in performance between Self-HPV versus Physician-HPV and their ability to detect abnormal cytology results (ASC-US+) were evaluated. Descriptive analyses were used to examine the correlation between HPV positivity and cervical abnormalities by age. A sample of 789 women was prospectively enrolled. HPV prevalence was 14.6% and 12.7% for Self-HPV and Physician-HPV, respectively (Cohen's kappa = 0.74). HPV positivity by cytological diagnosis for ASC-US+ was similar with the two tests. positive predictive value of the Self-HPV for ASC-US+ was 20.4; odds ratio and number needed to treat were 6.5 (3.2-13.4) and 6 (4.2-10.9), respectively. We observed a trend of increasing cytological abnormalities in 30-49 year-old women and a concomitant trend of decreasing HPV prevalence supporting that this age group might be the most eligible group for screening. In conclusion, Self-HPV can be used as a primary screening test but needs to be followed by a triaging test that would identify the subset of women affected by clinically significant precancer or cancer.

Human papillomavirus self-sampling in Cameroon: women's uncertainties over the reliability of the method are barriers to acceptance.

OBJECTIVE: The study aimed to assess acceptability and preference for self-collected human papillomavirus tests (self-HPV) compared with traditional physician-sampled Pap tests (physician sampling) in a low-resource country. MATERIALS AND METHODS: Women were recruited through a cervical cancer screening campaign conducted in Cameroon. Written and oral instructions were given to carry out an unsupervised self-HPV, followed by a physician-collected cervical sample for HPV testing and cytology. Subsequently the women were asked to answer a questionnaire. RESULTS: A total of 243 women were prospectively enrolled in this study. Median age of participants was 39 years (range = 25-65 years). Acceptability score was higher for self-HPV (p < .001) compared with physician sampling. Preference was lower for self-HPV than physician sampling (29% vs 62%; p < .001). Most participants thought that physician sampling was more reliable than self-HPV (59% vs 1%; p < .001). Women who preferred physician sampling were significantly more likely to have low knowledge about cervical cancer and a low educational level. CONCLUSIONS: Although most of the women were more comfortable and less embarrassed with the self-HPV, they did not trust the method and did prefer physician sampling. The study underlines the need not only to educate women about HPV, cervical cancer, and its prevention but also to reassure them about the accuracy of self-HPV.

Risk factors for hypertensive disorders in pregnancy: a report from the maroua regional hospital, cameroon.

INTRODUCTION: A recent study at the Maroua Provincial Hospital revealed that hypertension in pregnancy was the first cause of maternal death, representing 17.5% of the 63 maternal deaths recorded between 2003 and 2005. Knowing little about the causes, this study was to identify the possible risk factors for hypertensive disorders in pregnancy. METHODS: This case-control study was-done at the Maroua Regional Hospital, Cameroon between June 2005 and May 2007. All the 152 deliveries complicated with hypertension were compared and analyzed with 414 pregnancies that were not complicated with the disease. Data analysis was performed using EPI Info 3.5.1. The differences were considered to be significant if the p-values were less than 0.05. RESULTS: Using univariate analysis, several factors linked to hypertensive disorder in pregnancy were identified. They included early adolescence, nulliparity, illiteracy, lack of occupation and family history of hypertension. At multivariate analysis, the risk of having hypertension during pregnancy remained greater for illiterate women (OR: 1.6; 95%CI: 1.0-2.3), housewives (OR: 2.8; 95%CI: 1.1-6.9), nulliparae (OR: 2.8; 95%CI: 1.5-3.6), women with family histories of hypertension (OR: 3.6; 95%CI: 1.6-8.5) and women with histories of hypertension during pregnancy (OR: 7.0; 95%CI: 3.0-16.4). CONCLUSION: Risk factors for hypertensive diseases in pregnancy in Maroua, Cameroon seem to include early teenage status, illiteracy, housewife status, nulliparity and family or personal histories of hypertension. The knowledge about the aforesaid factors seems to lay the tracks for its prevention in Cameroon.