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Habila MA, Obeng-Kusi M, Ali MJ, Magaji FA, Shambe IH, Daru PH, Jacobs ET, Madhivanan P, Sagay AS, Musa J. The impact of the COVID-19 pandemic on routine HIV care and cervical cancer screening in North-Central Nigeria. BMC Womens Health 2023; 23:640. [PMID: 38037005 PMCID: PMC10687784 DOI: 10.1186/s12905-023-02782-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 11/13/2023] [Indexed: 12/02/2023] Open
Abstract
INTRODUCTION Cervical cancer is the fourth most diagnosed cancer among women globally, with much of the burden being carried by women in limited-resource settings often worsened by the high prevalence of HIV. Furthermore, the COVID-19 pandemic disrupted organized screening efforts and HIV management regimens worldwide, and the impact of these disruptions have not been examined in these settings. The purpose of this paper is to describe whether uptake of cervical cancer screening and HIV management changed before, during, and since the COVID-19 pandemic in North-Central Nigeria. METHODS Longitudinal healthcare administration data for women who obtained care between January 2018 and December 2021 were abstracted from the AIDS Prevention Initiative Nigeria (APIN) clinic at Jos University Teaching Hospital. Patient demographics, pap smear outcomes, and HIV management indicators such as viral load and treatment regimen were abstracted and assessed using descriptive and regression analyses. All analyses were conducted comparing two years prior to the COVID-19 pandemic, the four quarters in 2020, and the year following COVID-19 restrictions. RESULTS We included 2304 women in the study, most of whom were between 44 and 47 years of age, were married, and had completed secondary education. About 85% of women were treated with first line highly active retroviral therapy (HAART). Additionally, 84% of women screened using pap smear had normal results. The average age of women who sought care at APIN was significantly lower in Quarter 3, 2020 (p = 0.015) compared to the other periods examined in this study. Conversely, the average viral load for women who sought care during that period was significantly higher in adjusted models (p < 0.0001). Finally, we determined that the average viral load at each clinic visit was significantly associated with the period in which women sought care. CONCLUSIONS Overall, we found that COVID-19 pandemic mitigation efforts significantly influenced women's ability to obtain cervical cancer screening and routine HIV management at APIN clinic. This study buttresses the challenges in accessing routine and preventive care during the COVID-19 pandemic, especially in low-resource settings. Further research is needed to determine how these disruptions to care may influence long-term health in this and similar at-risk populations.
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Affiliation(s)
- Magdiel A Habila
- Mel and Enid, Department of Epidemiology and Biostatistics, Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA.
- Department of Health and Pharmaceutical Outcomes, R. Ken Coit College of Pharmacy, University of Arizona, Tucson, AZ, USA.
| | - Mavis Obeng-Kusi
- Department of Health and Pharmaceutical Outcomes, R. Ken Coit College of Pharmacy, University of Arizona, Tucson, AZ, USA
| | - Maryam J Ali
- Department of Obstetrics and Gynecology, University of Jos and Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Francis A Magaji
- Department of Obstetrics and Gynecology, University of Jos and Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Iornum H Shambe
- Department of Obstetrics and Gynecology, University of Jos and Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Patrick H Daru
- Department of Obstetrics and Gynecology, University of Jos and Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Elizabeth T Jacobs
- Mel and Enid, Department of Epidemiology and Biostatistics, Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Purnima Madhivanan
- Mel and Enid, Department of Health Promotion Sciences, Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
- Public Health Research Institute of India, Mysore, India
| | - Atiene S Sagay
- Department of Obstetrics and Gynecology, University of Jos and Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Jonah Musa
- Department of Obstetrics and Gynecology, University of Jos and Jos University Teaching Hospital, Jos, Plateau State, Nigeria
- Department of Preventive Medicine, Division of Cancer Epidemiology and Prevention, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Okafor IP, Kukoyi FO, Kanma-Okafor OJ, Izuka MO. Male involvement in female partners' screening for breast and cervical cancers in Southwest Nigeria. PLoS One 2023; 18:e0284141. [PMID: 37163507 PMCID: PMC10171596 DOI: 10.1371/journal.pone.0284141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 03/25/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Breast and cervical cancers are in the top 10 most common cancers in women globally and the most common cancers in Nigerian women. The incidences have been rising steadily over the years. Involvement of men as key players in reproductive health issues has been receiving global attention especially in low and middle-income countries. AIM To assess male involvement in their female partners' screening for breast and cervical cancers in Southwest, Nigeria. METHOD This was a community-based, cross-sectional study that employed a multi-stage sampling method to select 254 men who were married or in steady relationships in Lagos State, Southwest Nigeria. Data were collected from June to October 2018 using a semi-structured interviewer-administered questionnaire, analyzed using Epi Info version 3.5.1 and summarized with mean and standard deviation. Chi-square test was used for bivariate statistics, and the p-value of ≤0.05 was considered statistically significant. Multivariable logistic regression was used for predictor variables of male involvement in screening. RESULTS 29.5% of the respondents had good knowledge of breast and cervical cancers and screening and majority (85.5%) had a positive attitude towards screening. Only few, 19.3% and 15.7% had provided money for breast and cervical cancer screening respectively. Most men, 75% and 87.4% respectively had not accompanied their wife/female partner for breast and cervical cancer screening, while almost half (49.2%) and one-third (33.5%) respectively, had encouraged their female partners to screen for breast and cervical cancers. Overall, only about half, 138 (54.3%) of the men were considered 'involved' in their female partners' screening for breast and cervical cancers. Male involvement was significantly associated with screening for female cancers (χ2 = 77.62, p = 0.001). Older age group (AOR = 2.64, 95% CI: 1.3-4.9), higher educational attainment (AOR = 3.51, 95% CI: 1.14-10.73), and positive attitude (AOR = 2.48, 95% CI:1.16-5.33) were found to be the predictors of male involvement. CONCLUSION Community-based programs for males, especially the younger and less educated, should be implemented to increase their involvement. It is also suggested that mass media messages be spread and online platforms be explored in order to increase men's awareness and participation in female cancer screening.
