1
|
Atiase Y, Effah K, Mawusi Wormenor C, Tekpor E, Aku Catherine Morkli E, Boafo E, Yorke E, Aryee R, Essel NOM, Danyo S, Kemawor S, Akpalu J. Prevalence of high-risk human papillomavirus infection among women with diabetes mellitus in Accra, Ghana. BMC Womens Health 2024; 24:260. [PMID: 38664791 PMCID: PMC11044360 DOI: 10.1186/s12905-024-03078-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 04/04/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND There is increasing evidence of a higher risk and poorer prognosis of cervical cancer among women with diabetes mellitus (DM) compared to the general population. These are mediated by higher susceptibility to persistent high-risk human papillomavirus (hr-HPV) infection due to dysfunctional clearance in an immunocompromised state. We aimed to determine the prevalence of hr-HPV infection and cervical lesions in a cohort of women with DM in Ghana. We further disaggregated the prevalence according to DM type and explored factors associated with hr-HPV infection. METHODS This retrospective descriptive cross-sectional study assessed 198 women with DM who underwent cervical screening via concurrent hr-HPV DNA testing and visual inspection with acetic acid in an outpatient department of the National Diabetes Management and Research Centre in Korle-Bu Teaching Hospital, Accra from March to May 2022. Univariate and multivariable binary logistic regression were used to explore factors associated with hr-HPV positivity. RESULTS Among 198 women with DM (mean age, 60.2 ± 12.1 years), the overall hr-HPV prevalence rate was 21.7% (95% CI, 16.1-28.1), disaggregated as 1.5% (95% CI, 0.3-4.4) each for HPV16 and HPV18 and 20.7% (95% CI, 15.3-27.0) for other HPV genotype(s). Respective hr-HPV prevalence rates were 37.5% (95% CI, 15.2-64.6) for type 1 DM, 19.8% (95% CI, 13.9-26.7) for type 2 DM, and 25.0% (95% CI, 8.7-49.1) for unspecified/other DM types. Past use of the combined contraceptive pill independently increased the risk of hr-HPV infection by approximately three times (adjusted odds ratio [aOR] = 2.98; 95% CI, 1.03 - 8.64; p-value = 0.045), whereas each unit increase in FBG level increased the odds of hr-HPV infection by about 15% (aOR = 1.15; 95% CI, 1.02 - 1.30; p-value = 0.021). CONCLUSION Our study points to a high prevalence of hr-HPV among women with DM and highlights a need for glycemic control among them as this could contribute to lowering their odds of hr-HPV infection. The low overall rates of HPV vaccination and prior screening also indicate a need to build capacity and expand the scope of education and services offered to women with DM as regards cervical precancer screening.
Collapse
Affiliation(s)
- Yacoba Atiase
- Department of Medicine and Therapeutics, University of Ghana Medical School, P. O. Box GP 4236, Accra, Ghana.
- Department of Medicine and Therapeutics, Korle-Bu Teaching Hospital, Korle-Bu, P. O. Box KB 77, Accra, Ghana.
