Comparative efficacy of visual inspection with acetic acid versus cytology for cervical cancer screening in Ogbomoso, Nigeria

Background: Screening test for cervical cancer using visual inspection with acetic acid (VIA) has been advocated by World Health Organization as a suitable, low cost and feasible alternative modality for control of cervical cancer in resource-poor settings as compared to cytological and colposcopic screening. The need for reproducibility, accuracy and comparable efficacy will influence the acceptability of VIA as primary screening modalities for cervical cancer.Methods: A cross–sectional comparative study conducted at BUTH. Data were obtained from 318 consenting women aged 30–65 years using a systematic random sampling method and an interviewer–administered structured questionnaire. Pap smear samples were taken followed by visual inspection with acetic acid. Using Statistical Package for Social Sciences (SPSS) version 23.0, Frequencies were obtained and Chi-square test (X2) was used to compare rates and proportions with the level of statistical significance set at less than 0.05.Results: Positive results for premalignant cervical lesion was 1.3% and 4.1% for VIA and Pap smear respectively (X2=4.52; p=0.034). The sensitivity of VIA was 7.7% with positive predictive value of 25% while specificity was 99.0% with a negative predictive value of 96.2%. The prevalence of abnormal cervical lesion in the population studied was 4.1% (95% CI 2.2% – 6.9%).Conclusions: The detection rate for pre-cancerous lesions of the cervix using VIA was significantly lower than that of Pap smear in this study. There may be needed to exercise caution in adopting VIA as primary screening modality for cervical cancer

Bayesian Semi-Parametric Modeling of Infertility in Nigeria

Infertility in Nigeria is a neglected reproductive health issue despite its negative impact. Majority of infertility-related research has focused on treating the consequences of infertility rather than investigating the determinantsto explain the spatial and spline effect of infertility in the country. This work is aimed at investigating spatial variation of determinants of infertility among female in Nigeria. The finding reveals that women at reproductive age have a high probability of infertility in some southern part of Nigeria astheir ages are steadily increasing. Also, change in the characteristics of place of residence and source of water increase the chance of woman being infertile. Policy makers on health sectors should make effort to address problems of climatic and atmospheric change in the identified social and demographic risk factors

Genetic counseling and testing for gynecological cancers: Perception of female undergraduates of universities in Ibadan, Nigeria

Introduction: Genetic education and counseling give individuals an opportunity to make informed choices related to risks, benefits, and limitations of genetic testing for social and medical purposes. We aimed to assess the perception of female undergraduates of universities in Ibadan to genetic counseling and testing (GCT) for gynecological cancers and their willingness to participate in the twin procedure. Materials and Methods: This was a cross-sectional study involving consented female students from the two universities within Ibadan metropolis – University of Ibadan and Lead City University, Ibadan. Using a self-administered, semi-structured questionnaire, information on their understanding of GCT, perception of implications, and willingness to participate in the procedure were obtained. Results: There were 943 respondents with mean age of 20.0 ± 3.4 years, 908 (96.3%) had ever heard of cancers, but only 252 (26.7%) provided proper definition. Overall, 484 (51.3%) were aware of GCT although three-quarters, 712 (75.5%), wished to know their inheritable risk of developing gynecologic cancer. All the respondents were willing to participate in the counseling procedure, but only 815 (86.4%) would be willing to proceed with testing if indicated. Possible surgical intervention reduced willingness to test from 82.3% to 45.7%. Conclusion: The female undergraduates of universities in Ibadan were willing to partake in GCT provided there are no surgical interventions. There is a need for an increased awareness and encouragement of GCT for at-risk groups and also in the prevention and/or early detection to reduce the burden of familial gynecologic cancers

