Hepatitis B vaccine birth dose coverage among hepatitis B-exposed and hepatitis B-unexposed infants: evidence from the Healthy Beginning Initiative program in Benue State, Nigeria.

Introduction: Nigeria offers universal hepatitis B birth-dose vaccine (HepB-BD) for the prevention and control of hepatitis B (HepB). While prior studies suggest low coverage of HepB-BD in Nigeria, there is a paucity of evidence on the association between the uptake of HepB-BD and maternal HepB status. This study aimed to determine HepB-BD coverage and the associated factors among infants of HepB-positive and -negative women in Nigeria. Methods: the study was a secondary analysis of data from the Healthy Beginning Initiative program conducted between June 2016 and October 2018 in Benue State, Nigeria. The analysis was restricted to data from a cohort of 6269 mothers who had HepB screening during pregnancy and completed the HepB infant immunization question in the post-delivery survey. The association between the coverage of HepB-BD and maternal HepB status, sociodemographic characteristics, and obstetric factors were determined using crude and adjusted relative risks. Results: about 10% of the women tested HepB positive. The coverage of HepB-BD was 64% (63.2% among infants of HepB-positive mothers and 63.8% among HepB-negative mothers). The likelihood of infants of HepB-positive mothers receiving HepB-BD was not significantly different from infants of HepB-negative mothers (aRR=0.97, 95%CI= 0.92-1.04). Among HepB-positive mothers, infants of mothers younger than 20 years (aRR=1.49, 95%CI=1.03-2.16) or those who received antenatal care (aRR=1.41, 95%CI=1.16-1.71) were more likely to receive HepB-BD, while mothers with no previous pregnancies (aRR=0.73, 95%CI=0.59-0.91) were less likely to receive HepB-BD. Among HepB-negative mothers, infants of less-educated mothers were less likely to receive HepB-BD (aRR=0.96, 95%CI=0.92-0.99), whereas infants of mothers who received antenatal care (aRR=1.23, 95%CI=1.16-1.31) or had an institutional delivery were more likely (aRR=1.29, 95%CI=1.23-1.36) to receive HepB-BD. Conclusion: our findings highlight the need to improve HepB-BD uptake, particularly among HepB-exposed infants who are at risk of perinatal transmission of HepB.

Comparative effectiveness of implementation strategies for Accelerating Cervical Cancer Elimination through the integration of Screen-and-treat Services (ACCESS study): protocol for a cluster randomized hybrid type III trial in Nigeria.

BACKGROUND: Despite the increased risk of cervical cancer (CC) among women living with HIV (WLHIV), CC screening and treatment (CCST) rates remain low in Africa. The integration of CCST services into established HIV programs in Africa can improve CC prevention and control. However, the paucity of evidence on effective implementation strategies (IS) has limited the success of integration in many countries. In this study, we seek to identify effective IS to enhance the integration of CCST services into existing HIV programs in Nigeria. METHODS: Our proposed study has formative and experimental activities across the four phases of the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework. Through an implementation mapping conducted with stakeholders in the exploration phase, we identified a core package of IS (Core) and an enhanced package of IS (Core+) mostly selected from the Expert Recommendations for Implementing Change. In the preparation phase, we refined and tailored the Core and Core+ IS with the implementation resource teams for local appropriateness. In the implementation phase, we will conduct a cluster-randomized hybrid type III trial to assess the comparative effectiveness of Core versus Core+. HIV comprehensive treatment sites (k = 12) will be matched by region and randomized to Core or Core+ in the ratio of 1:1 stratified by region. In the sustainment phase, we will assess the sustainment of CCST at each site. The study outcomes will be assessed using RE-AIM: reach (screening rate), adoption (uptake of IS by study sites), IS fidelity (degree to which the IS occurred according to protocol), clinical intervention fidelity (delivery of CC screening, onsite treatment, and referral according to protocol), clinical effectiveness (posttreatment screen negative), and sustainment (continued integrated CCST service delivery). Additionally, we will descriptively explore potential mechanisms, including organizational readiness, implementation climate, CCST self-efficacy, and implementation intentions. DISCUSSION: The assessment of IS to increase CCST rates is consistent with the global plan of eliminating CC as a public health threat by 2030. Our study will identify a set of evidence-based IS for low-income settings to integrate evidence-based CCST interventions into routine HIV care in order to improve the health and life expectancy of WLHIV. TRIAL REGISTRATION: Prospectively registered on November 7, 2023, at ClinicalTrials.gov no. NCT06128304. https://classic. CLINICALTRIALS: gov/ct2/show/study/NCT06128304.