| | - Kofi Effah
- Catholic Hospital, Battor, P. O. Box 2, Battor, Ghana
| | | | - Ethel Tekpor
- Catholic Hospital, Battor, P. O. Box 2, Battor, Ghana
| | | | - Eunice Boafo
- Department of Medicine and Therapeutics, Korle-Bu Teaching Hospital, Korle-Bu, P. O. Box KB 77, Accra, Ghana
| | - Ernest Yorke
- Department of Medicine and Therapeutics, University of Ghana Medical School, P. O. Box GP 4236, Accra, Ghana
- Department of Medicine and Therapeutics, Korle-Bu Teaching Hospital, Korle-Bu, P. O. Box KB 77, Accra, Ghana
| | - Robert Aryee
- Department of Cardiology, University of Ghana Medical Center, P. O. Box LG 25, Accra, Ghana
| | - Nana Owusu Mensah Essel
- Department of Emergency Medicine, College of Health Sciences, Faculty of Medicine and Dentistry, University of Alberta, 730 University Terrace, Edmonton, AB, T6G 2T4, Canada
| | - Stephen Danyo
- Catholic Hospital, Battor, P. O. Box 2, Battor, Ghana
| | | | - Josephine Akpalu
- Department of Medicine and Therapeutics, University of Ghana Medical School, P. O. Box GP 4236, Accra, Ghana
- Department of Medicine and Therapeutics, Korle-Bu Teaching Hospital, Korle-Bu, P. O. Box KB 77, Accra, Ghana
| |
Collapse
|
2
|
Ampofo AG, Mackenzie LJ, Osei Asibey S, Oldmeadow C, Boyes AW. Prevalence and Correlates of Cervical Cancer Prevention Knowledge Among High School Students in Ghana. HEALTH EDUCATION & BEHAVIOR 2024; 51:185-196. [PMID: 38105234 PMCID: PMC10981191 DOI: 10.1177/10901981231217978] [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] [Indexed: 12/19/2023]
Abstract
INTRODUCTION Cervical cancer is a preventable yet highly prevalent disease in Africa. Despite female adolescents and young women being a target group for cervical cancer prevention strategies, little research has examined their knowledge of how to prevent the disease. The study aimed to describe: (a) knowledge about cervical cancer prevention and (b) sociodemographic, social, and systemic factors associated with and interacting with knowledge among female senior high school students in Ghana. METHODS A cross-sectional survey assessed knowledge about (a) risk factors and (b) primary and secondary prevention of cervical cancer among 2,400 female students from 17 public senior high schools in the Ashanti region, Ghana. Descriptive statistics were used to describe knowledge. Linear mixed-effects regression models were used to examine factors associated with knowledge scores. RESULTS Knowledge gaps were observed for at least two-thirds (>65%) of students. Most students (mean age = 17) did not know that early sexual debut (before 18 years) is a risk factor for cervical cancer (72%) and that a blood test cannot detect cervical cancer (71%). Students in later stages of senior high school education and those who received sexual health education from teachers and parents had significantly greater cervical cancer knowledge scores than their counterparts. Interactive effects showed that school-based sexual health education was associated with higher knowledge scores than home-based education among students. CONCLUSIONS Most female senior high school students had gaps in knowledge about cervical cancer prevention. Finding new ways to strengthen the capacity of schools and parents to deliver accurate cervical cancer prevention information is warranted.
Collapse
Affiliation(s)
- Ama Gyamfua Ampofo
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
- Equity in Health and Wellbeing Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Lisa J Mackenzie
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
- Equity in Health and Wellbeing Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Shadrack Osei Asibey
- Faculty of Applied Sciences and Technology, Kumasi Technical University, Kumasi, Ghana
| | | | - Allison W Boyes
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
- Equity in Health and Wellbeing Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| |
Collapse
|
3
|
Mensah KB, Boamah Mensah AB, Yamoah P, Manfo J, Amo R, Wiafe E, Padayachee N, Bangalee V. Socio-Demographic Factors and Other Predictors of Pap Test Uptake Among Women: A Retrospective Study in Ghana. Cancer Manag Res 2023; 15:489-499. [PMID: 37332844 PMCID: PMC10275324 DOI: 10.2147/cmar.s398500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 05/13/2023] [Indexed: 06/20/2023] Open
Abstract
Introduction The World Health Organization has reported a rise in cervical cancer in Ghana. Ghanaian women predominantly undergo opportunistic Pap smear screening for cervical cancer. Numerous studies have documented differences in the sociodemographic traits of participants undergoing Pap smear testing or screening, which correlates with their screening habits. This study aims to assess sociodemographic variables, including others that determine Pap test utilization at a single center in Ghana. Methods A single-center survey was conducted by extracting data from the records of women who walked in for Pap smear testing. A telephone survey was also conducted among these women to document their barriers to utilizing the center. For data analysis, descriptive statistics and chi-square were utilized. Results A total of 197 participants' records were retrieved for the study. Most participants were market women (69.4%) and uneducated (71.4%). Their Pap smear screening records indicate that the majority (86%) had no history of cervical cancer screening, and only 3% tested positive for Pap smear test. Educational level, occupation and family history of cancer significantly correlated with participants' Pap smear history (p<0.05). However, most sociodemographic factors were not significant with the Pap test results of the participants (p>0.05). The perceived barrier identified by most participants was the need for more information (67.40%) on the test. Conclusion This study revealed that sociodemographic and gynaecological factors do not correlate with Pap test results. However, education level, occupation, and family history of cancer were significantly associated with the history of Pap smear uptake. The most significant barrier hindering Pap smear services was the need for more information.
