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Corrado G, Mazzara C, Certelli C, Nsubuga JB, Zanetto F, Schurfeld K, Dell'Antonio G, Orti CD, Savarese A, Andriani MT. Screening for cervical cancer in Africa: A proposal of a different combination of VIA test and cervical smear in Uganda. Int J Gynaecol Obstet 2020; 152:68-71. [PMID: 32812648 DOI: 10.1002/ijgo.13350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 05/29/2020] [Accepted: 08/17/2020] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To evaluate the efficacy of visual inspection with acetic acid (VIA) screening combined with a cervical smear in Uganda. METHODS Nine screening campaigns were held in Uganda between January 2011 and October 2019. In the last three campaigns, a new approach was used: the cervical smear was performed before the VIA test and, in case of a positive VIA test, the slide was sent for examination. The data collected were divided into two groups: the first six campaigns and the last three campaigns. RESULTS During the study period, 10 520 women were screened, of whom 911 had a positive VIA test. The VIA test showed 84.2% false positives. In the first group, the VIA test was positive in 516 women, of whom 93% were referred for further examinations. In the second group, the VIA test was positive in 395 women, but the cervical smear was positive in only 65 women. Thus, only 16.5% women were referred for further examinations. CONCLUSION Combining cervical smear, VIA test, and slide analysis in positive VIA tests may allow women who need treatment to be selected more effectively, while waiting for other more expensive solutions to become more affordable for this setting.
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Affiliation(s)
- Giacomo Corrado
- Department of Woman, Child Health and Public Health, Gynecologic Oncology Unit, Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica Di Roma, Roma, Italy
| | - Calogero Mazzara
- Department of Pediatrics, IPSI - Istituto Pediatrico della Svizzera Italiana, Lugano, Switzerland
| | - Camilla Certelli
- Department of Woman, Child Health and Public Health, Gynecologic Oncology Unit, Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica Di Roma, Roma, Italy
| | - John B Nsubuga
- Department of Obstetrics and Gynecology, St. Kizito Hospital, Matany, Uganda
| | - Francesca Zanetto
- Department of Obstetrics and Gynecology, Fatebenefratelli Hospital, Erba, Italy
| | - Karin Schurfeld
- Department of Human Pathology and Oncology, Policlinico Le Scotte, Siena, Italy
| | | | | | - Antonella Savarese
- Department of Oncology, Regina Elena National Cancer Institute, Rome, Italy
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Dykens JA, Smith JS, Demment M, Marshall E, Schuh T, Peters K, Irwin T, McIntosh S, Sy A, Dye T. Evaluating the implementation of cervical cancer screening programs in low-resource settings globally: a systematized review. Cancer Causes Control 2020; 31:417-429. [PMID: 32185604 PMCID: PMC7105425 DOI: 10.1007/s10552-020-01290-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 02/27/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE Cervical cancer disproportionately burdens low-resource populations where access to quality screening services is limited. A greater understanding of sustainable approaches to implement cervical cancer screening services is needed. METHODS We conducted a systematized literature review of evaluations from cervical cancer screening programs implemented in resource-limited settings globally that included a formal evaluation and intention of program sustainment over time. We categorized the included studies using the continuum of implementation research framework which categorizes studies progressively from "implementation light" to more implementation intensive. RESULTS Fifty-one of 13,330 initially identified papers were reviewed with most study sites in low-resource settings of middle-income countries (94.1%) ,while 9.8% were in low-income countries. Across all studies, visual inspection of the cervix with acetic acid (58.8%) was the most prevalent screening method followed by cytology testing (39.2%). Demand-side (client and community) considerations were reported in 86.3% of the articles, while 68.6% focused scientific inquiry on the supply side (health service). Eighteen articles (35.3%) were categorized as "Informing Scale-up" along the continuum of implementation research. CONCLUSIONS The number of cervical cancer screening implementation reports is limited globally, especially in low-income countries. The 18 papers we classified as Informing Scale-up provide critical insights for developing programs relevant to implementation outcomes. We recommend that program managers report lessons learnt to build collective implementation knowledge for cervical cancer screening services, globally.
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Affiliation(s)
- J Andrew Dykens
- University of Illinois at Chicago College of Medicine, Chicago, IL, USA.
| | - Jennifer S Smith
- University of North Carolina School of Public Health, Chapel Hill, NC, USA
| | - Margaret Demment
- University of Rochester Department of Obstetrics and Gynecology, Rochester, NY, USA
| | - E Marshall
- University of Illinois at Chicago Institute for Health Research and Policy, Chicago, IL, USA
| | - Tina Schuh
- University of Illinois at Chicago Institute for Health Research and Policy, Chicago, IL, USA
| | - Karen Peters
- University of Illinois at Chicago Institute for Health Research and Policy, Chicago, IL, USA
| | - Tracy Irwin
- University of Washington Department of Obstetrics and Gynecology, Seattle, WA, USA
| | - Scott McIntosh
- University of Rochester Department of Public Health Sciences, Rochester, NY, USA
| | - Angela Sy
- University of Hawaii John A Burns School of Medicine, Honolulu, HI, USA
| | - Timothy Dye
- University of Rochester Department of Obstetrics and Gynecology, Rochester, NY, USA
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Amin S, Abdullahi K, Muhammad M, Mohammed L, Mahmoud R, Muhammad R. Perception of cervical cancer and its cytological screening among medical students. SAHEL MEDICAL JOURNAL 2020. [DOI: 10.4103/smj.smj_26_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Benski AC, Viviano M, Jinoro J, Alec M, Catarino R, Herniainasolo J, Vassilakos P, Petignat P. HPV self-testing for primary cervical cancer screening in Madagascar: VIA/VILI triage compliance in HPV-positive women. PLoS One 2019; 14:e0220632. [PMID: 31408474 PMCID: PMC6692065 DOI: 10.1371/journal.pone.0220632] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 07/19/2019] [Indexed: 12/02/2022] Open
Abstract
Objective To assess triage compliance and the effect of the time from screening to triage on follow-up among HPV-positive women. Methods We recruited 1232 women in a screening campaign in Madagascar from February to October 2015. In the first period (February–May), HPV tests were performed remotely using the cobas test. In the second period (May–October), testing was performed on-site using the Xpert HPV assay. HPV-positive women were invited for triage with visual inspection with acetic acid (VIA) and Lugol’s iodine (VILI). Systematic biopsy and endocervical brushing were performed on all HPV-positive women for quality control. Three groups were defined according to time from HPV testing to triage invitation for HPV-positive women—Group I: delayed (> 3 months), Group II: prompt (24–48 hours), and Group III: immediate (< 24 hours). Results A total 1232 self-sampled HPV tests were performed in the study period (496 in Group I, 512 in Group II, and 224 in Group III). Participants’ mean age was 43.2 ± 9.3 years. Mean time from screening to VIA/VILI testing was 103.5 ± 43.6 days. Overall HPV prevalence was 28.0%. HPV prevalence was 27.2% in Group I (cobas test), 29.2% in Group 2 (Xpert test), and 26,7% in Group III (Xpert test). The VIA/VILI compliance rate was 77.8% for Group I, 82.7% for Group II, and 95.0% for Group III. Of women undergoing VIA/VILI, 56.3% in Group I and 43.5% in Groups II/III had positive results. Prevalence of cervical intraepithelial neoplasia grade 2 or worse among HPV-positive women was 9.8% for Group I and 6.8% for Groups II/III. Non-adherence was higher among rural women, uneducated women, and women in Group I. Conclusion HPV-positive women with immediate VIA/VILI triage invitation had the best triage compliance. A single-day test and triage strategy is preferred for low-resource settings.