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Affiliation(s)
- Ifeoma Peace Okafor
- Department of Community Health & Primary Care, College of Medicine, University of Lagos, Mushin, Lagos, Nigeria
| | - Folayemi Oyinkansola Kukoyi
- Department of Community Health & Primary Care, College of Medicine, University of Lagos, Mushin, Lagos, Nigeria
| | - Oluchi Joan Kanma-Okafor
- Department of Community Health & Primary Care, College of Medicine, University of Lagos, Mushin, Lagos, Nigeria
| | - Michael Orji Izuka
- Department of Community Health & Primary Care, College of Medicine, University of Lagos, Mushin, Lagos, Nigeria
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Nomatshila SC, Apalata TR, Mabunda SA. Perceptions and knowledge of school management teams about non-communicable diseases and strategies to prevent them. Health SA 2022; 27:1781. [PMID: 35281281 PMCID: PMC8905376 DOI: 10.4102/hsag.v27i0.1781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 12/09/2021] [Indexed: 11/08/2022] Open
Abstract
Background In 2016, non-communicable diseases (NCDs) were reported to be responsible for 41 million of the world’s 57 million deaths. These deaths were reported to be associated with modifiable lifestyle behaviours, such as tobacco smoking, poor physical activity and diets of poor nutritional value. There could be a knowledge gap on NCD risk factors amongst non-health professionals. Knowledge of NCDs is, therefore, important for the implementation of preventive measures to onset of NCDs. Aim This study aimed at describing perceptions and knowledge of school management teams about NCDs and strategies to prevent them. Setting This study was conducted in Mt Frere, South Africa. Methods This explorative qualitative study using a phenomenological data collection approach was conducted amongst purposively selected school authorities in 2016–2017 to understand their perceptions and knowledge about NCDs and what can be performed to prevent them. Two focus group discussions (FGDs) were conducted using open-ended and unstructured questions guided by interview schedule. Tesch’s eight phases of thematic analysis approach was used to analyse narrative data resulting in two main themes and nine subthemes. Results Two themes (understanding and prevention of NCDs, and control measures for NCDs) and nine sub-themes emerged from the data analysis. Inconsistent description of NCDs, its causes and controls were identified amongst school management teams in the FGD. Diet, poverty, societal factors, gaps between decision makers and communities, and poor policy implementation were identified by participants as major issues in the development of NCDs. Conclusion There was no adequate knowledge on NCDs amongst the school management team participants. Improved visibility of health promotion personnel is needed to ensure community empowerment on NCDs prevention. Contribution The findings in this study will help in closing the gaps in the implementation of preventive health services for NCDs within school health.
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Affiliation(s)
- Sibusiso C Nomatshila
- Department of Public Health, Faculty of Health Sciences, Walter Sisulu University, Mthatha, South Africa
| | - Teke R Apalata
- Department of Laboratory Medicine, Faculty of Health Sciences, Walter Sisulu University, Mthatha, South Africa
| | - Sikhumbuzo A Mabunda
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
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John-Akinola YO, Ndikom CM, Oluwasanu MM, Adebisi T, Odukoya O. Cervical Cancer and Human Papillomavirus Vaccine Knowledge, Utilisation, Prevention Educational Interventions and Policy Response in Nigeria: A Scoping Review. Cancer Control 2022; 29:10732748221130180. [PMID: 36168955 PMCID: PMC9523857 DOI: 10.1177/10732748221130180] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE This review evaluated the knowledge, utilisation, prevention education, and policy response across the six geopolitical regions of Nigeria to inform national efforts for the prevention and control of cervical cancer. METHODS A keyword-based systematic search was conducted in PubMed/MEDLINE (NCBI), Google Scholar, and AJOL electronic databases, including a manual scan of papers, journals and websites to identify relevant peer-reviewed studies. Articles were screened and assessed for eligibility. RESULTS Many (158) articles were downloaded and after duplicates were removed, 110 articles were included in the final analysis. These were made up of qualitative, quantitative (cross-sectional), intervention and policy studies. Studies have generally reported poor knowledge and awareness of cervical cancer screening but those carried out in urban areas demonstrated a slightly higher level of awareness of Human Papilloma Virus (HPV) vaccine, HPV vaccination uptake and utilization of cervical cancer preventive services than the rural studies. The studies did not show strong government support or policies in relation to cervical cancer control. CONCLUSION Knowledge and uptake of cervical cancer preventive services across diverse groups in Nigeria remain poor. These could be linked to socio-cultural factors, the lack of an organised cervical cancer screening programme and low financial resource pool for cervical cancer prevention. Therefore, it is necessary to increase government, donor prioritisation and political support in order to ensure increased investment and commitment to cervical cancer elimination in Nigeria.
