Perception and risk factors for cervical cancer among women in northern Ghana.

OBJECTIVE: This study assessed the perception of risk of cervical cancer and existence of risk factors for cervical cancer based on five known risk factors among women attending the Tamale Teaching Hospital in Tamale, Ghana. METHODS: A consecutive sample of 300 women was interviewed using a semi-structured questionnaire to inquire about risk factors and perception of risk of cervical cancer. Specific risk factors that were explored included early coitarche, multiple sexual partners, polygamous relationships, history of smoking, and having a current partner who had multiple sexual partners. RESULTS: Sixty-one per cent of women reported that they had no personal risk for cervical cancer. 27% of respondents were in polygamous relationships, and of those, more than half didn't think they were at an increased risk of cervical cancer. 2 women had a total of ≥ 5 sexual partners in their lifetime and neither believed they were at any risk for cervical cancer. 23% said their current partner had had at least 2 sexual partners in his lifetime, and of those, (61%) thought they were at no risk for cervical cancer. 46% of respondents reported not having any of the risk factors listed in the study. 23% of respondents reported having one risk factor while 21% had two risk factors and 11% had three or more risk factors. CONCLUSION: Women's perception of personal risk for cervical cancer is lower than their actual risk based on the five behavioural risk factors assessed and a lack of knowledge of the personal factors for the disease. FUNDING: This project was supported by NIH Research Training Grant #R25 TW009345 funded by the Fogarty International Centre, in partnership with several NIH Institutes (NIMH, NIGMS, NHLBI, OAR and OWH).

A low-cost simulator for learning to manage postpartum hemorrhage in rural Africa.

INTRODUCTION: Postpartum hemorrhage (PPH) is the leading cause of maternal mortality in Africa and Asia. Despite an UN Millennium Development Goal to reduce maternal mortality rates, no significant effect has resulted to date, in large part because women in these areas give birth in rural communities with poor access to definitive care. Traditional birth attendants (TBAs) provide care for delivering mothers; however, they are neither trained nor equipped to recognize or manage PPH as a life-threatening emergent condition. The purpose of this study was to design and evaluate a low-cost, portable simulator for training TBAs and nurse midwives in the use of bimanual compression to manage PPH. METHODS: Clinicians in USA and Ghana were consulted to develop the engineering specifications, including low cost, long lifetime, easy to use, portable, and high anatomic and procedural fidelity. Pugh charts were used to finalize the design from multiple concepts. The simulator was built and evaluated for validity by American and Ghanaian obstetricians, nurse midwives, midwifery students, and TBAs. The feasibility of the simulator for training illiterate learners was also assessed. RESULTS: The simulator was evaluated to be an effective training platform with excellent fidelity and valid feedback mechanisms. It was demonstrated to be a feasible platform for training illiterate TBAs to perform bimanual compression. CONCLUSIONS: The low cost, portable simulator developed for this project has the potential to reduce maternal mortality from PPH in the developing world. Research is ongoing in this application.