African Health Sciences

Awareness and uptake of human papilloma virus vaccines among female secondary school students in Benin City, Nigeria

Background: There is no Government endorsed HPV vaccine immunisation program in Nigeria. The Vaccine has been available at the University of Benin Teaching Hospital (UBTH) in Benin City for more than 7 years. Objectives: The aim was to evaluate awareness about HPV, the prevalence of HPV immunisation and its associated factors among the study population. Methods: A cross-sectional study using interviewer-administered questionnaires among 215 females attending secondary schools in Benin city, Nigeria. Participants were selected using multi-stage stratified sampling. The primary outcome measure was HPV immunisation of the girls. Results: The majority of the participants were between 14 to 18 years (58.6%). Almost all the participants (>97%) had not heard of HPV, HPV Vaccines and Cervical cancer. In addition, 2 (0.9%) persons correctly identified that the virus can be transmitted sexually while only 1 person (0.5%) had received the HPV vaccine. The respondents all agreed that they needed to be enlightened about HPV, HPV vaccines and Cervical cancer. Majority (49.3%) of the girls suggested that this could be done through the mass media (49.3%) or their parents (32.1%). Conclusion: HPV immunisation, knowledge of HPV vaccines and Cervical cancer among the study population was very low. We recommend interventions in Schools to increase knowledge about cervical cancer and HPV vaccines. Keywords: Human papilloma virus; vaccines; cervical cancer; Nigeria.

Clinicopathological pattern of oestrogen receptor, progesterone receptor and human epidermal growth factor receptor-2 over-expression of epithelial ovarian carcinomas in Nigeria

Background: Ovarian cancer is the leading cause of death from all gynaecological malignancies. Only few biomarkers of epithelial ovarian cancer (EOC) prognosis have been studied so far among Nigerian patients.
 Objective: To determine the pattern of oestrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER-2) expression in patients with EOC seen in Nigeria
 Materials and Methods: This was a retrospective multicentre study of 102 cases of epithelial ovarian cancers. Relevant clinical information was obtained from hospital-based records in the 3 participating centres. Tissue microarrays were constructed using representative tumour tissue and the ER, PR and HER2 immunohistochemical staining was carried out at the University of Chicago, United States of America.
 Results: Serous carcinomas predominated (71% of cases). ER positivity was observed in 31.4%, PR positivity in 21.5% and HER2/neu in 16.7% of tumours. Fifty-two percent of tumours were triple negative. Serous tumours were significantly associated with ER positivity (p=0.001). Mean patient age for EOC was 52.6 ± 13.1 years. There were no statistically significant associations between hormone receptor status and histological grade, FIGO staging or survival.
 Conclusion: Serous tumours were significantly associated with ER expression while non-serous tumours tended to be triple negative.
 Keywords: Oestrogen receptor; Progesterone receptor; HER-2 over-expression; Epithelial ovarian cancer.

Mir-21 and Mir-125b as theranostic biomarkers for epithelial ovarian cancer in Tunisian women

Background: Ovarian cancer (OC) is the third most common cancer in women and the leading cause of death associated with gynecologic tumors. Because this disease is asymptomatic in the early stages, most patients are not diagnosed until the late stages. This highlights the need for the development of diagnostic biomarkers. MicroRNAs (miRNAs), small non-coding RNAs, are currently being explored as potential biomarkers for the early detection of various malignancies in humans. However, their expression and diagnostic value in OC have not been well studied. Materials and Methods: the plasma levels of miR-21, miR-200a, miR-200b, miR-200c, miR-205 and miR-125b were determined in epithelial ovarian cancer (EOC) patients and healthy controls by Reverse Transcription Quantitative Realtime Polymerase Chain Reaction (RT-qPCR). The expression levels of the deregulated microRNAs were analysed according to clinical characteristics. Results: It was found that miR-21 and miR-125b were upregulated in EOC compared with healthy controls. Moreover, decreased miR-125b was associated with resistance to platinum-based chemotherapy. Conclusions: Our data suggest that miR-21 and miR-125b in plasma may serve as potential circulating biomarkers for the early detection of EOC. MiR-125b may also be useful for predicting chemosensitivity in EOC patients. Keywords: Epithelial ovarian cancer; miRNAs; biomarkers; resistance to treatment; Tunisia.

Endometrial cancer and associated risk factors among non-pregnant women with abnormal uterine bleeding in Kampala, Uganda: a 7-year experience from a Single Institution

Introduction: Endometrial cancer is the most common malignancy of among postmenopausal women in high income countries, however, its prevalence has been reported to be raising even in low-and middle-income countries due to change in lifestyle behaviors. We aimed to determine the prevalence of endometrial cancer and its associated factors among non-pregnant women with abnormal uterine bleeding. Methods: After obtaining ethical approval from the Research Ethical Committee of the Makerere college of Health Sciences, we retrospectively retrieved and analyzed the paraffin embedded tissue blocks of 159 patients who were non-pregnant women and they were presenting with abnormal uterine bleeding from January 2012 to December 2018. The clinical and pathological information was obtained from the patient’s files. Statistical analysis was done using SPSS version 23.0. Binary logistic regression analysis was applied in determining the risk factors of endometrial cancer. A two-tailed p -value <0.05 was considered significant. Results: The overall mean age of the patients was 36.4 ± 13.7 years and the vast majority 71.1% (113/159) of the patients were premenopausal women. The prevalence of endometrial cancer was 11.9% (19/159). Being postmenopausal (AOR = 7.7, 95% CI = 2.155 – 27.666, p = 0.003), having menarche below 12 years (AOR = 4.5, 95% CI = 0.217-0.390, p<0.001), being obese (AOR = 2.5, 95% CI = 0.305-0.822, p = 0.01), and being nulliparous (AOR = 5.4, 95% CI = 0.292-0.957, p = 0.009) were significantly associated with endometrial cancer. However, use of contraceptive pills, family history of reproductive cancers, having hypertension and/or diabetes mellitus all were not associated with endometrial cancer. Conclusion: Our study has further proven that, there is a significant proportion of non-pregnant women with AUB who have endometrial cancer. Using the clinical parameters such as age of the patient and age at menarche, nulliparity and obesity, it may help in increasing the index of clinical suspicion in daily clinical practice to diagnosing endometrial cancer among women with AUB at early stage. This will help in improving the prognosis of the patients. Keywords: Abnormal uterine bleeding; endometrial cancer.