Collapse
Affiliation(s)
- Kofi Boamah Mensah
- Department of Pharmacy Practice, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Peter Yamoah
- Department of Pharmacy Practice, University of Health and Allied Sciences, Kumasi, Ghana
| | - Jennifer Manfo
- Pharmacy Department, Maternal and Child Health Hospital, Kumasi, Ghana
| | - Richmond Amo
- Internal Medicine & Department of Herbal Medicine, University Hospital & Faculty of Pharmacy and Pharmaceutical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Neelaveni Padayachee
- Department of Pharmacy and Pharmacology, University of the Witwatersrand, Johannesburg, South Africa
| | - Varsha Bangalee
- Discipline of Pharmaceutical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| |
Collapse
|
4
|
Isla-Ortiz D, Torres-Domínguez J, Pérez-Peralta L, Jiménez-Barrera H, Bandala-Jacques A, Meneses-García A, Reynoso-Noverón N. Insurance status and access to cervical cancer treatment in a specialized cancer center in Mexico. Medicine (Baltimore) 2023; 102:e33655. [PMID: 37115063 PMCID: PMC10145798 DOI: 10.1097/md.0000000000033655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 04/06/2023] [Accepted: 04/10/2023] [Indexed: 04/29/2023] Open
Abstract
To describe access to complete treatment in women with cervical cancer and state-sponsored insurance versus no insurance. We conducted a retrospective observational study. The source population consisted of women treated for cervical cancer from January 2000 to December 2015 in a tertiary care hospital. We included 411 women with state-sponsored insurance and 400 without insurance. We defined access to cervical cancer treatment as complete treatment (according NCCN/ESMO (National Comprehensive Cancer Network/European Society for Medical Oncology) standards) and timely initiation of treatment (less than 4 weeks). Clinical and sociodemographic characteristics were described and analyzed with logistic regression using complete treatment as the main outcome. A total of 811 subjects were included, the median age was 46 (IQR (Interquartile range) 42-50) years. Most of them were married (36.1%), unemployed (50.4%), and had completed primary school (44.0%). The most common clinical stages at diagnosis were II (38.2%) and III (24.7%). In the adjusted regression model, being married (OR (odds ratio): 4.3, 95% CI (confidence interval): 1.74-10.61) and having paid employment (OR: 2.79, 95% CI: 1.59-4.90) or state-sponsored insurance (OR: 1.54, 95% CI: 1.04-2.26) were positively associated with the possibility of having a complete treatment. Women with insurance were likely to be younger and receive timely treatment compared with uninsured women. Complete treatment was associated to insurance status and advanced stages of cervical cancer. State-sponsored insurance improves access to complete treatment. Government policies are needed to avoid social and economic inequity and provide better management of cervical cancer in our country.
