The magnitude and predictors of cervical squamous intraepithelial lesions among women in Enugu, Nigeria: a cross-sectional study of women in a low-resource setting

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Abstract

Introduction

the prevalence of cervical squamous intraepithelial lesion is not well appreciated in most low-income countries. The study aimed to determine the level of awareness, prevalence and the pattern of squamous intraepithelial lesions and predictors for abnormal Pap smear reports (development of pre-malignant lesions of the cervix) among women attending various clinics in a tertiary health facility in Enugu, Nigeria.

Methods

a cross-sectional study of 207 female patients attending various clinics of Enugu State University Teaching Hospital, Parklane, Enugu between June and August 2017 was undertaken. Structured interviewer-administered questionnaires were used for data collection while cervical smears were collected from the patients and sent for cytology. Data analysis was done using the Statistical Package for the Social Sciences (SPSS) version 22.0. The results were presented as means, standard deviations, frequencies and proportions. Pearson´s Chi-square test was used to test for associations between categorical variables and statistical significance was set at a p-value of < 0.05.

Results

the levels of awareness of cervical cancer and the screening methods among the respondents were 76.8% and 36.7% respectively. The overall knowledge of cervical cancer and its screening was poor (6.8% and 29.0% respectively). The prevalence of pre-malignant lesions of the cervix among the respondents was 15.0% with low grade squamous intraepithelial lesion (LGSIL) having the highest frequency (38.7%). Among all the other risk factors for the development of premalignant lesions of the cervix among the respondents, a report of abnormal pap (positive) smear report was significantly associated with only age ≥35 years (χ ²=5.723; p=0.017). The same age of 35 years and above also correctly predicted abnormal Pap smear reports among other factors (AOR = 3.02, 95% CI = 1.16 - 7.89, p = 0.024).

Conclusion

the awareness of cervical cancer and cervical cancer screening was high but the overall knowledge on cervical cancer and its screening was very poor among the respondents. The prevalence of pre-malignant lesions of the cervix was high, and the commonest abnormal smear was LGSIL. Only age 35 years and above correctly predicted the occurrence of abnormal Pap smear reports among the respondents.

Most cited references 28

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Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration.

Jan P. Vandenbroucke, Erik von Elm, Douglas G. Altman … (2007)

Much medical research is observational. The reporting of observational studies is often of insufficient quality. Poor reporting hampers the assessment of the strengths and weaknesses of a study and the generalizability of its results. Taking into account empirical evidence and theoretical considerations, a group of methodologists, researchers, and editors developed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) recommendations to improve the quality of reporting of observational studies. The STROBE Statement consists of a checklist of 22 items, which relate to the title, abstract, introduction, methods, results and discussion sections of articles. Eighteen items are common to cohort studies, case-control studies and cross-sectional studies and four are specific to each of the three study designs. The STROBE Statement provides guidance to authors about how to improve the reporting of observational studies and facilitates critical appraisal and interpretation of studies by reviewers, journal editors and readers.This explanatory and elaboration document is intended to enhance the use, understanding, and dissemination of the STROBE Statement. The meaning and rationale for each checklist item are presented. For each item, one or several published examples and, where possible, references to relevant empirical studies and methodological literature are provided. Examples of useful flow diagrams are also included. The STROBE Statement, this document, and the associated web site (http://www.strobe-statement.org) should be helpful resources to improve reporting of observational research.

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Effective screening programmes for cervical cancer in low- and middle-income developing countries.

A M Budukh, R. Sankaranarayanan, R. Rajkumar (2000)