Correlation between abdominal visceral fat and the risk of endometrial cancer in patients with polycystic ovary syndrome

Objective: To explore the correlation between abdominal fat and the occurrence risk of endometrial cancer (EC) in patients with polycystic ovary syndrome (PCOS). Methods: The clinical information of 120 PCOS patients receiving treatment in our hospital from March 2019 to April 2022 were included in this study. Patients were divided into two groups, endometrial cancer (EC, n=35) and normal group (NM, n=85). Statistical analysis included t-test, c2-test, and Pearson's correlation coefficient. We analysed the data using logistic regression. The predictive accuracy and discriminative ability of the prediction model were assessed by the area under the receiver operating characteristic (ROC) curve (AUC) and calibration curves. Results: The incidence rate of EC in women with PCOS is 10.91% (12/110). Significant differences were found in waist circumference, hypertension, diabetes, hyperlipidemia, body mass index (BMI), waist-hip ratio (WHR), insulin resistance index (HOMA-IR), visceral fat area (VFA) oestrogen receptor, progesterone receptor, human epidermal growth factor receptor-2 (HER2), estradiol (E2), and luteinizing hormone (LH) between the two groups (P<0.05). No statistical difference was found in age, hip circumference, menopause, use of intrauterine device, progesterone (P) and follicle-stimulating hormone (FSH) between the groups (P>0.05). Multivariate logistic regression analysis showed that BMI, HOMA-IR, VFA and HER2 were independent influencing factors of EC in PCOS patients (P<0.05). The AUC of BMI, HOMA-IR, VFA, HER2 were 0.878 (95%CI: 0.810~0.946), 0.831 (95%CI: 0.751~0.911), 0.816 (95%CI: 0.704~0.929) and 0.737 (95%CI: 0.634,0.840), respectively. The model had more diagnostic effectiveness (AUC=0.973). Conclusions: In PCOS disease, high-level BMI, HOMA-IR, VFA, and positive HER2 show an increased risk in the incidence of EC. These findings suggest that BMI, HOMA-IR, VFA, and HER2 are potential markers for Risk assessment of EC. HER2: Human epidermal growth factor receptor-2, E2: estradiol, P: progesterone, LH: Luteinizing hormone, FSH: Follicle-stimulating hormone. Keywords: Polycystic ovary syndrome; Abdominal visceral fat; Endometrial cancer; Occurrence risk.

Pattern and determinants of endometrial thickness among asymptomatic postmenopausal women in an African population

Background: The occurrence of endometrial cancer may be on the increase among African population due to lifestyle changes. Measurement of endometrial thickness (ET) in postmenopausal women may enhance timely diagnosis of endometrial pathology to improve prognosis and quality of life. Objectives: To determine the relationship between anthropometric measurements hypertension and diabetes mellitus on ET. Methods: A cross-sectional study conducted at the outpatient clinics of a tertiary facility among asymptomatic postmenopausal women (no malignancy, abnormal vaginal bleeding or hormone replacement therapy). Participants recruited by purposive sampling were sub-categorized into those with chronic hypertension, diabetes mellitus or no chronic medical disorder. All participants had anthropometric measurements, fasting blood glucose and transvaginal ultrasonography. The main outcome measure was the ET while p-value <0.05 was significant. Results: The mean ET was 2.17±2.57 and prevalence of ET (>5mm) was 1.1%. Mean ET was significantly higher among women <5 years post-menopause (2.53±1.61 vs. 2.06±2.79; P0.048); chronic hypertension (2.82±4.07mm vs. 1.42±1.16mm; P0.026) or diabetes mellitus (2.27±1.08mm vs. 1.42±1.16; P0.005). Parity was inversely related to ET (P0.005); body mass index (P0.191), duration of hypertension (P0.213) or diabetes mellitus (P0.085) were not statistically significant. Conclusion: Parity, number of years post-menopause, hypertension and diabetes mellitus were important determinants of ET. Keywords: Endometrial thickness; postmenopausal women; biosocial characteristics; determinants; asymptomatic women.

Role of HE4 in evaluation of adnexal masses and its comparison with CA125, ROMA and RMI in premenopausal women

Background: Ovarian cancer is the seventh most common cancer in women and is ranked third among gynaecological malignancies after cervical and uterine cancers. Prospective studies have failed to establish a definite screening programme based on tumour markers or ultrasonography. Objective: To evaluate potential role of Human Epididymis protein 4 (HE4) as a biomarker for diagnosis of various ovarian malignancies in premenopausal age group, either alone or as a part of diagnostic algorithm like Risk of Malignancy Algorithm (ROMA) and to analyse if it has any advantage over Cancer Antigen 125 (CA125) or Risk of Malignancy Index (RMI). Methods: It was an observational cross-sectional study which included 100 premenopausal women having ovarian mass and underwent surgery. The diagnostic performances of CA125, HE4, ROMA score and RMI for ovarian cancer were evaluated. Results: Postoperative histopathology confirmed 30% (n=30) women to have malignant ovarian tumors. According to receiver operating characteristic (ROC) analysis; area under curve (AUC) was maximum for ROMA (0.791) followed by HE4 (0.784), RMI (0.750) and CA125 (0.715). Conclusion: HE4 is not superior to CA125 but, it can be used in series or as part of diagnostic algorithm (ROMA) along with CA125 to get higher diagnostic accuracy for premenopausal women. Keywords: Adnexal mass; CA125; HE4; Ovarian neoplasms; Risk of malignancy index (RMI); Risk of malignancy algorithm (ROMA).