AVIVA: a telehealth tool to improve cervical cancer screening in resource-constrained settings.

Cervical cancer accounts for 21.7% of all cancer deaths in the sub-Saharan Africa with a case fatality rate of 68%. Nigeria's Federal Ministry of Health has adopted cervical cancer screening (CCS) using visual inspection with acetic acid or Lugol's iodine (VIA/VILI) and cryotherapy treatment for precancerous lesions as the preferred screening and treatment strategy. Using the Exploration, Preparation, Implementation and Sustainment Framework, our study documents our experience during the development, piloting and roll-out of the APIN Public Health Initiatives (APIN)-developed VIA Visual Application (AVIVA) for CCS using the VIA method in 86 APIN-supported health facilities across 7 states in Nigeria. Between December 2019 and June 2022, with the aid of 9 gynaecologists and 133 case finders, a total of 29 262 women living with HIV received VIA-based CCS and 1609 of them were VIA-positive, corresponding to VIA positivity rate of 5.5%. Over the 30 months duration and the 5 phases of CCS scale-up, AVIVA development and expansion, a total of 1247 cases were shared via the AVIVA App (3741 pictures), with 1058 of such cases undergoing expert review, corresponding to a reviewer rate of 84.8%. Overall, the use of the AVIVA App improved both the VIA-positive and VIA-negative concordance rates by 16 percentage points each (26%-42% and 80%-96%, respectively) from baseline to the end of the study. We concluded that the AVIVA App is an innovative tool to improve CCS rates and diagnostic precision by connecting health facility staff and expert reviewers in resource-limited settings.

Evaluating the hemostatic effects of tranexamic acid in women with pre-eclampsia.

OBJECTIVE: To evaluate the hemostatic effects of tranexamic acid (TXA) ex vivo in women with pre-eclampsia. METHODS: This was an ex vivo study involving 45 normal pregnant women and 45 women with pre-eclampsia (nine with mild and 36 with severe features) matched for age, gestational age, and body mass index. Blood samples were collected and divided into two parts. The first served as the pre-TXA sample, while the second was spiked with TXA and served as the post-TXA sample. Plasma levels of D-dimer and plasmin-antiplasmin complex (PAP) were determined using enzyme-linked immunosorbent assay. RESULTS: The mean D-dimer and PAP values in the pre-TXA samples differed significantly between groups. Following spiking with TXA, the mean D-dimer and PAP levels did not differ significantly in the pre-TXA and post-TXA samples (P = 0.560 and P = 0.500, respectively) in the pre-eclampsia cohort. In normal pregnancy, the mean D-dimer and PAP levels in the post-TXA samples did not differ significantly (P = 0.070 and P = 0.050, respectively) from the pre-TXA samples following TXA spiking. CONCLUSION: TXA did not significantly affect D-dimer and PAP levels in pre-eclampsia, suggesting that TXA may not increase the thrombotic risks in patients with pre-eclampsia.

Postnatal care services use by mothers: A comparative study of defaulters versus attendees of postnatal clinics in Enugu.

