Cervical cancer screening and practice in low resource countries: Nigeria as a case study

Cervical cancer is the most common female genital tract malignancy in Nigeria and majority of the patients present with advanced disease. It is a preventable cancer as there are well‑defined treatable premalignant phases. The objective of the study is to review the burden of cervical cancer, its screening modalities, and practice of screening and treatment in low resource countries with emphasis on Nigeria. This is a review involving internet and literature search. While developed countries have recorded significant reduction in the incidence of cervical cancer owing to organizedscreening programs, treatment of premalignant cervical lesions, and follow‑up of treated cases, developing countries including Nigeria are yet to optimally utilize screening services due to lack of organized population‑based screening programs with only pockets of screening services which are at best opportunistic. This has not reduced the incidence of cancer because only a fraction of the target population is covered. Apart from this, loss to follow‑up is rampant. The level of awareness of cervical cancer and its preventive strategies are low among the population and policymakers in Nigeria. There is no organized screening program, and the few services available are only opportunistic with little or no impact. Development of cervical cancer screening policy and institution of organized screening program targeted at covering ≥80% of population at risk is fundamental. There is also a need for widespread education of the populace on the burden of cervical cancer and the public health importance of the disease using the mass media, counseling at antenatal clinics, and the involvement of men will contribute immensely to reduction in the incidence of cervical cancer. Decentralization of services by incorporation of cervical screening and treatment in primary health care programs will ensure adequate rural‑urban coverage.Keywords: Cervical cancer screening; human papillomavirus, low resource countries; Nigeria; premalignant diseas

Ectopic Pregnancy: Reasons for the High Tubal Rupture Rates in a Nigerian Population

Context: Nigeria has a high incidence of ruptured ectopic pregnancy. Identification of predisposing factors will help reduce morbidity and mortalityAim: To determine the reasons for the high incidence of ruptured ectopic pregnancy.Methods: All cases of ectopic pregnancies managed at Wesley Guild Hospital, Ilesha, Nigeria , between January 2004 and December 2008 were the subjects of this study. The case notes were reviewed to obtain information on the socio demographic characteristics of the patients, clinical history and operative findings.Results: Of the 1,048 gynaecological admissions during the study period 98(9.4%) were for ectopic pregnancy out of which76(96.2%) were ruptured The mean age of the patients was 28.3 years (SD=5.1), majority (82.3%) were married and 68.4% have had one or more previous deliveries.Amenorrhea was present in 66(83.5%). Abdominal pain (98.%), dizziness (62.0%) and vaginal bleeding (44.3%) were the commonest symptoms. Only 30 (38.0%) presented to any medical facility within 24 hours of the onset of symptoms. The ectopic was tubal in 67(84.8%), abdominal in one and could not be specified in 11. Of the tubal pregnancies ampulla (49.3%), cornual (25.4%) and isthmus (15..0%) were the commonest sites. All patients had laparotomy and salpingectomy. There was no maternal death.Conclusion In our community ectopic pregnancy tends to occur more often in parous women and are more commonly located in the isthmio cornual part of the tube. Besides, majority of our women present late making them more vulnerable to ruptured ectopic pregnancy.Key Words: Ectopic, Pregnancy, Complications, Presentation

Survey of the Problems of Girl Child in Ekiti State, Nigeria

Objectives: To determine the prevalence of teenage pregnancy and knowledge of reproductive health problems among adolescent girls in Ekiti State, Southwest Nigeria.Methods: A cross-sectional community based study was conducted. Using convenient random sampling technique, four local government areas were selected. Eligible participants were both in and out of school children between the ages of 13 -18 years. A hundred respondents were sampled from each selected local government, making a total sample size of 400. Consenting participants were administered questionnaire in their homes by trained LGA enumerators. It elicited information on socio-demographic and reproductive health issues. Data collected were subsequently collated and analyzed.Results: Majority of the girls (78%) were still in-school. All were already menstruating, mostly attaining menarche between the age 15-16years. Only 212 (53%) could remember their last menstrual period. Sexual derby mainly occurred around age 15-16years; 53.3% were already sexually exposed. A quarter of respondents had been pregnant before. Only 187 (46.8%) were aware of modern contraception. The girls had a fair knowledge of implication of early sexual derby and unprotected intercourse, though it did not translate to behavioural change.Conclusion: There is a high prevalence of teenage pregnancy and poor reproductive health knowledge among teenagers in Ekiti State. More collective efforts involving parents, community heads, opinion leaders, civil societies and the state are needed to help our girls attain and sustain healthy reproductive behaviours

Prostaglandin levels and semen quality in male partners of infertile couples in Ile-Ife, Nigeria