Factors associated with clinical breast examination and cervical cancer screening uptake in Ghanaian women, Evidence from the 2022 Ghana Demographic and Health Survey

Background: Breast and cervical cancer screening uptake remains limited in Ghana despite the public health importance of cancer screening. This study examines factors that influence this behavior. Methods: Secondary analyses of the 2022 Ghana Demographic and Health Survey (GDHS) were conducted. A total of 9,489 women between the ages of 25 to 49 years were evaluated for clinical breast examination (CBE) and cervical cancer screening (CCS) uptakes. Univariable and multivariable logistic regressions were fitted to examine factors that influence women utilization of CBE and CCS. Results: Women in the richer and richest quintiles of wealth index were 40% (AOR=1.40; 95%CI: 1.00 – 1.97) and 118% (AOR=2.18; 95%CI: 1.51 – 3.16) significantly more likely to attain CBE compared to women in the poorest quintile. Women with secondary and higher education were 2.02 times (AOR=2.02; 95%CI: 1.59 – 2.56) and 4.94 times (AOR=4.94; 95%CI: 3.61 – 6.76) as likely to attain CBE compared to women with no education. Women with health insurance were 85% (AOR=1.85; 95%CI: 1.37 – 2.52) more likely to attain CBE compared to women without health insurance. Similar results were found on the associations between wealth index, educational level and health insurance status and CCS uptake. Conclusion: CBE and CCS uptakes were significantly higher in women with higher wealth index, higher education, and health insurance highlighting potential disparities in access to and utilization of preventive services in Ghanaian women. Tailoring policies to address the poverty burden will likely lead to an increase in breast and cervical cancer screening uptakes and potentially better health outcomes. Keywords: Screening; breast; cervical; cancer; Ghana; wealth index.

Clinical profile and immediate outcomes of concurrent chemoradiation for cervical cancer at the Bugando medical centre in Mwanza, Tanzania

Background: Globally, cervical cancer poses a challenge to public health. It is the fourth most prevalent cancer diagnosed in women worldwide, with an estimated annual death rate of 311,000. It is currently the most prevalent malignant disease in Tanzania in which the majority of patients with advanced cervical cancer have been offered concurrent chemoradiation (CCR). However, neither the clinical profile nor the immediate outcomes of these patients treated at the Bugando Medical Centre (BMC) have been thoroughly studied. Methodology: The prospective cohort study was conducted from November 2021 to April 2022, involving 160 eligible patients with histopathologically confirmed cervical cancer who received concurrent chemoradiation at BMC. Patients were followed for seven weeks, with the main clinical profiles of interest being age, histological type, histological tumor grade, FIGO disease stage, and HIV status, and the outcomes of interest being short-term clinical treatment-related toxicity and symptoms disappearance. The history and physical examination provided information about the patient's characteristics. Multivariate Logistic regression analysis was performed to evaluate the strength of the association between the patient's clinical profile and the short-term clinical treatment-related toxicity and symptoms disappearance. P-values less than 0.05 were considered statistically significant. Results: A total of 160 cervical cancer patients eligible were enrolled, with a median age of 50 years, 117 (73.5%) living in rural areas, and 152 (95%) being illiterate or having only primary education. The most common presenting symptoms were abnormal vaginal discharge 116 (72.5%) and bleeding 111 (69.4%). 119 (74%) patients presented at a late stage (IIB-1VA), 59 (36.9%) were HIV-positive, the majority 134 (83.7%) had squamous cell carcinoma, and 91 (56,2%) had a tumor of grade II type. At week 7, 60% of patients had a complete response to treatment. Vaginal bleeding and discharge improved, with only 12.5% and 6% of women still experiencing these symptoms respectively by week 7 however, 31% of reported cases of low back pain persisted. The majority of patients experienced tolerable grade II toxicities, including diarrhea (58%), vomiting (44.3%), and skin desquamation (52.5%). Fewer study participants reported grade III toxicity, and neither grade IV toxicity nor toxicity-related deaths were reported. Age > 60 years of age (OR 5.58; 95%CI 1.91-16.30; p = 0.002), late tumor stage at presentation (OR 3.36; 95%CI 1.53-7.37; p = 0.002), and HIV seropositivity (OR 11.8; 95%CI 4.87-28.6; p = 0.001) were associated with poor treatment responses. Conclusion: Cervical cancer still affects the majority of middle-aged women from rural areas with low levels of education and the majority present at an advanced stage. At BMC, concurrent chemoradiation has tolerable toxicity and a promising outcome. Early treatment outcomes are heavily influenced by HIV seropositivity, disease stage, and advanced age. Keywords: Cervical cancer; chemoradiation; toxicity; treatment outcomes; Tanzania.

Clinical efficacy comparison of CO2 laser treatment and LEEP surgery for cervical intraepithelial neoplasia with high-risk HPV infection

Background: To investigate the clinical efficacy of CO2 laser and loop electrosurgical excision procedure (LEEP) in the treatment of cervical intraepithelial neoplasia (CIN) with high-risk human papillomavirus (HPV) infection. Methods: A total of 150 CIN patients with high-risk HPV infection admitted to our hospital from December 2020 to June 2022 were divided into CO2 laser treatment group (CO2 group) with 63 cases and LEEP treatment group (LEEP group) with 87 cases based on treatment principles and patient preferences. The postoperative recovery time, CIN treatment effect, high-risk HPV clearance rate, treatment safety, and recurrence rate were compared between the two groups. Results: The vaginal discharge time, vaginal bleeding time, and wound healing time in the CO2 group were significantly lower than those in the LEEP group (P < 0.05). The incidence of adverse events in the CO2 group was 14.29%, which was significantly lower than that in the LEEP group (28.74%, P < 0.05). Conclusion: CO2 laser and LEEP surgery for the treatment of CIN combined with high-risk HPV infection both have good clinical efficacy, and CO2 laser can effectively shorten the postoperative recovery time with good safety. Keywords: CO2 laser; loop electrosurgical excision procedure; cervical intraepithelial neoplasia; high-risk human papillomavirus; clinical efficacy; safety.