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Affiliation(s)
- Anne-Caroline Benski
- Gynecology Division, Geneva University Hospitals, Geneva, Switzerland
- Saint Damien Health Center, Ambanja, Madagascar
- * E-mail:
| | - Manuela Viviano
- Gynecology Division, Geneva University Hospitals, Geneva, Switzerland
| | | | | | - Rosa Catarino
- Gynecology Division, Geneva University Hospitals, Geneva, Switzerland
| | | | - Pierre Vassilakos
- Geneva Foundation for Medical Education and Research, Geneva, Switzerland
| | - Patrick Petignat
- Gynecology Division, Geneva University Hospitals, Geneva, Switzerland
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Mohamad KAA, Saad AS, Murad AWA, Altraigy A. Visual inspection after acetic acid (VIA) as an alternative screening tool for cancer cervix. APOLLO MEDICINE 2016. [DOI: 10.1016/j.apme.2016.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Cervical Cancer Screening in Cameroon: Interobserver Agreement on the Interpretation of Digital Cervicography Results. J Low Genit Tract Dis 2016; 19:288-94. [PMID: 26164295 DOI: 10.1097/lgt.0000000000000133] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE The World Health Organization recommends visual inspection with acetic acid (VIA) for cervical cancer screening in resource-limited settings. In Cameroon, we use digital cervicography (DC) to capture images of the cervix after VIA. This study evaluated interobserver agreement of DC results, compared DC with histopathologic results, and examined interobserver agreement among screening methods. METHOD Three observers, blinded to each other's interpretations, evaluated 540 DC photographs as follows: (1) negative/positive for acetowhite lesions or cancer and (2) assigned a presumptive diagnosis of histopathologic lesion grade in the 91 cases that had a histopathologic diagnosis. Observer A was the actual screening nurse; B, a reproductive health nurse; C, a gynecologic oncologist; and D, the histopathologic diagnosis. We compared inter-rater agreement of DC impressions among observers A, B, and C, and with D, with Cohen kappas. RESULTS For interpretations of DC, (negative/positive) strengths of agreement of paired observers were the following: A/B, moderate [K, 0.54; 95% confidence interval (CI), 0.47-0.61], A/C, fair (K, 0.37; 95% CI, 0.29-0.44), and B/C, moderate (K, 0.45; 95% CI, 0.37-0.53). For presumptive pathologic grading, strengths of agreement for weighted Ks were as follows: A/B, moderate (K, 0.42; 95% CI, 0.28-0.56); A/C, fair (K, 0.33; 95% CI, 0.20-0.46); B/C, fair (K, 0.54; 95% CI, 0.40-0.67); A/D, moderate (K, 0.59; 95% CI, 0.45-0.74); B/D, moderate (K, 0.58; 95% CI, 0.46-0.70); and C/D, moderate (K, 0.50; 95% CI, 0.37-0.63). CONCLUSIONS Interobserver agreement of DC interpretations was mostly moderate among the 3 observers, between them and histopathology, and comparable to that of other visual-based screening methods, i.e., VIA, cytology, or colposcopy.
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DeGregorio GA, Bradford LS, Manga S, Tih PM, Wamai R, Ogembo R, Sando Z, Liu Y, Schwaiger C, Rao SR, Kalmakis K, Kennedy Sheldon L, Nulah K, Welty E, Welty T, Ogembo JG. Prevalence, Predictors, and Same Day Treatment of Positive VIA Enhanced by Digital Cervicography and Histopathology Results in a Cervical Cancer Prevention Program in Cameroon. PLoS One 2016; 11:e0157319. [PMID: 27280882 PMCID: PMC4900564 DOI: 10.1371/journal.pone.0157319] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 05/29/2016] [Indexed: 11/25/2022] Open
Abstract
Background In 2007, the Cameroon Baptist Convention Health Services (CBCHS) implemented a screen-and-treat cervical cancer prevention program using visual inspection with acetic acid enhanced by digital cervicography (VIA-DC). Methods We retrospectively analyzed 46,048 medical records of women who received care through the CBCHS Women’s Health Program from 2007 through 2014 to determine the prevalence and predictors of positive VIA-DC, rates of same day treatment, and cohort prevalence of invasive cervical cancer (ICC). Results Of the 44,979 women who were screened for cervical cancer, 9.0% were VIA-DC-positive, 66.8% were VIA-DC-negative, 22.0% were VIA-DC-inadequate (normal ectocervix, but portions of the transformation zone were obscured), and 2.2% were VIA-DC-uncertain (cervical abnormalities confounding VIA-DC interpretation). Risk factors significantly associated with VIA-DC-positive screen were HIV-positivity, young age at sexual debut, higher lifetime number of sexual partners, low education status and higher gravidity. In 2014, 31.1% of women eligible for cryotherapy underwent same day treatment. Among the 32,788 women screened from 2007 through 2013, 201 cases of ICC were identified corresponding to a cohort prevalence of 613 per 100,000. Conclusions High rate of VIA-DC-positive screens suggests a significant burden of potential cervical cancer cases and highlights the need for expansion of cervical cancer screening and prevention throughout the 10 regions of Cameroon. VIA-DC-inadequate rates were also high, especially in older women, and additional screening methods are needed to confirm whether these results are truly negative. In comparison to similar screening programs in sub-Saharan Africa there was low utilization of same day cryotherapy treatment. Further studies are required to characterize possible program specific barriers to treatment, for example cultural demands, health system challenges and cost of procedure. The prevalence of ICC among women who presented for screening was high and requires further investigation.
