Rose Anorlu

Cervical cancer: the sub-Saharan African perspective.

Abstract Cervical cancer is the second most common cancer in women worldwide and the leading cause of cancer deaths in developing countries. While incidence and mortality rates of cervical cancer have fallen significantly in developed countries, 83% of all new cases that occur annually and 85% of all deaths from the disease occur in developing countries. Cervical cancer is the most common cancer among women in sub-Saharan Africa. The incidence is on the increase in some countries. Knowledge and awareness of this disease on the continent are very poor and mortality still very high. Facilities for the prevention and treatment of cervical cancer are still very inadequate in many countries in the region. Governments in sub-Saharan Africa must recognise cervical cancer as a major public health concern and allocate appropriate resources for its prevention and treatment, and for research. Indeed, cervical cancer in this region must be accorded the same priority as HIV, malaria, tuberculosis and childhood immunisations. Résumé Le cancer du col de l’utérus est le deuxième cancer féminin le plus fréquent dans le monde et la principale cause de décès par cancer dans les pays en développement. Si ses taux d’incidence et de mortalité ont reculé sensiblement dans les pays développés, 83% des nouveaux cas qui se déclarent chaque année et 85% des décès dus à la maladie se produisent dans les pays en développement. Le cancer du col de l’utérus est la forme de cancer la plus fréquente chez les femmes en Afrique subsaharienne. Dans certains pays, son incidence augmente. La connaissance de la maladie sur le continent est très médiocre et la mortalité demeure très élevée. Les équipements de prévention et de traitement du cancer du col de l’utérus sont encore nettement insuffisants dans beaucoup de pays de la région. Les gouvernements d’Afrique subsaharienne doivent comprendre qu’il s’agit d’un problème majeur de santé publique et allouer assez de ressources pour sa prévention et son traitement, ainsi que pour la recherche. En fait, le cancer du col de l’utérus doit recevoir dans la région la même priorité que le VIH, le paludisme, la tuberculose et la vaccination des enfants. Resumen El cáncer cervical es el segundo cáncer más común en las mujeres mundialmente y la causa principal de muertes por cáncer en los países en desarrollo. Aunque la incidencia y las tasas de mortalidad por cáncer cervical han disminuido considerablemente en los países desarrollados, el 83% de todos los casos nuevos que ocurren anualmente y el 85% de todas las muertes atribuibles a esta enfermedad ocurren en países en desarrollo. El cáncer cervical es el cáncer más común entre las mujeres de Ãfrica subsahariana. Su incidencia está en alza en algunos países. Existe muy poco conocimiento y conciencia de esta enfermedad en el continente, y la tasa de mortalidad continúa siendo muy alta. En muchos países de la región, los establecimientos para la prevención y el tratamiento del cáncer cervical aún son muy inadecuados. Los gobiernos de Ãfrica subsahariana deben reconocer al cáncer cervical como un grave problema de salud pública y alocar los recursos necesarios para su prevención, tratamiento e investigación. Es más, en esta región se le debe dar la misma prioridad al cáncer cervical que al VIH, malaria, tuberculosis e inmunizaciones de niños.

Human papillomavirus prevalence and type distribution in invasive cervical cancer in sub‐Saharan Africa

In sub‐Saharan Africa, invasive cervical cancer (ICC) incidence and mortality are among the highest in the world. This cross‐sectional epidemiological study assessed human papillomavirus (HPV) prevalence and type distribution in women with ICC in Ghana, Nigeria, and South Africa. Cervical biopsy specimens were obtained from women aged ≥21 years with lesions clinically suggestive of ICC. Histopathological diagnosis of ICC was determined by light microscopy examination of hematoxylin and eosin stained sections of paraffin‐embedded cervical specimens; samples with a confirmed histopathological diagnosis underwent HPV DNA testing by polymerase chain reaction. HPV‐positive specimens were typed by reverse hybridization line probe assay. Between October 2007 and March 2010, cervical specimens from 659 women were collected (167 in Ghana, 192 in Nigeria and 300 in South Africa); 570 cases were histologically confirmed as ICC. The tumor type was identified in 551/570 women with ICC; squamous cell carcinoma was observed in 476/570 (83.5%) cases. The HPV‐positivity rate in ICC cases was 90.4% (515/570). In ICC cases with single HPV infection (447/515 [86.8%]), the most commonly detected HPV types were HPV16 (51.2%), HPV18 (17.2%), HPV35 (8.7%), HPV45 (7.4%), HPV33 (4.0%) and HPV52 (2.2%). The prevalence of single and multiple HPV infections seemed higher among HIV‐positive women and HPV type distribution appeared to differ according to tumor type and HIV status. In conclusion, HPV16, 18, 45 and 35 were the most common HPV types in sub‐Saharan African women with ICC and HPV infections were more common in HIV‐positive women.

