Background Though obesity has been said to be associated with a number of malignancies including cervical cancer, its association with cervical intraepithelial neoplasia (CIN) is still a contentious issue. This study was designed to determining the prevalence and association between obesity and CIN. Methods This was an unmatched case control study, involving women with cervical intraepithelial neoplasia (cases) and those negative for intraepithelial lesions or malignancy (controls) at the cervical cancer clinic of Mbarara Regional Referral Hospital, in south-western Uganda, between April and November 2022. Cases and controls provided written informed consent and were recruited in a ratio of 1:1. Cases were identified by visual inspection with acetic acid (VIA) and subsequent confirmation with cytology and/or histology. Demographic information was collected using an enrolment form and height, weight and waist circumference were recorded. We calculated body mass index (BMI) and identified obese women as those with body mass index of ≥ 30 kg/m2 from both case and control groups. Central obesity was defined as waist: height ration of ≥ 0.5. Data was analysed using STATA version 17. Categorical variables were analysed using proportions, chi-square and logistic regression analysis to determine association between obesity and CIN. Our level of statistical significance was set at ≤ 0.05. Results The prevalence of general and central obesity among cases was 25.5% (24/94) and 0% (0/94) respectively while the prevalence of general and central obesity among controls was 33.3% (37/111) and 0% (0/111) respectively. There was an increased prevalence of general obesity among women with low grade squamous intraepithelial lesions (LSIL). However, there was no statistically significant association between general obesity and CIN. Factors associated with general obesity included residing in Mbarara city (AOR 2.156, 95%CI 1.085–4.282, P-value 0.028), age group of 31–45 years (AOR 2.421, 95%CI 1.577–9.705, P-value 0.003) and ≥ 46 years (AOR 1.971, 95%CI 1.022–11.157, P-value 0.046). Conclusion We observed an increased prevalence of general obesity among women with LSIL. However, there was no association between obesity and CIN. Factors associated with general obesity included residing in Mbarara city, and being in the age groups of 31–40 and ≥ 46 years. This highlights the need to rethink management of CIN to control other non-communicable diseases that could arise due to general obesity.
Background: Uganda has approximately 1.2 million people aged 15–64 years living with human immunodeficiency virus (HIV). Previous studies have shown a higher prevalence of premalignant cervical lesions among HIV-positive women than among HIV-negative women. Additionally, HIV-infected womenare more likely to have their human papilloma virus (HPV) infection progress to cancer than non-HIV-infected women. We determined the prevalence of premalignant cervical lesions and their association with HIV infection among women attending a cervical cancer screening clinic at Mbarara Regional Referral Hospital (MRRH) in southwestern Uganda. Methods: We conducted a comparative cross-sectional study of 210 women aged 22–65 years living with HIV and 210 women not living with HIV who were systematically enrolled from March 2022 to May 2022. Participants were subjected to a structured interviewer-administered questionnaire to obtain their demographic and clinical data. Additionally, Papanicolaou smears were taken for microscopy to observe premalignant cervical lesions. Multivariable logistic regression was performed to determine theassociation between HIV status and premalignant cervical lesions. Results: The overall prevalence of premalignant cervical lesions in the study population was 17% (n=72; 95% C.I: 14.1-21.4), with 23% (n=47; 95% C.I: 17.8-29.5) in women living with HIV and 12% (n=25; 95% C.I: 8.2-17.1) in women not living with HIV (p<0.003). The most common premalignant cervical lesions identified were low-grade squamous intraepithelial lesions (LSIL) in both women living with HIV (74.5%; n=35) and women not living with HIV (80%; n=20). HIV infection was significantly associated with premalignant lesions (aOR: 2.37, 95% CI: 1.27–4.42,p=0.007). Conclusion: Premalignant cervical lesions, particularly LSILs, were more common in HIV-positive women than in HIV-negative women, highlighting the need to strengthen the integration of cervical cancer prevention strategies into HIV care programs.
