Covert contraceptive use among women of reproductive age in Ibadan, Nigeria

Background: This study assessed the prevalence and determinants of covert contraceptive use among women of reproductive age in Ibadan, Nigeria.Methods: A cross sectional study among women attending a family planning clinic in a maternity teaching hospital in Ibadan, Nigeria was conducted. Data was collected on sociodemographic characteristics, contraceptive use and partner awareness of use. The socio-demographic predictors of covert contraceptive use were explored using logistic regressions.Results: Twenty-five (6.8%) of the 365 respondents were practicing covert contraception. Their mean age was 34.7±6.67 years, 98.6% were married and with modal parity of 3 (29.6%). A logistic regression analysis showed that participants' age (p = 0.555), occupation (p = 0.679), education (p = 0.642), parity (p = 0.385) and husbands' education (p = 0.926) were not statistically associated with covert contraceptive use while husbands' financial supports (p = 0.000) and approval for family planning use (p = 0.000) were associated with reduction in the likelihood covert contraceptive use.Conclusions: Covert contraceptive use exist among our women. Poor financial support and disapproval by the husbands were the strongest predictors of the practice. Greater male involvement in contraceptive service provision will help address these negative factors promoting covert contraceptive practices.Keywords: covert, contraception, women, reproductive age.Running Title: Covert contraceptive in Ibadan, Nigeri

Multimodal hyperspectroscopy screening in women at risk of cervical cancer: Results of a pilot study in a developing country

Background: Screening and treatment of pre‑cancerous lesions is important for prevention of cervical cancer. Currently, most available screening tests for cervical cancer are limited by low sensitivity, prohibitive costs, logistics and technical concerns. This study evaluates the role of multimodal hyperspectroscopy (MHS) as a cost‑effective, sensitive and user‑friendly point‑of‑care machine for early detection in women at risk of pre‑cancer lesions.Materials and Methods: Multimodal hyperspectroscopy of the cervix using the LuViva® Advanced Cervical Scan was performed first in a 1‑minute procedure among 100 previously screened for cervical cancer using either visual inspection after application of acetic acid (VIA) or cytology within the last 120 days. This was then followed by obtaining human papilloma virus (HPV) samples and biopsies from women for histology.Results: Of the 22 women with abnormal Pap tests of at least low‑grade squamous intraepithelial lesion, 3 had CIN2+, 6 had  CIN1, 4 were free of dysplasia at  histopathology while 9 had cervicitis. All 3 of the CIN2+ recorded high likelihood of CIN2+ by MHS. However, HPV was negative for all 3 women. The machine classified 1 of 1 CIN1s and 7 of the 13 women without dysplasia or cervicitis as low or  moderate risk for CIN2+ (40% specificity); of the 37 women who were VIA+, 81% were classified as high risk, and 66% of 37 women with normal Pap tests and biopsy were either at moderate or low risk.Conclusions: The findings from this pilot study show that MHS reduced the  percentage of unnecessary colposcopy and biopsy by 37.5%. It was also able to differentiate between VIA+ and Pap negative women suggesting its potential of being a point‑of‑care primary and objective screening test.Key words: Cervix; hyperspectroscopy; pre‑cancer; screening; sensitive

INVASIVE CERVICAL CANCER IN IBADAN: SOCIO-SEXUAL CHARACTERISTICS, CLINICAL STAGE AT PRESENTATION, HISTOPATHOLOGY DISTRIBUTIONS AND HIV STATUS

Background: Human Papillomavirus (HPV) infection persistence is the necessary but not sufficient cause of invasive cervical cancer (ICC). The effects of Human Immunodeficiency Virus (HIV) co-infection have been well documented. The purpose of this study was to describe our experience on the clinico-pathological characteristics of patients with cervical cancer and HIV status at a tertiary Hospital in Nigeria. Materials and Methods: This was a descriptive study among ICC patients presenting for clinical staging and biopsy for histological diagnosis at the Obstetrics and Gynaecology outpatient theatre of our hospital between January 2009 and February 2011 Results: Sixteen (6.8%) of the 248 patients with histologically confirmed ICC in this study were HIV positive. The mean age of all the participants was 55.4 (SD±10.2) years with the HIV positive patients’ younger than the HIVnegative and those that declined HIV testing. Coitarche was at lower age (18 [SD±4.4] vs 22[SD±3.4] years vs 24.5[SD±4.4], respectively). The modal lifetime sexual partners were four, one and two, respectively. Clinically, more HIV positive patients, presented at advanced stage of ≥ 2B. Also, the adenocarcinoma histological variant was slightly more among the HIV positive patients. Conclusion: HIV seemed relatively common among ICC patients and they presented at lower ages, at more advanced stages, earlier coitarche and more lifetime sexual partners. The proportion of adenocarcinoma histological types was slightly higher among the HIV positive patients compared with seronegative patients and those with unknown HIV status. Larger studies to substantiate these findings and ICC-HIV causal relationship are required