Cervical Cancer in Africa

Cervical cancer is a relatively rare disease in countries that have instituted and maintained national screening programs, with call and recall of women at various intervals and built-in quality control with appropriate monitoring and evaluation. Unfortunately, this process has failed in most areas of the world where more than 80% of new cases of cervical cancer are diagnosed. Cervical cancer affects women in the prime of their lives causing premature and needless suffering and death in a critically important segment of the worlds population, despite being one of the few cancers that can be prevented with simple testing. In the past 15 years innovative approaches to both primary and secondary prevention of cervical cancer have been subjected to a number of large scale, scientifically valid and applicable studies that have opened the way for new approaches. Treatment of cervical cancer in Africa is hampered by the lack of diagnostic and treatment facilities, lack of healthcare infrastructure and poor pathology services. Further, there is a significant brain drain of trained healthcare workers in Africa that exacerbates the problem. Cancer is becoming an increasingly important public health problem as more people live longer. It is time to develop programs for the prevention, early detection, treatment, and palliation of cancer sufferers in Africa. Cancer Epidemiol Biomarkers Prev; 21(9); 1434–8. ©2012 AACR.

Cervical Cytology in an Urban Population in Lagos, Nigeria

Eight hundred and eighty-four consecutive women had cervical smears in a clinic in Lagos, Nigeria between September 1998 and 31 August 1999. Mean age was 36.6 ± 11.6 years (range 16-81 years); 93.7% were first-time screening. Three hundred and twenty-five (36.5%) smears were normal, inflammatory smears 52.7%, mild dyskaryosis 2.4%, moderate dyskaryosis 1.5%, severe dyskaryosis 0.3% and probable malignancy (malignant cells) 0.8%. Abnormal smears were higher in symptomatic cases compared with asymptomatic cases (χ2 = 15.3, P< 0.01); 6.1% and 2.1% of symptomatic cases had dyskaryosis and carcinoma, respectively, compared with 3.4% and 0.1% for asymptomatic cases. In postcoital bleeding 9.3% and 1.9% had dyskaryosis and carcinoma, respectively. Fifty-six of 62 cases of cervical erosion had abnormal smears. In postmenopausal bleeding 13.0% and 4.3% had dyskaryosis and carcinoma, respectively. Prevalence of abnormal cervical smears is high in women who have genital tract disease. In places with no national screening programmes every effort should be made to screen such women.

Knowledge of and attitude toward human papillomavirus infection and vaccines among female nurses at a tertiary hospital in Nigeria

Background Persistent infection with high-risk types of human papillomavirus (HPV) is a prerequisite for the development of cervical cancer. Highly immunogenic HPV vaccines have been developed and licensed for the primary prevention of cervical cancer in some developed and developing countries. This calls for assessment of the knowledge of the HPV infection and the acceptability of the HPV vaccines among health care providers. Objective The aim of this study was to assess awareness and knowledge of HPV infection and vaccines and to assess attitude toward these vaccines among female nurses at Lagos University Teaching Hospital, Lagos, Nigeria. Study design The study was a cross-sectional, descriptive study using a pretested, structured, anonymous, self-administered, 19-item questionnaire. Results A total of 178 female nurses were interviewed during a 4-week period. The mean age of respondents was 37.1 ± 3.1 years. Almost all (99.4%) of the respondents had heard of cervical cancer, while about 85% of them had heard of HPV infection. Only a quarter (25.3%) of respondents had heard of the HPV vaccines, and of those only 26.7% knew the vaccines were for the prevention of cervical cancer. Most (70.2%) of the nurses expressed a desire to be vaccinated and 120 (67.4%) supported the vaccination of preadolescent girls. Those who expressed a willingness to be vaccinated were more likely to recommend HPV vaccination for preadolescent girls. Conclusion Overall, there was a poor knowledge of the HPV vaccines among female nurses at Lagos University Teaching Hospital. Despite this poor knowledge, most of the nurses expressed a strong desire to be vaccinated and their intention to recommend it for preadolescent girls. The main reason given overall for not recommending the vaccines was lack of information. There is an urgent need to bridge this information gap.