Early pregnancy body mass index and obstetric outcomes in Ibadan

Introduction: Obesity in pregnancy has been associated with adverse pregnancy outcomes. In this study, we estimate the prevalence of early pregnancy obesity and the impact on materno-fetal outcomes. Materials and Methods: A cohort of 176 pregnant women were purposively recruited before 20 weeks. Women <18 years, with multiple pregnancies or chronic medical conditions, were excluded from the study. Body mass index (BMI) grouping was done at the first clinic. Data were presented as means (standard deviation) and proportions and differences compared using Chi-square or ANOVA. Results: Early pregnancy weight of 173 women followed up from booking to delivery showed 41.2%, 24.3%, and 32.2% were normal weight, overweight, and obese, respectively. At recruitment, the mean age, mean BMI, and mean gestational age were 31.7 ± 4.4 years, 27.1 ± 5.3 kg/m2, and 14.4 ± 3.2 weeks, respectively. Compared to normal weight women, the obese were older (31.1 ± 4.0 vs. 32.8 ± 4.1, P = 0.06) and of higher parity >2 (19.2% vs. 36.9%, P = 0.17). Compared to those with normal BMI, occurrence of gestational diabetes mellitus (1.3% vs. 10.53%) and preeclampsia (6.9% vs. 14.0%) were more in obese women whereas overweight women had higher occurrence of pregnancy-induced hypertension (6.9% vs. 16.3%) and preeclampsia (6.9% vs. 13.95%). At delivery, compared to normal weight, obese women had more cesareans (57.5% vs. 69.7%), more deliveries <37 weeks (20.6% vs. 41.07%), more babies <2.5 kg (13.7% vs. 25.0%), acrosomic (9.6% vs. 12.5%), and more special care baby unit admissions (4.1% vs. 10.7%). Conclusion: Even in low-resource setting, obesity in pregnancy is not uncommon. Affected women would benefit from prepregnancy interventions

Comparative effectiveness of 50g glucose challenge test and risk factor based screening in detection of gestational diabetes mellitus in Ibadan, Nigeria.

Context: Gestational diabeles mellitus (GDM) complicates 3- 5% of pregnancies. Prompt diagnosis helps to prevent its subsequent complications and one-step effective screening method is desirable for our environment.Objective: To compare the effectiveness of 50g glucose challenge test (GCT) with risk factors alone in screening for GDM.Study Design: Prospective study of booked, consenting pregnant women with no previous history of diabetes mellitus.Fasting sample ofvenous blood was obtained for plasma glucose, followed by administration of 50g oral glucose and collection of blood sample an hour later. The process was repeatedafter a week using 75g oral glucose; each patient serving as her own control. Threshold blood glucose of 140mg/dl was used for both post-ingestion tests. Statistical analysis was done using SPSS version 17.Results: All the seventy-nine study participants completed the 2 arms.Mean maternal and gestational ages at recruitment were 30.8+1.2 years and 24.2+1.6 weeks respectively.Among the respondent, 35( 44.3%)were nulliparous while24(30.3%) had positiverisk factors for GDM. The 50g GCT was abnormal in 10 patients (12.7%) while GDM was confirmed in 2 patients giving an incidence rate of 2.5%. The 50g GCT was normal in 89.6% of women with normal 75g OGTT and it was more predictive ofGDM (Positive Predictive Value, PPV - 20%) compared to risk factors only (PPV- 11.1%).Conclusion: Using 50g GCT will enhance selection of patients for confirmatory test for GDM as compared to risk factorsalone. It would therefore be of great benefit in this environment.Keywords: 50g Glucose Challenge Test, Gestational Diabetes Mellitus, Screenin

Awareness and perception of risk for cervical cancer among women in Ogbomoso, Nigeria