The study revealed a high percentage of men with sub-normal semen .Range of PGF2á in the subjects was 0.15-11.05µg/ml with a mean of 2.77± 0.23 µg/ml while that of PGE was 21.8- 652.0 µg/ml with a mean of 248.79± 13.88 µg/ml. Among men with normal semen profile, mean PGF2á and PGE levels are 2.1± 0.32 µg/ml and 325.1± 28.3 µg/ml respectively while that in semen of men with subnormal semen are 3.0± 0.28 µg/ml and 225.1 ± 15.1µg/ml respectively. Despite the wide range of PG values in all the groups, significant differences(P<0.05) were found to exist between the PG values of men in the normal and sub normal semen groups. Significant differences were also found when they were grouped according to sperm count alone. However, differences observed when in the grouping according to other individual semen characteristics are not significant. Conclusion: The wide range of PG values obtained in all the groups make it difficult to make far reaching conclusions as to the relationship between PG levels and semen quality. Further research is desirable in establishing the role of PGs in sperm function

Cross-sectional study of antioxidant status in normotensive and hypertensive pregnancy

Objectives: The study measured the concentrations of antioxidants in women during pregnancy and the Post Partum Period (PPP) with a view to investigating their role in the aetiology of pregnancy induced hypertension (PIH). Study Design: Informed consent was obtained from 105 women who were divided into three groups: 15 age and parity matched normotensive non-pregnant (control group), 45 normotensive and 45 hypertensive pregnant women. The two groups of pregnant women were divided into three groups of 15 each and studied in the second and third trimesters and PPP respectively. Venous blood was obtained from all the participants for measurements of some antioxidants (uric acid, albumin, catalase and vitamin C). Data were analyzed using descriptive and inferential statistical methods. Results: The results show that the mean concentrations of catalase, albumin, vitamin C and uric acid for the control were 3.1 ± 0.18 µ/l, 46.6 ± 6.6 g/l, 0.38 ± 0.01 mg/dl and 0.16 ± 0.03 mmol/l respectively. The mean concentration of all antioxidants except uric acid were significantly lower during pregnancy when compared with controls (t= 2.06; p<0.01). In the normotensive group of pregnant women, vitamin C was the only antioxidant that showed significant higher concentration when the second trimester concentration and third trimester concentration were compared (t=2.06; p<0.05). Uric acid levels were significantly higher (t=2.06; p<0.05) and nd rd catalase and vitamin C levels were significantly lower in the hypertensive group during the 2 and 3 trimesters (t=2.06; p<0.05). There was a tendency for all antioxidant concentrations to return to normal values during the PPPin the normotensive group; however in the hypertensive group, uric acid levels remained significantly higher (t=2.06; p<0.05). Conclusion: In conclusion this study showed that pregnancy generally reduced the concentration of antioxidants but vitamin C levels were higher in late pregnancy of normotensive women. Therefore higher levels of vitamin C may protect against PIH

Cross-sectional study of antioxidant status in normotensive and hypertensive pregnancy

Objectives: The study measured the concentrations of antioxidants in women during pregnancy and the Post Partum Period (PPP) with a view to investigating their role in the aetiology of pregnancy induced hypertension(PIH).Study Design: Informed consent was obtained from 105 women who were divided into three groups: 15 age and parity matched normotensive non-pregnant (control group), 45 normotensive and 45 hypertensive pregnant women. The two groups of pregnant women were divided into three groups of 15 each and studied in the second and third trimesters and PPP respectively. Venous blood was obtained from all the participants for measurements of some antioxidants (uric acid, albumin, catalase and vitamin C). Data were analyzed using descriptive and inferential statistical methods.Results: The results show that the mean concentrations of catalase, albumin, vitamin C and uric acid for the control were 3.1 ± 0.18 ì/l, 46.6 ± 6.6 g/l, 0.38 ± 0.01 mg/dl and 0.16 ± 0.03 mmol/l respectively. The meanconcentration of all antioxidants except uric acid were significantly lower during pregnancy when compared with controls (t= 2.06; p&lt;0.01). In the normotensive group of pregnant women, vitamin C was the only antioxidant that showed significant higher concentration when the second trimester concentration and third trimester concentration were compared (t=2.06; p&lt;0.05). Uric acid levels were significantly higher (t=2.06; p&lt;0.05) and catalase and vitamin C levels were significantly lower in the hypertensive group during the 2nd and 3rd trimesters (t=2.06; p&lt;0.05). There was a tendency for all antioxidant concentrations to return to normal values during the PPP in the normotensive group; however in the hypertensive group, uric acid levels remained significantly higher(t=2.06; p&lt;0.05).Conclusion: In conclusion this study showed that pregnancy generally reduced the concentration of antioxidants but vitamin C levels were higher in late pregnancy of normotensive women. Therefore higher levels of vitamin C may protect against PIH.Keywords: Antioxidants, Normal Pregnancy, Pregnancy Induced Hypertension (PIH)