Cervical cancer is an important public health problem among adult women in developing countries in South and Central America, sub-Saharan Africa, and south and south-east Asia. Frequently repeated cytology screening programmes--either organized or opportunistic--have led to a large decline in cervical cancer incidence and mortality in developed countries. In contrast, cervical cancer remains largely uncontrolled in high-risk developing countries because of ineffective or no screening. This article briefly reviews the experience from existing screening and research initiatives in developing countries. Substantial costs are involved in providing the infrastructure, manpower, consumables, follow-up and surveillance for both organized and opportunistic screening programmes for cervical cancer. Owing to their limited health care resources, developing countries cannot afford the models of frequently repeated screening of women over a wide age range that are used in developed countries. Many low-income developing countries, including most in sub-Saharan Africa, have neither the resources nor the capacity for their health services to organize and sustain any kind of screening programme. Middle-income developing countries, which currently provide inefficient screening, should reorganize their programmes in the light of experiences from other countries and lessons from their past failures. Middle-income countries intending to organize a new screening programme should start first in a limited geographical area, before considering any expansion. It is also more realistic and effective to target the screening on high-risk women once or twice in their lifetime using a highly sensitive test, with an emphasis on high coverage (>80%) of the targeted population. Efforts to organize an effective screening programme in these developing countries will have to find adequate financial resources, develop the infrastructure, train the needed manpower, and elaborate surveillance mechanisms for screening, investigating, treating, and following up the targeted women. The findings from the large body of research on various screening approaches carried out in developing countries and from the available managerial guidelines should be taken into account when reorganizing existing programmes and when considering new screening initiatives.

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Chapter 8: Screening for cervical cancer in developing countries.

Michael CJ Quinn, Lynette Denny, R. Sankaranarayanan (2006)

Organised and quality assured cytology-based screening programmes have substantially reduced cervical cancer incidence in many developed countries. However, there are considerable barriers to setting up cytology-based screening programs, particularly in developing countries. This has stimulated the search for novel and alternative approaches to cytology for cervical cancer prevention. These approaches generally perform as well as cytology, and sometimes better, although many of them have a lower specificity, resulting in higher false-positive rates. The possibility of linking screening to treatment in a one- or two-visit strategy appears to be safe, feasible and effective. Barriers to establishing screening programs and the pitfalls encountered differ from one country to the next. Country-specific solutions need to be found, while being cognizant of the criteria that have enabled successful screening programmes.

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Author and article information

Contributors

Joseph Tochukwu Enebe: https://orcid.org/0000-0002-3517-1104

Emmanuel Obiora Izuka: https://orcid.org/0000-0001-9064-2020

Elias Chike Aniwada: https://orcid.org/0000-0001-9218-2726

Journal

Journal ID (nlm-ta): Pan Afr Med J

Journal ID (iso-abbrev): Pan Afr Med J

Journal ID (publisher-id): PAMJ

Title: The Pan African Medical Journal

Publisher: The African Field Epidemiology Network

ISSN (Electronic): 1937-8688

Publication date (Electronic): 16 February 2022

Publication date Collection: 2022

Volume: 41

Electronic Location Identifier: 130

Affiliations

[1 ]Department of Obstetrics and Gynaecology, Enugu State University of Science and Technology Teaching Hospital, Parklane, Enugu, Nigeria,

[2 ]Department of Obstetrics and Gynaecology, Enugu State University of Science and Technology, College of Medicine/Teaching Hospital, Parklane, Enugu, Nigeria,

[3 ]Department of Pathology, Enugu State University of Science and Technology, College of Medicine/Teaching Hospital, Parklane, Enugu, Nigeria,

[4 ]Departments of Health Administration and Management, University of Nigeria Enugu Campus, Enugu, Nigeria,

[5 ]Department of Community Medicine, University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria,

[6 ]Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria

Author notes

[& ] Corresponding author: Joseph Tochukwu Enebe, Department of Obstetrics and Gynaecology, Enugu State University of Science and Technology, College of Medicine/Teaching Hospital, Parklane, Enugu, Nigeria. drenebe2002@ 123456yahoo.co.uk

Article

Publisher ID: PAMJ-41-130

DOI: 10.11604/pamj.2022.41.130.28173

PMC ID: 9011909

PubMed ID: 35480408

SO-VID: 0de0d192-edc7-481e-9923-8022ccfb92ba

License:

The Pan African Medical Journal (ISSN: 1937-8688). This is an Open Access article distributed under the terms of the Creative Commons Attribution International 4.0 License ( https://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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The magnitude and predictors of cervical squamous intraepithelial lesions among women in Enugu, Nigeria: a cross-sectional study of women in a low-resource setting

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Abstract

Introduction

Methods

Results

Conclusion

Most cited references 28

Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration.

Effective screening programmes for cervical cancer in low- and middle-income developing countries.

Chapter 8: Screening for cervical cancer in developing countries.

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