INTRODUCTION: Despite much emphasis on the reproductive health of women, maternal mortality is still high, especially in postnatal period. OBJECTIVE: To assess the prevalence of postnatal care use and reasons for defaults among mothers attending the child immunization clinics in Enugu, Nigeria. METHODS: This was a cross-sectional comparative study of 400 consecutive nursing mothers who presented at the Institute of Child Health of UNTH and ESUTH, Enugu for Second dose of the Oral Polio Vaccine (OPV2) for their babies at 10 weeks postpartum. Data was collected using Interviewer-administered questionnaire and subsequently analyzed with version 22.0 IBM SPSS software, Chicago, Illinois. A p-value of less than 0.05 was considered as statistically significant. RESULT: The prevalence of the 6th week postnatal clinic attendance among the mothers was 59%. The majority of the women (60.6%) who had antenatal care by skilled birth attendants attended postnatal clinic. Unawareness and being healthy were the main reasons for not attending postnatal clinic. Following multivariate analysis, place of antenatal (OR = 2.870, 95% C.I = 1.590-5.180, p < 0.001) and mode of delivery (OR = 0.452, 95% C.I = 0.280-0.728, p = 0.001) were the only significant predictors of postnatal clinic attendance (p < 0.05). CONCLUSION: Postnatal clinic attendance by women in Enugu is still suboptimal. The main reason for non-attendance of the 6th week postnatal clinic was lack of awareness. There is need for healthcare professionals to create awareness about the importance of postnatal care and encourage mothers to attend.

Physical Activity and Outdoor Leisure Time Physical Exercise: A Population Study of Correlates and Hindrances in a Resource-Constrained African Setting.

PURPOSE: The study evaluated the burden of physical inactivity, its correlates, and the self-reported hindrances to outdoor leisure-time physical exercises in Enugu Nigeria. It also evaluated the prevalence of leisure-time outdoor physical exercise and its correlates in Enugu Nigeria. PATIENT AND METHODS: This is a cross-sectional household survey involving 6628 individuals aged 20 to 60 years from 2848 households in Enugu Nigeria. Binary logistic regression and multinomial regression analyses were carried out as appropriate. Estimates were weighted to account for the actual population distribution of important sociodemographic variables and reported with the 95% confidence interval. RESULTS: The burden of physical inactivity was 32.68% (95% CI: 31.24-34.12%). Urban dwellers were less likely to be physically active than rural dwellers (AOR = 0.477; 95% CI = 0.410-0.555). For each year increase in age, the odds of being physically active decreases by a factor of 0.993 (AOR = 0.993; 95% CI= 0.988-0.998). Gender, income level and education did not predict physical inactivity. Physical inactivity significantly increases the odds of being obese by a factor of 1.428 (AOR: 1.428; 95% CI: 1.190-1.714). Only 6.45% (95% CI: 5.82%-7.09%) participants reported at least once a week outdoor leisure-time physical exercise. The major barriers include lack of time and lack of interest in outdoor leisure-time physical exercise. CONCLUSION: The burden of physical inactivity is high, while the level of outdoor physical exercise is low in Enugu, Nigeria. Urban dwelling and increasing age are risk factors for physical inactivity. Living in urban areas, being less than 40 years of age, having a university education, and a high personal income are factors that positively drive outdoor leisure-time physical exercises. Policies that will promote awareness of the health benefits of physical activity and outdoor physical exercise are needed if Nigeria is to achieve the global mandate of reducing physical inactivity by 10% in the year 2025.

Association between obesity and abnormal Papanicolau(Pap) smear cytology results in a resource-poor Nigerian setting.

BACKGROUND: Though obesity is associated with some malignancies, its association with cervical cancer is still inconclusive. This study was aimed at determining if there was an association between obesity and cervical epithelial cell abnormalities (CEA). METHODS: This was a cross-sectional comparative study of obese and non-obese women at the Cervical Cancer Screening Clinic, University of Nigeria Teaching Hospital (UNTH), Enugu between January, 2012 and June, 2013. The participants whose body mass index (BMI) were ≥ 30 kg/m2 were classified as obese (200 women) while those whose BMI were < 30 kg/m2 were classified as non-obese (200 women) and the two groups were consecutively recruited at the ratio of 1:1. Pap smear cytology, random blood sugar (RBS) and human immune-deficiency virus (HIV) screening was done for all the participants. Data was analyzed with SPSS version 20. Categorical variables were analyzed using McNemar's test and Chi-squared test. Logistic regression analysis was used to determine the influence of socio-demographic characteristics on cervical epithelial cell abnormalities. The level of significance was set at ≤0.05. RESULTS: Among the obese women, 152(76%) had negative for intra-epithelial lesion or malignancy (NILM) while 48(24%) had cervical epithelial cell abnormalities (CEA). Also 182(91%) non-obese women had NILM while the remaining 18(9%) had CEA. The prevalence of CEA among all the study participants was 16.5%. There was an association between obesity and CEA[OR (95%CI) = 1.353(1.013-1.812); P-value = 0.04].CEA were significantly more common among women who were 40 years and above and single/separated women as well as widows (P-value = < 0.05). CONCLUSION: There was an association between obesity and CEA. This underscores the need for a positive behavioural change among women in order to stem the tide of this public health problem.