Perceived Barriers to Uptake of Cervical Cancer Screening Among Women of Childbearing Age in a Gynaecological Clinic

Introduction Cervical cancer is an important reproductive health problem for women in the developing countries where it constitutes 13% of all female malignancies. It is the second most common cancer in women worldwide and 83 percent of the world’s 500,000 new cases and 85 percent of the 288,000 cervical cancer deaths occur in developing countries. Evidences show that women attending various health facilities were not routinely screened for cervical cancer. Gynaecological clinics present an important access to target group for cervical cancer screening. This study assessed the barriers to uptake of cervical cancer screening services among women attending a gynaecological clinic of a tertiary health i a tertiary health facility in South West region of Nigeria, the most populous black country of the world. Methodology Adopting a descriptive cross-sectional approach and Health Belief Model (HBM), women aged 15 – 49 years attending gynaecological clinic at the health institution were interviewed.   The respondents were selected using systematic random sampling technique and interviewed using a specially designed structured questionnaire. Barrier to uptake of cervical cancer screening services was defined as significant when the number of the respondents in the “agree” and “strongly agree” domains to the selected reasons for not screening for cervical cancer are at least 50%. Results Of the 100 respondents interviewed, 85 responses were found suitable for analysis. The mean age of the respondents was 33.3 (SD±8.6) years. Although a large proportion of the respondents (77.1%) were aware of cervical cancer, 95.2% with at least secondary education and 51.9% earning at least ₦50,000/month, only 23 (27.1%) had undergone the screening for cervical cancer. Age > 44 years and earning > ₦100,000/month were positively and significantly associated with uptake of cervical cancer screening. The significant reasons for not screening for cervical cancer by the respondents were Lack of information/counselling (77.4%), Lack of convenient clinic time (62.9%), Fear of having a positive result (61.3%), Lack of support from partners and significant others is a barrier (56.5%) and Attitude of health workers discourage women from assessing cervical cancer screening (51.6%) Conclusion It can be concluded from this this study that there is need for need for regular information on cervical screening at every opportunity for the populations that will benefit from this preventive service like women of reproductive age group attending our obstetric services. There is an urgent need for provision of more screening opportunities especially the type that will have population coverage and to leverage on other programmes like family planning services, post-natal clinic services and HIV/AIDS programmes. Screening services should be available in all secondary facilities and primary health care centres. Reminder/Recall services should be in place to ensure compliance with appointments in order to increase utilization Keywords: Perceived Barriers, Uptake, Women of childbearing age, Cervical Cancer screening DOI: 10.7176/JHMN/67-07 Publication date:October 31st 201

Human papillomavirus-based cervical precancer screening with visual inspection with acetic acid triage to achieve same-day treatments among women living with human immunodeficiency virus infection: testof-concept study in Ibadan, Nigeria

Introduction: cervical precancer screening with same day treatment facilitates maximization of benefits of secondary prevention of cervical cancer. This is particularly important for women living with human immunodeficiency virus (WLHIV) infection because of their exceptional risk for cervical cancer. The availability of HIV programmes in low- and middle-income countries (LMICs) provide unique opportunity for possible introduction “human papillomavirus (HPV) screening followed by visual inspection after application of acetic acid (VIA) with same day treatment of eligible patients”. This study piloted this concept. Methods: in this prospective, cohort study, 98 WLHIV had HPV and VIA screening for cervical precancer lesions in a HIV clinic in Nigeria. Participants positive to HPV and/or VIA had biopsies from the visible lesions or quadrant of transformation zone. Participants positive to VIA and/or HPV16 or HPV18/45 had same-day thermal ablation treatment and the number of cases documented. The HPV, VIA and scenario of HPV followed by VIA results were compared with histologically confirmed cervical lesion grade 2 or worse statistically. Results: same day treatment was achieved in 95.0% of eligible cases. Statistically, sensitivity and specificity of VIA was 25.0% and 50.0% and HPV had 95.5% and 75.0%, respectively. In the HPV screening with VIA triage, sensitivity dropped to 45.5% but specificity improved to 100.0%. Conclusion: triaging HPV positive test with VIA for same-day treatment in cervical precancer screening among PLWHIV looks feasible. The improved specificity will reduce the overtreatment rate, loss to follow-up associated with repeat clinic visits and improve completion of continuum of care