Prevalence and pattern of renal complications of uterine fibroids in a Teaching Hospital in Nigeria

Background: Symptomatic uterine fibroids causing obstructive nephropathy were thought to be uncommon, but recent prevalence studies showed otherwise. The aim of the study is to determine the prevalence of obstructive uropathy and nephropathy in patients with uterine leiomyoma. Methodology: The study was a hospital-based cross-sectional retrospective study of 114 patients diagnosed with symptomatic uterine fibroids seen in the gynecology clinic of Lagos State University Teaching Hospital, Ikeja from February 2021 to June 2022. Results: The overall prevalence of obstructive uropathy and nephropathy was 22.8% and 10.5% respectively. The average level of serum creatinine was 2.2 ± 1.9mg/dl with a creatinine range of 1.8 to 6.7mg dl. The average of the GFR among patients was 29.3 ± 13.4ml/min/1.73m2 with a range of 9 – 54ml/min/1.73m2. There is a positive association between uterine size and uropathy and subjects with uropathy are more likely to develop nephropathy. (CI 95% 3.281 - 108.670). Conclusion: This study showed that prevalence of obstructive nephropathy in the patients with uterine leiomyomata is 10.5%. Uterine size and myoma diameter were positively associated with development of obstructive nephropathy Keywords: Fibroids; uropathy; nephropathy; uterine leiomyomata.

Oncogenic human papillomavirus infection (HPV 16/18) and associated factors among women in East Gojjam Zone, NorthWest Ethiopia 2021

Background: Human papillomavirus is a common pathogen that infects the skin and mucosal epithelium, is transmitted sexually; causes condylomas or squamous cell carcinomas. Two (16 and 18) of the 150 HPV serotypes are oncogenic types. Studies have been done on the infection by oncogenic human papillomavirus 16/18 and associated factors are found to be very limited in Ethiopia. This study aimed to assess the prevalence of oncogenic human papillomavirus infection (HPV 16/18) and associated factors among women. Methods: An institutional-based cross-sectional study was conducted among 337 women screened for cervical cancer in two hospitals in East Gojjam Zone from February to April 2021 G.C. Four BSc-qualified nurses who worked in the chosen hospitals collected the data using pretested questionnaire and an HPV test (OncoE6TM Cervical Test) specific to HPV16/18 in cervical swabs. Descriptive analysis was performed to determine the prevalence and a multivariate logistic regression model was used to identify the associated factors of HPV16/18 infection. Finally, statistical significance was declared at P < 0.05. Results: The prevalence of HPV infection was 14.2% (95% CI: 10.7% -18.1%). The mean age of the respondents was 36.7±9.1 years. Women with the age group of 55-65 years (AOR = 7.91, 95% CI: 1.95-32.09), early initiation of sexual intercourse (AOR = 5.36, 95% CI: 1.58-18.13), history of sexually transmitted infection (STI) (AOR = 3.52, 95% CI: 1.27-9.72), human immunodeficiency virus (HIV) positive status (AOR = 6.8, 95% CI: 1.99-23.54), and number of lifetime sexual partners (AOR = 4.37, 95% CI: 1.15-17.3) were important independent factors associated with the presence of oncogenic HPV infection. Conclusion and Recommendation: We found a relatively low prevalence of high-risk HPV infection. Age, early initiation of sexual intercourse at less than 18 years, STI of women, being HIV seropositive, and a number of sexual partners were important factors for high-risk HPV infection. Women aged > 46 years, women with early initiation of sex, a history of STI, being HIV positive, and a history of multiple sexual partners should be encouraged to be screened and vaccinated for HPV infection. Wider-ranging studies are also needed in HPV-infected women in association with the cervical lesion. Keywords: OncoE6TM cervical test; HPV; East Gojjam zone; prevalence; associated factors.

Knowledge, perception and cervical cancer screening practices among nurses and midwives: a case study of Our Lady of Grace Hospital in the Asikuma Odoben Brakwa district, Central region-Ghana

Background: Cervical cancer prevention can be achieved through comprehensive programs involving education, awareness creation, vaccination, screening, and early treatment. Health workers have a vital role to play in achieving this. Hence, they must be adequately equipped with the requisite knowledge of the condition since they provide information to their clients.Objective: This study determined the knowledge, perception, and screening practices on cervical cancer among female nurses and midwives in the Central Region of Ghana.Method: A quantitative descriptive cross-sectional survey amongst nurses and midwives was used for the study. A conveniencesampling technique was applied to yield a representative sample of 130 female nurses and midwives working in Our Lady of Grace Hospital in the Central Region, Ghana. Data was collected from the participants using a self-administered questionnaire.The data was analysed using SPSS version 20, and standard descriptive statistics such as proportions were used to summarize the survey data.Results: Almost all the nurses (99%) had heard of cervical cancer. Majority (97.1%) of the respondents believed cervical cancer is preventable however, 67.6% also believed that it is incurable. Almost half (42.2%) of the respondents did not perceive themselves as at risk of cervical cancer. Thus, only 11.8% of the nurses had ever screened for cervical cancer. However, majority (92.2%) were willing to recommend the screening to others.Conclusion: The respondents of this study had some knowledge of cervical cancer however had low patronage for recommendedscreening practices. Therefore, strategies must be implemented to increase screening practices among female nurses.

