Precancerous cervical lesion in Ethiopia: systematic review and meta-analysis

Background Though cervical cancer is largely preventable, it is still the second most common female cancer globally and the leading cause of cancer deaths among females in African. Though many efforts have been done to study the burden of the disease in Ethiopia, primary studies examining the prevalence of precancerous cervical lesions are fragmented. Hence, this systematic review and meta-analysis is aimed at estimating the pooled prevalence of precancerous cervical lesion and its trends in Ethiopia. Methods This systematic review and meta-analysis was conducted using the following electronic databases. PubMed, Web of Science, SCOPUS, Science Direct, Google Scholar, African Index Medicus (AIM), African Journals Online databases, and Addis Ababa and Bahir Dar Universities research repositories were searched following the Preferred Items for Systematic Review and Meta-analysis (PRISMA) Guideline. STATA 15 statistical software was used to analyze the data. The quality of the included studies was assessed using the Joanna Briggs Institute (JBI) quality appraisal tool for meta-analysis. Heterogeneity between studies was assessed using the Cochrane Q test and I2 test statistics based on the random effects model. A random effects model was computed to estimate the pooled prevalence of precancerous cervical lesion in Ethiopia. Finally, the trend of precancerous cervical lesion in the country was presented. Result Seventeen studies with a total of 26,112 participants were included in the analysis. The pooled prevalence of precancerous cervical lesion was 15.16 (95% CI 10.16–19.70). The subgroup analysis by region showed the highest prevalence of precancerous cervical lesion at the Southern Nations and Nationalities Peoples Region (19.65%; 95% CI 15.51–23.80). The trend of precancerous cervical lesion prevalence showed an increased pattern over time. Conclusion Approximately one among six of the study participants had precancerous cervical lesion. The trend also showed that there is still an increasing precancerous cervical lesion in Ethiopia. Best practices in achieving high vaccination coverage shall be informed by practices in other successful countries.

Study of Cervical Biopsy over a Decade at a Tertiary Level Hospital, Nepal

Cervical carcinoma is the most common gynecological malignancy and almost curable cancer, if identified at an early stage. Cervical biopsy remains the ‘gold standard’ for the diagnosis of precancerous cervical lesion. The objective of this study was to review the histopathological findings of cervical biopsy including cervical polypectomy and hysterectomy specimens at Dhulikhel Hospital from January 2008 to December 2018. Out of 2098 cases, almost half of the cases (49.3%) were of Brahmin/Chhetri castes. There were significant differences in mean ages among hysterectomy cases (47.55±9.26), cervical biopsy cases (43.08±11.50) and polypectomy cases (33.59±12.47) (p value < 0.005). Out of 925 cervical specimens (cervical biopsy and polypectomy), colposcopy and hysteroscopy were performed in 18.2% and 12.7%, respectively. Out of 1173 hysterectomies, there were 110 cases (9.4%) of malignancies and cervical cancer was the most common (67, 60.9%). The mean age of cervical cancer patients was 52.87±11.94 years. Cervical cancer detected in age group of 40 – 59 years was significantly high (p value < 0.005). Incidence of cervical cancer was lowest in Brahmin/Chhetris (2.4%) compared to Newars (3.4%) and other Janajatis (12.8%) and the difference was statistically significant (p value < 0.005). The findings of this study is useful in updating the histopathological pattern of cervical biopsies.

Precancerous Cervical Lesion Among HIV-Positive Women in Sub-Saharan Africa: A Systematic Review and Meta-Analysis