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Affiliation(s)
- Geneva A. DeGregorio
- Department of Obstetrics and Gynecology, University of Massachusetts Medical School, Worcester, MA, United States of America
| | - Leslie S. Bradford
- Department of Obstetrics and Gynecology, University of Massachusetts Medical School, Worcester, MA, United States of America
| | - Simon Manga
- Cameroon Baptist Convention Health Services, Bamenda, North West Region, Cameroon
| | - Pius M. Tih
- Cameroon Baptist Convention Health Services, Bamenda, North West Region, Cameroon
| | - Richard Wamai
- Department of African American Studies, Northeastern University, Boston, MA, United States of America
| | - Rebecca Ogembo
- Graduate School of Nursing, University of Massachusetts Medical School, Worcester, MA, United States of America
| | - Zacharie Sando
- Yaoundé Gyneco-Obstetrics and Pediatric Hospital, Yaoundé, Centre Region, Cameroon
| | - Yuxin Liu
- Department of Pathology, University of Massachusetts Medical School, Worcester, MA, United States of America
| | - Constance Schwaiger
- School of Nursing, University of Massachusetts Amherst, Amherst, MA, United States of America
| | - Sowmya R. Rao
- Department of Surgery, Boston University School of Medicine, Boston, MA, United States of America
| | - Karen Kalmakis
- School of Nursing, University of Massachusetts Amherst, Amherst, MA, United States of America
| | - Lisa Kennedy Sheldon
- Department of Nursing, University of Massachusetts Boston, Boston, MA, United States of America
| | - Kathleen Nulah
- Cameroon Baptist Convention Health Services, Bamenda, North West Region, Cameroon
| | - Edith Welty
- Cameroon Baptist Convention Health Services, Bamenda, North West Region, Cameroon
| | - Thomas Welty
- Cameroon Baptist Convention Health Services, Bamenda, North West Region, Cameroon
| | - Javier Gordon Ogembo
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States of America
- * E-mail:
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Finocchario-Kessler S, Wexler C, Maloba M, Mabachi N, Ndikum-Moffor F, Bukusi E. Cervical cancer prevention and treatment research in Africa: a systematic review from a public health perspective. BMC Womens Health 2016; 16:29. [PMID: 27259656 PMCID: PMC4893293 DOI: 10.1186/s12905-016-0306-6] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Accepted: 05/21/2016] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Women living in Africa experience the highest burden of cervical cancer. Research and investment to improve vaccination, screening, and treatment efforts are critically needed. We systematically reviewed and characterized recent research within a broader public health framework to organize and assess the range of cervical cancer research in Africa. METHODS We searched online databases and the Internet for published articles and cervical cancer reports in African countries. Inclusion criteria included publication between 2004 and 2014, cervical cancer-related content pertinent to one of the four public health categories (primary, secondary, tertiary prevention or quality of life), and conducted in or specifically relevant to countries or regions within the African continent. The study design, geographic region/country, focus of research, and key findings were documented for each eligible article and summarized to illustrate the weight and research coverage in each area. Publications with more than one focus (e.g. secondary and tertiary prevention) were categorized by the primary emphasis of the paper. Research specific to HIV-infected women or focused on feasibility issues was delineated within each of the four public health categories. RESULTS A total of 380 research articles/reports were included. The majority (54.6 %) of cervical cancer research in Africa focused on secondary prevention (i.e., screening). The number of publication focusing on primary prevention (23.4 %), particularly HPV vaccination, increased significantly in the past decade. Research regarding the treatment of precancerous lesions and invasive cervical cancer is emerging (17.6 %), but infrastructure and feasibility challenges in many countries have impeded efforts to provide and evaluate treatment. Studies assessing aspects of quality of life among women living with cervical cancer are severely limited (4.1 %). Across all categories, 11.3 % of publications focused on cervical cancer among HIV-infected women, while 17.1 % focused on aspects of feasibility for cervical cancer control efforts. CONCLUSIONS Cervical cancer research in African countries has increased steadily over the past decade, but more is needed. Tertiary prevention (i.e. treatment of disease with effective medicine) and quality of life of cervical cancer survivors are two severely under-researched areas. Similarly, there are several countries in Africa with little to no research ever conducted on cervical cancer.
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Affiliation(s)
| | - Catherine Wexler
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, USA
| | - May Maloba
- Family AIDS Care and Education Services, Kenya Medical Research Institute, Kisumu, Kenya
| | - Natabhona Mabachi
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, USA
| | - Florence Ndikum-Moffor
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, USA
| | - Elizabeth Bukusi
- Family AIDS Care and Education Services, Kenya Medical Research Institute, Kisumu, Kenya
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
- Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya
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Desire BK, Philippe CM, Thierry K, Félix KWM, Wembodinga GU, Prosper KL, Oscar LN. Visual inspection with acetic acid and Lugol's iodine in cervical cancer screening at the general referral hospital Kayembe in Mbuji-Mayi, Democratic Republic of Congo. Pan Afr Med J 2016; 23:64. [PMID: 27217888 PMCID: PMC4862765 DOI: 10.11604/pamj.2016.23.64.8450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 02/01/2016] [Indexed: 12/02/2022] Open
Abstract
Introduction Cervical cancer is the leading cause of morbidity and mortality of women from cancer in the developing World. It is the primary cause of reduced life expectancy in Sub-Saharan countries such as Democratic Republic of Congo. The aim of this work was to determinate the socio-demographic profile of women with precancerous and cancerous lesions of the cervix, to determinate the frequency of VIA and VILI positive cases and to show the challenges that can be faced in managing patients with abnormalities in the city of Mbuji-Mayi in the Democratic Republic of Congo. Methods As part of its activities, the “Association de Lutte contre le Cancer du Col utérin” (ALCC) organized a community outreach followed by free voluntary testing for cervical cancer for two weeks (26thMarch to 10th April 2011) at the General Referral Hospital Kayembe in Mbuji-Mayi (Democratic Republic of Congo). Results A total of 229 women were examined. 38% of tests (VIA + VILI) were positive with 6 clinically suspected cases of invasive cancer at stage 1 (7% of cases). Nearly 70% of patients were still of childbearing age and had started their first sexual intercourse before 18 years of age and 86% of cases were multiparous. Given the material, financial and technical constraints, 75% of patients were placed in a monitoring program of 9 months to 1 year (= expectation and another test) while 11% of them were selected for a biopsy to be locally practiced and sent to the pathologist. Nearly 8% of the cases were candidates for hysterectomy. Conclusion Given the difficulties encountered and the frequency of positive tests, we recommend another study with a larger sample, improved working conditions (mainly equipment) and the association of another test such as the Human Papilloma Virus (HPV) test.