Thermo-coagulation versus cryotherapy for treatment of cervical precancers: A prospective analytical study in a low-resource African setting.

AIMS: To evaluate the outcomes of cryotherapy and thermo-coagulation in the treatment of cervical precancers. METHOD: Prospective analytical study. Women who screened positive to visual inspection with acetic acid and confirmed by colposcopy using the Swede's score were randomized to receive either cryotherapy or thermo-coagulation. Participants were re-evaluated 6 months later. RESULTS: A total of 11 124 women were screened. Only 1023 of the 1294 colposcopically confirmed positive cases were eligible for ablative therapy. Five hundred and twelve women received cryotherapy while 511 women received thermo-coagulation. Cryotherapy had similar cure rate with thermo-coagulation (85.5 vs 89.2%, P = 0.09). The mean patient satisfaction score for thermo-coagulation was higher than that for cryotherapy (3.9 ± 1.3 vs 2.8 ± 1.7; P < 0.0001). The mean duration of treatment per patient was higher for cryotherapy than thermo-coagulation (660.0 ± 0.0 vs 50.9 ± 15.3 s, P < 0.0001). The mean cost of treatment per patient was significantly higher for cryotherapy than for thermo-coagulation (2613.1 ± 254.9 vs 533.2 ± 45.2 Nigerian Naira, P < 0.0001). Higher proportion of women who had thermo-coagulation reported no side effect (55.2 vs 12.5%, P < 0.0001). CONCLUSION: Cryotherapy and thermo-coagulation have similar efficacy in the treatment of cervical precancers. Thermo-coagulation offers lower cost and lower duration of treatment, less side effects and higher patient satisfaction than cryotherapy. Thermo-coagulation should be the recommended ablative treatment method for low-resource settings of the world.

Prevalence and sociodemographic determinants of adult obesity: a large representative household survey in a resource-constrained African setting with double burden of undernutrition and overnutrition.

BACKGROUND: The obesity epidemic has continued to spread across the globe involving even poor nations of the world. METHOD: Household population survey of adults aged 20-60 years. Multistage stratified cluster randomised sampling involving both urban and rural statewide representative population samples. Anthropometric measurements were taken using standard methods. Prevalences were weighted and multinomial regression analyses were done. RESULTS: A total of 6628 individuals from 2843 households were surveyed. The weighted overall prevalence for underweight was 9.1% (95% CI 8.1 to 10.1), 65.1% (95% CI 63.6 to 66.6) for normal weight, 19.0% (95% CI 17.8 to 20.3) for overweight and 6.8% (95% CI 6.0 to 7.5) for obese. Men were less likely to be overweight (adjusted OR (AOR) 0.79; 95% CI 0.68 to 0.92) and obese (AOR 0.24; 95% CI 0.19 to 0.31) than women. Urban residents were more likely to be overweight (AOR 1.42; 95% CI 1.18 to 1.71) and obese (AOR 2.09; 95% CI 1.58 to 2.76) than rural residents. Each additional 1-year increase in age increased the risk of overweight by 1.012 (AOR 1.012; 95% CI 1.005 to 1.018) and that of obesity by 1.03 (AOR 1.03; 95% CI 1.02 to 1.04). The low-income class was less likely to be overweight (AOR 0.694; 95% CI 0.507 to 0.951) and obese (AOR 0.44; 95% CI 0.28 to 0.67). CONCLUSION: The prevalence of obesity and overweight in Enugu Nigeria is high and fast approaching that of underweight. Women, urban dwellers, older adults and high-income earners are at higher risk for obesity and overweight. The study provides robust information for public health policies towards the prevention of obesity in Nigeria.

The impact of community health educators on uptake of cervical and breast cancer prevention services in Nigeria.