Vulval leiomyoma causing coital difficulty: report of two cases

Leiomyoma is a smooth muscle benign tumor and it is a common benign lesion of the uterus in women of the reproductive age group with a prevalence of about 30%. Though the prevalence of uterine fibroid was 6.5% in Ile-Ife, and 8.5% of gynecological admissions in Ilesha, Nigeria, vulval leiomyoma is very rare and often misdiagnosed as Bartholin cyst or with other differentials like lipoma, etc. It is usually not considered a differential of vulval masses, but with detailed examination and with the use of investigative tools, the diagnosis can become clearer. This paper presents 2 cases of histologically diagnosed vulval leiomyoma seen at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC) between January 2017 and December 2021 with both patients complaining of coital difficulty. During this time, the prevalence of this lesion was calculated to be 0.092% of gynecology admissions and 0.17% of gynecological surgeries done in the hospital

Trends in vaginal hysterectomy in a Nigerian teaching hospital: A 14-year review

Background: The procedure of vaginal hysterectomy is a fast disappearing art. This study looks at 14 years’ experience of vaginal hysterectomy in Ile‑Ife, Nigeria.Objectives: To determine and compare the rate, indications, and complications of vaginal hysterectomy over a 14-year period at Ile‑Ife, Nigeria.Methods: The medical records of patients managed with vaginal hysterectomies performed from 1st January 2005 to 31st December 2018 were reviewed. The demographics and indications for vaginal hysterectomy were extracted. Data were analyzed using Statistical Package for Service Solutions – IBM version 22. Frequencies and percentages were calculated and associations compared where applicable using Chi‑square with level of significance set at &lt;0.05.Results: Pelvic organ prolapse accounted for 0.8% of gynecological admissions and vaginal hysterectomy accounted for 2.3% of major&nbsp; gynaecological operations. The mean age was 66.1 ± 9.2 years with a mean age of menopause of 15.2 ± 7.1 years. The mean parity was 6.2 ± 1.6. Pelvic organ prolapse was the commonest indication. The mean blood loss at surgery was 314.2 ± 184.8 ml. The modal post‑operative complication was post‑operative anemia, and hypertension was the commonest comorbidity. The mean duration of surgery was 3 ± 0.9 h and the mean duration of admission was 5.4 ± 2.7 days.Conclusion: The rate of vaginal hysterectomy is on the decline. This may be due to case under reporting, limiting of family size, or low uptake of farming occupation in our society. Key words: Comorbidities; complications; incidence; indications; vaginal hysterectomy

Contributions of uterine fibroids to infertility at Ile‑Ife, South‑Western Nigeria

Background: Uterine fibroid is the most common tumor of the female genital tract. The benign tumors often grow into large sizes and assume unsightly shapes with concomitant symptoms and signs. Being a predominantly reproductive age disease, concurrent infertility and symptomatic uterine fibroids pose management challenges. Individualization of the patient is thus essential to the success of the reproductive outcome.Objectives: This study determined the prevalence, trend, management modalities, pregnancy outcome, and exposition of factors affecting pregnancy outcome among patients presenting with uterine fibroids and infertility at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC).Materials and Methods: This is a retrospective study of case records of 106 women managed for uterine fibroids and infertility over a 5‑year period (January 1, 2012, to December 31, 2016) at the OAUTHC. The outcome measure is the pregnancy rate among those who had a myomectomy.Results: About a quarter of women with infertility had symptomatic uterine fibroids and this represents about 35%–40% of the overall number of women presenting as uterine fibroid within the study. About 84.9% had uterine size &gt;12 weeks at presentation. Two‑third of the patients had open myomectomy alone with 43.9% achieving conception thereafter. Conception rate for myomectomy with tuboplasty was 31.3% whereas myomectomy with subsequent in vitro fertilization (IVF) was 50%. Pregnancy rate decreased with increasing size of the uterus before myomectomy.Conclusion: Symptomatic fibroid was significantly prevalent among women with infertility. Myomectomy improves fertility potential and success rate of IVF. Uterine fibroid has both direct and indirect effect on infertility and pregnancy rate in this group of the patient can be improved through routine screening for uterine fibroids and early removal of the fibroids before they grow into giants size.Keywords: Infertility; myomectomy; pregnancy outcome; uterine fibroid

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