Cervical cancer-a neglected health tragedy

Individual and partner risk factors associated with abnormal cervical cytology among women in HIV-discordant relationships

Individual and sexual partner characteristics may increase the risk of abnormal cervical cytology among women in human immunodeficiency virus (HIV)-discordant relationships. Papanicolaou smears were obtained in a prospective cohort of Kenyan HIV-discordant couples. Of 441 women, 283 (64%) were HIV-infected and 158 (36%) were HIV-uninfected with HIV-infected partners. Overall, 79 (18%) had low-grade and 25 (6%) high-grade cervical abnormalities. Male herpes simplex virus type 2 (HSV-2) seropositivity and lower couple socioeconomic status were associated with cervical abnormalities (p < 0.05). HIV-uninfected women with HIV-infected male sex partners (CD4 > 350 cells/µL) had the lowest prevalence of high-grade cervical lesions. HIV-infected women (CD4 > 350 cells/µL) and HIV-uninfected women with HIV-infected partners (CD4 ≤ 350 cells/µL) were at similar intermediate risk (p > 0.05), and HIV-infected women (CD4 ≤ 350 cells/µL) had significantly higher risk of high-grade cervical abnormalities (p = 0.05). Women in HIV-discordant relationships have high rates of cervical lesions and this may be influenced by couple-level factors, including HIV status and CD4 count of the infected partner.

A population-based study of visual inspection with acetic acid (VIA) for cervical screening in rural Nigeria

OBJECTIVE

Cervical cancer is the most common gynecological cancer in developing countries. Visual inspection with acetic acid (VIA) was introduced to screen for cervical premalignant lesions in developing countries owing to the inability of many countries to implement high-quality cytologic services. We sought to compare VIA performance among different health workers in Nigeria.

METHODS

In a population-based project, 7 health workers who had been screening women with VIA for approximately 2 years at local government health centers in rural Nigeria were retrained in a 2-week program using the International Agency for Research on Cancer training manual. Women from a rural village who had never had cervical cancer screening were recruited into the study. Each woman had cervical cancer screening by VIA, liquid-based cytologic test, and oncogenic human papillomavirus (HPV) DNA test.

RESULTS

Despite similar participant characteristics, across all age groups, providers had wide ranges of VIA results; 0% to 21% suspect cancer and 0% to 25% were VIA positive. Visual inspection with acetic acid was insensitive compared to a combination of cytologic and HPV tests.

CONCLUSION

In our study, VIA was not reproducible, nor was it sensitive compared to cytologic and HPV tests.

The retained placenta: historical and geographical rate variations

In this study, we sought to explore the variation in reported rates of retained placenta around the world and over time in the UK. A systematic review of observational studies was performed to obtain retained placenta rates from around the world and annual hospital reports from the Royal College of Obstetricians and Gynaecologists archives were examined to obtain historical retained placenta rates. The data show that the median rate of retained placenta at 30 minutes was higher in developed countries (2.67% vs 1.46%, p < 0.02), as was the median manual removal rate (2.24% vs 0.45%, p < 0.001). In addition to this, there appears to have been a rise in rate of manual removal in the UK from a mean of 0.66% in the 1920s to 2.34% in the 1980s (p < 0.0001).

Poor obstetric performance of teenagers: is it age- or quality of care-related?

We studied prospectively the effect of antenatal care on the obstetric performance of teenagers seen at a university teaching hospital over a 14-month period. When the obstetric complications among the teenagers were compared to their older counterpart, there were significantly higher complication rates, especially anaemia, preterm delivery, low birth weight and neonatal admission. After controlling for utilisation of antenatal care, significant differences were observed only in the incidence of low birth weight babies. In conclusion, this study has shown that the poor obstetric outcome of teenage pregnancy is related to non-utilisation of prenatal care rather than their biological age.

Delivery outside hospital after antenatal care: prevalence and its predictors

Over a period of 5 years (1994 - 1998), of 9519 women who booked for antenatal care at the two tertiary hospitals of the Obafemi Awolowo University Teaching Hospital Complex, Ile Ife,-Nigeria,12.8% (1220) defaulted from hospital delivery. The casenotes of these patients were retrieved from the medical records department and were sorted into two groups of defaulters and non-defaulters from hospital delivery. Information obtained from the casenotes includes sociodemographic characteristic, past obstetric and present obstetric history. Bivariate analysis revealed six potential predictors; however, following adjustment by multiple logistic regression, only history of previous delivery outside the hospital (OR = 3.13, CI = 2.06 - 4.67), planned elective caesarean section in current pregnancy (OR = 2.03, 1.66 - 2.75), caesarean section in last delivery (OR = 1.93, CI = 1.57 - 2.76) and objection to admission in the current pregnancy (OR = 1.33, CI = 1.04 - 1.65) remained as significant predictors.

Cervical cancer risk factors and predictors of cervical dysplasia among women in south-west Nigeria

AIM

This study identified predictors of cervical dysplasia and assessed the prevalence of risk factors for cervical cancer among women of different socioeconomic classes in Ogun State, Nigeria.

METHOD

In a two-phase study, self-reported information on cervical cancer awareness, risk factors and cervical cancer screening practices was obtained from 278 randomly selected working women. A random subset was screened for dysplasia using visual inspection with acetic acid (VIA).

RESULTS

Of the 278 women, 126 (45.3%) were semi-skilled while 152 (54.7%) were skilled and professional workers. Median age at first sexual intercourse was 19 years (range 13-29) and lower than the median age at first marriage (25 years). Gonorrhoea and genital warts were the commonest reported sexually transmitted infections. Only 12.2% of the women used male condoms as their primary method of birth control and 4.7% of the women had ever had a Papanicolaou smear, a practice that was significantly higher among the professional/skilled compared with semi-skilled workers (P = 0.031). Of the 125 screened, 20 (16%) had positive VIA. Young age at first sex (< or = 17 years) (OR = 3.7 (95% CI, 1.07-12.8)) and early first marriage (< 25 years) (3.3 (1.00-10.9)) were associated with a positive VIA. Women with lower parity (0-3) had borderline significantly increased risk of having a positive VIA (3.1 (0.9-10.6)). Women currently over 34 years and those without a history of sexually transmitted infections had lower risk of positive VIA (P > 0.05).

CONCLUSIONS

Acceptable screening services and cervical cancer awareness campaigns that address modifiable risk factors are urgently needed in this community.