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Yadav J, Agarwal S, Jain A. Comparison of Visual Inspection Methods with Pap Smear as Screening Test for Premalignant Lesions of the Cervix. J Midlife Health 2024; 15:19-24. [PMID: 38764929 PMCID: PMC11100638 DOI: 10.4103/jmh.jmh_201_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 02/20/2024] [Accepted: 02/24/2024] [Indexed: 05/21/2024] Open
Abstract
Aim and Objectives The present study was done to compare the visual inspection methods with Pap smear as a screening test for premalignant lesions of the cervix. Materials and Methods The present observational prospective study was done at the Department of Obstetrics and Gynecology at Teerthanker Mahaveer Medical College and Research Center for 18 months. All study subjects were subjected to Papanicolaou smear, VIA, and VILI examination. If any of these tests were found positive, then a colposcopy and cervical biopsy were done. Results The sensitivity of Pap, VIA, VILI, and colposcopy was 52.63%, 84.21%, 73.68%, and 84.21%, respectively. The specificity of Pap, VIA, VILI, and colposcopy was 60.0%, 80.0%, 60.0%, and 80.0%, respectively. The accuracy of Pap, VIA, VILI, and colposcopy was 54.17%, 83.33%, 70.83%, and 83.33%, respectively. Conclusion It is well known that VIA and VILI are very easy to carry out and apply. Even technically they do not cost much, consume less tax and can be applied to all the patients. Even the results are calculated in a faster manner which helps in chalking out the plan in an easy way.
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Affiliation(s)
- Jyoti Yadav
- Department of Obstetrics and Gynaecology, Teerthanker Mahaveer Medical College and Research Centre, Teerthanker Mahavir University, Moradabad, India
| | - Shubhra Agarwal
- Department of Obstetrics and Gynaecology, Teerthanker Mahaveer Medical College and Research Centre, Teerthanker Mahavir University, Moradabad, India
| | - Aayushi Jain
- Department of Obstetrics and Gynaecology, Teerthanker Mahaveer Medical College and Research Centre, Teerthanker Mahavir University, Moradabad, India
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Shah S, Munyuzangabo M, Gaffey MF, Kamali M, Jain RP, Als D, Meteke S, Radhakrishnan A, Siddiqui FJ, Ataullahjan A, Bhutta ZA. Delivering non-communicable disease interventions to women and children in conflict settings: a systematic review. BMJ Glob Health 2021; 5:bmjgh-2019-002047. [PMID: 32341086 PMCID: PMC7202786 DOI: 10.1136/bmjgh-2019-002047] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 03/30/2020] [Accepted: 04/04/2020] [Indexed: 12/25/2022] Open
Abstract
Background Non-communicable diseases (NCDs) are the leading cause of death worldwide. In the context of conflict settings, population displacement, disrupted treatment, infrastructure damage and other factors impose serious NCD intervention delivery challenges, but relatively little attention has been paid to addressing these challenges. Here we synthesise the available indexed and grey literature reporting on the delivery of NCD interventions to conflict-affected women and children in low- and middle-income countries (LMICs). Methods A systematic search in MEDLINE, Embase, CINAHL and PsycINFO databases for indexed articles published between 1 January 1990 and 31 March 2018 was conducted, and publications reporting on NCD intervention delivery to conflict-affected women or children in LMICs were included. A grey literature search of 10 major humanitarian organisation websites for publications dated between 1 January 2013 and 30 November 2018 was also conducted. We extracted and synthesised information on intervention delivery characteristics and delivery barriers and facilitators. Results Of 27 included publications, most reported on observational research studies, half reported on studies in the Middle East and North Africa region and 80% reported on interventions targeted to refugees. Screening and medication for cardiovascular disease and diabetes were the most commonly reported interventions, with most publications reporting facility-based delivery and very few reporting outreach or community approaches. Doctors were the most frequently reported delivery personnel. No publications reported on intervention coverage or on the effectiveness of interventions among women or children. Limited population access and logistical constraints were key delivery barriers reported, while innovative technology use, training of workforce and multidisciplinary care were reported to have facilitated NCD intervention delivery. Conclusion Large and persistent gaps in information and evidence make it difficult to recommend effective strategies for improving the reach of quality NCD care among conflict-affected women and children. More rigorous research and reporting on effective strategies for delivering NCD care in conflict contexts is urgently needed. PROSPERO registration number CRD42019125221