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Affiliation(s)
- Banza Kamba Desire
- Department of Public Health, Faculty of Medicine, University of Lubumbashi, DR Congo
| | | | | | - Kitenge Wa Momat Félix
- Department of Gynaecology and Obstetrics, Faculty of Medicine, University of Lubumbashi, DR Congo
| | | | - Kakudji Luhete Prosper
- Department of Gynaecology and Obstetrics, Faculty of Medicine, University of Lubumbashi, DR Congo
| | - Luboya Numbi Oscar
- Department of Public Health, Faculty of Medicine, University of Lubumbashi, DR Congo
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Comparative Study of the Role of Visual Inspection with Acetic Acid and Pap Smear in Screening of Cervical Cancer in Low Resource Setting in a Tertiary Care Hospital. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2015. [DOI: 10.1007/s40944-015-0024-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Sando Z, Fouogue JT, Fouelifack FY, Fouedjio JH, Mboudou ET, Essame JLO. [Profile of breast and gynecological cancers in Yaoundé--Cameroon]. Pan Afr Med J 2014; 17:28. [PMID: 24932339 PMCID: PMC4048679 DOI: 10.11604/pamj.2014.17.28.3447] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Accepted: 11/09/2013] [Indexed: 01/31/2023] Open
Affiliation(s)
- Zacharie Sando
- Département des sciences morphologiques de la Faculté de Médecine et des Sciences Biomédicales de l'Université de Yaoundé 1, Cameroun ; Chef Service de l'unité d'anatomie pathologique de l'Hôpital Gynéco-Obstétrique et Pédiatrique de Yaoundé, Cameroun
| | - Jovanny Tsuala Fouogue
- Département de Gynécologie et obstétriques de la Faculté de Médecine et des Sciences Biomédicales de l'Université de Yaoundé I, Cameroun
| | | | - Jeanne Hortence Fouedjio
- Département de Gynécologie et obstétriques de la Faculté de Médecine et des Sciences Biomédicales de l'Université de Yaoundé I, Cameroun ; Unité de Gynécologie et d'Obstétrique de l'Hôpital Central de Yaoundé, Cameroun
| | - Emile Telesphore Mboudou
- Département de Gynécologie et obstétriques de la Faculté de Médecine et des Sciences Biomédicales de l'Université de Yaoundé I, Cameroun ; Chef de l'Unité de Gynécologie et Obstétriques de l'Hôpital Gynéco-Obstétrique et Pédiatrique de Yaoundé-Cameroun
| | - Jean Louis Oyono Essame
- Chef de département des sciences morphologiques de la Faculté de Médecine et des Sciences Biomédicales de l'Université de Yaoundé 1, Cameroun
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ORANG-OJONG BARNABASBESSEM, MUNYANGAJU JOSEEDWARD, WEI MASHANG, LIN MIAO, WEI FANGUAN, FOUKUNANG CHARLES, ZHU YAN. Impact of natural resources and research on cancer treatment and prevention: A perspective from Cameroon. Mol Clin Oncol 2013; 1:610-620. [PMID: 24649217 PMCID: PMC3916164 DOI: 10.3892/mco.2013.132] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2012] [Accepted: 02/19/2013] [Indexed: 11/26/2022] Open
Abstract
Cancer is a significant public health concern and treatment poses a problem and is frequently unsuccessful. As such, continuous efforts in the search for new agents and therapies to improve survival are required. A considerable number of plant extracts and isolated compounds possess significant anti-proliferative or pro-apoptotic effects. The majority of biologically active compounds belong to terpenoids, phenolics and alkaloids. Terpenoid plants such as Hypericum lanceolatum and a few alkaloid plants have been found to be potent anti-parasitic agents but have exhibited poor antimicrobial effects. The screening of medicinal plants for anticancer drugs has provided modern medicine with effective cytotoxic pharmaceuticals. Numerous medicinal plants have traditionally been used for the treatment of various ailments. However, a number of these medicinal plants have not been standardized and their mechanisms of actions are generally unknown. Active drug discovery research using local medicinal plants is ongoing. Some of these plant-derived compounds, including 3,39-dimethoxy-49-O-β-d-xylopyronosylellagic acid, have been tested for their potential use as anticancer agents. This review discussed the scope and possibility of natural products as anticancer remedy.