OBJECTIVE: To determine the impact of trained community health educators on the uptake of cervical and breast cancer screening, and HPV vaccination in rural communities in southeast Nigeria. METHODS: A prospective population-based intervention study, with a before-and-after design, involved four randomly selected communities in southeast Nigeria from February 2014 to February 2016. Before the intervention, baseline data were collected on the uptake of cervical and breast cancer prevention services. The intervention was house-to-house education on cervical cancer and breast cancer prevention. Postintervention outcome measures included the uptake of cervical and breast cancer screening, and HPV vaccination within 6 months of intervention. RESULTS: In total, 1327 women were enrolled. Before the intervention, 42 (3.2%) women had undergone cervical cancer screening; afterwards, 897 (67.6%) women had received screening (P<0.001). Clinical breast examination was performed for 59 (4.4%) women before and 897 (67.6%) after the intervention (P<0.001). Only 2 (0.9%) of 214 children eligible for HPV vaccination had received the vaccine before versus 71 (33.2%) after the intervention (P<0.001). CONCLUSION: The use of community health educators for house-to-house cervical and breast cancer prevention education was associated with significant increases in the uptake of cervical cancer screening, clinical breast examination, and HPV vaccination.

Association of Intrauterine Device (IUD) and Cervical Neoplasia - A Study in a Poor Nigerian Population.

INTRODUCTION: Intrauterine Device (IUD) is a contraceptive method used by women of reproductive age group. However, there are conflicting reports on the association between IUD and cervical neoplasia. These controversies may further hamper the poor uptake of modern contraception in Nigeria. AIM: This study was therefore aimed at evaluating the association between IUD and cervical neoplasia. MATERIALS AND METHODS: This was a case control study in which Pap smear results of 156 participants on IUD were compared with those of 156 non-users of modern contraception. The participants who were found to have abnormal cervical smear cytology results were further subjected to colposcopy. Biopsy specimens for histology were collected from the participants with obvious cervical lesions or those with suspicious lesions on colposcopy. The results were analysed with descriptive and inferential statistics at 95% level of confidence. RESULTS: Seven (4.5%) and 2(1.3%) of participants using IUD had Cervical Intraepithelial Neoplasia (CIN) 1 and CIN 2 respectively. Also, 5(3.2%) and 1(0.6%) of non-users of modern contraception had CIN 1 and CIN 2 respectively. The prevalence of cervical neoplasia among all the participants was 4.8%. Although, the proportion of women who had CIN was more among participants using IUD than non-users of modern contraception, the difference was not statistically significant. CONCLUSION: There was no significant association between IUD and cervical neoplasia in this study.

Is there any association between hormonal contraceptives and cervical neoplasia in a poor Nigerian setting?

BACKGROUND: The association between hormonal contraception and cervical cancer is controversial. These controversies may hamper the uptake of hormonal contraceptives. OBJECTIVE: To determine the association between hormonal contraceptives and cervical neoplasia. MATERIALS AND METHODS: This was a case-control study in which Pap-smear results of 156 participants on hormonal contraceptives were compared with those of 156 participants on no form of modern contraception. Modern contraception is defined as the use of such contraceptives as condoms, pills, injectables, intrauterine devices, implants, and female or male sterilization. Those found to have abnormal cervical smear cytology results were subjected further to colposcopy. Biopsy specimens for histology were collected from the participants with obvious cervical lesions or those with suspicious lesions on colposcopy. The results were analyzed with descriptive and inferential statistics at a 95% level of confidence. RESULTS: A total of 71 (45.5%), 60 (38.5%), and 25 (16.0%) of the participants on hormonal contraceptives were using oral contraceptives, injectable contraceptives, and implants, respectively. Cervical neoplasia was significantly more common among participants who were ≥35 years old (6% versus 1%, P<0.0001), rural dwellers (6% versus 3.5%, P<0.0001), unmarried (7.6% versus 3.5%, P<0.0001), unemployed (6.8% versus 3.5%, P<0.0001), less educated (6% versus 3.8%, P<0.0001), and had high parity (6.8% versus 3.6%, P<0.0001). There was no statistical significant difference in cervical neoplasia between the two groups of participants (7 [4.5%] versus 6 [3.8%], P=1.0). CONCLUSION: There was no association between hormonal contraceptives and cervical neoplasia in this study.

