Cervical cancer screening uptake in Sub-Saharan Africa: a systematic review and meta-analysis.

OBJECTIVES: The objective of this study is to estimate the pooled uptake of cervical cancer screening and identify its predictors in Sub-Saharan Africa. STUDY DESIGN: Systematic review and meta-analysis. METHODS: We searched PubMed, EMBASE, CINAHL, African Journals OnLine, Web of Science and Scopus electronic databases from January 2000 to 2019. All observational studies published in the English language that reported cervical cancer uptake and/or predictors in Sub-Saharan Africa were initially screened. We assessed methodological quality using the Newcastle-Ottawa Scale. An inverse variance-weighted random-effects model meta-analysis was performed to estimate the pooled uptake and odds ratio (OR) of predictors with a 95% confidence interval (CI). The I2 test statistic was used to check between-study heterogeneity, and the Egger's regression statistical test was used to check publication bias. RESULTS: We initially screened 3537 citations and subsequently 29 studies were selected for this review, which included a total of 36,374 women. The uptake of cervical cancer screening in Sub-Saharan Africa was 12.87% (95% CI: 10.20, 15.54; I2 = 98.5%). A meta-analysis of seven studies showed that knowledge about cervical cancer increased screening uptake by nearly five times (OR: 4.81; 95% CI: 3.06, 7.54). Other predictors of cervical screening uptake include educational level, age, Human Immune deficiency Virus (HIV) status, contraceptive use, perceived susceptibility and awareness about screening locations. CONCLUSIONS: Cervical screening uptake is low in Sub-Saharan Africa as a result of several factors. Health outreach and promotion programmes to target these identified predictors are required.

Non-puerperal induced lactation in a Nigerian community: case reports.

Six Nigerian women aged from 22 to 56 years who had not recently been pregnant were successfully relactated by breast suckling alone. All of them produced enough milk to exclusively breastfeed 'motherless' infants. All except one child have continued to breastfeed up to the time of this report and show adequate growth.

PIP: In developing countries such as Nigeria, breast feeding is essential to child health and survival. Since almost 8 of every 1000 pregnant women in Nigeria die in childbirth or from its complications, breast feeding by surrogate mothers is an important child health intervention. This article presents six case studies from the Irepodun Local Government Area of Osun State of successful induction of lactation by breast suckling alone in women who had not recently been pregnant. Surrogate mothers ranged in age from 22 to 56 years. The 6 infants of mothers who had died or abandoned their baby were 1 week to 2 months of age when surrogate breast feeding was commenced. Surrogate mothers were instructed to initiate lactation by suckling the infants repeatedly at least 10 times a day for at least 10 minutes on each breast. Afterward, the infants were fed with artificial milk given by cup or spoon. Successful relactation was considered to have been achieved when the infants could be sustained on breast milk alone. Milk secretion following suckling appeared on the fourth through seventh day, while complete lactation was achieved after 21-25 days. All surrogate mothers were able to produce adequate amounts of breast milk without any nutritional supplementation, even though they were of low socioeconomic status. 4 of the infants were malnourished before relactation was commenced and 3 had episodes of severe diarrhea. With establishment of full breast feeding, all 6 infants gained weight and achieved satisfactory weight for age. The one death in this series involved an infant who developed severe gastroenteritis after the surrogate mother introduced supplementary feeds at 4.5 months of age.