Background: Cervical cancer is the second most common cancer in women globally after breast cancer. It is a preventable cancer with a well‑defined premalignant phase where treatment could be offered before invasive cancer develops.
Objective: To determine the prevalence, socio-demographic characteristics and serotypes of high-risk HPV amongst positive women using self-sampling HPV-based cervical cancer screening.
Methods: A cross-sectional pilot study in an urban setting in Lagos, Nigeria where one hundred women, following community-based counselling on cervical cancer and its prevention, underwent cervical cancer screening via self-sampling for hr-HPV. Structured questionnaires were administered for data collection. Appropriate instruction for self-sample collection using Flobam cervical sampling kit was given to each subject. The samples were processed using DNA analysis via PCR (polymerase chain reaction) amplification and flow through hybridization to identify the hr-HPV serotypes. Women who tested positive for hr-HPV had colposcopic-guided biopsy. The data obtained were analysed using SPSS version 20.0.
Findings: Almost all (97%) the women were successful at self-sampling. The prevalence of hr-HPV positivity was 19% with peak (31.6%) of hr-HPV positivity observed in subjects aged 31-40 years. HPV 53 was the commonest (36%) serotype, HPV 33 and 39 were the least (7%) identified and 47% of hr-HPV positive subjects had infection with two or more HPV serotypes. Two-third (66.7%) of hr-HPV positive subjects attended follow-up for colposcopy guided biopsy and 10.5% of the hr-HPV positive subjects had premalignant/malignant cervical lesion.
Conclusion: Infection with more than one hr-HPV serotype is common in our study. Self-sampling modality of HPV cervical cancer screening is feasible in this environment.
Introduction
the World Health Organization (WHO) reviewed the threshold values required for the diagnosis of Gestational Diabetes Mellitus (GDM) in 2013 and the implementation of the new diagnostic criteria have been associated with increase in the prevalence of GDM in some populations. The new cohort of pregnant women that will be labeled to have GDM by the 2013 WHO diagnostic criteria but not by the 1999 WHO diagnostic criteria will pose additional burden to specialized antenatal care, though their pregnancy outcome may not warrant such care. It is thus important to first determine the effect of the implementation of these new consensus diagnostic criteria on the prevalence of GDM in our environment.
Methods
this is a prospective hospital-based study that compared the implementation of both 1999 and 2013 WHO GDM diagnostic criteria among 117 pregnant women who were initially screened with 50-gram Glucose Challenge Test (50-g GCT). Women with a positive Glucose Challenge Test (GCT) result underwent a 75-gram Oral Glucose Tolerance Test (75-g OGTT), which was used as the actual diagnostic test for GDM using both 2013 WHO and 1999 WHO diagnostic criteria. Associations between variables were tested using Chi-square, Fisher's exact and t-test as appropriate. Significance level was set at P value < 0.05.
Results
the prevalence rates of GDM in the study were 2.6% and 7.7% for 1999 WHO and 2013 WHO criteria respectively. Clinical characteristics were similar in women with GDM and women without GDM. The fasting component of the OGTT identified all the women with GDM.
Conclusion
the implementation of the 2013 WHO diagnostic criteria is associated with a 2.5 to 3-fold rise in the prevalence of GDM. Selective risk-factor based screening may be clinically irrelevant with the adoption of the 2013 WHO diagnostic criteria. A minimum of fasting plasma glucose in resource poor settings can be considered to identify women with GDM since it appeared to have 100% sensitivity in our study.
Implementation of the 2013WHO diagnostic criteria for Gestational Diabetes Mellitus (GDM), with lower threshold values required for the diagnosis of GDM, may be associated with further rise in the number of missed cases, especially among “low risk women”. This prospective study determined the proportions of women with GDM who were low risk. A hundred and seventeen pregnant women of gestational age 24-32weeks were screened with 50-g glucose challenge Test (GCT) and their GDM risk factor status noted. GCT positive women had 75-gOGTT, using 2013WHO GDM diagnostic criteria. The prevalence of GDM was 7.7% and about 55% of women with GDM had “low risk” status. There was no significant difference in the plasma glucose values of low risk and high risk women. With more than 50% of women with GDM being low risk, risk factor-based screening approach may be very unreliable in screening for GDM.
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