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Affiliation(s)
- Shailja Shah
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mariella Munyuzangabo
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Michelle F Gaffey
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mahdis Kamali
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Reena P Jain
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Daina Als
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sarah Meteke
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Amruta Radhakrishnan
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Fahad J Siddiqui
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada.,Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore
| | - Anushka Ataullahjan
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada .,Center of Excellence in Women and Children Health, Aga Khan University, Karachi, Pakistan
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Hailemariam G, Gebreyesus H, Wubayehu T, Gebregyorgis T, Gebrecherkos K, Teweldemedhin M, Kifle M. Magnitude and associated factors of VIA positive test results for cervical cancer screening among refugee women aged 25-49 years in North Ethiopia. BMC Cancer 2020; 20:858. [PMID: 32894100 PMCID: PMC7487853 DOI: 10.1186/s12885-020-07344-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 08/25/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Worldwide cervical cancer is the third most common malignancy in women. It usually arises from the cervical area which is susceptible to Human Papilloma virus induced malignancy changes. In low-resource setting visual inspection with acetic acid (VIA) is an alternative sensitive cervical screening method. Therefore the aim of this study was to assess the magnitude and associated factors of VIA positive test results for Cervical Cancer screening among Eritrean refugee women aged 25-49 years in northern Ethiopia refugee camps. METHODS A community based cross-sectional study was conducted among 412 Eritrean refugee women aged 25-49 years from august 10 to September 25, 2018. Study subjects were selected by simple random sampling method. Data were collected using pretested structured questioner through Face-to-face interview and cervical examination. Data were coded and entered to Epi info software version 7 and then exported to Statistical package for Social Science (SPSS) version 21 for analysis. Bivariable and multivariable logistic regression analysis was made to test the association between the independent variables and the outcome variable. P-value of less than 0.05 with 95% CI was considered to declare statistical significance. RESULT In this study the magnitude of VIA positive precancerous cervical lesions was 9% (95% CI: 6.3-11.8%). Previous history of sexually transmitted infections (STI) [AOR (95%CI) = 2.84(1.07-7.53)] and presence of STI during cervical examination [AOR (95%CI) =3.97(1.75-9.00)] were found significantly associated with VIA positive precancerous cervical lesions. CONCLUSIONS In this study the magnitude of VIA positive precancerous cervical lesions was high. Previous history of sexually transmitted infections (STI) and presence of STI during cervical examination were found associated with VIA positive precancerous cervical lesions. Efforts such as early screening for sexually transmitted disease shall be done to prevent precancerous cervical lesions.
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Affiliation(s)
- Gebretsadik Hailemariam
- Adminstration for Refugee and Returnee Affairs Adiharsh Eritrean refugee camps Health and Neutrino Coordinator, Adiharsh camp, Shire, Ethiopia
| | - Hailay Gebreyesus
- Department of Public Health, College of Health Science, Aksum University, Aksum, Ethiopia
| | - Tewolde Wubayehu
- School of Medicine, College of Health Science, Aksum University, Aksum, Ethiopia
| | - Tsgehana Gebregyorgis
- Department of Public Health, College of Health Science, Aksum University, Aksum, Ethiopia.