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Affiliation(s)
- Yetunde O John-Akinola
- Department of Health Promotion and Education, Faculty of Public Health, College of Medicine, 113092University of Ibadan, Ibadan, Nigeria
| | - Chizoma M Ndikom
- Department of Nursing, College of Medicine, 113092University of Ibadan, Ibadan, Nigeria
| | - Mojisola M Oluwasanu
- Department of Health Promotion and Education, Faculty of Public Health, College of Medicine, 113092University of Ibadan, Ibadan, Nigeria
| | - Temitayo Adebisi
- Department of Radiation Oncology, 107962University College Hospital, Ibadan, Nigeria
| | - Oluwaponmile Odukoya
- Department of Radiation Oncology, College of Medicine, 113092University of Ibadan, Ibadan, Nigeria
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Habila MA, Kimaru LJ, Mantina N, Valencia DY, McClelland DJ, Musa J, Madhivanan P, Sagay A, Jacobs ET. Community-Engaged Approaches to Cervical Cancer Prevention and Control in Sub-Saharan Africa: A Scoping Review. Front Glob Womens Health 2021; 2:697607. [PMID: 34816234 PMCID: PMC8594022 DOI: 10.3389/fgwh.2021.697607] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/25/2021] [Indexed: 12/24/2022] Open
Abstract
Background: Cervical cancer remains one of the top causes of cancer mortality among African women. Cervical cancer screening and early detection and treatment of precancer is one of the evidence-based interventions to reduce incidence and mortality. The application of community-based participatory research (CBPR) has been used in the United States to improve participation in screening and reduce cervical cancer disparities. However, it is unclear whether these engaged approaches have been used in sub-Saharan African to address disparities related to cervical cancer mortality. Objectives: Highlight community engagement in cervical cancer prevention and control in Sub-Saharan Africa (SSA), describe the community engagement efforts that are currently being used, and to describe the best practices for community engagement toward the end-goal of cervical cancer prevention and control. Methods: We searched PubMed, Embase, CINHAL, African Journals Online (AJOL), and African Index Medicus-WHO from inception until June 8, 2020. After screening 620 titles and abstracts, and reviewing 56 full-text articles according to inclusion and exclusion criteria, 9 articles met the selection criteria and were included. Relevant data variables were extracted from the included articles and a narrative synthesis was performed. Results: Between 2005 and 2019, 9 articles describing research in Ghana, Kenya, Zambia, Senegal, South Africa, and Nigeria were included. These articles described work that largely took place in rural settings predominantly among women age 15-65 years. Leveraging community networks such as community health workers, religious organizations, traditional leaders, and educational institutions increased awareness of cervical cancer. Working within existing social structures and training community members through the research effort were promising methods for addressing the disparities in cervical cancer incidence and mortality among communities. Discussion: The findings of this scoping review have contributed to the understanding of which novel approaches to community-based practices can be used to address cervical cancer disparities among SSA communities that carry a disproportionate disease burden. Community engagement in the research process, while effortful, has shown to be beneficial to researchers and to the communities that they serve, and provides valuable next steps in the effort to address cervical cancer disparities in SSA.
