| 1. |
- Asp, Gustav, et al.
(författare)
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Challenges of immediate newborn care in maternity units in Lagos, Nigeria: An observational study.
- 2011
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Ingår i: Journal of Obstetrics and Gynaecology. - : Informa UK Limited. - 1364-6893 .- 0144-3615. ; 31:7, s. 612-616
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Tidskriftsartikel (refereegranskat)abstract
- Substandard newborn care has been identified as a major contributor to the estimated annual 4 million neonatal deaths and 1 million fresh stillbirths. Low-income countries, including Nigeria account for more than 95% of all cases. A cross-sectional comparative study utilising non-participant observation methods was used to study perinatal care at two maternity centres in Lagos, Nigeria. Data on 63 mother-baby pairs were included in the study. Two stillbirths and two early neonatal deaths occurred during the study period, equally divided between the two hospitals. The partograph, a crucial tool for monitoring progress of labour, was in use in 77.4% vs 50% of cases at the two centres. The only interventions utilised for the prevention of hypothermia were drying and covering newborns with towels. Hygiene routines were poor and caring procedures did not demonstrate adequate knowledge related to a newborn's health. An enabling environment and supportive supervision is urgently required.
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| 2. |
- Ezechi, Oliver, et al.
(författare)
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Evaluation of direct visual inspection of the cervix in detecting cytology diagnosed squamous intraepithelial lesion in women of known HIV status. A randomized trial (CANHIV study)
- 2016
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Ingår i: African Journal of Reproductive Health. - 1118-4841. ; 20:4, s. 77-88
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Tidskriftsartikel (refereegranskat)abstract
- A two-arm, open label, randomized study, evaluated the test characteristics of visual inspection of cervix with Acetic acid (VIA) and Lugol’s Iodine (VILI) in detecting cytology diagnosed squamous intraepithelial lesion (SIL) in 1160 women of known HIV status in southwestern Nigerian. Using SIL as reference standard and the HIV status masked, VIA and VILI had similar test characteristics except for the positive predictive value in which VIA value of 91.5% was significantly higher than 77.7% for VILI (p=0.01). Among HIV positive women, VILI performed poorly across all the 4 test characteristics compared to VIA. Among severely immuno-compromised HIV positive participants VILI performance was consistently below 80% across all test characteristics (sensitivity-70.0%; specificity-66.9%; positive predictive value-46.7%; negative predictive value (NPV) -50.0%) compared to VIA (Senstivity-71.3%; specificity-88.2%; positive predictive value-83.3%; negative predictive value-88.2). Our study shows that VILI is insufficiently sensitive and specific in the presence of HIV infection especially in those with severe immunosuppression. Based on VIA’s acceptable sensitivity and NPV in all situations, it is recommended for cervical cancer screening in HIV positive women and in settings of high HIV burden.
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| 3. |
- Ezechi, Oliver, et al.
(författare)
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Predictors of default from follow-up care in a cervical cancer screening program using direct visual inspection in south-western Nigeria
- 2014
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Ingår i: BMC Health Services Research. - : Springer Science and Business Media LLC. - 1472-6963. ; 14:143, s. 1-10
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Tidskriftsartikel (refereegranskat)abstract
- Background: Increasingly evidence is emerging from south East Asia, southern and east Africa on the burden of default to follow up care after a positive cervical cancer screening/diagnosis, which impacts negatively on cervical cancer prevention and control. Unfortunately little or no information exists on the subject in the West Africa sub region. This study was designed to determine the proportion of and predictors and reasons for default from follow up care after positive cervical cancer screen. Method: Women who screen positive at community cervical cancer screening using direct visual inspection were followed up to determine the proportion of default and associated factors. Multivariate logistic regression was used to determine independent predictors of default. Results: One hundred and eight (16.1%) women who screened positive to direct visual inspection out of 673 were enrolled into the study. Fifty one (47.2%) out of the 108 women that screened positive defaulted from follow-up appointment. Women who were poorly educated (OR: 3.1, CI: 2.0 – 5.2), or lived more than 10 km from the clinic (OR: 2.0, CI: 1.0 – 4.1), or never screened for cervical cancer before (OR: 3.5, CI:3:1–8.4) were more likely to default from follow-up after screening positive for precancerous lesion of cervix . The main reasons for default were cost of transportation (48.6%) and time constraints (25.7%). Conclusion: The rate of default was high (47.2%) as a result of unaffordable transportation cost and limited time to keep the scheduled appointment. A change from the present strategy that involves multiple visits to a “see and treat” strategy in which both testing and treatment are performed at a single visit is recommended.