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Affiliation(s)
- BARNABAS BESSEM ORANG-OJONG
- Tianjin State Key Laboratory of Modern Chinese Medicine, Institute of Traditional Chinese Medicine and Development, Tianjin University of Traditional Chinese Medicine, Tianjin 300139,
P.R. China
| | - JOSE EDWARD MUNYANGAJU
- Tianjin State Key Laboratory of Modern Chinese Medicine, Institute of Traditional Chinese Medicine and Development, Tianjin University of Traditional Chinese Medicine, Tianjin 300139,
P.R. China
| | - MA SHANG WEI
- Tianjin State Key Laboratory of Modern Chinese Medicine, Institute of Traditional Chinese Medicine and Development, Tianjin University of Traditional Chinese Medicine, Tianjin 300139,
P.R. China
| | - MIAO LIN
- Tianjin State Key Laboratory of Modern Chinese Medicine, Institute of Traditional Chinese Medicine and Development, Tianjin University of Traditional Chinese Medicine, Tianjin 300139,
P.R. China
| | - FAN GUAN WEI
- Tianjin State Key Laboratory of Modern Chinese Medicine, Institute of Traditional Chinese Medicine and Development, Tianjin University of Traditional Chinese Medicine, Tianjin 300139,
P.R. China
| | - CHARLES FOUKUNANG
- Department of Pharmacy and Traditional Pharmacopoeia Development, University of Yaoundé 1, Yaoundé and Faculty of Medicine University of Bamenda, Yaoundé 00237,
Cameroon
| | - YAN ZHU
- Tianjin State Key Laboratory of Modern Chinese Medicine, Institute of Traditional Chinese Medicine and Development, Tianjin University of Traditional Chinese Medicine, Tianjin 300139,
P.R. China
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Wamai RG, Ayissi CA, Oduwo GO, Perlman S, Welty E, Welty T, Manga S, Onyango MA, Ogembo JG. Awareness, knowledge and beliefs about HPV, cervical cancer and HPV vaccines among nurses in Cameroon: an exploratory study. Int J Nurs Stud 2013; 50:1399-406. [PMID: 23395482 DOI: 10.1016/j.ijnurstu.2012.12.020] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Revised: 12/28/2012] [Accepted: 12/29/2012] [Indexed: 12/31/2022]
Abstract
BACKGROUND While it is known that sub-Saharan African countries face multiple obstacles such as cost in adopting vaccination against human papillomavirus (HPV), the crucial role nurses can play in implementing such programs has not been adequately examined. OBJECTIVES To investigate the knowledge and awareness of HPV, primary cause of cervical cancer and HPV vaccine among nurses working at four Cameroon Baptist Convention Health Services facilities, and to explore what factors influence nurses' willingness to inform and recommend HPV vaccine to adolescents and parents attending clinics. DESIGN AND SETTING A structured questionnaire survey was administered to a convenience sample of nursing staff working at the four health facilities. RESULTS Of 192 eligible nurses 76 (39.6%) participated in the study. There were moderately low levels of knowledge about HPV infection and prevention of cervical cancer, but a moderately high level of knowledge about HPV vaccine. Although 90.8% acknowledged that cervical cancer is directly linked to HPV infection, nearly 32% failed to identify it as a sexually transmitted infection (STI), while 43.4% believed it is an uncommon infection. Willingness to recommend the HPV vaccine was moderate, with 69.7% intentionally initiating discussions with patients about the subject. The most important factors considered when deciding to recommend the vaccine included effectiveness (56.6%) and side effects/safety (11.8%). Cost was less of a concern (6.6%), likely due to the availability of donated vaccine. CONCLUSION Despite high awareness about HPV, more education about the virus, cervical cancer and the vaccine are required to further increase nurses' willingness to recommend the vaccine and strengthen strategies for reaching adolescents through nurses in Cameroon.
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Wamai RG, Ayissi CA, Oduwo GO, Perlman S, Welty E, Manga S, Ogembo JG. Assessing the effectiveness of a community-based sensitization strategy in creating awareness about HPV, cervical cancer and HPV vaccine among parents in North West Cameroon. J Community Health 2013; 37:917-26. [PMID: 22302651 DOI: 10.1007/s10900-012-9540-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
In 2010, the Cameroon Baptist Convention Health Services (CBCHS) received a donation of HPV vaccine (Gardasil®) to immunize girls of ages 9-13 years in the North West Region of Cameroon. We evaluated the effectiveness of the CBCHS campaign program in sensitizing parents/guardians to encourage HPV vaccine uptake, identified factors that influence parents' decisions to vaccinate girls, and examined the uptake of cervical cancer screening among mothers. We conducted a cross-sectional survey in four healthcare facilities run by CBCHS, churches and other social settings. A total of 350 questionnaires were distributed and 317 were used for the analysis. There were high levels of awareness about cervical cancer, HPV and HPV vaccine. 75.5% understood HPV is sexually transmitted and 90.3% were aware of the use of vaccine as a preventive measure. Effectiveness of the vaccine (31.8%) and side effects/safety (18.4%) were the major barriers for parents to vaccinate their daughters. Bivariate analysis further revealed that the level of education (p = 0.0006), income level (p = 0.0044) and perceived risks (p = 0.0044) are additional factors influencing parents' decisions to vaccinate girls. 35.3% of women had sought a cervical cancer screening, significantly higher than the general estimated rate of screening (<10%) in other parts of Cameroon and sub-Saharan Africa. These results support the viability of a community-tailored sensitization strategy to increase awareness among the targeted audience of parents/guardians, who are critical decision-makers for vaccine delivery to children.
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Affiliation(s)
- Richard G Wamai
- Department of African American Studies, Northeastern University, Boston, MA, USA
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Awareness, Acceptability and Uptake of Human Papilloma Virus Vaccine Among Cameroonian School-Attending Female Adolescents. J Community Health 2012; 37:1127-35. [DOI: 10.1007/s10900-012-9554-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Echouffo-Tcheugui JB, Kengne AP. Chronic non-communicable diseases in Cameroon - burden, determinants and current policies. Global Health 2011; 7:44. [PMID: 22112686 PMCID: PMC3251529 DOI: 10.1186/1744-8603-7-44] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Accepted: 11/23/2011] [Indexed: 11/10/2022] Open
Abstract
Cameroon is experiencing an increase in the burden of chronic non-communicable diseases (NCDs), which accounted for 43% of all deaths in 2002. This article reviews the published literature to critically evaluate the evidence on the frequency, determinants and consequences of NCDs in Cameroon, and to identify research, intervention and policy gaps. The rising trends in NCDs have been documented for hypertension and diabetes, with a 2-5 and a 10-fold increase in their respective prevalence between 1994 and 2003. Magnitudes are much higher in urban settings, where increasing prevalence of overweight/obesity (by 54-82%) was observed over the same period. These changes largely result from the adoption of unfavorable eating habits, physical inactivity, and a probable increasing tobacco use. These behavioral changes are driven by the economic development and social mobility, which are part of the epidemiologic transition. There is still a dearth of information on chronic respiratory diseases and cancers, as well as on all NDCs and related risk factors in children and adolescents. More nationally representative data is needed to tract risk factors and consequences of NCDs. These conditions are increasingly been recognized as a priority, mainly through locally generated evidence. Thus, national-level prevention and control programs for chronic diseases (mainly diabetes and hypertension) have been established. However, the monitoring and evaluation of these programs is necessary. Budgetary allocations data by the ministry of health would be helpful, to evaluate the investment in NCDs prevention and control. Establishing more effective national-level tobacco control measures and food policies, as well as campaigns to promote healthy diets, physical activity and tobacco cessation would probably contribute to reducing the burden of NCDs.