| | - Kidanemariam Gebrecherkos
- Adminstration for Refugee and Returnee Affairs Adiharsh Eritrean refugee camps Health and Neutrino Coordinator, Adiharsh camp, Shire, Ethiopia
| | - Mebrahtu Teweldemedhin
- Department of Medical Laboratory Sciences, College of Health Science, Aksum University, Aksum, Ethiopia
| | - Manaye Kifle
- Department of Public Health, College of Health Science, Aksum University, Aksum, Ethiopia
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Alan M, Gunyeli I, Gultekin M, Sancı M, Yuce K. Correlation of Swede score colposcopy scoring system and histopathological results in patients with high-risk HPV infection other than HPV16 and 18. Int J Gynecol Cancer 2019; 30:35-40. [PMID: 31792083 DOI: 10.1136/ijgc-2019-000932] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 10/22/2019] [Accepted: 10/30/2019] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Triage with HPV genotyping has some caveats and debates for HPV positive cases other than 16 and 18. The Swede score colposcopic scoring system has not previously been evaluated in this group of patients. OBJECTIVE To use the Swede score colposcopic scoring system to compare scores and final histopathological results in women who have undergone colposcopy owing to infection with high risk-HPVs other than HPV16 and 18 and to establish new cut-off values to predict pre-malignant lesions in this group of patients. METHODS This study was conducted in 613 women undergoing colposcopic evaluation because of abnormal cervical cytology together with high-risk HPV infection. All patients referred were evaluated by an expert colposcopist, given a Swede score (using the Swede score colposcopic scoring system) by using five variables (acetowhiteness, margins plus surface, vessel pattern, lesion size, and iodine staining), and had at least one biopsy procedure (either colposcopically directed or by a loop electrical excision procedure). Sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratio values, and receiver operating characteristic curves for each clinico-pathological variable to detect low-grade and high-grade squamous intra-epithelial lesions, and any squamous cell abnormality (low-grade + high-grade squamous intra-epithelial lesions) were evaluated individually. RESULTS Final histopathological results of the patients were normal in 53.2% of cases, low-grade lesions in 32.5% of cases, and high-grade lesions in 14.4% of cases. Swede score was ≥8 (median 7.97) for high-grade lesions and ≥5 (median 5.06) for low-grade lesions. The area under the curve values (95% CI) of Swede scores for low-grade and high-grade squamous intra-epithelial lesions, and low-grade + high grade lesions were 0.92, 0.98, and 0.96, respectively. A Swede score cut-off value ≥6 had a sensitivity, specificity, positive predictive value, negative predictive value, and likelihood ratios of 92%, 98%, 93%, 98%, and 50 (22.6 to 110.8), respectively, for high-grade lesions at the final pathology (P<0.001). One high-risk HPV type (except 16 and 18) was no better than another for calculating the median Swede score during colposcopy (P=0.43). CONCLUSIONS The Swede score colposcopic scoring system appears to be a useful tool for evaluating atypical cervical cytology in women with high-risk HPV infection other than HPV types 16 and 18.
