Situational analysis for diagnosis and treatment of cervical cancer in mainland Tanzania.

OBJECTIVE: To determine factors influencing early diagnosis and treatment of cervical cancer in Tanzania women. DESIGN: A cross-sectional study. SETTING: Forty primary health care facilities, twenty district/regional and four referral (tertiary) hospitals in mainland Tanzania. RESULTS: The most basic equipment for cytology-based cervical cancer were available at all health care facilities. However, screening against cervical cancer was appallingly inadequate at all levels of health care delivery system. Apart from medical doctors at tertiary level, other medical personnel including nurses were poorly or hardly utilised for cervical cancer screening. Treatment facilities for pre-cancerous lesions in most district, regional and even tertiary hospitals were inadequate or non-existent despite being very simple, cheap and yet very effective. There was total lack of organised institutional or national policy guidelines on cervical cancer screening in Tanzania. CONCLUSION: There is an urgent need to introduce systematic screening against cervical cancer and treatment of precursor lesions at all levels of health care delivery system in Tanzania. A national policy guideline should be urgently drawn addressing specifically frequency of screening and at what age to start screening.

Situation analysis for cervical cancer diagnosis and treatment in east, central and southern African countries.

OBJECTIVE: To determine the factors influencing cervical cancer diagnosis and treatment in countries of East, Central and Southern Africa (ECSA). METHODS: Data were collected from randomly selected primary health care centres, district and provincial hospitals, and tertiary hospitals in each participating country. Health care workers were interviewed, using a questionnaire; the facilities for screening, diagnosing, and treating cervical cancer in each institution were recorded, using a previously designed checklist. FINDINGS: Although 95% of institutions at all health care levels in ECSA countries had the basic infrastructure to carry out cervical cytology screening, only a small percentage of women were actually screened. Lack of policy guidelines, infrequent supply of basic materials, and a lack of suitable qualified staff were the most common reasons reported. CONCLUSIONS: This study demonstrates that there is an urgent need for more investment in the diagnosis and treatment of cervical cancer in ECSA countries. In these, and other countries with low resources, suitable screening programmes should be established.

Evaluation of a human papillomavirus assay in cervical screening in Zimbabwe.

OBJECTIVE: To determine the utility of an assay for high risk genital human papillomavirus (HPV) in cervical screening in Zimbabwe, Africa. DESIGN: Cross-sectional study. SETTING: Harare, Zimbabwe. POPULATION: Zimbabwe women (n = 2,140), 25 to 55 years old, recruited in clinics in Chitungwiza and Greater Harare. METHODS: Genital specimens were assessed for HPV, using the HPV DNA test Hybrid Capture II (probe B). Further assessment of the women was conducted using colposcopy and biopsy as indicated. High grade squamous intraepithelial lesions were diagnosed in 215 women. Colposcopy and/or biopsy showed low grade lesions in 346 women. RESULTS: The overall prevalences were: 42 x 7% for HPV, 10% for high grade squamous intraepithelial lesions and 16% for low grade lesions. Prevalence for HPV decreased significantly with increase in age (P for trend < 0 x 0001) and increased significantly with increasing disease severity, from 35% in normal women, to 53% in women with low grade lesions and 81% in women with high grade lesions (P for trend < 0 x 001). In specimens positive for HPV, the amount was 14-fold higher in women with high grade lesions compared with normal women. In screening for high grade lesions the assay for HPV had a sensitivity of 81% (CI 75%-86%); sensitivity for low grade lesions was 64% (CI 60%-68%). Specificity was 62% (CI 59%-64%) for high grade lesions and 65% (CI 62%-67%) for low grade lesions. The positive predictive value was 19% (CI 17%-22%) for high grade lesions and 39% (CI 36%-42%) for low grade lesions. CONCLUSION: For high grade squamous intraepithelial lesions the sensitivity of the Hybrid Capture II HPV DNA test was high, but the specificity was relatively low. The test may therefore be most useful in conjunction with other screening tests.

Situation analysis for cervical cancer diagnosis and treatment in Zimbabwe.

OBJECTIVE: To establish factors influencing early diagnosis and treatment of cervical cancer in Zimbabwean women. DESIGN: A cross sectional study. SETTING: A random selection of 29 primary health care facilities, 11 district/provincial and four tertiary hospitals in Zimbabwe. RESULTS: All the institutions at primary health care, district, provincial and tertiary levels had the basic infrastructure to perform exfoliative cytology screening (Pap. smear). An average of only nine pap. smears per month were performed at primary health clinics and at district/provincial and tertiary levels seven and 23 Pap. smears per week were done respectively. Infrequent supplies of consumable materials and lack of policy guidelines were the most common reasons for not screening women. Surgical treatment for cervical cancer was offered in all tertiary hospitals but only 22% of provincial hospital had facilities to perform hysterectomy. CONCLUSION AND RECOMMENDATIONS: There is an urgent need to improve screening for cervical pre-cancer in Zimbabwean women with emphasis to provide adequate treatment facilities especially at district and provincial Hospitals. A national policy guideline should be drawn to address specific ages and frequency of screening for cervical cancer.