In sub-Saharan Africa, cervical cancer is an intersecting epidemic with HIV and it is the second most common cause of cancer-related deaths in women. Therefore, this study was aimed to estimate the current status of the prevalence and associated factors of precancerous cervical lesions among HIV-positive women in sub-Saharan Africa. A systematic literature search was conducted from legitimate electronic databases, including MEDLINE (Ovid), PubMed, EMBASE (Ovid), Emcare (Ovid), CINAHL (EBSCOhost), Web of Science, Scopus, and PopLine and other gray literature including Google, Google Scholar, World Cat, ResearchGate, and Mednar. Data were extracted with a structured format prepared in Microsoft Excel. Each study was evaluated using the Joanna Briggs Institute critical appraisal tool for cross-sectional and cohort studies checklists. Accordingly, medium and high-quality studies were included in the review. Data synthesis and statistical analysis was conducted using OpenMeta and comprehensive meta-analysis version 2 software. The study protocol is registered on PROSPERO with ID: CRD42018114266. The pooled prevalence of precancerous cervical lesion among HIV-positive women in sub-Saharan Africa was 25.6% (95% confidence interval [CI]: 19.4%-31.8%). Having more than 2 lifetime sexual partners (odds ratio [OR]: 4.77; 95% CI: 1.35-16.93), having had a history of sexually transmitted infections (STIs; OR: 1.92; 95% CI: 1.03-3.57), having more than 2 births (OR: 1.84; 95% CI: 1.33-2.53), and CD4 count <200 cells/mm3 (OR: 1.765; 95% CI: 1.23-2.535) were significantly associated with precancerous cervical lesions. The prevalence of precancerous cervical lesion among HIV-positive women was high. One in 4 HIV-infected women suffers from precancerous cervical lesion. Lower CD4 cell count, STIs, multiple sexual partnering, and histories of multiple births and abortions were the foremost contributing factors for this burden. Precancerous cervical lesion could be reduced significantly if preventive and promotive measures are done on the associated factors.

Dietary Intervention on Precancerous Cervical Lesion among Women in Selected Rural Area of Bangalore

Introduction : Cervical cancer is one of the leading cancers among women, which affects approximately 4,90,000 women each year, resulting in approximately 2,70,000 deaths worldwide. Epidemiological studies have shown that 70-90% of all cancers are environmental. Lifestyle related factors are the most important and preventable among the environmental exposures. Dietary practices, reproductive and sexual practices will account for 20-30% of cancers. Dietary intervention by millet based antioxidants has been shown to dramatically reduce the incidence of PCCL. Aim :The aim of the study was to evaluate the effectiveness of dietary intervention on precancerous cervical lesion among wome. Methodology : A Quasi experimental research design, convenient sampling technique was used to collect data from 100 women in Bangalore rural. Data was collected by using structured interview schedule and VIA observation rating scale followed by dietary intervention through administration of millet based antioxidants for 90 days to women in experimental group. Statistical Analysis :The data was collected and analyzed using software statistical package for social sciences (SPSS) version 12.0. Results :The mean PCCL after dietary intervention was 3.0 (SD = 2.5) significantly less than the pretest 7.04 (SD = 1.4), t = 20.3 (p < 0.05). Conclusion : It was found that dietary intervention was significantly effective in reducing PCCL among women.

Precancerous Cervix in Human Immunodeficiency Virus Infected Women Thirty Years Old and above in Northern Uganda

Background. Little is known about precancerous cervical lesion (PCCL), the precursor of cervical cancer among Human Immunodeficiency (HIV) infected women in a postconflict setting of Northern Uganda.Objective. To establish factors associated with PCCL among HIV infected women above thirty years of age in a postconflict setting of Northern Uganda.Method. This retrospective cohort study used electronic data from 995 HIV-positive women that attended cervical cancer screening during June 2014 and December 2015. Data on social, sexual, obstetric, and gynecological factors was analyzed at 95% confidence level. Multivariate analysis determined factors independently associated with positive PCCL. Probability value less than 5% was considered significant.Results. Prevalence of PCCL was 3.0% (95% confidence interval (CI): 2.0–4.3). A positive PCCL was significantly associated with absence of sexually transmitted diseases (STDs) during clinic visits (adjusted odds ratio, aOR = 0.24; 95% confidence interval (CI): 0.09–0.64;P=0.004) and first pregnancy before the age of 20 years (aOR = 3.09; 95% CI: 1.21–7.89;P=0.018).Conclusion. The prevalence of PCCL was low in the postconflict setting of Northern Uganda. HIV-positive women presenting with STDs and those with first pregnancy before the age of 20 years were at increased risk of PCCL.