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Affiliation(s)
- Murat Alan
- Obstetrics and Gynecology, University of Health Sciences, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
| | - Ilker Gunyeli
- Obstetrics and Gynecology, Suleyman Demirel University, Isparta, Turkey
| | - Murat Gultekin
- Obstetrics and Gynecology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Muzaffer Sancı
- Gynecological Oncology, University of Health Sciences, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
| | - Kunter Yuce
- Obstetrics and Gynecology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
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Bhatta MP, Johnson DC, Lama M, Maharjan B, Lhaki P, Shrestha S. Cervical Cancer and Human Papillomavirus Vaccine Awareness Among Married Bhutanese Refugee and Nepali Women in Eastern Nepal. J Community Health 2020; 45:516-25. [DOI: 10.1007/s10900-019-00770-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Thapa N, Maharjan M, Shrestha G, Maharjan N, Petrini MA, Zuo N, He C, Yang J, Xu M, Ge C, Song Z, Cai H. Prevalence and type-specific distribution of human papillomavirus infection among women in mid-western rural, Nepal- A population-based study. BMC Infect Dis 2018; 18:338. [PMID: 30029626 PMCID: PMC6053738 DOI: 10.1186/s12879-018-3175-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 05/30/2018] [Indexed: 11/19/2022] Open
Abstract
Background Cervical cancer is the most common cancer among women in Nepal. The prevalence of human papillomavirus (HPV) 16 and or HPV 18 among women with cervical pre-cancer and cancer is higher than the incidence of HPV in the world population. The population-based epidemiological data of HPV in the general population in most parts of the country remains unknown. The objective of this study was to assess the prevalence and type distribution of HPV infection and association of abnormal cytology with high risk HPV infection among women in mid-western rural, Nepal. Methods A population-based cross sectional study was conducted in Jumla, one of the most remote districts in Nepal. A total of 1050 cervical samples were collected from married and non- pregnant women aged 20–65 years during mobile Cervical Cancer Screening Clinics conducted from May 2016 to January 2017. The presence of HPV DNA was firstly confirmed by HPV consensus PCR using PGMY09/PGMY11 designed primers, then HPV positive samples were further genotyped by the membrane hybridization method to detect the 21 high-risk HPV (HR-HPV) and low-risk HPV types. The prevalence of HR-HPV among women with normal and abnormal cytology was calculated. Data were analyzed using SPSS software for Windows. P < 0.05 was considered statistically significant. Results A total of 998 women were eligible for this study with the mean age 32.6 ± 8.6 years, and the mean marital age was 16.7 ± 3.8 years. The overall prevalence of HPV infections was 19.7%. HR-HPV and low-risk HPV were 11.7 and 8.7% respectively. The six most common HR-HPV types were HPV16, 39, 58, 33, 51 and 18. HR-HPV infection among the women with abnormal and normal cytology was of 27.3 and 10.8% respectively. Conclusions There was a higher prevalence of HR-HPV infection among women living in Jumla than other parts of Nepal. This study provides preliminary information on overall HPV and type-specific HR-HPV prevalence, HR-HPV 16, 39, 58, 33, 51, and 18 are the most prevalent genotypes in this region. The data contribute to the epidemiological knowledge about HPV and type-specific HR-HPV genotypes prevalence in mid-Western Nepal.
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Affiliation(s)
- Niresh Thapa
- Department of Gynecological Oncology, Zhongnan Hospital of Wuhan University, Hubei Cancer Clinical Study Center, Hubei Key laboratory of Tumor Biological Behaviors, Wuhan, 430071, People's Republic of China.,Karnali Academy of Health Sciences, Jumla, Nepal
| | - Muna Maharjan
- Zhongnan Hospital of Wuhan University, HOPE School of Nursing, Wuhan, Hubei, China
| | | | - Narayani Maharjan
- Department of Clinical Laboratory Science, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | | | - Na Zuo
- Department of Gynecological Oncology, Zhongnan Hospital of Wuhan University, Hubei Cancer Clinical Study Center, Hubei Key laboratory of Tumor Biological Behaviors, Wuhan, 430071, People's Republic of China
| | - Can He
- Department of Gynecological Oncology, Zhongnan Hospital of Wuhan University, Hubei Cancer Clinical Study Center, Hubei Key laboratory of Tumor Biological Behaviors, Wuhan, 430071, People's Republic of China
| | - Jing Yang
- Department of Gynecological Oncology, Zhongnan Hospital of Wuhan University, Hubei Cancer Clinical Study Center, Hubei Key laboratory of Tumor Biological Behaviors, Wuhan, 430071, People's Republic of China
| | - Mengfei Xu
- Department of Gynecological Oncology, Zhongnan Hospital of Wuhan University, Hubei Cancer Clinical Study Center, Hubei Key laboratory of Tumor Biological Behaviors, Wuhan, 430071, People's Republic of China
| | - Caiyun Ge
- Department of Gynecological Oncology, Zhongnan Hospital of Wuhan University, Hubei Cancer Clinical Study Center, Hubei Key laboratory of Tumor Biological Behaviors, Wuhan, 430071, People's Republic of China
| | - Ziye Song
- Department of Gynecological Oncology, Zhongnan Hospital of Wuhan University, Hubei Cancer Clinical Study Center, Hubei Key laboratory of Tumor Biological Behaviors, Wuhan, 430071, People's Republic of China
| | - Hongbing Cai
- Department of Gynecological Oncology, Zhongnan Hospital of Wuhan University, Hubei Cancer Clinical Study Center, Hubei Key laboratory of Tumor Biological Behaviors, Wuhan, 430071, People's Republic of China.
