Cervical cancer is an important public health problem worldwide, which comprises approximately 12% of all cancers in women. In Tanzania, the estimated incidence rate is 30 to 40 per 100,000 women, indicating a high disease burden. Cervical cancer screening is acknowledged as currently the most effective approach for cervical cancer control, and it is associated with reduced incidence and mortality from the disease. The aim of the study was to identify the most important factors related to the uptake of cervical cancer screening among women in a rural district of Tanzania. A cross sectional study was conducted with a sample of 354 women aged 18 to 69 years residing in Moshi Rural District. A multistage sampling technique was used to randomly select eligible women. A one-hour interview was conducted with each woman in her home. The 17 questions were modified from similar questions used in previous research. Less than one quarter (22.6%) of the participants had obtained cervical cancer screening. The following characteristics, when examined separately in relation to the uptake of cervical cancer screening service, were significant: husband approval of cervical cancer screening, women's level of education, women's knowledge of cervical cancer and its prevention, women's concerns about embarrassment and pain of screening, women's preference for the sex of health provider, and women's awareness of and distance to cervical cancer screening services. When examined simultaneously in a logistic regression, we found that only knowledge of cervical cancer and its prevention (OR = 8.90, 95%CI = 2.14-16.03) and distance to the facility which provides cervical cancer screening (OR = 3.98, 95%CI = 0.18-5.10) were significantly associated with screening uptake. Based on the study findings, three recommendations are made. First, information about cervical cancer must be presented to women. Second, public education of the disease must include specific information on how to prevent it as well as screening services available. Third, it is important to provide cervical cancer screening services within 5 km of where women reside.

/pdf/demographic-knowledge-attitudinal-and-accessibility-factors-5bafcs9uom.pdf

Demographic, knowledge, attitudinal, and accessibility factors associated with uptake of cervical cancer screening among women in a rural district of Tanzania: Three public policy implications

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. 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. 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. 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.

/pdf/cervical-cancer-prevention-and-treatment-research-in-africa-3agjf83b6j.pdf

Cervical cancer prevention and treatment research in Africa: a systematic review from a public health perspective

Background: In contrast to the developed nations invasive cervical cancer (ICC) is the most common womens malignancy in Kenya and many other locations in sub-Saharan Africa. However studies on survival from this disease in this area of the world are severely restricted by lack of patient follow-up. We now report a prospective cohort study of ICC in Kenyan women analysing factors affecting tumour response and overall survival in patients undergoing radiotherapy. Methods and Findings: Between 2008 and 2010 355 patients with histologically confirmed ICC were recruited at the Departments of Gynaecology and Radiotherapy at Kenyatta National Hospital (KNH). Structured questionnaires were completed recording socio-demographics tumour response and overall survival following treatment with combinations of external beam radiation (EBRT) brachytherapy and adjuvant chemotherapy. Of the 355 patients 42% (146) were lost to follow-up while 18% (64) died during the two year period. 80.5% of patients presented with advanced stage IIB disease or above with only 6.7% of patients receiving optimal combined EBRT brachytherapy and adjuvant chemotherapy. Kaplan Meier survival curves projected two year survival at 20%. Conclusion: Cervical cancer is preventable yet poverty poor education lack of cancer awareness coupled with an absence of regular screening programs late patient presentation sub-optimal diagnosis and treatments are major factors contributing to the alarmingly low survival rate of cervical cancer patients in Kenya. It is concluded that simple cost-effective changes in clinical practice could be introduced which would have a marked impact on patient survival in this setting.

/pdf/analysis-of-factors-contributing-to-the-low-survival-of-3s01ijlqci.pdf

Analysis of Factors Contributing to the Low Survival of Cervical Cancer Patients Undergoing Radiotherapy in Kenya

Cervical cancer is a leading cause of cancer death in women in developing countries. A key factor linked to the relatively high levels of cervical cancer in these populations is the lack of awareness and access to preventive methods. This study aimed to determine the level of awareness of cervical cancer and Papanicolaou test (Pap smear test) and factors associated with the utilization of Pap test among female civil servants in Jos. Data was obtained from female workers (n=388) aged 18–65 years in a Nigerian Federal establishment. Participants were randomly approached and instructed to complete validated questionnaires. Data was analyzed using Chi-square, t-tests and logistic regression analysis to determine if there was an association between variables and identify any predictors of awareness and utilization of the Pap test. Cervical cancer and Pap smear test awareness was 50.9% and 38.6% respectively, with the media as the major source of information. Pap smear test utilization rate was 10.2%, with routine antenatal care (ANC) as the major reason for getting screened. Personal barriers to screening include the lack of awareness, and belief that cervical cancer is not preventable. Opportunistic screening, mass media campaigns and ANC education were suggested as ways of improving awareness and utilization of cervical cancer screening services.