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Affiliation(s)
- Justin B Echouffo-Tcheugui
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
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Pothisuwan M, Pataradool K, Tangjitgamol S, Srijaipracharoen S, Manusirivithaya S, Thawaramorn T. Visual inspection with acetic acid for detection of high grade lesion in atypical squamous cells and low grade squamous intraepithelial lesions from cervical Pap smear. J Gynecol Oncol 2011; 22:145-51. [PMID: 21998756 PMCID: PMC3188712 DOI: 10.3802/jgo.2011.22.3.145] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2011] [Revised: 04/26/2011] [Accepted: 05/13/2011] [Indexed: 11/08/2022] Open
Abstract
Objective To evaluate the value of visual inspection with acetic acid (VIA) test to detect high grade lesion in women with atypical squamous cells or low grade squamous intraepithelial lesions cervical cytology. Methods Women with atypical squamous cells or low grade squamous intraepithelial lesions who were scheduled to undergo colposcopy at Vajira Hospital and met inclusion criteria were included. All participants underwent VIA test prior to usual steps of colposcopy. The VIA results were interpreted as positive or negative using the criteria by the International Agency for Cancer Research. The standard colposcopic examination and appropriate investigations for cervical pathology were then continued. The diagnostic values of VIA test including sensitivity, specificity, positive predictive value, and negative predictive value were determined using high grade lesion including cervical intraepithelial neoplasia 2-3 and squamous cell carcinoma as a threshold. Results Total of 106 women was included. The VIA test was positive in 33 women (31.1%) and negative in 73 women (68.9%). Among the women with VIA test positive, 14 had high grade lesion (42.4%) while 19 had no significant lesions. Only 2/73 (2.7%) cases with negative VIA test had high grade lesion (both had cervical intraepithelial neoplasia 2). The sensitivity, specificity, positive predictive value and negative predictive value with 95% confidence interval were 87.5% (81.2 to 93.8%), 78.8% (71.1 to 86.7%), 42.4% (33.0 to 51.8%), and 97.2% (94.2 to 1.0%) respectively. Conclusion VIA as the intermediate test in atypical squamous cells and low grade squamous intraepithelial lesions cytology may reduce the necessity to refer some women for colposcopy.
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Affiliation(s)
- Methasinee Pothisuwan
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, Vajira Hospital, University of Bangkok Metropolitan Administration Medical College, Bangkok, Thailand
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Guggisberg K, Okorie C, Khalil M. Cytopathology including fine-needle aspiration in sub-Saharan Africa: a Cameroon experience. Arch Pathol Lab Med 2011; 135:200-6. [PMID: 21284438 DOI: 10.5858/135.2.200] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Surgical pathology is unavailable in most of sub-Saharan Africa because of equipment costs and lack of expertise. Cytopathology is an inexpensive and reliable alternative. OBJECTIVE To explore the utility of cytopathology in a rural hospital setting in Africa. DESIGN A cytopathologist and a pathology resident from Calgary, Alberta, Canada, went to Cameroon to provide a cytopathology service at the Banso Baptist Hospital. Both performed the fine-needle aspiration procedures. Direct smears were fixed in alcohol and stained with hematoxylin-eosin. Surgical specimens subsequently obtained from the patients were processed and reported at Calgary Laboratory Services, Canada. The histopathologic diagnoses were the gold standard for determining the accuracy of the cytologic diagnoses. RESULTS Fifty-nine patients were examined during a 5-week period, 33 females (56%) and 26 males (44%). Sixteen (27%) were known to be HIV positive. Forty-four fine-needle aspiration procedures were performed for 43 patients (73%). The cost of each procedure was approximately US $10. Head and neck and breast were the sites most frequently sampled for aspirates. Cervical smears from 5 patients were also assessed, as were 8 fluid specimens and 2 touch preparations of prostatic core biopsies. The most frequent diagnoses for malignancy were carcinoma and lymphoma. Tuberculous lymphadenitis was diagnosed in 6 patients, 4 of whom were HIV positive. Surgical specimens were received from 18 patients (30%). Cytohistologic and clinicopathologic correlation revealed 1 false-positive (1.6%) and 1 false-negative (1.6%) diagnosis. CONCLUSION Cytopathology is a reliable alternative for tissue diagnosis in low-resource settings.
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Affiliation(s)
- Kelly Guggisberg
- Department of Pathology and Laboratory Medicine, University of Calgary and Calgary Laboratory Services, Alberta, Canada
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Patil K, Durdi G, Lakshmi KS. Comparison of Diagnostic Efficacy of Visual Inspection of Cervix with Acetic Acid and Pap Smear for Prevention of Cervical Cancer: Is VIA Superseding Pap Smear? ACTA ACUST UNITED AC 2011. [DOI: 10.5005/jp-journals-10006-1148] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
ABSTRACT
Objectives
To estimate diagnostic efficacy of visual inspection with acetic acid (VIA) in comparison to Pap smear.
Methods
This cross-sectional study was carried over a period of 24 months on 200 women attending colposcopy clinic at KLES Dr Prabhakar Kore Hospital and Medical Research Center, Belgaum, India. All women enrolled in study underwent Pap smear, VIA, colposcopy and biopsy. The sensitivity, specificity, PPV, NPV, false-positive rate and false-negative rate were calculated for VIA, Pap smear and colposcopy with biopsy as the reference standard.
Results
In our study, sensitivity and specificity of VIA were found to be 86.95% and 72.51% respectively, and that of Pap smear 37.68% and 92.36% respectively. Colposcopy showed higher sensitivity (94.20%) and specificity (94.65%).
Conclusion
VIA is a suitable primary screening procedure alternative to Pap smear as it has high sensitivity and negative predictive value.
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Aggarwal P, Batra S, Gandhi G, Zutshi V. Comparison of Papanicolaou test with visual detection tests in screening for cervical cancer and developing the optimal strategy for low resource settings. Int J Gynecol Cancer 2010; 20:862-8. [PMID: 20606535 DOI: 10.1111/igc.0b013e3181e02f77] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES To compare the sensitivity, specificity, positive and negative predictive values, and accuracy of Papanicolaou test with visual inspection with acetic acid (VIA)/VIA using magnification devices (VIAM) and develop the best strategy for screening in low resource settings. MATERIALS AND METHODS This is a prospective cross-sectional study on 408 symptomatic multiparous women in the reproductive age group, sequentially using the Papanicolaou test, the VIA, and the VIAM for screening. Women with a positive screening test underwent guided biopsy and endocervical curettage. The site of biopsy was recorded. Histopathological findings were taken as the "gold" standard in comparing the methods. RESULTS The mean (SD) age was 32.3 (6.8) years (range, 15-49 years), whereas the mean (SD) parity was 2.9 (1.2) (range, 1-9). Abnormal cytological findings were detected in 2.9% patients, whereas the remaining smears were negative for any intraepithelial lesion or malignancy. A total of 113 cases were screened positive by one/all methods. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the Papanicolaou test, the VIA, and the VIAM were 24, 98, 42, 96, and 94%; 95, 78, 19, 99, and 79%; and 95, 78, 19, 99, and 79%, respectively, for high-grade lesions. CONCLUSIONS The Papanicolaou test had low sensitivity but high specificity, whereas visual detection methods had a high sensitivity in addition to being cheaper. Alternative methods of screening such as VIA/VIAM can be a valuable alternative to the Papanicolaou test for cervical cancer screening in low resource settings. Visual inspection using magnification devices may be of benefit over VIA in doubtful cases.