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| 4. |
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| 5. |
- Ezechi, Oliver
(författare)
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The battleground of two Infections and a cancer: Human Papilloma Virus, premalignant lesions of the cervix and their interaction with Human Immunodeficiency Virus in southwestern Nigeria
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: The highest numbers of HIV-infected women are in sub- Saharan Africa, where the natural progression of HIV disease in the absence of treatment results in death before the onset of invasive cervical cancer. With improved access to treatment, several studies outside West Africa demonstrated an increased risk of pre-invasive cervical lesions among HIV-infected women and the positive impact of treatment on the outcome. Given the various HIV strains in Nigeria and other West African countries, a different outcome may be expected. Unfortunately, limited information exists on the subject in the sub-region. Aim: To study the effect of HIV infection on the burden of premalignant lesions of the cervix; assess the diagnostic accuracy of direct visual inspection of the cervix; and contribute to policy formulation and the development and implementation of effective cervical cancer prevention and control programme in Nigeria. Method: The studies (I-V) were conducted among adult women of known HIV status in south-western Nigerian (2011- 2012). Study I, a randomised control study among 1140 women, determined the effect of HIV infection on the test performance of direct visual inspection of the cervix in detecting cytology - diagnosed squamous intraepithelial lesions. Studies II and III utilised data generated in Study I to determine the interaction between HIV infection, antiretroviral therapy, and precancerous lesions of the cervix. Study IV, a cross-sectional study, assessed the acceptability of cervical cancer screening among 1517 HIV- positive women. Study V prospectively determined the outcome of follow- up after a positive cervical cancer screening test. Results: Visual inspection with Lugol’s iodine was found to be inferior to visual inspection with acetic acid and inadequate as a cervical cancer screening tool in cases of severe immune deficiency (specificity of 66.9% and negative predictive value of 50.0%). The prevalence of high risk HPV and squamous intraepithelial lesions were 19.6% and 8.4%, respectively. HPV 16 (3.9%), 35 (3.5%) and 58 (3.5%) were most frequently found. HIV positive women were found to be at increased risk of high risk HPV infection (OR: 1.8; 95% CI: 1.4 - 2.2) and squamous intraepithelial lesion (OR: 5.4; 95% CI: 2.9 - 8.8). Antiretroviral drugs was found to protect against high risk HPV infection (OR: 0.4; 95% CI: 0.3- 0.5) and development of squamous intraepithelial lesions. Although only 56.2% of HIV positive women were aware of cervical cancer screening, the test was acceptable to 79.8% of them. Among the 108 women who screened positive during outreach cervical cancer screening, 47.2% defaulted from follow -up as a result of transportation and cost- related issues and an anticipated long waiting time at the referral centre. Poorly educated women (OR: 3.1, CI:2.0 – 5.2) and those residing more than 10 km from the clinic (OR: 2.0, CI:1.0 – 4.1) were most likely to default. Conclusion. Precancerous lesions of the cervix were found to be higher in HIV positive women, especially severely immuno-compromised ones and those not on treatment. Cervical cancer screening is acceptable to women but default from follow - up after positive screening was high, especially among poorly educated rural women. Visual inspection with Lugol’s iodine was found to be inadequate for cervical cancer screening in cases of severe immune deficiency. The current strategy needs to be changed to one that will integrate cervical cancer prevention into HIV care as well as to improve access services for poorly educated rural women.