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Affiliation(s)
- Magdiel A. Habila
- Department of Epidemiology and Biostatistics, University of Arizona, Tucson, AZ, United States
- Department of Health and Pharmaceutical Outcomes, University of Arizona, Tucson, AZ, United States
| | - Linda Jepkoech Kimaru
- Department of Health Promotion Sciences, University of Arizona, Tucson, AZ, United States
| | - Namoonga Mantina
- Department of Health Promotion Sciences, University of Arizona, Tucson, AZ, United States
| | - Dora Yesenia Valencia
- Clinical Translational Sciences, College of Medicine, University of Arizona Health Sciences, Tucson, AZ, United States
| | - D. Jean McClelland
- Department of Health Promotion Sciences, University of Arizona, Tucson, AZ, United States
- Health Sciences Library, University of Arizona, Tucson, AZ, United States
| | - Jonah Musa
- Department of Obstetrics and Gynecology, Jos University Teaching Hospital, Jos, Nigeria
- Department of Preventive Medicine, Division of Cancer Epidemiology and Prevention, Northwestern University, Chicago, IL, United States
| | - Purnima Madhivanan
- Department of Health Promotion Sciences, University of Arizona, Tucson, AZ, United States
| | - Atiene Sagay
- Department of Obstetrics and Gynecology, Jos University Teaching Hospital, Jos, Nigeria
| | - Elizabeth T. Jacobs
- Department of Epidemiology and Biostatistics, University of Arizona, Tucson, AZ, United States
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Ba DM, Ssentongo P, Musa J, Agbese E, Diakite B, Traore CB, Wang S, Maiga M. Prevalence and determinants of cervical cancer screening in five sub-Saharan African countries: A population-based study. Cancer Epidemiol 2021; 72:101930. [PMID: 33756434 DOI: 10.1016/j.canep.2021.101930] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/19/2021] [Accepted: 03/14/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Cervical cancer is the fourth most common cancer among women worldwide, with an estimate of 570,000 new cases and about 311,000 deaths annually. Low-resource countries, including those in sub-Saharan Africa, have the highest-burden with an estimate of 84 % of all cervical cancers. This study examines the prevalence and socio-demographic-economic factors associated with cervical cancer screening in sub-Saharan Africa. METHODS A weighted population-based cross-sectional study using Demographic and Health Surveys data. We used available data on cervical cancer screening between 2011 and 2018 from the Demographic and Health Surveys for five sub-Saharan African countries (Benin, Ivory Coast, Kenya, Namibia, and Zimbabwe). The study population included women of childbearing age, 21-49 years (n = 28,976). We fit a multivariable Poisson regression model to identify independent factors associated with cervical cancer screening. RESULTS The overall weighted prevalence of cervical cancer screening was 19.0 % (95 % CI: 18.5 %-19.5 %) ranging from 0.7 % in Benin to 45.9 % in Namibia. Independent determinants of cervical cancer screening were: older age (40-49 years) adjusted prevalence ratio (aPR) = 1.77 (95 % CI: 1.64, 1.90) compared with younger age (21-29 years), secondary/higher education (aPR = 1.51, 95 CI: 1.28-1.79) compared with no education, health insurance (aPR = 1.53, 95 % CI: 1.44-1.61) compared with no insurance, and highest socioeconomic status (aPR = 1.39, 95 % CI: 1.26-1.52) compared with lowest. CONCLUSION The prevalence of cervical cancer screening is substantially low in sub-Saharan Africa countries and shows a high degree of between-country variation. Interventions aimed at increasing the uptake of cervical cancer screening in sub-Saharan Africa are critically needed.
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Affiliation(s)
- Djibril M Ba
- Penn State College of Medicine, Department of Public Health Sciences, Hershey, PA, United States.
| | - Paddy Ssentongo
- Penn State College of Medicine, Department of Public Health Sciences, Hershey, PA, United States
| | - Jonah Musa
- Department of Obstetrics and Gynecology, College of Health Sciences, University of Jos, Nigeria; Department of Preventive Medicine, Division of Cancer Epidemiology and Prevention, Northwestern University, IL 60611, USA
| | - Edeanya Agbese
- Penn State College of Medicine, Department of Public Health Sciences, Hershey, PA, United States
| | - Brehima Diakite
- University of Sciences, Techniques, and Technologies of Bamako (USTTB), Faculty of Medicine and Odontostomatology, Bamako, Mali
| | - Cheick Bougadari Traore
- University of Sciences, Techniques, and Technologies of Bamako (USTTB), Faculty of Medicine and Odontostomatology, Bamako, Mali
| | - Steve Wang
- Mobile Imaging Innovations, Inc., Evanston, IL, United States
| | - Mamoudou Maiga
- University of Sciences, Techniques, and Technologies of Bamako (USTTB), Faculty of Medicine and Odontostomatology, Bamako, Mali; Northwestern University, Department of Biomedical Engineering, Evanston, IL, United States; Department of Preventive Medicine, Division of Cancer Epidemiology and Prevention, Northwestern University, IL 60611, USA
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Rahman R, Clark MD, Collins Z, Traore F, Dioukhane EM, Thiam H, Ndiaye Y, De Jesus EL, Danfakha N, Peters KE, Komarek T, Linn AM, Linn PE, Wallner KE, Charles M, Hasnain M, Peterson CE, Dykens JA. Cervical cancer screening decentralized policy adaptation: an African rural-context-specific systematic literature review. Glob Health Action 2019; 12:1587894. [PMID: 30938248 PMCID: PMC6450494 DOI: 10.1080/16549716.2019.1587894] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Background: Worldwide, nearly 570,000 women are diagnosed with cervical cancer each year, with 85% of new cases in low- and middle-income countries. The African continent is home to 35 of 40 countries with the highest cervical cancer mortality rates. In 2014, a partnership involving a rural region of Senegal, West Africa, was facing cervical cancer screening service sustainability barriers and began adapting regional-level policy to address implementation challenges. Objective: This manuscript reports the findings of a systematic literature review describing the implementation of decentralized cervical cancer prevention services in Africa, relevant in context to the Senegal partnership. We report barriers and policy-relevant recommendations through Levesque’s Patient-Centered Access to Healthcare Framework and discuss the impact of this information on the partnership’s approach to shaping Senegal’s regional cervical cancer screening policy. Methods: The systematic review search strategy comprised two complementary sub-searches. We conducted an initial search identifying 4272 articles, then applied inclusion criteria, and ultimately 19 studies were included. Data abstraction focused on implementation barriers categorized with the Levesque framework and by policy relevance. Results: Our findings identified specific demand-side (clients and community) and supply-side (health service-level) barriers to implementation of cervical cancer screening services. We identify the most commonly reported demand- and supply-side barriers and summarize salient policy recommendations discussed within the reviewed literature. Conclusions: Overall, there is a paucity of published literature regarding barriers to and best practices in implementation of cervical cancer screening services in rural Africa. Many articles in this literature review did describe findings with notable policy implications. The Senegal partnership has consulted this literature when faced with various similar barriers and has developed two principal initiatives to address contextual challenges. Other initiatives implementing cervical cancer visual screening services in decentralized areas may find this contextual reporting of a literature review helpful as a construct for identifying evidence for the purpose of guiding ongoing health service policy adaptation.