Evaluation of the anatomical locations and sizes of uterine fibroids from ultrasound examination in Ghana

Background: Uterine fibroids locations and sizes, have significant influences on the quality of life of women especially pregnantwomen and on live birth rate.Objectives: To determine the anatomical locations and sizes of uterine fibroids and assess any possible associations with age groups.Methods: This retrospective study reviewed the locations and sizes of a total of 3,542 patients who were ultrasonographically diagnosed with uterine fibroids from January 2019 to December 2021. The obtained data were analysed using GNU PSPP, and Python on Jupyter Notebook with statistical significance level set at p≤0.05.Results: The overall average diameter of uterine myoma was 5.50±2.60cm (95%CI=5.41–5.58, range=1.00cm–19.10cm) and the respective mean diameter of intramural, subserosal and submucosal fibroids were 5.53±2.60cm (95%CI=5.44–5.62), 5.50±2.27cm (95%CI=5.27–5.74) and 5.82±2.77cm (95%CI=5.49–6.14). Most of the fibroid nodules were small (48.36%, n=1713) and only 5.84% (n=207) were large (>10cm). Posterofundal fibroids and lower anterior myomas were mostly seen in the 35-44 years age class.Conclusion: The majority of the uterine fibroids were intramural and were mostly at the anterior uterine wall. The submucosalfibroids, even though the rarest, were averagely larger than the other types of uterine myomas. The diameter of uterine fibroidsincreased with age.

Attitude to cervical cancer screening and human papillomavirus testing experience in self-sampled Nigerian women

Background: Cervical cancer is a disease of major public health significance which can be prevented by adequate screening. Objective: This study assessed the level of cervical cancer knowledge, attitude to screening and human papillomavirus testingexperience in women who self-sampled for cervical cancer screening. Methods: A descriptive cross-sectional study involving 790 women that had human papilloma virus (HPV) testing at the gynae-oncology unit of the Lagos State University Teaching Hospital. Participants were assessed of their cervical cancer screeningknowledge, attitude and HPV testing experience. High risk HPV (hr-HPV) nucleic acid testing was funded by the Clinton HealthAccess Initiative. Results: Majority (76.71%) of the respondents exhibited a high level of knowledge of cervical cancer, its causes, risk factors andprevention; and a positive experience with HPV self-sampling reported in 98.1%. hr-HPV positive rate was 13.4%. The mostcommon reason (43%) for not having a cervical screening done was lack of a doctor’s request. The most commonly knownmethod of cervical screening by the respondents was Pap Smear test (55.31%). Conclusion: There is need for more education to improve the level of awareness and uptake of hr-HPV testing for cervicalcancer in Lagos. Health care providers are not offering cervical cancer screening enough and this needs to be explored more infuture studies. Keywords: Cervical cancer; screening test; cancer screening.

Factors influencing utilisation of cervical cancer screening services among HIV positive women attending care and treatment centres in Kinondoni municipality, Dar es Salaam, Tanzania

Background: Cervical cancer is among the leading causes of cancer-related deaths among HIV+ve women. Objective: To determine factors influencing utilisation of cervical cancer screening among HIV+ve women attending Cancer Treatment and Care in Kinondoni Municipality, Dar es Salaam. Methods: Cross-sectional study among HIV+ve women was carried out between September and October 2021; collected using a standardised questionnaire. Descriptive statistics, bivariate and multivariate analyses were used to determine cervical cancer extent and association of predictors of cervical cancer screening. Results: 230 HIV+ve women aged 21–60 years were interviewed. Only 47% had screened for cervical cancer. Low knowledge of HIV+ve as risk significantly associated with less likelihood to screen for cervical cancer [AOR 0.49, 95% CI (0.253-0.957, P = 0.037)]. Parity of 3 or more was twice likely to screen for cervical cancer [AOR 2.124, 95% CI (1.012-4.456, P = 0.046)]; and housewives were 2.5 more likely to screen for cervical cancer [AOR 2.594, 95% CI (1.149-5.853, P = 0.002)]. Lack of knowledge on preventive measures was less associated with likelihood to screen [AOR 0.114, 95% CI (0.013-0.972, P = 0.047)]. Conclusion: Lack of knowledge on HIV+ve and prevention, age and parity are likely to influence utilisation of cervical cancer screening services. Keywords: Cervical cancer; HIV positive women.

A 10-year clinicopathological analysis of ovarian lesions in a tertiary hospital in Southern Nigeria

Background: Ovarian tumours are the most lethal of all gynaecological cancers and they are usually diagnosed in advanced stages when the `prognosis is very poor.
 Objective: To determine the pattern of ovarian lesions, their frequency, presentation, and associated clinical symptoms in Uyo, Nigeria.
 Methods: A 10-year retrospective study of all ovarian specimens that were surgically removed and histologically diagnosed.
 Results: The patients were between the ages of 5 and 73 years with median age of 34.1 years. Benign tumours occurred most commonly among the 20–39-year age group (31.3%) while malignant tumours were predominant among those aged 50-69 years (10.0%). Surface epithelial tumours (45.4%) were the most common neoplastic tumours while the mature cystic teratoma (33.2%) was the most common tumour overall. Surface epithelial malignancies accounted for 70.6% of all ovarian malignancies and the serous cyst adenocarcinoma (10.2%) was the most common surface epithelial tumour as well as the most common malignant tumour.
 Conclusion: There has been an increase in the number of malignant ovarian specimens in our centre. Though surface epithelial tumours were the most common category of ovarian tumours, overall, the mature cystic teratoma was the most common tumour. Serous cyst adenocarcinoma was the most common surface epithelial tumour and the most common malignant tumour.
 Keywords: Ovary tumours; ovarian malignancy; malignant tumours; benign tumours; histopathology Uyo.

Health-related quality of life associated with different cervical cancer therapies received by patients in two Nigerian tertiary hospitals

Background: There are important consequences from cervical cancer (CC) disease and its treatment among survivors, especiallythe impact on quality of life (QoL).
 Objective: To evaluate the health-related QoL associated with different CC therapies received by patients in two Nigerian tertiaryhospitals.
 Methods: This study employed a prospective longitudinal design. It was conducted at Usmanu Danfodiyo University TeachingHospital, Sokoto and Ahmadu Bello University Teaching Hospital Zaria, North-Western Nigeria. Data of all the 157 eligible CCpatients were collected at baseline and after therapy. Data analysis was done with appropriate descriptive and inferential statisticsusing SPSS V. 20 for windows. P<0.05 was considered statistically significant.
 Results: Chemotherapy (CT) was the major therapy option received by 78(49.7%) of the patients. Patients who received chemoradiation therapy (CRT) and adjuvant chemotherapy (CTS) had the highest increase in mean overall health-related QoL of 0.138(t=8.456, p<0.001) and 0.138 (t=6.489, p<0.001) higher than their respective baseline scores. Patients who received CT had theleast increase in mean overall health-related QoL of 0.095 (t=4.574, p<0.001) from baseline.
 Conclusion: Chemoradiation therapy and adjuvant chemotherapy were associated with highest increase in mean overallhealth-related QoL. Chemotherapy was associated with the least increase in mean overall health-related QoL.
 Keywords: Cervical cancer; quality of life; therapies.