Prevalence and pattern of rape among girls and women attending Enugu State University Teaching Hospital, southeast Nigeria.

OBJECTIVE: To determine the prevalence and pattern of rape in Enugu, southeast Nigeria. METHODS: A prospective descriptive study was conducted among female survivors of rape who presented at the emergency gynecologic and/or forensic unit of Enugu State University Teaching Hospital between February 2012 and July 2013. Data were collected via a pretested interviewer-administered questionnaire. RESULTS: Among 1374 gynecologic emergencies, there were 121 (8.8%) rape cases. The mean age of the rape survivors was 13.1±8.1 years. Ninety (74.4%) survivors were younger than 18 years. At least 72 hours had passed since the rape for 74 (61.2%) cases. The perpetrator was known to 74 (82.2%) patients younger than 18 years and 18 (58.1%) aged at least 18 years (P=0.013). The location of the rape was the bush or an uncompleted building for 36 (29.8%) and the perpetrator's residence for another 36 (29.8%). Four (3.3%) individuals became pregnant after the rape. CONCLUSION: A considerable proportion of patients with gynecologic emergencies had been raped. Individuals should be encouraged to report to the hospital quickly to prevent unwanted pregnancy and sexually transmitted infections.

Oral versus vaginal misoprostol for induction of labor in Enugu, Nigeria: a randomized controlled trial.

OBJECTIVE: The study aimed at comparing the effectiveness and maternal satisfaction of oral misoprostol with vaginal misoprostol for induction of labor at term. MATERIALS AND METHODS: A randomized controlled trial of 140 term pregnant women at the University of Nigeria Teaching Hospital Enugu, Nigeria, was conducted from April 2011 to May 2012. The women were equally randomized into two groups (A and B) to receive oral and vaginal misoprostol, respectively. RESULTS: The vaginal route reduced the mean induction-vaginal delivery interval by four-and-half hours (20.7 ± 12.1 vs. 16.2 ± 10.4; mean difference: 4.50, 95% CI 0.63-0.82; p = 0.02). Furthermore, the mean dose of misoprostol required to achieve induction of labor and the mean duration of oxytocin augmentation when indicated were significantly less in the vaginal group than in the oral group (2.5 ± 1.3 vs. 2.0 ± 1.1; mean difference: 0.50, 95% CI 0.10-0.90; p = 0.02 and 4.6 ± 3.2 vs. 3.4 ± 3.1; mean difference: 1.20, 95% CI 0.15-0.23; p = 0.03 respectively). However, neonatal complications and maternal satisfaction were similar between the two groups. CONCLUSION: Both routes of administration are effective in the induction of labor at term and have comparable maternal satisfaction. However, the vaginal route has the added advantage of shorter induction-delivery interval among others, and thus should be highly considered when induction of labor is indicated at term.

Experiences and unmet needs of women undergoing Pap smear cervical cancer screening: impact on uptake of cervical cancer screening in south eastern Nigeria.

The burden of cervical cancer is on the increase in sub-Saharan Africa mainly due to inadequate provision and utilisation of cervical cancer prevention services. Several evidence-based strategies have been deployed to improve cervical cancer screening uptake without much success. However, patients' experiences and satisfaction with service provision has not been adequately studied. Inefficiencies in service delivery and less fulfilling experiences by women who attend cervical cancer screening could have considerable impact in future voluntary uptake of cervical cancer screening. Six hundred and eighty women who underwent Pap smear screening in three health care facilities in two states in south eastern Nigeria were interviewed to evaluate their satisfaction, willingness to undertake future voluntary screening, unmet needs and correlation between satisfaction level and willingness to undergo future screening. Satisfaction with Pap smear screening correlated positively with willingness to undertake future voluntary screening (Pearson's correlation coefficient = 0.78, P = 0.001). The mean satisfaction score was significantly higher among participants handled by nurses than those handled by the physicians (3.16 ± 0.94 vs 2.52 ± 0.77, P = 0.001). 'Scrapping discomfort' of the spatula was reported as the most dissatisfying aspect of Pap smear experience. The need for less invasive screening procedures was the most unmet need. It was concluded that improving the Pap smear screening experience of women and providing less invasive methods of cervical cancer screening with immediate results could improve uptake of cervical cancer screening in south eastern Nigeria.