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Affiliation(s)
- R Rahman
- a University of Toledo College of Medicine and Life Sciences , Toledo , OH , USA
| | - M D Clark
- b Library of the Health Sciences , University Library, University of Illinois at Chicago , Chicago , IL , USA.,c Department of Medical Education, College of Medicine , University of Illinois at Chicago , Chicago , IL , USA
| | - Z Collins
- d Department of Family Medicine, Institute for Health Research and Policy , University of Illinois at Chicago (UIC) , Chicago , IL , USA
| | - F Traore
- e Region medical de Kedougou , Bureau de la santé de la reproduction, prevention transmission mere enfant du VIH-SIDA , Kedougou , Senegal
| | | | - H Thiam
- g Region medical de Kedougou , Bureau régional de la formation, de la supervision et de la recherche , Kedougou , Senegal
| | - Y Ndiaye
- h Département de Recherche , Sénégal Ministère de la Santé et l'Action Sociale , Dakar , Sénégal
| | - E L De Jesus
- i School of Public Health (SPH) , University of Illinois at Chicago (UIC) , Chicago , IL , USA
| | | | - K E Peters
- k School of Public Health, Division of Community Health Sciences, Illinois Prevention Research Center, Institute for Health Research and Policy , University of Illinois at Chicago (UIC) , Chicago , IL , USA
| | - T Komarek
- l Uniformed Services University , Bethesda , MD , USA
| | - A M Linn
- m School of Public Health, Center for Communications Programs , Johns Hopkins University , Baltimore , MD , USA
| | - P E Linn
- n Logistics Management Institute , Tysons , VA , USA
| | - K E Wallner
- o Elizabeth Glaser Pediatric AIDS Foundation , Washington , DC , USA
| | - M Charles
- p Department of Internal Medicine , University of Illinois at Chicago , Chicago , IL , USA
| | - M Hasnain
- q Department of Family Medicine , University of Illinois at Chicago College of Medicine , Chicago , IL , USA
| | - C E Peterson
- r School of Public Health, Division of Epidemiology & Biostatistics, UI Cancer Center , University of Illinois at Chicago (UIC) , Chicago , IL , USA
| | - J A Dykens
- s Department of Family Medicine, Center for Global Health, Institute for Health Research and Policy, Cancer Center , University of Illinois at Chicago (UIC) , Chicago , IL , USA
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Are Nigerian Women Pro-Active about Noncommunicable Disease Prevention? A Quantitative Survey. Ann Glob Health 2019; 85. [PMID: 30896134 PMCID: PMC6634947 DOI: 10.5334/aogh.2355] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Noncommunicable diseases (NCDs) continue to cause significant morbidity and mortality worldwide with incidence increasing rapidly in developing countries. Poor utilization of preventive healthcare services contributes to this high burden. Objective: To assess the knowledge and utilization of preventive healthcare services among women in Lagos, Nigeria. Methods: This was a cross-sectional descriptive study carried out at Mainland Local Government Area (LGA) between May and July 2014. Respondents were selected using the multistage sampling method. A pretested, interviewer-administered questionnaire was used to obtain information. Data were analyzed using Epi info software version 7. Summary and inferential statistics were done and the level of significance was set at <5% (p < 0.05). Findings: Awareness of specified NCDs among the 322 respondents was 82.61% and of preventive healthcare services for the NCDs was 65.22%. Virtually all (99.05%) of the respondents had poor knowledge of these preventive services. Utilization rates were equally poor. Most common screening/tests done were Blood Pressure measurement (78.18%), Self breast examination (69.96%) and blood sugar test (58.33%). Much lower utilization rates were recorded for lipid profile (37.57%), Pap smear (26.11%), Visual Inspection with Acetic Acid (VIA) (19.72%), Human Papilloma Virus (HPV) immunization (16.55%) and mammography (14.72%). Conclusions: Respondents were aware of specified NCDs and preventive healthcare services. They considered routine medical check-up important, however they had poor knowledge of the preventive health services for NCDs and hardly utilized them. Women should be given detailed information on the preventive healthcare services to improve their knowledge and utilization so as to reduce the NCD burden.