Background: Cervical cancer, though preventable, remains the leading cause of cancer death among women in developing countries after breast. Lack of awareness and access to preventive methods remains a key factor contributing to high levels of cervical cancer in these populations. Objectives: The study aimed to assess the level of awareness of, and perception of risk for, cervical cancer among women attending Bowen University Teaching Hospital (BUTH) general outpatient clinic. Methodology: This was a cross-sectional study conducted at the BUTH, Ogbomoso. Data were obtained from 318 consenting women using systematic random sampling method. An interviewer-administered questionnaire was used to gather information about their sociodemographic characteristics, marital and reproductive history, and awareness and perception of risk for cervical cancer. Data were analyzed using Statistical Package for the Social Sciences version 23.0. The level of statistical significance was set at P < 0.05. Results: Awareness for cervical cancer and its screening tests were 22.6% and 17.9%, respectively, with major sources of information being from health talks and hospital staffs. About 5.7% believed that they may be at risk whereas only 1.6% had ever been screened. Perception of risk is significantly associated with age (χ2 = 20.05, P = 0.005) and early coitarche (χ2 = 10.46, P = 0.015). Overall, respondents' attitude was positive to cervical cancer screening. Conclusion: The level of awareness of cervical cancer and screening was low among the respondents. Increased media campaign about its risks and preventive measures is urgently needed

An Assessment of Ovarian Cancer Histotypes Across the African Diaspora

ObjectiveOvarian cancer in Black women is common in many West African countries but is relatively rare in North America. Black women have worse survival outcomes when compared to White women. Ovarian cancer histotype, diagnosis, and age at presentation are known prognostic factors for outcome. We sought to conduct a preliminary comparative assessment of these factors across the African diaspora. MethodsPatients diagnosed with ovarian cancer (all histologies) between June 2016-December 2019 in Departments of Pathology at 25 participating sites in Nigeria were identified. Comparative population-based data, inclusive of Caribbean-born Blacks (CBB) and US-born Blacks (USB), were additionally captured from the International Agency for Research on Cancer and Florida Cancer Data Systems. Histology, country of birth, and age at diagnosis data were collected and evaluated across the three subgroups: USB, CBB and Nigerians. Statistical analyses were done using chi-square and student's t-test with significance set at pResultsNigerians had the highest proportion of germ cell tumor (GCT, 11.5%) and sex-cord stromal (SCST, 16.2%) ovarian cancers relative to CBB and USB (p=0.001). CBB (79.4%) and USB (77.3%) women were diagnosed with a larger proportion of serous ovarian cancer than Nigerians (60.4%) (p<0.0001). Nigerians were diagnosed with epithelial ovarian cancers at the youngest age (51.7 +/- 12.8 years) relative to USB (58.9 +/- 15.0) and CBB (59.0 +/- 13.0,p<0.001). Black women [CBB (25.2 +/- 15.0), Nigerians (29.5 +/- 15.1), and USB (33.9 +/- 17.9)] were diagnosed with GCT younger than White women (35.4 +/- 20.5, p=0.011). Black women [Nigerians (47.5 +/- 15.9), USB (50.9 +/- 18.3) and CBB (50.9 +/- 18.3)] were also diagnosed with SCST younger than White women (55.6 +/- 16.5, p<0.01). ConclusionThere is significant variation in age of diagnosis and distribution of ovarian cancer histotype/diagnosis across the African diaspora. The etiology of these findings requires further investigation

Building capacity for sustainable research programmes for cancer in Africa

Cancer research in Africa will have a pivotal role in cancer control planning in this continent. However, environments (such as those in academic or clinical settings) with limited research infrastructure (laboratories, biorespositories, databases) coupled with inadequate funding and other resources have hampered African scientists from carrying out rigorous research. In September 2012, over 100 scientists with expertise in cancer research in Africa met in London to discuss the challenges in performing high-quality research, and to formulate the next steps for building sustainable, comprehensive and multi-disciplinary programmes relevant to Africa. This was the first meeting among five major organizations: the African Organisation for Research and Training in Africa (AORTIC), the Africa Oxford Cancer Foundation (AfrOx), and the National Cancer Institutes (NCI) of Brazil, France and the USA. This article summarizes the discussions and recommendations of this meeting, including the next steps required to create sustainable and impactful research programmes that will enable evidenced-based cancer control approaches and planning at the local, regional and national levels