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

AbstractAimThis 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.MethodsA self-administered questionnaire was administered between May and July 2010, to 368 female students aged 16–29years, 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.ResultsOnly 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.ConclusionThe 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

Impact of Mobile Technologies on Cervical Cancer Screening Practices in Lagos, Nigeria (mHealth-Cervix): A Randomized Controlled Trial

Purpose We assessed the impact of mHealth on Pap test screening uptake and also determined the factors that affect screening uptake among women in Lagos, Nigeria. Materials and Methods A randomized controlled trial was carried out among women in two tertiary health institutions in Lagos, Nigeria, between July 2020 and March 2021. Participants were randomly assigned to either a text message (mHealth) intervention or usual care arm. The main study outcome was the uptake of Pap smear testing within 6 months of enrollment in the study. We tested the associations between two groups of continuous variables using the unpooled independent-sample t-test (normal distribution) and that of two groups of categorical variables with the chi-square (χ2) test. Using a multinomial logistic regression model, we adjusted for relevant sociodemographic and clinical predictors of uptake of Pap smear screening. Statistical significance was defined as P < .05. Results There was a significantly higher rate of uptake of Pap smear screening among women in the mHealth arm compared with those in the usual care arm (51.0% v 35.7%, P = .031). Following adjustment in the final multivariate model, level of income (odds ratio [OR] = 5.13, 95% CI, 1.55 to 16.95), awareness of Pap smear (OR = 16.26; 95% CI, 2.49 to 76.64), General Outpatient clinic attendance, and introduction of mHealth intervention during follow-up (OR = 4.36; 95% CI, 1.44 to 13.22) were the independent predictors of Pap smear uptake. Conclusion The use of mHealth technologies intervention via short-text message services is a feasible solution for cervical cancer prevention in low- and middle-income countries, and thus, the widespread use of mHealth services by health care providers and policymakers could contribute to the implementation of cervical cancer prevention services in Nigeria and in the settings of other low- and middle-income countries

Characteristics and risk factors of preterm births in a tertiary center in Lagos, Nigeria

Introduction: preterm birth is a dire complication of pregnancy that poses huge long-term medical and financial burdens for affected children, their families, and the health care system. The aim of the present study was to identify characteristics associated with preterm births at the Lagos University Teaching Hospital (LUTH), Lagos, Nigeria from 2011 to 2013. Methods: we obtained Information from 5,561 maternal, fetal/neonatal and obstetric records from the labor ward. We excluded delivery at less than 22 weeks (0.25%), post-term birth at ≥42 weeks gestation (1.3%), and unknown gestation (1.4%). Additionally, we excluded records of multiple births (5.4%) and stillbirths (8.3%) leaving 4,691 records of singleton live-births for analysis. Logistic regression analysis was performed comparing preterm birth (22-36 weeks gestation) to term birth (37-41 weeks gestation). Multiple variable models adjusting for maternal age, parity, fetal position, delivery method and booking status were also evaluated. Multinomial regression was used to identify characteristics associated with preterm birth (PTB) defined as early PTB (22-31 weeks gestation), moderate PTB (32-34 weeks gestation), late PTB (35-36 weeks gestation), compared to term birth (37-41 completed weeks gestation). Results: from our data, 16.8% of the singleton live-birth deliveries were preterm (&lt;37 weeks gestation). Of these, 4.7% were early (22-31 weeks), 4.5% were moderate (32-34 weeks) and 7.7% were late (35-36) PTBs. Older maternal age (≥35 years) [odds ratio (OR) = 1.41], hypertension (OR = 3.44) and rupture of membranes (OR = 4.03) were significantly associated with increased odds of PTB. Women being treated for the prevention of mother-to-child transmission of HIV were at a significantly decreased risk for PTB (OR = 0.70). Sixteen percent of women in this cohort were not registered for antenatal care in LUTH. These non-registered subjects had significantly greater odds of all categories of PTB, including early (odds ratio (OR) = 20.8), moderate (OR = 8.68), and late (OR = 2.15). Conclusion: PTB and risks for PTB remain high in Nigeria. We recommend that any high risk pregnancy should be referred to a tertiary center for prenatal care in order to significantly reduce adverse birth outcomes such as PTBs

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 ³21 years with lesions clinically suggestive of ICC. A questionnaire was used to evaluate the HIV status and the medical, sexual, and reproductive history of women. 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. HPVpositive 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%). HPV type distribution appeared to differ according to tumor type and HIV status. In conclusion, HPV16 and HPV18 were the most frequently detected types in women with ICC in sub-Saharan Africa and implementation of HPV vaccination may reduce the ICC disease burden in this region.GlaxoSmithKline Biologicals SAhttp://onlinelibrary.wiley.com/journal/10.1002/(ISSN)1097-0215hb201

