Recommendations for cervical cancer prevention and control in Ghana: public education and human papillomavirus vaccination

Globally, cervical cancer is a major public health issue causing increasing morbidity and mortality especially in low and middle-income countries where preventive and control measures are lacking. In Ghana, it is the most common cancer among women. Approaches to reduce the incidence and mortality of the disease in Ghana have had little success due to lack of accurate data on the disease among other factors, to inform policies on prevention, early detection, diagnosis and treatment. Additionally, the lack of clear commitment, policy direction and resources has hinderedthe scale-up of some of the initiatives implemented to curb the cervical cancer situation in Ghana. In this paper, we make recommendations on cervical cancer education and human papillomavirus vaccination. A collaborative approach is needed involving both private and government organizations, health professionals and the general public. Public education on cervical cancer and HPV vaccination needs to be delivered through a mixture of systems including both healthcare facilities and outreach programs, involving teachers, youth groups, community members and professional bodies. The vaccination of adolescents aged 10-14 years using the nonavalent HPV vaccine will beimportant in reducing the incidence and mortality of cervical cancer in Ghana. The integration of public education on cervical cancer prevention, HPV vaccination and screening programs into both medical and public health services is critical in achieving high coverage of these programs.Funding: NoneKeywords: Cervical cancer, Education, HPV vaccination, Prevention, Ghan

Body mass index-related cesarean section complications in sub-Saharan Africa: A systematic review and meta-analysis

BACKGROUND: Obesity and cesarean section (CS) rates are rising in sub-Saharan Africa (SSA), where risks for complications that adversely affect maternal health, such as infections, are high. OBJECTIVE: To conduct a systematic review and meta-analysis to report on the incidence and types of body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters)-related complications following CS in SSA. SEARCH STRATEGY: A systematic search was conducted in PubMed/MEDLINE, EMBASE, and Global Health Library up to August 2020 using (MeSH) terms related to CS, BMI, and SSA. SELECTION CRITERIA: Quantitative studies that evaluated BMI-related complications of CS in English. DATA COLLECTION AND ANALYSIS: Data were extracted using a standardized form. The risk of bias was assessed using the Newcastle-Ottawa Scale. The incidence of BMI-related complications at 95% confidence interval was calculated and a meta-analysis conducted. MAIN RESULTS: Of 84 articles screened, five were included. Complications associated with a higher BMI were: wound infection, hemorrhage, post-dural puncture headache, and prolonged surgery time in comparison with patients with a normal BMI. Women with a high BMI (>25.0) have a two-fold increased risk for post-cesarean wound infection compared with women with a normal BMI (20.0-24.9) (odds ratio 1.91, 95% confidence interval 1.11-3.52). CONCLUSION: Overweight and obesity were associated with CS complications in SSA, but limited research is available

Prevalence of adhesions and associated postoperative complications after cesarean section in Ghana : a prospective cohort study

BACKGROUND: The global increase in Cesarean section rate is associated with short- and long-term complications, including adhesions with potential serious maternal and fetal consequences. This study investigated the prevalence of adhesions and association between adhesions and postoperative complications in a tertiary referral hospital in Accra, Ghana. METHODS: In this prospective cohort study, 335 women scheduled for cesarean section at Korle-Bu Teaching Hospital in Accra, Ghana were included from June to December 2015. Presence or absence of adhesions was recorded and the severity of the adhesions was scored using a classification system. Associations between presence and severity of adhesions, postoperative complications, and maternal and infant outcomes at discharge and 6 weeks postpartum were assessed using multivariate logistic and linear regression analysis. RESULTS: Of the participating women, 128 (38%) had adhesions and 207 (62%) did not. Prevalence of adhesions increased with history of caesarean section; 2.8% with no CS but may have had an abdominal surgery, 51% with one previous CS, 62% with >1 CS). Adhesions significantly increased operation time (mean 39.2 (±15.1) minutes, absolute adjusted difference with presence of adhesions 9.6 min, 95%CI 6.4-12.8), infant delivery time (mean 5.4 (±4.8) minutes, adjusted difference 2.4 min, 95%CI 1.3-3.4), and blood loss for women with severe adhesions (mean blood loss 418.8 ml (±140.6), adjusted difference 57.6 ml (95%CI 12.1-103.0). No differences for other outcomes were observed. CONCLUSION: With cesarean section rates rising globally, intra-abdominal adhesions occur more frequently. Risks of adhesions and associated complications should be considered in counseling patients for cesarean section

