Knowledge, attitudes and practices on cervical cancer screening among the medical workers of Mulago Hospital, Uganda

BACKGROUND: Cervical cancer is the commonest cancer of women in Uganda. Over 80% of women diagnosed in Mulago national referral and teaching hospital, the biggest hospital in Uganda, have advanced disease. Pap smear screening, on opportunistic rather than systematic basis, is offered free in the gynaecological outpatients clinic and the postnatal/family planning clinics. Medical students in the third and final clerkships are expected to learn the techniques of screening. Objectives of this study were to describe knowledge on cervical cancer, attitudes and practices towards cervical cancer screening among the medical workers of Mulago hospital. METHODS: In a descriptive cross-sectional study, a weighted sample of 310 medical workers including nurses, doctors and final year medical students were interviewed using a self-administered questionnaire. We measured knowledge about cervical cancer: (risk factors, eligibility for screening and screening techniques), attitudes towards cervical cancer screening and practices regarding screening. RESULTS: Response rate was 92% (285). Of these, 93% considered cancer of the cervix a public health problem and knowledge about Pap smear was 83% among respondents. Less than 40% knew risk factors for cervical cancer, eligibility for and screening interval. Of the female respondents, 65% didn't feel susceptible to cervical cancer and 81% had never been screened. Of the male respondents, only 26% had partners who had ever been screened. Only 14% of the final year medical students felt skilled enough to use a vaginal speculum and 87% had never performed a pap smear. CONCLUSION: Despite knowledge of the gravity of cervical cancer and prevention by screening using a Pap smear, attitudes and practices towards screening were negative. The medical workers who should be responsible for opportunistic screening of women they care for are not keen on getting screened themselves. There is need to explain/understand the cause of these attitudes and practices and identify possible interventions to change them. Medical students leave medical school without adequate skills to be able to effectively screen women for cervical cancer wherever they go to practice. Medical students and nurses training curricula needs review to incorporate practical skills on cervical cancer screening

DIAGNOSTIC ACCURACY OF SHOCK INDEX AS SCREENING TOOL FOR PRIMARY POSTPARTUM HAEMORRHAGE AFTER CAESAREAN SECTION AMONG WOMEN AT KAWEMPE NATIONAL REFERRAL HOSPITAL -A CROSS-SECTIONAL STUDY.

Background:  Postpartum haemorrhage is the leading cause of maternal mortality globally and in sub-Saharan Africa. The shock index( ratio of the pulse to systolic pressure) is a quicker and more objective assessment tool for assessing the risk of deterioration as may occur in PPH, before apparent clinical deterioration. The diagnostic accuracy of the shock index in a Ugandan setting is not known. The objective of the study was to determine the sensitivity and specificity, positive and negative predictive values of shock index in the diagnosis of primary postpartum haemorrhage after caesarean section among women delivering at Kawempe National Referral Hospital. Methods:   A cross-sectional study design was used. The study was conducted in Kawempe National Referral Hospital among women who were delivered by a caesarean section between 1st January and 31st May 2021. A sample size of 594 was determined using formulae by Buderer. A consecutive sampling technique was used. The research assistants approached 650 participants; while 591 participants were fit for analysis. All participants were subjected to the determination of shock index at different intervals and the change in haematocrit as the gold standard for post-partum haemorrhage.   Results:  The sensitivity and specificity of the shock index at 2 hours were 40.0 and 82.8 percent respectively at a threshold of 0.8. The sensitivity and specificity were 70.0 and 54.6 percent after 24 hours when the shock index threshold of 0.7 was used. The PPV and NPV were 3.8 and 98.3 percent at 2 hours respectively while 2.6 and 99.1 percent at 24 hours. Conclusion:  The shock index is a poor screening tool for diagnosing primary postpartum haemorrhage after caesarean section. Recommendations : Shock index may not be included in routine care of post-operative mothers for early recognition of those at risk of primary postpartum haemorrhage

Influences on uptake of reproductive health services in Nsangi community of Uganda and their implications for cervical cancer screening