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Gu C, Chan CWH, Chow KM, Yang S, Luo Y, Cheng H, Wang H. Understanding the cervical screening behaviour of Chinese women: The role of health care system and health professions. Appl Nurs Res 2018; 39:58-64. [PMID: 29422178 DOI: 10.1016/j.apnr.2017.09.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 06/24/2017] [Accepted: 09/23/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND In China, cervical cancer cases are increasing, making an impact on the worldwide burden of cervical cancer. Despite the initiatives undertaken by the Chinese government, the current coverage of cervical screening in China remains suboptimal. There is an urgent need to identify the facilitators and barriers associated with the uptake of cervical cancer screening among the Chinese population. PURPOSE The study aimed to explore the experiences and perceptions of cervical cancer screening of mainland Chinese women in relation to their screening behaviour, particularly in the aspects of health care system and health profession roles. METHODS A qualitative research was conducted using semi-structured interviews. A total of 27 Chinese women aged 25 to 50 (both screened and non-screened women) completed the interviews. The analysis of the interview data was undertaken inductively using latent content analysis. DISCUSSION AND CONCLUSION Results showed that organised health examination programmes provide a good basis for integrating cervical screening into broader checks on the health of women, and utilising different networks of social support facilitate the utilisation of the screening service. However, education on cervical cancer and screening must be made more generally available. More importantly, there is a need for a more participatory and empowering exchange in the encounter between health professions and these women. Appropriate training program is strongly recommended for health professions about communicate skills with patients. Future work should focus on identifying strategies to overcome the barriers to cervical screening related to health care system and medical professions among this population.
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Affiliation(s)
- Can Gu
- Xiangya School of Nursing, Central South University, Changsha, PR China.
| | - Carmen W H Chan
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong.
| | - Ka Ming Chow
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong.
| | - Shengbo Yang
- Third Xiangya Hospital, Central South University, Changsha, PR China.
| | - Yang Luo
- Xiangya School of Nursing, Central South University, Changsha, PR China.
| | - Huilin Cheng
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong.
| | - Honghong Wang
- Xiangya School of Nursing, Central South University, Changsha, PR China.
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Chigbu CO, Onyebuchi AK, Onyeka TC, Odugu BU, Dim CC. The impact of community health educators on uptake of cervical and breast cancer prevention services in Nigeria. Int J Gynaecol Obstet 2017; 137:319-324. [PMID: 28295268 DOI: 10.1002/ijgo.12150] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 01/25/2017] [Accepted: 03/08/2017] [Indexed: 12/13/2022]
Abstract
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.
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Affiliation(s)
- Chibuike O Chigbu
- Department of Obstetrics and Gynecology, University of Nigeria Nsukka, Nsukka, Nigeria
| | - Azubuike K Onyebuchi
- Department of Obstetrics and Gynecology, Federal Teaching Hospital, Abakaliki, Nigeria
| | - Tonia C Onyeka
- Department of Anaesthesia, University of Nigeria Nsukka, Nsukka, Nigeria
| | - Boniface U Odugu
- Department of Obstetrics and Gynecology, Enugu State University Teaching Hospital, Enugu, Nigeria
| | - Cyril C Dim
- Department of Obstetrics and Gynecology, University of Nigeria Nsukka, Nsukka, Nigeria
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Sidabutar S, Martini S, Wahyuni CU. Analysis of Factors Affecting Women of Childbearing Age to Screen Using Visual Inspection with Acetic Acid. Osong Public Health Res Perspect 2017; 8:61-64. [PMID: 28443225 PMCID: PMC5402845 DOI: 10.24171/j.phrp.2017.8.1.08] [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] [Indexed: 11/18/2022] Open
Abstract
Objectives The purpose of this study was to evaluate patient factors such as knowledge, attitude, motivation, perception, socio-economic status and travel time to health facilities and assess how these factors affected patients’ decision to pursue cervical cancer screening with visual inspection with acetic acid (VIA). Methods A total of 80 women of childbearing age who visited Kenjeran and Balongsari Public Health Centers for health assessments were involved in this study. Patients who agreed to participate in the study underwent a verbal questionnaire to evaluate various factors. Results Bivariate analysis concluded that knowledge, attitude, motivation, perception, socioeconomic status, and travel time to health facilities were significantly different between women who received VIA screening and women who did not receive VIA screening (p < 0.05). The factors of knowledge, attitudes, motivation, perception, socio-economic status, and the travel time to health facilities accounted for 2.920-fold, 2.043-fold, 3.704-fold, 2.965-fold, 3.198-fold and 2.386-fold possibility, respectively, of patients to pursue cervical cancer screening with VIA. Multivariate analysis showed that perception, socio-economic status, and travel time to health facilities were the most important factors influencing whether or not women pursued VIA screening. Conclusion Knowledge, attitude, motivation, perception, socio-economic status, and travel time to health facilities appears to affect women’s’ decision to pursue cervical cancer screening with VIA, with the largest intake being the motivational factor.