Use of a portable diathermy machine for LEEP without colposcopy during see-and-treat management of VIA-positive cervical lesions in resource-poor settings.

OBJECTIVE: To compare the effectiveness of cryotherapy and loop electrosurgical excision procedure without colposcopy (visual LEEP) in treating cervical lesions detected through visual inspection with acetic acid (VIA). METHODS: In rural southeast Nigeria, women with VIA-positive lesions who were eligible for ablative treatment were selected to undergo immediate cryotherapy with nitrous oxide. Women with VIA-positive lesions who were not eligible for ablative treatment were selected to undergo visual LEEP at the same visit. A portable diathermy machine was used for LEEP. Participants were re-evaluated 6 months later using VIA. The main outcome measures included persistent VIA positivity at 6 months, duration of procedure, second clinic visits for complications, and patient acceptability. RESULTS: In total, 304 women completed the study. Persistent VIA-positivity rates, duration of procedure, second clinic visits for complications, and patient acceptability were similar in the 2 groups. CONCLUSION: Visual LEEP and cryotherapy have similar efficacy and patient acceptability in see-and-treat management of VIA-positive cervical lesions. In see-and-treat VIA-based cervical cancer prevention programs in low-resource countries, visual LEEP can be used to treat women who do not meet the criteria for ablative treatment. This would increase the treatment coverage of women with VIA-positive lesions and improve program efficiency.

See-and-treat management of high-grade squamous intraepithelial lesions in a resource-constrained African setting.

OBJECTIVE: To compare the treatment outcomes of women with high-grade squamous intraepithelial lesions (HSIL) who underwent immediate loop electrosurgical excision procedure (LEEP) and those who had directed biopsies prior to subsequent LEEP. METHODS: Women who were referred for HSIL to 2 centers in southeast Nigeria were examined via colposcopy. Those with positive colposcopic findings were randomized to receive either immediate LEEP (see-and-treat group) or directed biopsies (3-step group). Women with directed biopsy-confirmed results underwent follow-up LEEP. Overtreatment rate, cost, default rate, and cytology-treatment interval were compared between the 2 groups. RESULTS: In total, 314 women were included in the study. The overtreatment rate was similar between the groups. Treatment cost and cytology-treatment interval were significantly higher in the 3-step group (P=0.0001). The default rate was significantly lower in the see-and-treat group (P=0.0001). Most (219 [69.7%]) participants preferred the see-and-treat approach. CONCLUSION: Immediate see-and-treat LEEP for women with HSIL in southeast Nigeria is cheaper, less time-consuming, and associated with better patient compliance than the 3-step management procedure. Furthermore, it does not lead to significantly higher overtreatment. The immediate see-and-treat approach may be ideal for the management of women with HSIL in low-resource countries.

Denial of women's rights to contraception in southeastern Nigeria.

OBJECTIVE: To evaluate the opinions and experiences of married women in southeastern Nigeria regarding their rights to contraception, in addition to the impact of the denial of women's contraceptive rights on unplanned pregnancy rate. METHODS: A cross-sectional survey of women who registered for prenatal care at 2 federal tertiary healthcare facilities in southeastern Nigeria was conducted. Randomly selected samples of participants were interviewed via a structured, pretested questionnaire. RESULTS: In total, 1204 women participated in the survey. Overall, 526 (43.7%) were unaware of their rights to contraception. Denial of contraceptive rights was reported by 522 (43.4%) women. In total, 174/317 (54.9%) women with unplanned pregnancies blamed denial of access to contraception for their pregnancies. Among the women who had used contraception previously, 61.9% reported that the decision to do so was taken by their spouse. Formal education seemed to increase women's level of awareness of their rights to contraception (P=0.001) but it did not influence the exercising of such rights. CONCLUSION: A considerable proportion of women in southeastern Nigeria are being denied their rights to contraception, mainly owing to a culture of male dominance. There may be significant health implications for women with unplanned pregnancies arising from such denials.