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Affiliation(s)
- Pakhee Aggarwal
- Department of Obstetrics and Gynaecology, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India.
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Can visual inspection with acetic acid under magnification substitute colposcopy in detecting cervical intraepithelial neoplasia in low-resource settings? Arch Gynecol Obstet 2010; 284:397-403. [DOI: 10.1007/s00404-010-1673-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2010] [Accepted: 09/02/2010] [Indexed: 12/28/2022]
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Does acetic acid influence the non-dysplastic Pap smear? Arch Gynecol Obstet 2010; 283:1309-12. [PMID: 20552209 DOI: 10.1007/s00404-010-1556-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2010] [Accepted: 06/03/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Acetic acid tests are commonly performed for colposcopic evaluation of the cervix. However, it is unclear whether the acetic acid influences normal Papanicolaou (Pap) smear results. METHODS Patients were routinely seen in our outpatient department between April and May 2009. Two Pap smears were performed in 50 patients. One smear was done before, the other after the acetic acid test. The smears were evaluated by an experienced cytologist. He did not know whether the smear was done with or without acetic acid. RESULTS In a normal smear, there was no influence of acetic acid on the cytologic result. In two patients, a smear of Pap III [Bethesda, atypical squamous cells of undetermined significance (ASCUS)] was seen before acetic acid test. This changed to Pap IIID [Bethesda, low-grade squamous epithelial lesions (LSIL)] after acetic acid test. CONCLUSIONS The acetic acid test does not seem to alter the result of the non-dysplastic smear. In contrast to this, a dysplastic smear seems to be influenced by the acetic acid. This should be evaluated in a further investigation.
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Evaluation of a single-step diagnosis and treatment of premalignant cervical lesion by LEEP. Int J Gynaecol Obstet 2009; 107:224-7. [DOI: 10.1016/j.ijgo.2009.07.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2009] [Revised: 07/16/2009] [Accepted: 07/17/2009] [Indexed: 11/18/2022]
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Akinwuntan AL, Adesina OA, Okolo CA, Oluwasola OA, Oladokun A, Ifemeje AA, Adewole IF. Correlation of cervical cytology and visual inspection with acetic acid in HIV-positive women. J OBSTET GYNAECOL 2009; 28:638-41. [PMID: 19003664 DOI: 10.1080/01443610802259977] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The prevalence of squamous intraepithelial lesion is higher among human immunodeficiency virus (HIV)-positive women. These lesions when they occur in these patients are also more difficult to treat. A total of 205 consenting HIV-seropositive women were recruited. A cervical cytology (Pap smear) was taken, followed by visual inspection with freshly prepared 5% acetic acid and cervical biopsy taken from the squamocolumnar junction as the reference for diagnosis to avoid verification bias. The sensitivity of VIA was 76.0% (95% CI 52.0-91.0); specificity 83.0% (95% CI 77.0-88.0); positive predictive value 34.0% (95% CI 21.0-49.0). The sensitivity of cervical cytology (Pap smear) was 57.0% (95% CI 34.0-77.0), specificity of 95.0% (95% CI 90.0-97.0), and positive predictive value of 55.0% (95% CI 33.0-75.0). In HIV-seropositive women, the sensitivity of VIA is 76.0%, making it a useful screening test for preinvasive lesion of the cervix in low resource settings.
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Affiliation(s)
- A L Akinwuntan
- Department of Obstetrics and Gynaecology, University College Hospital, Ibadan, Nigeria.
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Chumworathayi B, Eamratsameekool W, Kularbkaew C, Chumworathayi P. Visual inspection with acetic acid test qualities in a secondary setting. J Obstet Gynaecol Res 2008; 34:909-13. [DOI: 10.1111/j.1447-0756.2008.00848.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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CHUMWORATHAYI B, SRISUPUNDIT S, LUMBIGANON P, LIMPAPHAYOM K. One-year follow-up of single-visit approach to cervical cancer prevention based on visual inspection with acetic acid wash and immediate cryotherapy in rural Thailand. Int J Gynecol Cancer 2008; 18:736-42. [DOI: 10.1111/j.1525-1438.2007.01112.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Direct Visual Inspection of the Cervix With Lugol Iodine for the Detection of Premalignant Lesions. J Low Genit Tract Dis 2008; 12:193-8. [DOI: 10.1097/lgt.0b013e31815f527c] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Tebeu PM, Major AL, Rapiti E, Petignat P, Bouchardy C, Sando Z, de Bernis L, Ali L, Mhawech-Fauceglia P. The attitude and knowledge of cervical cancer by Cameroonian women; a clinical survey conducted in Maroua, the capital of Far North Province of Cameroon. Int J Gynecol Cancer 2008; 18:761-5. [PMID: 17868337 DOI: 10.1111/j.1525-1438.2007.01066.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
This study was conducted to assess the knowledge, attitudes, and assumption of cervical cancer by women living in Maroua, the capital of the Far North Province of Cameroon. In a 1-month period, 171 women were surveyed as to their socioeconomic status, sexual habits, prior knowledge of cervical cancer, its prevention, and their attitudes toward cervical cancer. Of 171 women, 48 (28%) had prior knowledge of cervical cancer; they were classified as the "aware group" compared with 123 of 171 (72%) women who were uninformed about cervical cancer and they were classified as the "unaware group" (UG). The UG of women tended to be single mothers, illiterate, housewives, and had their first child before the age of 20 (P < 0.005). Despite the awareness of cervical cancer by 28% of women, only a minority of them, 4 of 48 (8.3%), underwent a preventative screening test. Only 71 of 171 (41.5%) women stated that they would be having a screening test in the future. The awareness of cervical cancer by women in Cameroon is still inadequate. Thus, to avoid deaths from cervical cancer, a curable and preventable disease, the need of an aggressive campaign to make Cameroonian women aware of cervical cancer and its prevention is needed.
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Affiliation(s)
- P-M Tebeu
- Department of Obstetrics and Gynecology, Provincial Hospital of Maroua-Cameroon, Maroua, Cameroon.