Cost-effectiveness of managing abortions: manual vacuum aspiration (MVA) compared to evacuation by curettage in Tanzania.

Cost effectiveness of managing 107 incomplete abortions by manual vacuum aspiration (MVA) is compared with management of 92 incomplete abortions by evacuation by curettage (E by C) at Muhimbili Medical Centre (September-November 1992). Pre-evacuation waiting times, duration of procedures and duration of hospital stay were less for MVA as compared to E by C. The total pre-evacuation waiting time, the durations of the procedure and hospital stay were 15.59 days (55.11%), 10.96 (46.41%) hours and 21.23 (40.53%) days less for MVA as compared to E by C. The direct costs revealed a cost differential of MVA over E by C of Tshs 776.9 (US$2.6). MVA is more cost effective than contemporary E by C and its introduction on a wider scale in our health care delivery system is recommended.

Newborn's arm circumference as a screening tool of low birth weight in Temeke District, Dar es Salaam, Tanzania.

To determine the extent to which newborn's mid-upper-arm circumference (MUAC) could be used as a screening tool for low birth weight (LBW), we examined a total of 601 full-term singleton babies delivered at Temeke District Hospital in Dar es Salaam, Tanzania, between January and April 1992. The mean birth weight and standard deviation (SD) was 2826 (+/- 436) g and the MUAC (SD) 9.9 (+/- 0.8) cm with a correlation coefficient of 0.88 between MUAC and birth weight (p = 0.0001). The percentage of LBW (< 2500 g) and an arm circumference below 9.5 cm were 18.8% and 11.8%, respectively. Use of 9.5 cm measurement as a cut-off point in MUAC was found to be a significant predictor of low birth weight. The sensitivity, specificity and positive predictive value were 57.5%, 98.8% and 91.6%, respectively. Newborns with a mid-upper-arm circumference < 9.5 cm were 10 times more likely to have a LBW compared with an arm circumference > or = 9.5 cm (p = 0.0001). In places where the conventional scales are not readily available MUAC of 9.5 cm could be used as a method to screen LBW babies in Tanzania. Significant maternal factors associated with LBW at the first antenatal clinic (ANC) booking included: weight < 43.5 kg, height < 150 cm, age of 14 to 19 years, positive malaria parasitemia and previous history of LBW. It is recommended that subjects with the above risk factors at ANC booking should be advised to deliver in hospital.

PIP: In Tanzania, health workers compared the birth weight of 627 newborns delivered at Temeke District Hospital in Dar es Salaam during January-April 1992 with their mid-upper-arm circumference (MUAC) to determine whether the MUAC could be used as an indicator of low birth weight (LBW) (2500 g) among newborns. The birth weight ranged from 1000 to 4400 g. The MUAC ranged from 7.5 to 13 cm. Around 18.8% of the newborns were LBW. 11.8% had an MUAC less than 9.5 cm. The researchers determined that 9.5 cm is the cut-off point in MUAC and a significant predictor of LBW. The sensitivity, specificity, positive predictive value, and negative predictive value for an MUAC of 9.5 cm were 57.5%, 98.8%, 91.6%, and 90.9%, respectively. The correlation coefficient between MUAC and birth weight was 88% and significant and positive (p = 0.0001). There was an 82.4% difference in LBWs with an MUAC less than 9.5 cm compared with those with an MUAC equal to or greater than 9.5 cm (p = 0.0001). Newborns with an MUAC less than 9.5 cm were 10 times more likely to weigh less than 2500 g than those with an MUAC equal to or greater than 9.5 cm (p = 0.0001). Significant maternal risk factors related to LBW were maternal weight less than 43.5 kg (odds ratio [OR] = 2.9), age of 14-19 years (OR = 1.5), height less than 150 cm (OR = 1.3), positive malaria parasitemia (OR = 1.3), and previous history of LBW (OR = 1.5). These findings suggest that, under conditions where conventional scales are not available (e.g., at the primary health care level), an MUAC of 9.5 cm could be used to screen newborns for LBW.

Evaluation of tolerance of and response to iron dextran (Imferon) administered by total dose infusion to pregnant women with iron deficiency anemia.

Six hundred twenty-three pregnant women with iron deficiency anemia received iron dextran Imferon by total dose infusion (TDI). Two dose levels were compared in respect of tolerance and hemoglobin response. The incidence of delayed reactions was significantly higher in the high dose group (P less than 0.01) but there was no significant difference in the incidence of reactions occurring during the infusion. These findings are discussed in relation to the hemoglobin response.