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Affiliation(s)
- Sondang Sidabutar
- Faculty of Public Health, Airlangga University, Surabaya, Indonesia.,Public Health Study Programme, Faculty of Health, Efarina University, Simalungun, Indonesia
| | - Santi Martini
- Department of Epidemiology, Faculty of Public Health, Airlangga University, Surabaya, Indonesia
| | - Chatarina Umbul Wahyuni
- Department of Epidemiology, Faculty of Public Health, Airlangga University, Surabaya, Indonesia
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12
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Mwaka AD, Orach CG, Were EM, Lyratzopoulos G, Wabinga H, Roland M. Awareness of cervical cancer risk factors and symptoms: cross-sectional community survey in post-conflict northern Uganda. Health Expect 2016; 19:854-67. [PMID: 26205470 PMCID: PMC4957614 DOI: 10.1111/hex.12382] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Lack of awareness of risk factors and symptoms for cancer may lead to late diagnosis and poor prognosis. OBJECTIVE We assessed community awareness about cervical cancer risk factors and symptoms and perceptions about prevention and cure of cervical cancer in order to contribute data to inform interventions to improve cervical cancer survival. DESIGN Cross-sectional population-based survey. SETTING AND PARTICIPANTS We conducted this study in Gulu, a post-conflict district in Uganda in 2012. The sample included 448 persons aged 18 years and above, selected through a multi-stage stratified cluster sampling process. DATA COLLECTION METHODS AND ANALYSIS We collected data using a pretested structured questionnaire. Logistic regressions were used to determine magnitudes of associations between socio-demographic and outcome variables. RESULTS Most participants (444/448) had heard about cervical cancer. Known risk factors including multiple sexual partners, human papillomavirus infection, and early onset of sexual activity, were recognized by 88%, 82%, and 78% of respondents respectively. 63% of participants believed that prolonged use of family planning pills and injections caused cervical cancer. The majority of participants recognized symptoms of cervical cancer including inter-menstrual bleeding (85%), post-menopausal bleeding (84%), and offensive vaginal discharge (83%). 70% of participants believed that cervical cancer is preventable and 92% believed that it could be cured if diagnosed at an early stage. DISCUSSION AND CONCLUSIONS Recognition of cervical cancer risk factors and symptoms was high among study participants. Targeted interventions including increasing availability of HPV vaccination, population-based cervical screening and diagnostic services can translate high awareness into actual benefits.
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Affiliation(s)
- Amos D Mwaka
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Christopher G Orach
- Department of Community Health and Behavioral Sciences, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Georgios Lyratzopoulos
- Department of Health Services Research, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Henry Wabinga
- Kampala Cancer Registry, Department of Pathology, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Martin Roland
- Department of Health Services Research, Institute of Public Health, University of Cambridge, Cambridge, UK
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Adegboyega A, Hatcher J. Factors Influencing Pap Screening Use Among African Immigrant Women. J Transcult Nurs 2016; 28:479-487. [PMID: 27470266 DOI: 10.1177/1043659616661612] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Papanicolau (Pap) screenings disparities exist for immigrant women in the United States. This study sought to have an understanding of factors influencing Pap screening among sub-Saharan African immigrant women. METHOD This is a qualitative descriptive study. Women were recruited from the community and by word of mouth following institutional review board approval. Data were gathered through in-depth focus group and demographic questionnaires. Interview sessions were digitally recorded and transcribed verbatim. Transcripts were analyzed for themes. FINDINGS Twenty-two women aged 24 to 65 years were interviewed. Barriers to screening included low knowledge of screening, cost, cultural beliefs, fear and communication issues. Motivators to improve Pap use include provider's recommendations, enlightenment, and family support. DISCUSSION Interventions addressing the barriers peculiar to this population may alleviate these barriers and improve Pap screening use in this population. Providers have the opportunity to influence screening attitudes of African-born women by providing awareness and patient-targeted interventions.
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14
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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: 102] [Impact Index Per Article: 12.8] [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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15
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Chigbu CO, Onyebuchi AK, Egbuji CC, Ezugwu EC. Experiences and unmet needs of women undergoing Pap smear cervical cancer screening: impact on uptake of cervical cancer screening in south eastern Nigeria. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2015; 30:81-85. [PMID: 24980966 DOI: 10.1007/s13187-014-0691-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
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.
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Kantelhardt EJ, Moelle U, Begoihn M, Addissie A, Trocchi P, Yonas B, Hezkiel P, Stang A, Thomssen C, Vordermark D, Gemechu T, Gebrehiwot Y, Wondemagegnehu T, Aynalem A, Mathewos A. Cervical cancer in Ethiopia: survival of 1,059 patients who received oncologic therapy. Oncologist 2014; 19:727-34. [PMID: 24951611 DOI: 10.1634/theoncologist.2013-0326] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Almost 500,000 women are newly diagnosed with cervical cancer (CC) every year, the majority from developing countries. There is little information on the survival of these patients. Our primary objective was to evaluate consecutive CC patients presenting over 4 years at the only radiotherapy center in Ethiopia. METHODS All patients with CC from September 2008 to September 2012 who received radiotherapy and/or surgery were included (without brachytherapy). Vital status was obtained through telephone contact or patient cards. RESULTS Of 2,300 CC patients, 1,059 patients with standardized treatment were included. At the end of the study, 249 patients had died; surviving patients had a median follow-up of 16.5 months; the 10% and 90% percentiles were 3.0 and 32.7 months, respectively. Mean age was 49 years (21-91 years). The majority of patients presented with International Federation of Gynecology and Obstetrics stage IIb-IIIa (46.7%). Because of progression during the waiting time (median 3.8 months), this proportion declined to 19.3% at the beginning of radiotherapy. The 1- and 2-year overall survival probabilities were 90.4% and 73.6%. If assuming a worst-case scenario (i.e., if all patients not available for follow-up after 6 months had died), the 2-year survival probability would be 45.4%. CONCLUSION This study gives a thorough 4-year overview of treated patients with CC in Ethiopia. Given the limited treatment availability, a relatively high proportion of patients survived 2 years. More prevention and early detection at all levels of the health care system are needed. Increasing the capacity for external-beam radiation as well as options for brachytherapy would facilitate treatment with curative intention.