Cervical cancer awareness and risk factors among women residing in an urban slum in Lagos, Southwest Nigeria

Background: Poor awareness of cervical cancer and high prevalence of its risk factors may be responsible for the large burdenof cervical cancer in low-income countries. This study assessed awareness of cervical cancer and prevalence of risk factorsamong women residing in a slum in Lagos, Nigeria. Methods: This was a descriptive cross-sectional study carried out amongst 305 women of reproductive age (15-49 years) inIdi-Araba, a slum in Urban Lagos. Data were collected using interviewer administered questionnaires. Analysis was done withSPSS 20 software. Results: Mean age of respondents was 33.5(9.0) years. Only 12.8% of the respondents had heard of cervical cancer. Ninety-fivepercent of respondents were sexually active and 56.2% had more than one lifetime sexual partner. Close to half (47.3%) ofrespondents had their first sexual intercourse before the age of 20. One in five (22.2%) had 5 or more children. Half of therespondents (54.8%) had had abnormal vaginal discharge. Conclusion: Awareness of cervical cancer among the women was poor and prevalence of risk factors of cervical cancer washigh. Campaigns aimed at increasing awareness of cervical cancer, and screening should be carried out by governmental andcharitable organizations for women residing in slums. Keywords: Cervical cancer; awareness; risk factors; slum; Nigeria.

Correlation between vaginal flora and cervical immune function of human papilloma virus-infected patients with cervical cancer

Background: To analyse the correlation between vaginal flora and cervical immune function of HPV-infected patients with cervical cancer.
 Methods: Six hundred females with genital tract infections treated in Xuzhou Hospital of Traditional Chinese Medicine from January 2014 to December 2016 were selected and divided into a high-risk HPV group (n=246) and a control group (n=354). The vaginal flora and human T lymphocyte subsets (CD3+, CD4+, CD8+) were detected. Multivariate logistic regression analysis was performed to explore the risk factors for HPV infection.
 Results: The numbers of CD4+ and CD4+/CD8+ T cells of the high-risk HPV group were significantly lower than those of the control group (P<0.05). The two groups had similar numbers of CD3+ and CD8+ T cells. In the high-risk HPV group, the positive rates of Lactobacillus, Chlamydia trachomatis, Mycoplasma hominis, mycetes, Ureaplasma urealyticum and bacterial vaginosis were significantly higher than those of the control group (P<0.05). There was no significant difference in the positive rates of trichomonads between the two groups. Multivariate logistic regression analysis revealed that C. trachomatis and U. urealyticum were independent risk factors for high-risk HPV infection (P<0.05).
 Conclusion: High-risk HPV infection in patients with cervical cancer was associated with vaginal flora and immune function. C. trachomatis and U. urealyticum were independent risk factors for high-risk HPV infection.
 Keywords: Cervical cancer; human papilloma virus; immune function; vaginal flora.

Expression of miR-152 in cervical cancer and its influence on cisplatin resistance

Background: Cervical cancer has a high mortality rate.
 Aim: We aimed to study the expression of micro ribonucleic acid 152 (miR-152) in cervical cancer and its influence on cisplatin(DDP) resistance.
 Methodology: Cervical cancer Hela cells were divided into control, DDP, DDP + mimic nc and DDP + miR-152 mimic groups.
 Results: DDP, DDP + mimic nc and DDP + miR-152 mimic groups had lower cell survival rate, smaller number of single clones and cells penetrating the membrane, and higher apoptosis rate and miR-152 expression than those of the control group (P<0.05). Compared with DDP and DDP + mimic nc groups, the cell survival rate, number of single clones and number of cells penetrating the membrane significantly decreased, while the apoptosis rate and miR-152 expression increased in the DDP + miR-152 mimic group (P<0.05). ERBB3 was a downstream target gene of miR-152. Hela cells transfected with miR-152 mimic had lower protein expressions of Snail, ERBB3, Akt2, p-Akt and c-myc than those of NC cells (P<0.05).
 Conclusion: MiR-152 suppresses the proliferation, migration and infiltration of cervical cancer cells and reduces their resistanceto DDP chemotherapy by inhibiting the expressions of proteins in the ERBB3/Akt/c-myc and ERBB3/Akt/Snail pathways.
 Keywords: miR-152; cervical cancer; cisplatin; drug resistance.

Fast-track surgery applied in gynecological oncological surgical treatment: a prospective randomized trial

Background: The study aimed to compare the fast-track and traditional gynaecological oncological surgeries from postoperative recovery. Methods: A total of 107 patients undergoing gynaecological oncological surgery were randomly assigned to the FTS group (n=50) and the traditional group (n=57). Results: No significant differences in LOS (Length of hospitalization post-operation) were observed. A less total cost of hospitalization and a lower C-Reactive protein (CRP) level were found (P < 0.05). Also, the trial revealed a significantly lower number of the overall complications in the FTS Group (P < 0.05). Conclusions: FTS applied in gynaecological oncological surgeries is beneficial to patients in terms of the postoperative recovery. Keywords: fast track surgery; gynaecological surgery; oncological surgery; post-operative length of hospitalization; randomised controlled study.