Collapse
Affiliation(s)
- David Isla-Ortiz
- Departamento de tumores ginecológicos, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Juan Torres-Domínguez
- Centro de Investigación en Prevención, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Liliana Pérez-Peralta
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Instituto de Oftalmología Fundación Conde de Valenciana, Mexico City, Mexico
| | - Hugo Jiménez-Barrera
- Centro de Investigación en Prevención, Instituto Nacional de Cancerología, Mexico City, Mexico
| | | | | | - Nancy Reynoso-Noverón
- Centro de Investigación en Prevención, Instituto Nacional de Cancerología, Mexico City, Mexico
| |
Collapse
|
5
|
Indracanti M, Berhane N, Minyamer T. Factors Associated with Pre- and Post-Educational Intervention Knowledge Levels of HPV and Cervical Cancer Among the Male and Female University Students, Northwest Ethiopia. Cancer Manag Res 2021; 13:7149-7163. [PMID: 34548819 PMCID: PMC8449546 DOI: 10.2147/cmar.s326544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 08/30/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Human papillomavirus (HPV) infections are sexually transmitted and most frequently associated with cervical cancer in women, but they are also a public health concern in men. There is rising evidence that HPV's role in other cancers, such as anal, vulva, vaginal, penis, head, and neck cancers. The present study aimed to understand the factors associated with HPV and cervical cancer knowledge levels of university students before and after an educational intervention. METHODS An Institutional-based cross-sectional study was conducted from October to November 2018. A total of 638 study participants were selected using a simple random multistage sampling technique. A pretested questionnaire was used, consolidated the data, and analyzed with SPSS version 23. Bivariate and multivariate logistic regression analyses were performed to identify which variables were associated with the knowledge levels. RESULTS Six hundred thirty-eight study participants with a 100% response rate, and the mean age was 21.07 years (±SD, 1.96). Initial awareness of various broad categories was 4.09, and after the intervention, it increased to 23.4, with an average increase of 19.31 at 99% CI, p≤0.001 significance level. Before the educational intervention, students with <21 years of age [6.16, 95% CI: (2.21-17.18)] and ≤2.5 CGPA [3.44, 95% CI: (1.51-7.81)] were less knowledgeable over other counterparts. After educational intervention, the year of study was significantly associated with increased knowledge of overall and different broad categories of cervical cancer and HPV. Year of study, 1st-year students [AOR: 0.27, 95% CI: (0.14-0.51)] over third years and above are less knowledgeable. First-year students and CGPA ≤2.5 were less improved awareness over others. CONCLUSION The educational intervention improved more than fourfold increase knowledge on cervical cancer and HPV, and the year of study was a key factor associated with overall improvement. This study suggests that educational intervention effectively strengthens our understanding of the spread of HPV and cervical cancer disease burden.
Collapse
Affiliation(s)
- Meera Indracanti
- Institute of Biotechnology, University of Gondar, Gondar, Ethiopia
| | - Nega Berhane
- Institute of Biotechnology, University of Gondar, Gondar, Ethiopia
| | - Tigist Minyamer
- Institute of Biotechnology, University of Gondar, Gondar, Ethiopia
| |
Collapse
|
6
|
Morhason-Bello IO, Kareem YO, Adewole IF. Modeling for Predictors of Knowledge Score on Etiology and Prevention Strategies for Cervical Cancer Among Women of Reproductive Age in Ibadan. JCO Glob Oncol 2020; 6:892-903. [PMID: 32589467 PMCID: PMC7328104 DOI: 10.1200/go.20.00086] [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: 12/24/2022] Open
Abstract
PURPOSE Poor knowledge regarding cervical cancer in at-risk populations directly affects health-seeking behavior and is associated with high mortality among women with cervical cancer. This study aims to evaluate the knowledge of women regarding the causes, risk factors, and prevention strategies of cervical cancer. METHODS A multistage cross-sectional study of 1,002 women of reproductive age (18-49 years) in Ibadan was conducted. Knowledge of cervical cancer risk causes and prevention strategies was assessed using 13 and 9 question items, respectively. The knowledge score was graded as 0 (no knowledge), 1-4 (poor knowledge), or ≥ 5 (good knowledge). The proportional or partial proportional odds model was used to fit 3 models using the forward stepwise selection. All analysis was performed using Stata 15.0 (Stata Corp, College Station, TX). RESULTS The median age of participants was 29 years (interquartile range [IQR], 23-35 years). The median knowledge scores of participants on causes and prevention strategies of cervical cancer were 3 (IQR, 0-4) and 3 (IQR, 0-5), respectively. The assessment of knowledge on causes and prevention strategies for cervical cancer revealed that having multiple sexual partners and no previous opportunity for counseling on cervical cancer screening were factors associated with lower odds of knowledge. CONCLUSION The knowledge of women about the risk factors, causes, and prevention strategies of cervical cancer was poor. It is worrisome that poor knowledge was common among women with potential demographic risk factors for cervical cancer. We recommend innovative community mobilization to improve women’s knowledge of the risk factors associated with cervical cancer and prevention strategies.
