Feasibility, acceptability, and effectiveness of visual inspection of the cervix with acetic acid and cryotherapy for dysplasia in Nigeria.

OBJECTIVE: To demonstrate the feasibility, acceptability, and effectiveness of visual inspection of the cervix with acetic acid (VIA) and treatment of dysplasia with cryotherapy in Nigeria. METHODS: A prospective study was conducted at Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria, between August 1, 2006, and July 31, 2009. Women aged 20-65 years who had had their sexual debut at least 3 years previously were screened for cervical dysplasia using VIA. Women with positive test results were offered cryotherapy immediately after screening. RESULTS: Overall, 5529 women (mean age 40.24 ± 10.33 years) underwent screening with VIA. Dysplasia was detected among 317 (5.7%) women. Lesions suspicious for cancer were recorded among 52 (1.0%) women; histological diagnosis of invasive cervical cancer was confirmed in 38 (0.7%) women. VIA was as expected or better for 5330 (96.4%) women screened. Cryotherapy was as expected or better for 219 (99.5%) women who received treatment. Among 127 women who underwent cryotherapy and had repeat screening, 121 (95.3%) had negative test results after 1 year. CONCLUSION: Cervical cancer screening using VIA and cryotherapy was feasible and effective despite scarce resources in the Nigerian health system. Furthermore, this approach was socially and culturally acceptable.

Trials and projects on cervical cancer and human papillomavirus prevention in sub-Saharan Africa.

Cervical cancer is the leading cause of cancer morbidity and mortality in women in sub-Saharan Africa (SSA), accounting for about 50,000 deaths annually. Until recently, cytology was the gold standard for screening and prevention of cervical cancer. This method of screening has not been successful in SSA due to a lack of human, financial and material resources and poor health care infrastructure. It is estimated that less than 5% of at risk women have ever being screened. In the past two decades alternative approaches to cytology for cervical cancer screening have been evaluated in low- and medium-income countries. Visual inspection with acetic acid (VIA) and/or Lugol's iodine (VILI) have been shown to have adequate sensitivity, although low specificity, in a number of cross-sectional research and demonstration projects. Visual inspection methods require minimal resources, are technologically accessible, and are feasible for screening for precancerous lesions. Linking screening with VIA/VILI to treatment with cryotherapy may enable screening and treatment to take place in one visit, but this is likely to result in large numbers of women being subjected to unnecessary treatment. A number of studies have shown that cryotherapy is not associated with significant side effects or complications and is well tolerated. Creating the infrastructure for screening of older women is considered desirable, despite the limitations of visual inspection methods as screening tests. Understanding the role of human papillomavirus (HPV) infection in the etiology of cervical cancer and the discovery of HPV rapid test kits, as well as the development of vaccines against the HPV oncogenic types, have created new opportunities for prevention of cervical cancer. Trials and projects have established (and are still ongoing) the feasibility of using these molecular tests for screening. The ultimate in prevention method is primary prevention, offered by the advent of prophylactic vaccines against the most important oncogenic types, namely HPV16 and 18. This article forms part of a regional report entitled "Comprehensive Control of HPV Infections and Related Diseases in the Sub-Saharan Africa Region" Vaccine Volume 31, Supplement 5, 2013. Updates of the progress in the field are presented in a separate monograph entitled "Comprehensive Control of HPV Infections and Related Diseases" Vaccine Volume 30, Supplement 5, 2012.

Pattern and factors affecting the outcome of pregnancy in hypertensive patients.

The pattern and factors affecting the outcome of pregnancy in hypertensive patients at the Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria between January 1997 and December 2002 were studied. There were 2,393 deliveries, with 127 (5.3%) patients fulfilling the criteria for hypertensive disorder of pregnancy. 26.2% had de-novo (gestational) hypertension, 19.7% had pre-eclampsia (PET) superimposed on chronic hypertension and 54.1% had PET/eclampsia. All patients with prepregnancy chronic hypertension had superimposed PET or eclampsia in this study. The PET/eclampsia group had the worst maternal and fetal outcomes as demonstrated by maternal mortality (6.1%), fetal mortality (36.4%), fetal respiratory distress (66.7%) and abruptio (6.1%). They also had more target organ damage (18.2%). 50.8% of these were categorized as high risk. Furthermore, patients in the PET/eclampsia group tended to be illiterate, attended antenatal clinic (ANC) less regularly and had more maternal and fetal adverse outcomes. Twenty percent of the patients had poorly controlled blood pressures (BP) at discharge, and only one out of five of the chronic hypertensive patients attended the medical hypertension clinic on discharge. These poor outcomes further emphasize the need for patient education; regular antenatal clinic attendance; prompt treatment of elevated BP; compliance with postnatal clinic follow-up, including medical outpatient care in these patients.