Demographic and epidemiological characteristics of HIV opportunistic infections among older adults in Nigeria

Background: In view of the maturing HIV epidemic in sub-Saharan Africa, better understanding of its epidemiology among older adults is necessary in order to design appropriate care and treatment programmes for them.Objectives: To describe the demographic and epidemiological characteristics of HIV opportunistic infections among newly enrolled patients aged 50 years and above in Ibadan, South-West Nigeria.Methods: Analysis of data extracted from electronic records of 17, 312 subjects enrolled for HIV/AIDS care and treatment between January 2006 and December 2014 at the ART clinic, University College Hospital, Ibadan.Results: Age of the patients ranged from 18 to 90 years with a mean of 36.4 years (SD= 10.3) with older adults constituting 12.0% (2075). Among older adults, about half (52.9%) were females. Majority (59.1%) were currently married while 25.9% were widowed. Prevalence of opportunistic infections was 46.6%. The commonest opportunistic infections (OIs) were: oral candidiasis (27.6%), chronic diarrhoea (23.5% and peripheral neuropathy (14.8%). Significant factors associated with opportunistic infections in older adults were: CD4 count less than 350 (OR=3.12, CI: 2.29-4.25) and hepatitis C virus co-infection (OR=2.17, CI: 1.14-4.13).Conclusion: There is need for prompt response to the peculiar challenges associated with the emerging shift in the epidemiology of HIV and associated infections in sub-Saharan Africa.Keywords: HIV/AIDS, older adults, epidemiological characteristics, opportunistic infections, Nigeri

Demographic and epidemiological characteristics of HIV opportunistic infections among older adults in Nigeria.

Background: In view of the maturing HIV epidemic in sub-Saharan Africa, better understanding of its epidemiology among older adults is necessary in order to design appropriate care and treatment programmes for them. Objectives: To describe the demographic and epidemiological characteristics of HIV opportunistic infections among newly enrolled patients aged 50 years and above in Ibadan, South-West Nigeria. Methods: Analysis of data extracted from electronic records of 17, 312 subjects enrolled for HIV/AIDS care and treatment between January 2006 and December 2014 at the ART clinic, University College Hospital, Ibadan. Results: Age of the patients ranged from 18 to 90 years with a mean of 36.4 years (SD= 10.3) with older adults constituting 12.0% (2075). Among older adults, about half (52.9%) were females. Majority (59.1%) were currently married while 25.9% were widowed. Prevalence of opportunistic infections was 46.6%. The commonest opportunistic infections (OIs) were: oral candidiasis (27.6%), chronic diarrhoea (23.5% and peripheral neuropathy (14.8%). Significant factors associated with opportunistic infections in older adults were: CD4 count less than 350 (OR=3.12, CI: 2.29-4.25) and hepatitis C virus co-infection (OR=2.17, CI: 1.14-4.13). Conclusion: There is need for prompt response to the peculiar challenges associated with the emerging shift in the epidemiology of HIV and associated infections in sub-Saharan Africa

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

Age-specific burden of cervical cancer associated with HIV: A global analysis with a focus on sub-Saharan Africa

HIV substantially worsens human papillomavirus (HPV) carcinogenicity and contributes to an important population excess of cervical cancer, particularly in sub-Saharan Africa (SSA). We estimated HIV- and age-stratified cervical cancer burden at a country, regional, and global level in 2020. Proportions of cervical cancer a) diagnosed in women living with HIV (WLHIV), and b) attributable to HIV, were calculated using age-specific estimates of HIV prevalence (UNAIDS) and relative risk. These proportions were validated against empirical data and applied to age-specific cervical cancer incidence (GLOBOCAN 2020). HIV was most important in SSA, where 24.9% of cervical cancers were diagnosed in WLHIV, and 20.4% were attributable to HIV (vs 1.3% and 1.1%, respectively, in the rest of the world). In all world regions, contribution of HIV to cervical cancer was far higher in younger women (as seen also in empirical series). For example, in Southern Africa, where more than half of cervical cancers were diagnosed in WLHIV, the HIV-attributable fraction decreased from 86% in women ≤34 years to only 12% in women ≥55 years. The absolute burden of HIV-attributable cervical cancer (approximately 28 000 cases globally) also shifted towards younger women: in Southern Africa, 63% of 5341 HIV-attributable cervical cancer occurred in women <45 years old, compared to only 17% of 6901 non-HIV-attributable cervical cancer. Improved quantification of cervical cancer burden by age and HIV status can inform cervical cancer prevention efforts in SSA, including prediction of the impact of WLHIV-targeted vs general population approaches to cervical screening, and impact of HIV prevention