Sociodemographic and gynaecological factors that influence uptake of cervical cancer screening. A cross-sectional study in Calabar, Nigeria

Background: Voluntary screening for cervical cancer has not been very effective in sub-Saharan Africa. Awareness and presence of risk factors may drive the need to screen. Objective: To characterise sociodemographic and gynaecological factors as promoters of screening uptake. Methodology: The setting was a women health rally in Calabar, Nigeria with women from different towns/ villages in Cross River State. An interviewer-administered questionnaire assessed sociodemographic and gynaecological risk factors for cervical cancer, previous Pap smear, and acceptance to screen. Data inputted in EpiInfo 7, and GraphPad Prism 7.04 statistical software’s, were analysed using descriptive and inferential statistics. Results: One hundred and eighty (180) women gave consent for inclusion in the study. The age ranged from 21 to 65 with a mean of 39.8±10.3 years. With 52.22% of respondents accepting and 47.78% declining to screen, test of association showed that knowledge of cervical cancer, history of multiple sexual partners, and presence of offensive watery vaginal discharge significantly reduced the number of women who refused to screen. Previously screened women were not more likely to accept screening.Conclusion: Screening for cervical cancer was still poor. Cervical cancer knowledge and recognition of risk factors improve screening uptake. Keywords: Cervical cancer screening uptake; risk factors.

Barriers to uptake of cervical cancer screening among women in Nigeria: a systematic review

Background: Cervical cancer is the second most frequent cancer and cause of cancer-related deaths among women in Nigeria. The Visual inspection with acetic acid and cryotherapy "see and treat" screening approach is a feasible and effective method that can be implemented in low resource settings like Nigeria; however, screening utilization is still low. Objective: This systematic review aims at offering a comprehensive synthesis of studies that assessed the barriers preventing women from utilizing cervical cancer screening services in Nigeria. Methods: Electronic data search was performed on PubMed, Cochrane Library, EMbase, Directory of Open Access Journals, Google Scholar, and ScienceDirect, and quality assessment was conducted for the included studies. Data were extracted independently by two authors and thematically analysed for barriers to cervical cancer screening utilization. Results: Fifteen studies, consisting of 9,995 women aged 15 and above published between 2007 and 2020, were included. Frequently reported barriers to cervical screening include lack of knowledge of cervical cancer and screening, health service factors, screening is unnecessary, fear of outcome and procedure, and financial constraints. Conclusion: Lack of adequate information about cervical cancer is a significant hindrance to screening; this factor is strongly associated with the numerous misconceptions and negative perceptions. The study highlights the need for further assessment of the sociodemographic determinants of cervical cancer screening uptake in Nigeria. Preventive strategies should be targeted at improving the dissemination of valid information, reducing the knowledge gap among women, and addressing the financial and health service factors. Keywords: Cervical cancer screening; barriers; uptake; Nigeria; systematic review.

Willingness to HPV self-sampling for cervical cancer screening and its predictors among women attending outpatient clinics in Meru District, Arusha Region, Northern Tanzania

Background: The ability for women to self-collect human papillomavirus (HPV) samples can potentially reduce the risk of cervical cancer and increase screening coverage. Objectives: To assess the willingness to HPV self-sampling for cervical cancer screening and its predictors among women attending outpatient clinics in Arusha region, northern Tanzania. Methods: A hospital-based cross-sectional study was conducted among 706 women aged 18-55 years in Meru District Hospital and Usa River Health Centre from March to April 2019. Face-to-face intervies were conducted using a questionnaire. Data analysis was performed using Stata version 14.0. The log-binomial regression was used to determine factors associated with willingness to self-collection of HPV samples. Results: Majority (70%) of the women were willing to self-collection of HPV samples for cervical cancer screening and was associated with attending Meru District hospital (PR=2.02, 95%CI 1.77-2.31); good knowledge about cervical cancer warning signs (PR=1.11, 95%CI 1.01-1.22), prevention (PR=1.13, 95%CI 1.04-1.20), and symptoms (PR=1.61, 95%CI 1.33-1.93); and having formal employment (PR=1.22, 95%CI 1.07-1.37). Conclusion: The majority of women were willing to self-collect HPV samples for cervical cancer screening. Self-collection is, therefore, an acceptable and viable means of screening for cervical cancer, which has great implications for Tanzania from a health policy perspective. Keywords: Cervical cancer; HPV testing; HPV self-collection; Tanzania.

Infection with high-risk genotypes of human papillomavirus and cervical cytological findings among kidney transplant recipients in Kenya: a single centre experience

Background: High-risk human papillomavirus (hrHPV) infection is linked with uterine cervix premalignant lesions and invasive carcinomaof the uterine cervix.
 Methods: Descriptive cross sectional study carried out among female kidney transplant (KTx) recipients in Kenyatta National Hospital, Nairobi-Kenya. We studied the risk factors for acquisition of hrHPV, examined cervical cytology and assayed for 14 hrHPV DNA using Cervista® HPV HR test and Cervista® MTA (Hologic®) automated platforms.
 Results: The 14-hrHPV genotypes assayed were 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68 and the prevalence rate was 31.25 % (10/32). Abnormal cervical cytology was noted in 4/32 (12.5%) and included low-grade squamous intraepithelial lesion (2/32), atypical squamous cells of undetermined significance (1/32) and atypical glandular cells (1/32). The average age was 41.9 years with mean age at first coitus being 20.4 years. Majority of the women 20(62.5%) were married while 8(25%) were single. About 18(56.3%) had only one sexual partner. About 20% of women were nulliparous and 4(12.5%) had a parity of five. Duration since transplantation ranged between 1-21 years.
 Conclusions: The burden of hrHPV and abnormal cervical cytology in our study seemed lower than that reported elsewhere andeven in general population. This study may form basis for further studies about HPV infections and carcinoma of the uterine cervixamong the kidney allograft recipients in our setting.
 Keywords: Cervical carcinoma; kidney transplant recipients; high risk Human Papillomavirus.