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Affiliation(s)
- Eva Johanna Kantelhardt
- Department of Gynaecology and Institute of Clinical Epidemiology, Martin Luther University, Halle an der Saale, Germany; School of Public Health, Departments of Pathology and Gynaecology, and Radiotherapy Center, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia; Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Ulrike Moelle
- Department of Gynaecology and Institute of Clinical Epidemiology, Martin Luther University, Halle an der Saale, Germany; School of Public Health, Departments of Pathology and Gynaecology, and Radiotherapy Center, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia; Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Matthias Begoihn
- Department of Gynaecology and Institute of Clinical Epidemiology, Martin Luther University, Halle an der Saale, Germany; School of Public Health, Departments of Pathology and Gynaecology, and Radiotherapy Center, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia; Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Adamu Addissie
- Department of Gynaecology and Institute of Clinical Epidemiology, Martin Luther University, Halle an der Saale, Germany; School of Public Health, Departments of Pathology and Gynaecology, and Radiotherapy Center, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia; Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Pietro Trocchi
- Department of Gynaecology and Institute of Clinical Epidemiology, Martin Luther University, Halle an der Saale, Germany; School of Public Health, Departments of Pathology and Gynaecology, and Radiotherapy Center, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia; Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Bekuretsion Yonas
- Department of Gynaecology and Institute of Clinical Epidemiology, Martin Luther University, Halle an der Saale, Germany; School of Public Health, Departments of Pathology and Gynaecology, and Radiotherapy Center, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia; Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Petros Hezkiel
- Department of Gynaecology and Institute of Clinical Epidemiology, Martin Luther University, Halle an der Saale, Germany; School of Public Health, Departments of Pathology and Gynaecology, and Radiotherapy Center, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia; Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Andreas Stang
- Department of Gynaecology and Institute of Clinical Epidemiology, Martin Luther University, Halle an der Saale, Germany; School of Public Health, Departments of Pathology and Gynaecology, and Radiotherapy Center, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia; Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Christoph Thomssen
- Department of Gynaecology and Institute of Clinical Epidemiology, Martin Luther University, Halle an der Saale, Germany; School of Public Health, Departments of Pathology and Gynaecology, and Radiotherapy Center, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia; Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Dirk Vordermark
- Department of Gynaecology and Institute of Clinical Epidemiology, Martin Luther University, Halle an der Saale, Germany; School of Public Health, Departments of Pathology and Gynaecology, and Radiotherapy Center, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia; Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Tufa Gemechu
- Department of Gynaecology and Institute of Clinical Epidemiology, Martin Luther University, Halle an der Saale, Germany; School of Public Health, Departments of Pathology and Gynaecology, and Radiotherapy Center, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia; Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Yirgu Gebrehiwot
- Department of Gynaecology and Institute of Clinical Epidemiology, Martin Luther University, Halle an der Saale, Germany; School of Public Health, Departments of Pathology and Gynaecology, and Radiotherapy Center, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia; Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Tigeneh Wondemagegnehu
- Department of Gynaecology and Institute of Clinical Epidemiology, Martin Luther University, Halle an der Saale, Germany; School of Public Health, Departments of Pathology and Gynaecology, and Radiotherapy Center, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia; Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Abreha Aynalem
- Department of Gynaecology and Institute of Clinical Epidemiology, Martin Luther University, Halle an der Saale, Germany; School of Public Health, Departments of Pathology and Gynaecology, and Radiotherapy Center, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia; Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Assefa Mathewos
- Department of Gynaecology and Institute of Clinical Epidemiology, Martin Luther University, Halle an der Saale, Germany; School of Public Health, Departments of Pathology and Gynaecology, and Radiotherapy Center, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia; Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts, USA
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Chigbu CO, Onyebuchi AK. See-and-treat management of high-grade squamous intraepithelial lesions in a resource-constrained African setting. Int J Gynaecol Obstet 2013; 124:204-6. [PMID: 24377647 DOI: 10.1016/j.ijgo.2013.07.040] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 08/24/2013] [Accepted: 11/27/2013] [Indexed: 10/25/2022]
Abstract
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.
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Affiliation(s)
- Chibuike O Chigbu
- Department of Obstetrics and Gynecology, University of Nigeria Teaching Hospital, Ituku-Ozalla, Nigeria.
| | - Azubuike K Onyebuchi
- Department of Obstetrics and Gynecology, Federal Teaching Hospital, Abakaliki, Nigeria
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