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Thapa N, Shrestha G, Maharjan M, Lindell D, Maskey N, Shah R, Ge C, Cai H. Burden of cervical neoplasia in mid-western rural Nepal: a population-based study. J Gynecol Oncol 2018; 29:e64. [PMID: 30022628 PMCID: PMC6078891 DOI: 10.3802/jgo.2018.29.e64] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 03/30/2018] [Accepted: 04/06/2018] [Indexed: 11/04/2022] Open
Abstract
Objective To assess the burden of cervical neoplasia in mid-western rural, Nepal using cytology, visual inspection with acetic acid (VIA) and visual inspection with Lugol's iodine (VILI). Method A cross-sectional, population-based study was conducted. Total of 2,279 married, non-pregnant women aged 20–65 years participated in a screening clinic from May 2016 to January 2017. All eligible women completed self-report of socio-demographic and reproductive health data followed by screening tests. Biopsies were obtained from areas on the cervix assessed by VIA and or VILI to be abnormal. Final disease was confirmed by biopsy report. Results A total of 96.09% (n=2,190) women were eligible for this study with mean age 32.78±9.33 years. The overall rate of positive cytology, VIA, and VILI were 3.69%, 12.45%, and 16.89%, respectively. Sixty-two cases were biopsy proven cervical neoplasia. Altogether 78 (3.69%) cases were cytologically abnormal: 25 (1.18%) were atypical squamous cells of undetermined significance, 33 (1.56%) were low-grade squamous intraepithelial lesion, 11 (0.52%) were high-grade squamous intraepithelial lesion, and 9 (0.42%) were squamous cell carcinoma. Illiterate women appeared to be at higher risk for cervical neoplasia (p<0.001). Similarly, age ≥46 years (p<0.013), participant's multiple marriages or sexual partners (p<0.005), and positive human immunodeficiency virus status (p<0.001) were significantly associated with abnormal cytology. Conclusion Based on cytology report, there is 3.69% prevalence of cervical neoplasia among women in a rural region of mid-western, Nepal. A “screen and treat” approach would be more attractive in low resource settings.
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Affiliation(s)
- Niresh Thapa
- Department of Gynecological Oncology, Zhongnan Hospital of Wuhan University, Hubei Cancer Clinical Study Center, Hubei Key Laboratory of Tumor Biological Behaviors Wuhan, China.,Karnali Academy of Health Sciences, Jumla, Nepal
| | - Girishma Shrestha
- Department of Pathology, Patan Hospital, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - Muna Maharjan
- HOPE School of Nursing, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Deborah Lindell
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
| | - Ninu Maskey
- Department of Haemato-Pathology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Rajiv Shah
- Department of Obstetrics and Gynecology, Karnali Academy of Health Sciences, Jumla, Nepal
| | - Caiyun Ge
- Department of Gynecological Oncology, Zhongnan Hospital of Wuhan University, Hubei Cancer Clinical Study Center, Hubei Key Laboratory of Tumor Biological Behaviors Wuhan, China
| | - Hongbing Cai
- Department of Gynecological Oncology, Zhongnan Hospital of Wuhan University, Hubei Cancer Clinical Study Center, Hubei Key Laboratory of Tumor Biological Behaviors Wuhan, China.
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