Screening for Cervical Cancer: Experience from a University Hospital in North Western Nigeria (2007‑2009)

Background: Cervical cancer is the most common gynecological cancer among women in Nigeria. The incidence is on the increase and poses a public health problem. The etiological agent is the human papilloma virus that is sexual transmitted. The cervical cancer incidence is related to lifestyle, poverty and sexual practices. Fortunately, it is a preventable disease as it is preceded by a pre‑invasive phase that can be detected and treated. There is paucity of report in literature on cervical cancer screening in Sokoto North‑West Nigeria.Aim: To determine the uptake, indications and results of cervical cancer screening in Usmanu Dan‑fodiyo University Teaching Hospital (UDUTH), Sokoto.Materials and Methods: A 3‑year descriptive study of the results of cervical cytology among women who attended the gynaecological out‑patient clinic of UDUTH, Sokoto.Results: During the period of study, 126 cervical smears were taken and 96% (121/126) of them were considered adequate for cytological evaluation thus constituting the subjects of the study. The average annual uptake of cervical smear was 1.29%. The main indications for cytologic smears were abnormal uterine bleeding 33.9% (41/121) and suspected carcinoma of the cervix 28.1% (34/121). Cytologic study was positive for dysplastic cells in 7% (25/121) of cases. Ten percent (12/121) of them were high grade squamous intra‑epithelial lesions while invasive carcinoma was seen in 3.3% (4/121) of the smears. Conclusion: Presence of abnormal cervical smear in 20% of the study subjects underscores the need for routine screening for cervical cancer. While organized national screening policy is awaited, opportunistic screening should be maximized. Keywords: Cervical cancer, cervical cytology, north‑west Nigeri

ANNOTATION: Implementation of the National Health Insurance Scheme: The Dawn of a New Era in Health Care Financing in Nigeria?

The Decree establishing the National Health Insurance Scheme (NHIS) was promulgated in 1999, however, actual implementation of the NHIS commenced in 2002. The goal of the NHIS is to provide easy access to qualitative healthcare services at an affordable price to all Nigerians. The NHIS operates on the principles of Social Health Insurance and has a total of 6 programmes designed to cater for all sections of the populace. 4 of the six Programmes of the NHIS have been commenced on a small scale. Further development of the NHIS to the stage of universal implementation will depend on several factors amongst which are continued political will, adequate funding, human resource development and public sensitization and mobilization to ensure widespread participation. KEYWORDS: National Health Insurance Scheme, Programmes, Political will Sahel Med. J. Vol.6(1) 2003: 1-

A five-year review of female genital tract malignancies in Sokoto, Northwestern Nigeria

Although female genital malignancies are known to contribute significantly to the disease burden in the developing world, little has been reported on them from the northwest of Nigeria. This study was thus conducted to determine the prevalence and clinico-pathological patterns of these tumors in Sokoto, Nigeria. A retrospective review of cancers of the female genital tract diagnosed at Usmanu Danfodiyo University Teaching Hospital, Sokoto in the period 1999 to 2003 was carried out. Female genital cancers were found to constitute about 14% of all cancers in the center. The pateints\' ages ranged from 11 months to 95 years with a mean of 44 (SDI5) years. The majority of tumors were of cervical origin (61.5%) followed by ovarian cancers (18.2%) and malignant gestational trophoblastic tumors (13.3%). We conclude that female genital malignancies are an important public health problem in northwestern Nigeria and that access to appropriate, cost-effective prevention and treatment options is required for a large number of women. It is recommended that this process is accelerated through heightened awareness of the female genital cancers among members of the community and health care providers. In addition, innovative approaches to screening and treatment of precancerous cervical lesions and improved service delivery systems are required. Keywords: female genital malignancies, Sokoto, Nigeria Mary Slessor Journal of Medicine Vol. 5(1), 2005: 51-5

Postoperative intussusception following caesarean section: Incidental finding at re-operation Case report

No Abstract.Tropical Journal of Health Sciences Vol. 14 (2) 2007: pp.51-5

Ectopic pregnancy in Sokoto, Northern Nigeria

Ectopic pregnancy is an important cause of maternal mortality and morbidity in the first trimester of pregnancy. We report a descriptive, cross-sectional study of ectopic pregnancy presenting to the Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto, between 1990 and 1997. There were 140 cases of ectopic pregnancy with incidence of 18.1 per 1,000 deliveries. The mean age of patients was 26.7 years and the median parity of cases of ectopic gestation was 1; 32% were nulliparae. Abdominal pain and tenderness were the most frequent symptom and sign respectively. Diagnosis was usually based on clinical findings augmented by procedures including paracentesis abdominis, abdominal ultrasound scan and urine pregnancy test. The ectopic pregnancy was sited in the Fallopian tube in 92% of cases. In 56 cases (41%), there was macroscopic evidence of previous pelvic infection at surgery. 66% of ectopic pregnancies had ruptured at presentation. Treatment was surgical in all but one case, and unilateral salpingectomy was the procedure most frequently performed. The case fatality rate was 1.5%. Malawi Medical Journal Vol.17(1) 2005: 14-1

Carcinoma Of The Uterine Cervix In Nigerian Women: The Need to Adopt a National Prevention Strategy.