Collapse
Affiliation(s)
- Imran O Morhason-Bello
- Department of Obstetrics and Gynecology, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria.,Institute of Advanced Medical Research and Training, College of Medicine, University of Ibadan, Nigeria
| | - Yusuf Olushola Kareem
- Institute of Advanced Medical Research and Training, College of Medicine, University of Ibadan, Nigeria.,Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Isaac F Adewole
- Department of Obstetrics and Gynecology, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
| |
Collapse
|
7
|
Ampofo AG, Adumatta AD, Owusu E, Awuviry-Newton K. A cross-sectional study of barriers to cervical cancer screening uptake in Ghana: An application of the health belief model. PLoS One 2020; 15:e0231459. [PMID: 32352983 PMCID: PMC7192489 DOI: 10.1371/journal.pone.0231459] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 03/24/2020] [Indexed: 02/02/2023] Open
Abstract
Background The high incidence (32.9, age-standardized per 100,000) and mortality (23.0, age-standardized per 100,000) of cervical cancer (CC) in Ghana have been largely attributed to low screening uptake (0.8%). Although the low cost (Visual inspection with acetic acid) screening services available at various local health facilities screening uptake is meager. Objective The purpose of the study is to determine the barriers influencing CC screening among women in the Ashanti Region of Ghana using the health belief model. Methods A analytical cross-sectional study design was conducted between January and March 2019 at Kenyase, the Ashanti Region of Ghana. The study employed self-administered questionnaires were used to collect data from 200 women. Descriptive statistics were used to examine the differences in interest and non-interest in participating in CC screening on barriers affecting CC screening. Multivariable logistic regression was used to determine factors affecting CC screening at a significance level of p<0.05. Results Unemployed women were less likely to have an interest in CC screening than those who were employed (adjustes odds ratio (aOR) = 0.005, 95%CI:0.001–0.041, p = 0.005). Women who were highly educated were 122 times very likely to be interested in CC screening than those with no or low formal education (aOR = 121.915 95%CI: 14.096–1054.469, p<0.001) and those who were unmarried were less likely to be interested in CC screening than those with those who were married (aOR = 0.124, 95%CI: 0.024–0.647, p = 0.013). Also, perceived threat, perceived benefits, perceived barriers and cues for action showed significant differences with interest in participating in screening with a P-values <0.003. The association was different for long waiting time, prioritizing early morning and late evening screening which showed no significant difference (P-value > 0.003). Conclusions Married women, unemployed and those with no formal education are less likely to participate in CC screening. The study details significant barriers to cervical cancer screening uptake in Ghana. It is recommended that the Ghana health services should develop appropriate, culturally tailored educational materials to inform individuals with no formal education through health campaigns in schools, churches and communities to enhance CC screening uptake.
Collapse
Affiliation(s)
- Ama G. Ampofo
- Department of Nursing, Garden City University College, Kumasi, Ghana
- Health Behaviour Research Collaborative, Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
- * E-mail:
| | - Afia D. Adumatta
- Department of Nursing, Garden City University College, Kumasi, Ghana
| | - Esther Owusu
- Department of Nursing, Garden City University College, Kumasi, Ghana
| | - Kofi Awuviry-Newton
- Priority Research Centre for Generational Health and Ageing, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia
| |
Collapse
|