Cervical cancer screening outcomes in public health facilities in three states in Nigeria

BACKGROUND

Cervical cancer continues to generate a significant burden of disease and death in low- and middle-income countries (LMICs). Lack of awareness and poor access to early screening and pre-cancer treatment contribute to the high mortality. We describe here cervical cancer screening outcomes in public health facilities in three states in Nigeria.

METHODS

We conducted an observational study in 177 government health facilities in Lagos, Kaduna, and Rivers State, Nigeria from January to December 2021, in which we reviewed programmatic data collected through the newly introduced Cervical Cancer Prevention Program. Women who received screening and provided consent were enrolled into the study. Data were extracted from registers in the health facilities using SurveyCTO and descriptive statistical analysis was conducted using StataSE 15 (StataCorp, College Station, TX, USA).

RESULTS

Eighty-three thousand, five hundred ninety-three women were included in the analysis including 6,043 (7%) WLHIV. 67,371 (81%) received VIA as their primary screening while 16,173 (19%) received HPV DNA testing, with 49 (< 1%) receiving both at the same time. VIA positivity was 7% for WLHIV and 3% for general population, while HPV prevalence was 16% for WLHIV and 8% for general population. Following a positive HPV result, 21% of women referred, completed triage examination. 96% of women identified with precancerous lesions, received treatment. 44% of women with suspected cancer were successfully referred to an oncology center for advanced treatment. Following treatment with thermal ablation, seven adverse events were reported.

CONCLUSIONS

The Program has successfully increased women's access to screening and treatment of precancerous lesions. Almost all women who were eligible for pre-cancerous lesion treatment received it, often on the same day when screened using VIA. However, for women referred for a triage exam or due to suspected cancer, many did not complete their referral visits. More effort is required to ensure HPV positive women and women with suspected cancer are adequately linked to care to further reduce morbidity and mortality associated with cervical cancer in Nigeria. Implementation studies should be conducted to provide insights to improve the utilization of the existing centralized and point of care (POC) platforms to facilitate same day results, and to improve triage and treatment rates.

Teachers’ mental health literacy and action competencies

Background

Teachers are very important in mental health promotion and early recognition of mental health burden (disorder, illness). Teachers’ surrogate mental health literacy (MHL) may be key to improving mental health in youth but has been little investigated. We assessed surrogate MHL in Swiss teachers and tested a measure of mental health action competencies (MHAC).

Methods

In 2020, all teaching and support staff at compulsory school level were invited to an online survey covering individual and professional characteristics, MHL (finding, understanding, critical appraisal of information) and action competencies (adapted scale Ahnert et al. 2016, range 17 - 68) personal experience with students’ MHB. Data was explored descriptively and with multivariate regression. Item response theory analyses were conducted to examine internal psychometric MHAC scale properties, and group-mean differences tested between school levels.

Results

Participation rate was 38% (N = 459). Nearly all participants had taught at least 1 mentally burdened student in the past year (average 4.7). 77% felt experienced to very experienced regarding these students. Only 32% felt they had sufficient tools and teaching resources. Participants felt it was difficult to very difficult to find (47%), understand (53%) and appraise (90%) information on students’ mental health. Kindergarden teachers and teachers without class responsibility showed significantly lower MHL. Internal psychometric properties of the MHAC measure support the use of a 1-factor scale and indicates discriminant validity with respect to age; experience and school level, median score was high (P50 48, P25 44, P75 53), but single items, e.g. on suicide signs, were rated low.

Conclusions

While overall subjective MHAC are high, teachers are insecure regarding MHL and report a lack of tools and resources. Targeted training could strengthen surrogate mental health literacy with a focus on critical appraisal and certain action competencies.

Cervical Cancer Knowledge, Risk Factors and Screening Practices among Women Residing in Urban Slums of Lagos, Southwest, Nigeria

BACKGROUND

Cervical cancer is the second leading cause of female cancer deaths in Nigeria. Routine cervical cancer screening and early treatment can prevent up to 80% of cervical cancers. This study was carried out to assess the knowledge, risk factors and practice of cervical cancer screening among women residing in urban slums of Lagos, Nigeria.

METHODS

This descriptive cross-sectional study was carried out among 315 women aged 21-65 years in two slums in Lagos, Nigeria. A two-stage sampling method was used to select respondents. Data was collected using interviewer administered questionnaires. Analysis was done with IBM SPSS version 20.

RESULTS

Only 3.2% had heard of cervical cancer. Most of the women did not know the symptoms (99.4%), or risk factors (99.7%) of cervical cancer, and 96.8% had not heard about cervical cancer screening. Forty-four percent of the respondents were between 21-30 years of age. Half of the respondents (51.4%) had only one lifetime sexual partner. Thirty-eight percent of the respondents had 3-4 children. About forty percent had their first childbirth at less than 20 years of age. Only 4.4% use tobacco. Only two respondents (0.6%) had undergone cervical cancer screening however, 93.3% of the respondents were willing to undergo cervical cancer screening. There was no significant association between socio-demographic factors, risk factors, and willingness to undergo cervical cancer screening.

CONCLUSION

Campaigns should be carried out by government and charitable organisations to increase the knowledge and practice of cervical cancer screening among women residing in slums.