/pdf/cervical-cancer-and-pap-smear-awareness-and-utilization-of-3gru98vgfk.pdf

Cervical Cancer and Pap Smear Awareness and Utilization of Pap Smear Test among Federal Civil Servants in North Central Nigeria

Cervical cancer is the most frequent cancer of women in the Democratic Republic of Congo (DRC). Nevertheless, the level of women’s awareness about cervical cancer is unknown. Knowledge, attitude and practice (KAP) are important elements for designing and monitoring screening programs. The study purpose was to estimate KAP on cervical cancer and to identify associated factors. A cross-sectional study was conducted in Kinshasa, DRC, including 524 women aged 16–78 years (median age 28; interquartile range 22–35). The women were interviewed at home by trained field workers using a standardized questionnaire. The women’s score on knowledge, attitude and practice were dichotomized as sufficient or insufficient. We used binary and multiple logistic regression to assess associations between obtaining sufficient scores and a series of socio-demographic factors: age, residence, marital status, education, occupation, religion, and parity.
 The women’s score on knowledge was not significantly correlated with their score on practice (Spearman’s rho = 0.08; P > 0.05). Obtaining a sufficient score on knowledge was positively associated with higher education (adjusted odds ratio (OR) 7.65; 95% confidence interval (95% CI) 3.31-17.66) and formal employment (adjusted OR 3.35; 95% CI 1.85-6.09); it was negatively associated with being single (adjusted OR 0.44; 95% CI 0.24-0.81) and living in the eastern, western and northern zone of Kinshasa compared to the city centre. The attitude score was associated with place of residence (adjusted OR for east Kinshasa: 0.49; 95% CI 0.27-0.86 and for south Kinshasa: 0.48; 95% CI 0.27-0.85) and with religion (adjusted OR 0.55; 95% CI 0.35-0.86 for women with a religion other than Catholicism or Protestantism compared to Catholics). Regarding practice, there were negative associations between a sufficient score on practice and being single (adjusted OR 0.24; 95% CI 0.13-0.41) and living in the eastern zone of the city (adjusted OR 0.39; 95% CI 0.22-0.70). Although 84% of women had heard about cervical cancer, only 9% had ever had a Papanicolaou (Pap) smear test. This study shows a low level of knowledge, attitude and practice on cervical cancer among women in Kinshasa. Increasing women’s awareness would be a first step in the long chain of conditions to attain a lower incidence and mortality.

/pdf/knowledge-attitude-and-practice-about-cancer-of-the-uterine-224m1uxutd.pdf

Knowledge, attitude and practice about cancer of the uterine cervix among women living in Kinshasa, the Democratic Republic of Congo

Improved awareness of Pap test by Nigerian women may not necessarily increase its use. This hypothesis was tested using female medical practitioners in Enugu state, Nigeria. They were expected to be advocates of disease screening and therefore should lead by example. All respondents were aware of the Pap smear but only 18% had used it. The mean frequency of Pap smear was 1.8+/-1.2 (range 1-5). Repeat Pap tests were observed only among respondents that had screened as routine. The majority (32%) of those who never screened for cervical cancer had no reason. There may be more to the use of Pap smear among women in Nigeria than its awareness.

Improved awareness of Pap smear may not affect its use in Nigeria: a case study of female medical practitioners in Enugu, southeastern Nigeria

The objective was to determine the awareness and practice of preconception care in a developing country. This is a cross-sectional study of women receiving antenatal care at the University of Nigeria Teaching Hospital and Enugu state university teaching hospital (ESUT) between October 2005 and March 2006. Sampling was systematic where every consenting second of two pregnant women receiving antenatal care at the hospital was mobilised for the study. Data analysis was by descriptive and inferential statistics using statistical package for social sciences (SPSS) software version 11 (SPSS Inc. 2001). A total of 1,500 questionnaires were distributed while 1,331 were completed and returned giving a response rate of 88.7%. The mean age was 30.0 + 5.0 years. Of these, 573 (43.1%) women had heard of preconception care. The respondent's awareness of preconception care and their ability to define the subject correctly increase significantly with their educational status and parity. However, there was a difference between knowledge and behaviour. The practice of preconception care was not affected significantly by the parity of the patients. The majority believed that preconception care might improve the health of mother and child. The practice of preconception care is almost non-existent in developing countries. It is important that all stake holders in maternal and child health be involved in vigorous, targeted and sustained female education to improve knowledge and utilisation of preconception care by women of reproductive age groups in developing countries. Health institutions in these underserved populations should develop, and maintain functional dedicated and multidisciplinary clinics for preconception care to decrease perinatal and maternal mortality. Preconception clinics are more important in developing countries such as Nigeria compared with the western world because they would help correct inadequate education and identify a high level of existing illness relevant to pregnancy - much higher than in the western world.