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| 6. |
- Ezechi, Oliver, et al.
(författare)
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The burden, distribution and risk factors for cervical oncogenic human papilloma virus infection in HIV positive Nigerian women
- 2014
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Ingår i: Virology Journal. - 1743-422X. ; 11:5
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Tidskriftsartikel (refereegranskat)abstract
- Background: The expected reduction in cervical cancer incidence as a result of increased access to antiretroviral therapy is yet to be seen. In this study we investigated the effect of HIV infection and treatment on high-risk (hr) human papilloma virus (HPV) prevalence and distribution. Methods: Cervical cells from 515 (220 HIV positive and 295 HIV negative) women, recruited during community cervical cancer screening programme in states of Ogun and Lagos and at the cervical cancer screen clinic, Nigerian Institute of Medical Research Lagos were evaluated for the presence of 13 hr HPV genotypes by polymerase chain reaction based assay. Results: The prevalence of high-risk HPV was 19.6% in the studied population. HPV 16 (3.9%), 35 (3.5%), 58 (3.3%) and 31 (3.3%) were the most common hr HPV infections detected. We observed that the prevalence of hr HPV was higher in HIV positives (24.5%) than 15.9% in HIV negative women (OR = 1.7; 95% CI: 1.1-2.7). A multivariate logistic regression analysis showed a lower hr HPV prevalence in HIV positive women on antiretroviral drugs (OR = 0.4; 95% CI: 0.3-0.5) and with CD4 count of 500 and above (OR = 0.7; 95% CI: 0.5-0.8). A higher prevalence of hr HPV was also noted in HIV positive women with CD4 count <200 cells/mm3 (OR = 2.4; 95% CI: 1.7-5.9). Conclusion: HPV 16, 35, 58 and 31 genotypes were the most common hr HPV infection in our study group, which could be regarded as high risk general population sample; with higher prevalence of HPV 16 and 35 in HIV positive women than in HIV negative women. The use of antiretroviral drugs was found to be associated with a lower prevalence of hr HPV infection, compared to those not on treatment. This study raises important issues that should be further investigated to enable the development of robust cervical cancer prevention and control strategies for women in our setting.
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| 7. |
- Ezechi, Oliver, et al.
(författare)
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Willingness and acceptability of cervical cancer screening among HIV positive Nigerian women
- 2013
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Ingår i: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 13
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Tidskriftsartikel (refereegranskat)abstract
- Background: The proven benefit of integrating cervical cancer screening programme into HIV care has led to its adoption as a standard of care. However this is not operational in most HIV clinics in Nigeria. Of the various reasons given for non-implementation, none is backed by scientific evidence. This study was conducted to assess the willingness and acceptability of cervical cancer screening among HIV positive Nigerian women. Methods: A cross sectional study of HIV positive women attending a large HIV treatment centre in Lagos, Nigeria. Respondents were identified using stratified sampling method. A pretested questionnaire was used to obtain information by trained research assistants. Obtained information were coded and managed using SPSS for windows version 19. Multivariate logistic regression model was used to determine independent predictor for acceptance of cervical cancer screening. Results: Of the 1517 respondents that returned completed questionnaires, 853 (56.2%) were aware of cervical cancer. Though previous cervical cancer screening was low at 9.4%, 79.8% (1210) accepted to take the test. Cost of the test (35.2%) and religious denial (14.0%) were the most common reasons given for refusal to take the test. After controlling for confounding variables in a multivariate logistic regression model, having a tertiary education (OR = 1.4; 95% CI: 1.03-1.84), no living child (OR: 1.5; 95% CI: 1.1-2.0), recent HIV diagnosis (OR: 1.5; 95% CI: 1.1-2.0) and being aware of cervical cancer (OR: 1.5; 95% CI: 1.2-2.0) retained independent association with acceptance to screen for cervical cancer. Conclusions: The study shows that HIV positive women in our environment are willing to screen for cervical cancer and that the integration of reproductive health service into existing HIV programmes will strengthen rather than disrupt the services.
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