Sociodemographic factors in anaemia in pregnancy at booking in Lagos, Nigeria

Summary Anaemia in pregnancy is a common problem in many developing countries. In Nigeria, it is responsible for 11.0% of maternal deaths. This study examined the sociodemographic factors associated with anaemia in pregnancy. Anaemia was defined as a haemoglobin (Hb) level <11 g/dl. Proportions were compared using the χ2 test. A total of 35.3% of the 374 women studied were anaemic. Anaemia was more common in primigravidae than in parous women of parity 2 – 4 (χ2 = 6.87; p = 0.0087). Low socioeconomic status, (χ2 = 24.67, p = 0.00090), short interval between pregnancies (χ2 = 20.34, p = 0.000144), booking in the third trimester (χ2 = 15.4, p = 0.00045) and recent febrile illness (χ2 = 6.80; p = 0.0091) were associated with anaemia. Women who only used haematenics were more anaemic than those who also used anti-malarial chemo-prophylaxis (χ2 = 57.32, p = 0.00001). Anaemia in pregnancy is associated with several social and demographic factors. To reduce the prevalence of anaemia women need to have a good formal education, be economically empowered and good antenatal care must be made available, accessible and affordable to all women.

Human papillomavirus (HPV) infection and vaccines: knowledge, attitude and perception among female students at the University of Lagos, Lagos, Nigeria.

Aim: This study sought to determine knowledge of and attitude towards human papillomavirus (HPV) infection, HPV-related diseases and HPV vaccines among female undergraduate students at the University of Lagos. Methods: A self-administered questionnaire was administered between May and July 2010, to 368 female students aged 16–29 years, who were selected from two faculties of the University of Lagos using two-stage sampling method. Data collected included: socio-demographic characteristics, sexual history, awareness and knowledge of HPV infection, cervical cancer and genital warts, and HPV vaccine; the perceived risk of acquiring genital HPV infection and developing cervical cancer or genital warts, and the willingness to receive an HPV vaccine. Results: Only 64 (17.7%) and 52 (14.4%) of the students had ever heard of HPV infection and HPV vaccines respectively. The median HPV knowledge on a 15-item score was 2. Overall, only 11.1% knew that genital HPV infection can cause cervical cancer. Fourteen (6.9%) of those who were aware of cervical cancer agreed they were at risk of developing the disease. Of the 52 students who had heard of the HPV vaccine, 24 (46.2%) knew it was given for cervical cancer prevention and 30 (57.7%) expressed their willingness to receive the vaccine. Conclusion: The knowledge of and the perceived susceptibility to HPV infection and HPV-related diseases among female students in the University of Lagos were generally low. The need for a well-designed HPV-educational program to bridge the knowledge gap cannot be overemphasized.

Risk factors for pre‐eclampsia in Lagos, Nigeria

Background:  Pre‐eclampsia is an important cause of maternal mortality. Although there have been many studies worldwide on pre‐eclampsia, not many have come from black Africa.

Cervical cancer screening practices among general practitioners in Lagos Nigeria

Summary Cervical cancer is the most common genital cancer in women in Nigeria. We studied the cervical cancer screening practices of 503 general practitioners in two urban and two rural areas of Lagos state. Only 60 (11.9%) ever informed their patients about cervical cancer screening and female doctors did this more often than their male counterparts (χ2 = 4.74, p = 0.001). A total of 89 (17.8%) had facilities for Pap smears but only 27(5.4%) screened their patients. A total of 6 out of 27 (22.2%) did routine screening and 21 (77.8%) did selective screening. Only 6 out of 503 (1.2%) therefore did routine screening. Some 126 (25.0%) and 109 (21.7%) would do Pap smears for patients with post-coital bleeding and post- menopausal bleeding. Screening services were more available in the urban than in the rural areas (p = 0.0000). Thus, cervical cancer screening practices and services in Lagos are inadequate, which is no different from other parts of Nigeria and sub-Saharan Africa. Cervical cancer should be accorded the same attention as HIV, malaria, TB and childhood immunisations.

Cancer mortality among patients admitted to gynecological wards at Lagos University Teaching Hospital, Nigeria.

to break her hymen using a candle, but the object could not be removed. The woman consulted a gynecologist the next day complaining of acute onset of urinary retention and intense pelvic pain; no lacerations or defects of the vaginal wall were found on examination. However, pelvic ultrasound showed the foreign body, which was thought to be in the bladder. Thepatientwas referred to theurologic emergencydepartment where urine was drained by suprapubic catheter. Cystoscopy under general anesthesia showed a normal bladder. Vaginoscopy was also performed, but did not show any foreign body. The patient returned home without treatment and experienced normal voiding. Sexual function was normal except for intermittent pelvic pain. During 3 years of infertility she consulted a gynecologist; hysterography revealed an obstruction in the left fallopian tube (Fig. 2) suggesting endosalpingitis. Pelvic ultrasound revealed a left ovarian cyst and the patient was referred to our department for further investigation. Uterine transmigration appears to be the most likely explanation for the presence of the foreign body in the fallopian tube, since there were no vaginal lacerations and no evidence of bladder transmigraFig. 2. Hysterogram suggesting endosalpingitis.