Society of obstetrics and gynecology of Nigeria – Clinical practice guidelines: Guidelines for the prevention of cervical cancer

Clinical practice guidelines have been developed by professional societies globally. Each guideline although based on published scientific evidence reflected each country’s socioeconomic peculiarities and unique medical environment. The Society of Obstetrics and Gynaecology of Nigerian has published guidelines in other clinical areas; however, this is the first edition of practice guidelines for the prevention of cervical cancer. The Guidelines Committee was established in 2015 and decided to develop the first edition of this guideline following Delphi pool conducted among members which selected cervical cancer prevention as the subject that guideline is urgently needed. These guidelines cover strategies for cervical cancer prevention, screening, and management of test results. The committee developed the draft guideline during a 2‑day workshop with technical input from Cochrane Nigeria and Dr. Chris Maske, Lancet Laboratories, South Africa. The recommendations for each specific area were developed by the consensus, and they are summarized here, along with the details. The objective of these practice guidelines is to establish standard policies on issues in clinical practice related to the prevention of cervical cancer.Keywords: Cervical cancer; guideline; management; prevention; screening; Society of Obstetrics and Gynecology of Nigeria

Selenium status and infant birth weight among HIV-positive and HIV-negative pregnant women in Lagos, Nigeria

Background: During pregnancy, selenium deficiency and reduced antioxidant activities may result in adverse perinatal outcome such as low birthweight, which is associated with significant perinatal morbidity and mortality. Many studies have reported conflicting findings on the relationship between maternal selenium status and infant birth weight.Objective: This study is to determine the relationship between maternal serum selenium concentration and infant birthweight in HIV-positive and HIV-negative pregnant women at term.Methods: A cross-sectional study carried out among HIVpositive and HIV-negative pregnant women at term. Participants were recruited from the antenatal clinic at the Lagos University Teaching Hospital. After obtaining an informed consent, participants were interviewed using a structured questionnaire. Five milliliters of venous blood sample was collected from each participant for estimation of selenium levels using the Inductively Coupled Plasma Mass Spectrometry (ICP-MS) method. At delivery, the infant birth weights were measured using a standard infant weighing scale.Results: Of the 240 participants, data were complete for analysis in 214 (89.2%) of the participants. HIV-positive women had significantly lower mean serum selenium concentration when compared with HIV-negative women(33.7 ± 22.2 μg/L versus 83.6 ± 18.7 μg/L; p&lt;0.01). Compared with HIV-negative women, the mean birth weight of infants of HIV positive women was significantly lower(2952 ± 572 g versus 3392 ± 452 g; p&lt;0.01). There was no significant association between maternal serum selenium levels at term and infant birth weight in both groups.Conclusion: HIV-positive pregnant women had a lower mean serum selenium level and their infants had a lower mean birth weight, when compared to HIV-negative pregnant women. However, no significant association was found between maternal serum selenium concentration and birth weight in both groups.Keywords: Selenium, birth weight , human immunodeficiency virus (HIV), pregnant women, Nigeria

Antibiotic susceptibility/resistant gene profiles of Group B streptococci isolates from pregnant women in a tertiary institution in Nigeria

Background: Penicillin is recommended as the first-line agent for intrapartum antibiotic prophylaxis (IAP). Although Group B Streptococcus (GBS) strains are generally susceptible to penicillin with only occasional resistance, they show varying resistance to erythromycin, clindamycin, and tetracycline. Therefore, knowledge of the resistance profile of GBS in the local environment will be useful for administration of appropriate intrapartum antibiotics prophylaxis. Methodology: Rectovaginal swabs collected from pregnant women were cultured for GBS using conventional media. Kirby-Bauer disc diffusion method was performed according to the Clinical and Laboratory Standards Institute guidelines on GBS isolates to determine the antibiotic susceptibility patterns of the isolates. Inducible clindamycin resistance was detected by using the D-zone test. Resistance determinants genes were discerned with conventional polymerase chain reaction. Results: Carriage rates of GBS among pregnant women studied were 19.7%. GBS colonizing the pregnant mothers were uniformly susceptible (100%) to penicillin, vancomycin, and ceftriaxone. Only three (6.5%) of the isolates showed inducible clindamycin resistance. ermA gene was present in all three GBS isolates with inducible macrolide-lincosamide-streptogramin resistance. ermB was absent in all the strains tested. mefA/E gene was carried by two of the macrolide-clindamycin resistance isolates. tetM gene was carried by all isolates with tetracycline resistance phenotypes. Conclusion: In this study, all GBS isolates were susceptible to penicillin G, the recommended antibiotic for IAP. The presence of resistance to erythromycin and inducible resistance to clindamycin excludes the use of these agents as alternatives in cases of penicillin allergy. In this case, vancomycin is the drug of choice as recommended in the updated Centers for Disease Control guideline