Preconception care in South Eastern Nigeria

Although cervical cancer is the commonest cause of cancer death in Nigeria, the use of cervical cancer screening is poor. This study aimed at determining the awareness and use of the available cervical cancer screening method (Pap smear) by women attending the outpatient clinics of a tertiary institution in Enugu, South-eastern Nigeria. Questionnaires were administered to 912 women from November 2005 to May 2006. A total of 550 (60.3%) respondents knew about cervical cancer but only 41.2% of them were aware of the Pap smear. Only 89 (9.0%) respondents had used the Pap smear. The majority (61.9%) of those who had not been screened despite knowledge of the Pap smear had no reason, while the remaining 112 (38.1%) felt they were not susceptible to cervical cancer. The use of the Pap smear among women attending the outpatient clinics in Enugu, Nigeria is very low. Routine cervical cancer counselling and screening with opt-out option should be offered to every eligible woman attending the outpatient clinics.

The need to incorporate routine cervical cancer counselling and screening in the management of women at the outpatient clinics in Nigeria.

Background: The burden of tuberculosis (TB) in Nigeria is high. Unfortunately, the data from the TB programme of the States' ministries of health are usually unpublished, which possibly contribute to the prevailing ignorance and poor attitude of Nigerians to the disease. This study determined the trends of TB burden and treatment outcome in Enugu state, Nigeria; and relate the State's disease burden to that of the Nation. Materials and Methods: A descriptive study of secondary data from the TB control programme, Ministry of Health, Enugu state, the National annual report of 2008, and World Health Organisation (WHO) TB database for the 10-year period of 2000-2009. Results: The number of female TB cases was higher than males within the 0-14 age group only. The annual number of all TB cases showed a rising trend from 914 cases in the year 2000 to 1684 in 2009; but the proportion of new sputum smear (ss+) pulmonary tuberculosis (PTB) cases declined (Trend X[2] = 7.37, P = 0.007). The average number of extra-pulmonary TB cases increased fourfold from 2000-2004 to 2005-2009 (36 versus 150 cases). The median treatment success rate was 82% (range: 78-85). For the period 2004-2008, 2.0% of all new ss + PBT cases reported in Nigeria, originated from Enugu state. The proportion of new ss + PTB reported in Enugu state was significantly higher than national value (59.6% versus 52.6%) [P < 0.001, OR = 1.33 (95% CI: 1.26, 1.40)]. Conclusion: The burden of TB in Enugu state of Nigeria had increased over the period reviewed. However, the State's contribution to the disease burden in Nigeria was low.

Trends of tuberculosis prevalence and treatment outcome in an under-resourced setting: The case of Enugu state, South East Nigeria.

CONTEXT: HIV infection and cervical cancer are common in Nigeria. HIV-positive women have a higher risk for cervical neoplasm; therefore counseling and regular cervical cancer screening are recommended. After post-HIV testing counseling HIV-positive women should be aware of the Papanicolaou (Pap) smear. OBJECTIVE: To determine the coverage of cervical cancer screening information for HIV-positive women by the post-HIV testing counseling. METHODS: Questionnaires were administered to 150 HIV-positive women and 150 HIV-negative controls after post-HIV testing counseling at the voluntary counseling and testing clinic of University of Nigeria Teaching Hospital Enugu Nigeria. Proportions of responses were compared by using a chi-square test at a 95% confidence level. RESULTS: Thirty-three (22.0%) HIV-positive women and 57 (38%) HIV-negative women were aware of cervical cancer. The awareness of the Pap smear among HIV-positive women (4.0%) was lower than that of HIV-negative women (21.3%) (P .05). No respondent agreed to being informed of Pap smears during post-HIV testing counseling. After counseling on cervical cancer 96.0% of the HIV-positive group and 98.7% of the HIV-negative group expressed willingness to undergo routine Pap screening. CONCLUSIONS: Cervical cancer screening information is not part of post-HIV testing counseling for women in Enugu southeastern Nigeria.

Ngozi R Dim

Papers

Improved awareness of Pap smear may not affect its use in Nigeria: a case study of female medical practitioners in Enugu, southeastern Nigeria

Preconception care in South Eastern Nigeria

The need to incorporate routine cervical cancer counselling and screening in the management of women at the outpatient clinics in Nigeria.

Trends of tuberculosis prevalence and treatment outcome in an under-resourced setting: The case of Enugu state, South East Nigeria.

An Unmet Cancer Screening Need of HIV-Positive Women in Southeastern Nigeria