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Tsu VD. Reconsidering the feasibility of papanicolaou and alternative screening tests for low-resource countries. Am J Public Health 2006; 97:199; author reply 199-200. [PMID: 17194850 PMCID: PMC1781411 DOI: 10.2105/ajph.2006.102830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Goldhaber-Fiebert JD, Goldie SJ. Estimating the cost of cervical cancer screening in five developing countries. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2006; 4:13. [PMID: 16887041 PMCID: PMC1570139 DOI: 10.1186/1478-7547-4-13] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2006] [Accepted: 08/03/2006] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cost-effectiveness analyses (CEAs) can provide useful information to policymakers concerned with the broad allocation of resources as well as to local decision makers choosing between different options for reducing the burden from a single disease. For the latter, it is important to use country-specific data when possible and to represent cost differences between countries that might make one strategy more or less attractive than another strategy locally. As part of a CEA of cervical cancer screening in five developing countries, we supplemented limited primary cost data by developing other estimation techniques for direct medical and non-medical costs associated with alternative screening approaches using one of three initial screening tests: simple visual screening, HPV DNA testing, and cervical cytology. Here, we report estimation methods and results for three cost areas in which data were lacking. METHODS To supplement direct medical costs, including staff, supplies, and equipment depreciation using country-specific data, we used alternative techniques to quantify cervical cytology and HPV DNA laboratory sample processing costs. We used a detailed quantity and price approach whose face validity was compared to an adaptation of a US laboratory estimation methodology. This methodology was also used to project annual sample processing capacities for each laboratory type. The cost of sample transport from the clinic to the laboratory was estimated using spatial models. A plausible range of the cost of patient time spent seeking and receiving screening was estimated using only formal sector employment and wages as well as using both formal and informal sector participation and country-specific minimum wages. Data sources included primary data from country-specific studies, international databases, international prices, and expert opinion. Costs were standardized to year 2000 international dollars using inflation adjustment and purchasing power parity. RESULTS Cervical cytology laboratory processing costs were I$1.57-3.37 using the quantity and price method compared to I$1.58-3.02 from the face validation method. HPV DNA processing costs were I$6.07-6.59. Rural laboratory transport costs for cytology were I$0.12-0.64 and I$0.14-0.74 for HPV DNA laboratories. Under assumptions of lower resource efficiency, these estimates increased to I$0.42-0.83 and I$0.54-1.06. Estimates of the value of an hour of patient time using only formal sector participation were I$0.07-4.16, increasing to I$0.30-4.80 when informal and unpaid labor was also included. The value of patient time for traveling, waiting, and attending a screening visit was I$0.68-17.74. With the total cost of screening for cytology and HPV DNA testing ranging from I$4.85-40.54 and I$11.30-48.77 respectively, the cost of the laboratory transport, processing, and patient time accounted for 26-66% and 33-65% of the total costs. From a payer perspective, laboratory transport and processing accounted for 18-48% and 25-60% of total direct medical costs of I$4.11-19.96 and I$10.57-28.18 respectively. CONCLUSION Cost estimates of laboratory processing, sample transport, and patient time account for a significant proportion of total cervical cancer screening costs in five developing countries and provide important inputs for CEAs of alternative screening modalities.
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Affiliation(s)
- Jeremy D Goldhaber-Fiebert
- Program in Health Decision Science, Harvard School of Public Health, Harvard University, 718 Huntington Avenue, Boston, MA, 02115, USA
| | - Sue J Goldie
- Program in Health Decision Science, Harvard School of Public Health, Harvard University, 718 Huntington Avenue, Boston, MA, 02115, USA
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Proceedings From the First Asia-Oceania Research Organisation on Genital Infections and Neoplasia (AOGIN) Meeting. Infect Dis Obstet Gynecol 2006. [PMCID: PMC1779609 DOI: 10.1155/idog/2006/59089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The First Asia-Oceania Research Organisation on Genital Infections
and Neoplasia (AOGIN) Meeting was held in Kota Kinabalu, Malaysia,
in July 2005. The conference covered regional issues relating to
infection with the human papillomavirus—epidemiology, virology,
and immunology, testing, screening, and prevention strategies—as
well as cervical cancer screening and its management.
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Goldhaber-Fiebert JD, Denny LE, De Souza M, Wright TC, Kuhn L, Goldie SJ. The costs of reducing loss to follow-up in South African cervical cancer screening. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2005; 3:11. [PMID: 16288646 PMCID: PMC1308836 DOI: 10.1186/1478-7547-3-11] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2005] [Accepted: 11/15/2005] [Indexed: 11/10/2022] Open
Abstract
Background This study was designed to quantify the resources used in reestablishing contact with women who missed their scheduled cervical cancer screening visits and to assess the success of this effort in reducing loss to follow-up in a developing country setting. Methods Women were enrolled in this Cape Town, South Africa-based screening study between 2000 and 2003, and all had scheduled follow-up visits in 2003. Community health worker (CHW) time, vehicle use, maintenance, and depreciation were estimated from weekly logs and cost accounting systems. The percentage of women who attended their scheduled visit, those who attended after CHW contact(s), and those who never returned despite attempted contact(s) were determined. The number of CHW visits per woman was also estimated. Results 3,711 visits were scheduled in 2003. Of these, 2,321 (62.5%) occurred without CHW contact, 918 (24.8%) occurred after contact(s), and 472 (12.7%) did not occur despite contact(s). Loss to follow-up was reduced from 21% to 6%, 39% to 10%, and 50% to 24% for 6, 12, and 24-month visits. CHWs attempted 3,200 contacts in 530 trips. On average, 3 CHWs attempted to contact 6 participants over each 111 minute trip. The per-person cost (2003 Rand) for these activities was 12.75, 24.92, and 40.50 for 6, 12, and 24-month visits. Conclusion CHW contact with women who missed scheduled visits increased their return rate. Cost-effectiveness analyses aimed at policy decisions about cervical cancer screening in developing countries should incorporate these findings.
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Affiliation(s)
| | - Lynette E Denny
- Department of Obstetrics and Gynecology, University of Cape Town, South Africa
| | - Michelle De Souza
- Department of Obstetrics and Gynecology, University of Cape Town, South Africa
| | - Thomas C Wright
- Department of Pathology, College of Physicians and Surgeons of Columbia University, New York, USA
| | - Louise Kuhn
- Gertrude H. Sergievsky Center, College of Physicians and Surgeons, and Division of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, New York, USA
| | - Sue J Goldie
- Harvard Initiative for Global Health, Harvard University, Massachusetts, USA
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