<p>Abstract</p> <p>Background</p> <p>Cervical cancer is the most common female cancer in Uganda. Over 80% of women diagnosed or referred with cervical cancer in Mulago national referral and teaching hospital have advanced disease. Plans are underway for systematic screening programmes based on visual inspection, as Pap smear screening is not feasible for this low resource country. Effectiveness of population screening programmes requires high uptake and for cervical cancer, minimal loss to follow up. Uganda has poor indicators of reproductive health (RH) services uptake; 10% postnatal care attendance, 23% contraceptive prevalence, and 38% skilled attendance at delivery. For antenatal attendance, attendance to one visit is 90%, but less than 50% for completion of care, i.e. three or more visits.</p> <p>Methods</p> <p>We conducted a qualitative study using eight focus group discussions with a total of 82 participants (16 men, 46 women and 20 health workers). We aimed to better understand factors that influence usage of available reproductive health care services and how they would relate to cervical cancer screening, as well as identify feasible interventions to improve cervical cancer screening uptake.</p> <p>Results</p> <p>Barriers identified after framework analysis included ignorance about cervical cancer, cultural constructs/beliefs about the illness, economic factors, domestic gender power relations, alternative authoritative sources of reproductive health knowledge, and unfriendly health care services. We discuss how these findings may inform future planned screening programmes in the Ugandan context.</p> <p>Conclusion</p> <p>Knowledge about cervical cancer among Ugandan women is very low. For an effective cervical cancer-screening programme, awareness about cervical cancer needs to be increased. Health planners need to note the power of the various authoritative sources of reproductive health knowledge such as paternal aunts (<it>Sengas</it>) and involve them in the awareness campaign. Cultural and economic issues dictate the perceived reluctance by men to participate in women's reproductive health issues; men in this community are, however, potential willing partners if appropriately informed. Health planners should address the loss of confidence in current health care units, as well as consider use of other cervical cancer screening delivery systems such as mobile clinics/camps.</p

Evaluation of 'see-see and treat' strategy and role of HIV on cervical cancer prevention in Uganda

<p>Abstract</p> <p>Background</p> <p>There is scant information on whether Human Immunodeficiency Virus (HIV) seropositivity has an influence on the outcome of treatment of precancerous cervical lesions using cryotherapy. We studied the prevalence of cervical abnormalities detectable by visual inspection and cervical lesions diagnosed by colposcopy according to HIV serostatus and described the outcomes of cryotherapy treatment.</p> <p>Methods</p> <p>Trained nurses examined women not previously screened for cervical cancer using visual inspection with acetic acid (VIA) and Lugol's iodine (VILI) in two family planning/post natal clinics in Kampala, Uganda, from February 2007 to August 2008. Women with abnormal visual inspection findings were referred for colposcopic evaluation and HIV testing. Women with precancerous cervical lesions detected at colposcopy were treated mainly by cryotherapy, and were evaluated for treatment outcome after 3 months by a second colposcopy.</p> <p>Results</p> <p>Of the 5 105 women screened, 834 presented a positive screening test and were referred for colposcopy. Of these 625 (75%) returned for the colposcopic evaluation and were tested for HIV. For the 608 (97.5%) women in the age range 20-60 years, colposcopy revealed 169 women with cervical lesions: 128 had inflammation, 19 had low grade squamous intraepithelial lesion (LGSIL), 13 had high grade squamous intraepithelial lesion (HGSIL), 9 had invasive cervical cancer and 2 had inconclusive findings. Detection rates per 1 000 women screened were higher among the older women (41-60 years) compared to women aged 20-40 years. They were accordingly 55% and 20% for inflammation, 10% and 2% for LGSIL, 5% and 2% for HGSIL, 6% and 1% for invasive cervical cancer.</p> <p>Of the 608 women, 103 (16%) were HIV positive. HIV positivity was associated with higher likelihood of inflammation (RR = 1.7; 95% CI: 1.2-2.4).</p> <p>Conclusions</p> <p>Detection rates were higher among older women 41-60 years. Visual inspection of the cervix uteri with acetic acid (VIA) and Lugol's iodine (VILI) used as a sole method for cervical cancer screening would entail significant false positive results. HIV seropositivity was associated with a higher prevalence of inflammatory cervical lesions. In view of the small numbers and the relatively short follow up time of 3 months, we could not make an emphatic conclusion about the effect of HIV serostatus on cryotherapy treatment outcome.</p

Early cervical lesions detected by visual inspection : Viral factors, management and follow-up