Background: Cervical cancer is the second most common type of cancer affecting women, and was responsible for over 250,000 deaths in 2005, approximately 80% of which occurred in developing countries. Without urgent action, deaths due to cervical cancer are projected to rise by almost 25% over the next 10 years. Prevention of these deaths will contribute to the achievement of the Millennium Development Goals. In Nigeria, carcinoma of the cervix is the commonest malignancy of the female genital tract, with an estimated incidence of 32 per 100,000 females. As a result of extremely poor knowledge and attitude towards cervical screening, and limitations posed by lack of facilities and human resources for its control, many women are presenting with, and dying from, complications of advanced stages of this preventable disease. Unfortunately, there are only five major functional radiotherapy facilities in Nigeria at present culminating in very long waiting queues for treatment. Consequently, many women never benefit from treatment before they die in despair. The subject of this review is to explore how this situation can be reversed. Objective: To determine the magnitude of, and social factors associated with, cervical cancer in Nigeria and the efforts being made to reduce the disease burden in Nigerian women. To proffer cost-effective strategies for intervention. Method: The review of previous strategies employed in targeted, hospital-based cervical screening programs in Nigeria and literature search in Medline, PubMed and Google. Results: There is poor public awareness of cervical cancer and strategies for its prevention. The utilization of hospital-based prevention programs (cervical screening) is extremely poor leading to a minute percentage of the population at-risk being reached. Many women present with advanced stages of the disease that require radiotherapy, which many can neither access nor afford. Conclusion: The number of Nigerian women with unmet need for cervical cancer screening is large. We recommend the augmentation of current prevention strategies with three pragmatic models viz the “Hub and Spoke Model”, the “Mobile Van Cervical Cytology Clinic (MV3C) Model” and the “Screen and Treat Model” to reach the larger rural population who are the predominant victims of this disease. Keywords: Cervical cancer, Prevention, ‘Hub and Spoke', Mobile Clinic, Screen and Treat, Model, NigeriaSahel Medical Journal Vol. 11 (1) 2008: pp. 1-1

Asymptomatic bacteriuria in pregnancy in Sokoto, Nigeria

Aims/Objectives: Prior to this time there has been no study on asymptomatic bacteriuria in pregnancy at Usmanu Danfodiyo University Teaching Hospital, Sokoto. The objective of this study, therefore, was to determine the incidence and common organisms (and their sensitivity patterns) associated with asymptomatic bacteriuria in pregnancy among booked patients at Usmanu Danfodiyo University Teaching Hospital, Sokoto.Methodology: A hospital-based cross-sectional, semi-quantitative screening for asymptomatic bacteriuria was carried out at the antenatal booking clinic in randomly selected patients. Mid-stream urine specimen was collected in sterile bottle using the clean-catch technique. Microscopy, culture and sensitivity test were performed.Results: 300 women were studied and 24 clinical specimens showed significant bacteriuria on two occasions, representing an incidence of 8.0%. The incidence was highest in the mid-trimester, 9.7%; among the para 2, 11.6% and the Para 3, 12.5%. Escherichia coli constituted the commonest cultured organism, 8(33.3%). Other organisms were Klebsiella spp, 25.0%, Colliform spp, 25.0%, Proteus spp, 8.3% and Staphylococcus aureus 8.3%. On the average, the sensitivities of the organisms were: nitrofurantoin, 75%, gentamicin, 75%, ofloxacin, 66.7%, augmentin, 66.7%, nalidixic acid, 50%, cotrimoxazole, 41.7% and tetracycline, 25.0%. All the organisms were resistant to ampicillin. One of the patients developed pyelonephritis before the commencement of treatment. Cure rate after the first course of treatment was 87.5% and 100% following a second course.Conclusion: This study revealed that the incidence of asymptomatic bacteriuria in pregnancy was 8.0% at Usmanu Danfodiyo University Teaching Hospital, Sokoto, which was mainly caused by Eschericha coli, Klebsiella spp and Coliform spp. These pathogens were shown to be sensitive to nitrofurantoin and gentamicin both of which are easily available and affordable. Routine screening of pregnant women for asymptomatic bacteriuria is hereby recommended.Sahel Medical Journal Vol. 9(1) 2006: 1-