Feasibility of a community-based cervical cancer screening with "test and treat" strategy using self-sample for an HPV test: Experience from rural Cameroon, Africa.

To achieve higher coverage and effectiveness in limited-resource settings, World Health Organization (WHO) guidelines for cervical cancer prevention recommend a screen-and-treat strategy with high-risk human papillomavirus (HPV) testing. We piloted a real-word project to examine the feasibility of this approach in rural Cameroon. Nurses from the Women's Health Program (WHP) of the Cameroon Baptist Convention Health Services (CBCHS) educated women in remote villages on cervical cancer prevention. At a follow-up visit, they explained to nonpregnant women aged 30-65 how to self-collect vaginal specimens for HPV testing with the careHPV assay. The cytobrush specimens were transported in coolers to a CBCHS laboratory for analysis. The nurses returned to villages to inform women of their results, examined HPV-positive women in the primary health centers (PHCs) using visual inspection with acetic acid and Lugol's iodine (VIA/VILI) enhanced by digital cervicography (DC) to guide treatment. Of the 1,270 eligible women screened (mean age: 44.7 years), 196 (15.4%) were HPV-positive, of whom 185 (94.4%) were examined, 16 (8.6%) were VIA/VILI-positive, 8 (4.3%) were VIA/VILI-inadequate, one (0.5%) was VIA/VILI-uncertain and 161 (87.0%) were treated with thermal ablation. One woman had LEEP, and another woman with invasive cancer was treated at a referral facility. The cytobrushes broke off in the vaginas of two women (removed in the village) and in the bladder of another (surgically removed). Community-based cervical cancer screening with self-collected specimens for HPV testing is feasible in rural Cameroon. Education on the proper sampling procedure and follow-up of women who are HPV-positive are essential.

Cultural barriers to exclusive breastfeeding by mothers in a rural area of Cameroon, Africa.

Because of the known nutritional and health benefits to the infant, the World Health Organization recommends that women in resource-poor countries exclusively breastfeed until their babies reach 6 months of age. In the primarily rural geographical region of the North West Province of Cameroon, previous studies identified the prevalence of breastfeeding to be 90%. It is common knowledge that women are culturally encouraged to mix-feed their infants, but the extent of these feeding practices is not known. The objective of this study was to identify the extent of mixed feeding/supplementation and the cultural/social barriers to exclusive breastfeeding. All women surveyed introduced water and food supplementation prior to 6 months of age, with more than 38% giving water in the first month of life. Mothers identified cultural factors influencing their decision to mix-feed their babies, which included 1) pressures by village elders and families to supplement because it is a traditional practice, 2) belief that breast milk is an incomplete food that does not increase the infants weight, 3) belief that all family members should receive the benefit of food grown in the family farm, and 4) the taboo of prohibiting sexual contact during breastfeeding.