Additional file 3: Table S3. of Prevalence of adhesions and associated postoperative complications after cesarean section in Ghana: a prospective cohort study

Associations of adhesion groups by score and classification. (DOCX 15 kb

Le Courrier

28 octobre 18361836/10/28 (N298)

Human papillomavirus genotype distribution among women with and without cervical cancer: Implication for vaccination and screening in Ghana

Introduction Determining the high-risk human papillomavirus (HR-HPV) genotypes burden in women with and without cervical cancer afford a direct comparison of their relative distributions. This quest is fundamental to implementing a future population-based cervical cancer prevention strategy in Ghana. We estimated the cervical cancer risk by HPV genotypes, and the HPV vaccine-preventable proportion of cervical cancer diagnosed in Ghana. Materials and methods An unmatched case-control study was conducted at the two largest cervical cancer treatment centres in Ghana from 1st October 2014 to 31st May 2015. Cases were women diagnosed with cervical cancer and controls were women without cervical cancer who were seeking care at the two hospitals. Nested multiplex polymerase chain reaction (NM-PCR) was used to detect HPV infection in cervical samples. Logistic regression was used to determine the association between the risk of cervical cancer and identified HPV infection. P ≤0.05 was considered statistically significant. Results HPV deoxyribonucleic acid (DNA) data were analysed for 177 women with cervical cancer (cases) and 201 without cancer (controls). Cervical cancer was diagnosed at older ages compared to the age at which controls were recruited (median ages, 57 years vs 34 years; p Conclusion Women with cervical cancer in Ghana have HPV infection with multiple genotypes, including some non-vaccine genotypes, with an estimated cervical cancer risk of about six- to ten-fold in the presence of a positive HPV test. HPV DNA tests and multivalent vaccine targeted at HPV 16, 18, 45 and 35 genotypes will be essential in Ghana’s cervical cancer control programme. Large population-based studies are required in countries where cervical cancer is most prevalent to determine non-vaccine HPV genotypes which should be considered for the next-generation HPV vaccines

Uterine Tonus Assessment by Midwives versus Patient self-assessment in the active management of the third stage of labor (UTAMP) : study protocol for a randomized controlled trial

BACKGROUND: Postpartum hemorrhage (PPH) is the leading cause of maternal mortality worldwide and accounts for one third of maternal deaths in low-income and middle-income countries. PPH can be prevented by active management of the third stage of labor (AMTSL), a series of steps recommended by the World Health Organization to be performed by skilled birth attendants (SBAs). Task shifting in the AMTSL step of uterotonic drugs administration to community health workers, traditional birth attendants and self-administration has been investigated as a strategy to increase access to quality obstetric care considering persistent SBA and facility-based delivery shortages. The aim of this study is to assess task shifting in the final step of AMTSL and compare uterine tonus assessment by a SBA to self-assessment. METHODS AND DESIGN: The study is an individual-level two-arm non-inferiority randomized controlled trial (RCT). A total of 800 women will be recruited in Korle Bu Teaching Hospital in Accra, Ghana. Adult women in labor at term with an expected vaginal delivery who received antenatal instructions for self-assessment of uterine tonus will be eligible for inclusion. Women with an increased risk for PPH will be excluded. Women will be randomized to uterine tone assessment by a skilled birth attendant (midwife) or uterine tone self-assessment (with the safety back-up of a midwife present in case of PPH or uterine atony). Postpartum blood loss will be measured through weighing of disposable mats. The main study endpoints are PPH (≥500 ml blood loss), severe PPH (≥1000 ml blood loss), mean blood loss, and routine maternal and neonatal outcomes. Participants and caregivers will not be blinded given the nature of the intervention. DISCUSSION: A reduction of PPH-related maternal mortality requires full implementation of AMTSL. Task shifting of uterine tone assessment may contribute to increased AMTSL implementation in (clinical) settings where SBAs capacity is constrained. TRIAL REGISTRATION: Clinicaltrials.gov: NCT02223806 , registration August 2014. PACTR: PACTR201402000736158 , registration July 2014. University of Ghana, Medical School Ethical and Protocol Review Committee: MS-Et/M.8-P4.1/2014-2015

Additional file 1: of Uterine Tonus Assessment by Midwives versus Patient self-assessment in the active management of the third stage of labor (UTAMP): study protocol for a randomized controlled trial

Script of antenatal clinic health talk. (DOC 23 kb