Human Papillomavirus types prevalence and their association with cervical dysplasia among HIV and non-HIV infected women attending reproductive health clinics in Eastern Kenya

Background: Human Papillomavirus (HPV) causes over 99% of all cervical cancer globally. In 2019; it was responsible for 3,286 deaths in Kenya. Understanding the epidemiological distribution of HPV genotypes by cervical dysplasia and HIV infection is important in designing prevention strategy and management of cervical cancer. Objective: To determine HPV genotypes prevalence and their distribution by cervical dysplasia, social-demographic and risk factors associated with cervical cancer among HIV-infected women aged 18-48 years seeking reproductive healthcare in Eastern Kenya. Methods: Cervical specimens were obtained for cytology, HPV-genotyping, histology while social-demographic factors were collected using a questionnaire and analysed using Pearson chi-square test. Results: 317 womencases: 161(50.8%); control 156(49.2%), mean age: 34.3, range 18-46 years were recruited. Thirteen HPV genotypes associated with cervical dysplasia were: CIN1{cases: HPV81[12(3.8%), HPV11[2(0.6%); control: HPV53 and HPV66[1(0.3%)}, CIN2 {cases: HPV11, HPV16, HPV661(0.3%), HPV816(1.9%) and single case1(0.3%) of HPV9, HPV11, HPV16, HPV44, HPV66, HPV81 HPV88, HPV53 and HPV58; control: HPV81[2(0.6%)} and invasive cancer {cases: HPV16[1(0.3%) and HPV81[3(0.9%); control: HPV16and HPV66[1(0.3%). Conclusions: Cervical dysplasia was associated with more mixed-lr/hrHPV genotypes among HIV-infected than HIV-uninfected women. The finding adds to the pool of knowledge the epidemiological data required in determining the population at risk for cervical cancer. Keywords: Human Papillomavirus; cervical dysplasia; HIV; Eastern Kenya.

Identification of HPV16’s E6 gene in suspected cases of cervical lesions and docking study of its L1 protein with active components of Echinacea purpurae

Background: HPV 16 is the primary etiologic agent of cervical cancer and the presence of L1 and E6 oncoproteins are largely responsible for its virulence. It was the objective of this study to identify HPV16 isolates from suspected cases of cervical cancer at Specialist Hospital Sokoto and Sir Yahaya Memorail Hospiatal Birnin Kebbi, Nigeria and also to identifypotent HPV16’s L1 protein inhibitor using in silico analysis.
 Methods: A total of 144 cervical samples consisting of 21 low grade squamous intraepithelial lesion, 6 high grade lesion and 117 negative pap smears were collected. The samples were subjected for molecular detection using PCR targeting E6 gene of the virus. Data generated for the molecular prevalence was statistically analyzed using Chi-square method. AutoDock Vina was used to carry out the molecular docking between 2hr5 and Chicoric acid, curcumin and Echinacoside.
 Results: Out of the 144 samples, 24 samples were positive for the PCR representing 16.9% molecular prevalence rate. There is statistically significant association between cyto-diagnoses and presence of HPV16 (P < 0.05). Docking analysis showed that the Chicoric acid components of Echinacea purpurae have strong binding affinity (-8.7 kcal/mol) to the L1 protein of the HPV.
 Conclusion: This study provides data on HPV 16 epidemiology in northern Nigeria, and also provides novel evidence for consideration on certain interacting residues, when synthesizing Anti-HPV compounds in the wet lab.
 Keywords: HPV; Echinacea purpurae; chicoric acid; echinacoside; curcumin.

Cervical precancerous lesions at the Tchibanga Regional Hospital and the University Hospital in Gabon in 2018: smartphone as a screening tool for diagnosis

Background: Cervical precancerous lesions are disorders that can induce discolouration changes. Their detection is difficult in remote areas in the absence of adequate equipment. The objectives were to evaluate Smartphone performance in diagnosing cervical precancerous lesions in Tchibanga, Gabon.
 Methods: It was an interventional cross-sectional study to evaluate the validity and reliability of the smartphone as a tool for diagnosing atypical changes in the cervix. Study period was between July 1, 2017 to February 28, 2018 at the Tchibanga Regional Hospital (CHRT) and the University Hospital (CHU). The variability between examiners was determined according to Cohen's Kappa formula. The Gold standard test was the cytology.
 Results: Compared to the examiner -1, the examiner - 2 found a high percentage of inflammations as atypical transformations: 15.3% versus 9%. With regard to smartphonic impressions, the examiner-1 found the normal impressions almost equal to that of the examiner-2, 72.9% versus 72.2%. The concordance between positive smartphonic impressions was 93.8% and 95.5% between negative smartphonic impressions, with k = 0.86.
 Conclusion: In view of the above, the concordance between positive and negative smart phonic impressions was 93.8 and 95.5% with k = 0.86. The performance parameters being good, there is a need to use the smartphone as a tool for the diagnosis of precancerous lesions.
 Keywords: Diagnosis; cervical precancerous lesions; Tchibanga; smartphone.

Potential anticancer activity of Acetone extracts of Toona cilliata, Seriphium plumosum and Schkuhria pinnata on HeLa cervical cancer cells

Background: Cervical cancer is common in women in less developed regions of the world. The plant biomolecules can be employed for synergistic activity with chemo- and radiotherapy. This combinations might result in reduced toxicity and increased efficacy of the treatment regimen. Objectives: The anti-HeLa cells activity of the acetone extracts of S. plumosum, T. cilliata and S. pinnata was assessed using different parameters. Methods: Secondary metabolite detection and antioxidant activity quantification were determined using the DPPH and ferric iron reducing assays. HeLa cell growth inhibition and mechanistics were assessed by employing MTT and Annexin-V flous assays. Results: Observations revealed the presence of phenolic, flavonoids, tannins steroids and coumarins in all the plants ex- tracts. High amount of total phenolic and flavonoid content were detected in S. plumosum and T. cilliata. S. plumosum extract had the best DPPH scavenging activity and ferric reducing powers. Conclusion: Observable concentration dependent cell proliferation inhibition by test materials was exhibited. The leaf ex- tracts from T. cilliata, S. plumosum and S. pinnata contain compounds of various polarities with free-radical, antioxidant and anti-cancerous activities that may play a beneficial role in treatment. Keywords: Medicinal plants; anticancer activity; antioxidant activity.