Currently 80% of cervical cancer cases worldwide arise in low income countries. In Uganda, the age standardized incidence rate of cervical cancer is estimated at 40.7 per 100,000 women. Public health policies, logistical, socio-political-cultural factors and other inequities limit the delivery of services for cervical cancer prevention. This thesis presents data on biological factors and service delivery issues that may affect cervical cancer control. Article I: A qualitative study using focus group discussions (FGDs) explored factors that influence the usage of reproductive health care services with an emphasis on cervical cancer. Barriers identified included: a lack of knowledge and misconceptions about cervical cancer, cultural constructs about the illness, economic factors, patriarchal domestic gender power relations, alternative authoritative sources of reproductive health knowledge, and unfriendly health care services. Article II: An open interventional study with 2 arms, to evaluate the efficacy of male partner involvement in reducing the loss to follow-up among women referred for colposcopy after a positive cervical cancer-screening test. A total of 5,094 women were screened in two family planning/postnatal clinics at Mulago Hospital, Kampala, Uganda. 824 screened positive and were referred for colposcopy, half were allocated to the intervention group and half to the control group. In the intervention group, information about the screening findings and a request to assist their partner in attending the next examination were sent to the male partners. In the control group, a standard service was provided, which did not include a letter to the male partner. Women in the intervention group were more than twice as likely to return for colposcopy (odds ratio, OR 2.8, 95% confidence interval, CI 1.9 3.9). Article III: We estimated the prevalence of cervical abnormalities detectable by visual inspection and cervical lesions diagnosed by colposcopy according to Human Immunodeficiency Virus (HIV) serostatus and described the outcomes of cryotherapy treatment. In a see and treat cervical prevention strategy, trained nurses screened women for cervical cancer using visual inspection with acetic acid (VIA) and visual inspection with Lugol s iodine (VILI). Women with abnormal visual inspection findings were referred for colposcopic evaluation and HIV testing. Women with premalignant cervical lesions detected at colposcopy were treated mainly by cryotherapy, and were evaluated for treatment outcome after 3 months by a second colposcopy. The colposcopy diagnosed abnormal cervical lesions in 27% of women who returned.HIV seropositivity was associated with a higher likelihood of cervical lesions especially inflammation (Risk Ratio, RR=1.7, 95% CI 1.2-2.4) and low grade squamous intraepithelial lesions (LGSIL) (RR= 2.6, 95% CI 1.0-6.7). Article IV: From 625 women who underwent colposcopic evaluation, information on social demographic characteristics was collected. They were tested for HIV testing and HPV typing was performed using SPF10/LiPA. The overall prevalence of HPV infection was 39.4 %. The most common HPV types in decreasing order of frequency were: HPV16, HPV52, HPV35, and HPV18. An age of less than 40 years, low income status and infection with HIV were statistically significant risk factors for any HPV infection. Conclusions: The work in this thesis identified potential barriers for the successful implementation of cervical cancer programs in Uganda, proposed some practical solutions that may improve cervical cancer screening uptake and added to the body of knowledge about the distribution of HPV types that may be relevant to the development of second generation HPV vaccines

MOESM2 of Acceptability of study procedures (self-collected introital swabs, blood draws and stool sample collection) by students 10–16 years for an HPV vaccine effectiveness study: a pilot study

Additional file 2. The pilot survey questionnaire: it includes the demographic characteristics of the girls who participated in the study as well as questions that assessed their willingness to participate in the study by providing blood, stool and self collected introital vaginal swab

A randomized clinical trial comparing safety, clinical and parasitological response to artemether-lumefantrine and chlorproguanil-dapsone in treatment of uncomplicated malaria in pregnancy in Mulago

Background: Malaria infection during pregnancy is a major public health problem. Due to increasing resistance to Chloroquine and Sulphadoxine/Pyrimethamine, the Ugandan national policy on malaria treatment was changed in 2005 to Artemisinin-based combination therapy (ACT) as the first-line treatment for uncomplicated malaria. The policy recommends assessment of safety and efficacy of alternative drugs for treatment of uncomplicated malaria. We compared the efficacy and safety of Artemether-Lumefantrine (Coartem®) and Chlorproguanil-Dapsone (Lapdap®) in the management of uncomplicated malaria in pregnancy.Methodology: We enrolled 110 pregnant women in the second and third trimester of pregnancy who presented to Mulago hospital, Uganda, with uncomplicated malaria. The study design was an open-label randomized clinical trial. Participants were randomized to receive either Artemether-Lumefantrine (Coartem® 20mg/120mg) orally or Chlorproguanil-Dapsone (Lapdap®) orally for 3 consecutive days. Primary endpoints were clinical and parasitological response assessed on days 0, 1, 2, 4, 7, 14and 28. Adverse effects, clinical response (treatment failure) and parasitological response were compared. Analysis was by intention to treat.Results: Of the 100 women who completed the study, there was no statistically significant difference in clinical and parasitological response by Day 4. The mean fever clearance time 3.0 days with Lapdap® versus 2.5 days with Coartem® was comparable. Likewise, mean parasite clearance time of 2.4 and 2.2 days for Lapdap® and Coartem® respectively was comparable. The adverse effects were comparable between the two groups.Conclusion: Artemether-Lumefantrine and Chlorproguanil-Dapsone have high and comparable cure rates and similar safety profiles when used for treatment of uncomplicated malaria in pregnancy