Background High-risk HPV is considered a major risk factor for the development of cervical cancer, the most common malignancy among women in Uganda. However, there is a paucity of updated epidemiological data on the extent of the burden and factors associated with hr-HPV infection among women of reproductive age. The aim of this study was to determine the prevalence and genotype distribution of hr-HPV and associated factors among women of reproductive age attending a rural teaching hospital in western Uganda. Methods We conducted a cross-sectional study from April to June 2022. A total of 216 women of reproductive age attending the gynecological outpatient clinic were consecutively enrolled. Interviewer-administered questionnaires were used to collect participant characteristics, cervical specimens were collected by clinicians, and molecular HPV testing was performed using the Cepheid Xpert HPV DNA test. Descriptive statistics followed by binary logistic regression were conducted using SPSS version 22. Results The prevalence of hr-HPV was 16.67%. Other hr-HPV types other than HPV 16 and 18 were predominant, with a prevalence of 10.6%; HPV 18/45 (2.31%), HPV 16 (0.46%), and 3.24% of the study participants had more than one hr-HPV genotype. On multivariate logistic regression, an HIV-positive status (aOR = 7.06, CI: 2.77–10.65, p = 0.007), having 3 or more sexual partners in life (aOR = 15.67, CI: 3.77–26.14, p = 0.008) and having an ongoing abnormal vaginal discharge (aOR = 5.37, CI: 2.51–11.49, p = 0.002) were found to be independently associated with hr-HPV infection. Conclusions and recommendations The magnitude of hr-HPV is still high compared to the global prevalence. HIV-positive women and those in multiple sexual relationships should be prioritized in cervical cancer screening programs. The presence of abnormal vaginal discharge in gynecology clinics should prompt HPV testing.
Background: Ureterovaginal fistulae usually follow iatrogenic injury to the ureter during pelvic surgery. This manifests as urine incontinence and results in serious psychosocial effects to the women. Ureterovaginal fistulae unlike vesicovaginal fistulae present challenges in diagnosis and management especially in resource constrained settings. Objective: To describe the magnitude, aetiology, diagnosis, management and outcomes of ureterovaginal fistula at four fistula surgery centres in Uganda over a twelve-year period. Methods: A retrospective review of charts for women who had fistula repair at four regional fistula repair centres in Uganda from 2010 to 2021 was conducted. The diagnosis of ureterovaginal fistula was made clinically using a combination of a history of leakage of urine through the vagina following a pelvic surgery, absence of visible anterior vaginal wall defect on speculum examination, a negative methylene blue dye test, and a three-swab test. All women were managed using open transvesical ureteral reimplantation with or without Boari flap. A ureteral stent and Foley catheter were left in situ for 2 weeks. The outcome of surgery (successful fistula repair with urine continence) was determined at 2 months post-surgery. This was confirmed through a vaginal speculum exam. Results: Overall, there were 477 women who were managed for genito-urinary fistulae during the study period. Approximately 1 in every 10 women with genitourinary fistula had uretero-vaginal fistula (n=47, 9.8%). The mean age of the women with ureterovaginal fistula was 31.9 (SD ±11.8) years. Majority of the ureterovaginal fistulae (n=33, 70.7%) followed caesarean sections done at general hospitals (n=22, 46.8%) by medical officers (n=32, 68.1%). The clinical assessment method used in this study was accurate in diagnosing ureterovaginal fistula. Successful fistula repair with urine continence using the open transvesical ureteral reimplantation was achieved in 45 (95.7%) of the cases. Conclusion: Iatrogenic ureterovaginal fistulae are common in Uganda and most follow caesarean section performed at lower-level health facilities by medical officers. In resource limited settings where advanced diagnostic techniques aren’t available or not affordable, a simple but careful step-wise clinical evaluation described in this study is effective in making a diagnosis. Open transvesical ureteral re-implantation fistula repair technique has a high successful repair rate with urine continence.
Background: More than 95% of genito-urinary fistulae in low-income countries are due to prolonged neglected obstructed labour. However, with improving obstetric care and variations in medical training, there seems to be an increase in fistulae resulting from surgical errors. Objective: The aim of this study was to describe the magnitude and trend of iatrogenic genitourinary fistula at four fistula surgery sites in Uganda from 2010 to 2021 and also determining the risk factors of iatrogenic genitourinary fistula following Cesarean Section (CS). Methods: A retrospective review of charts for all women who underwent surgery for genitourinary fistula at four regional fistula repair sites in Uganda between 2010 and 2021 was conducted. A fistula was classified as iatrogenic if a participant had any of; ureteric, vesico-cervical, vesico-uterine, or vaginal vault fistula that followed an obstetric or gynecological surgery. Vesico-vaginal and urethro-vaginal fistulae were classified as ischemic irrespective of the mode of delivery. The annual proportions for the obstetric and iatrogenic fistula over the 12-year period were compared. Descriptive analyses and multivariable log binomial regression were performed to determine the independent risk factors. Results: Over the study period, 521 women had surgery for genito-urinary fistula of which, 169 (32.4%) were iatrogenic. Most of the iatrogenic fistulae followed CS (71%). There was a gradual increase in the proportions of iatrogenic fistulae from 8/52 (9.6%) in 2010 to 38/88 (43.2%) in 2020. The risk factors for iatrogenic fistula following CS were; Grand-multiparity (RR = 5.79; 95% CI: 2.18-15.4; P = 0.001), repeat CS (RR = 4.06; 95% CI: 1.77-9.3; P = 0.001), CS performed by an intern doctor (RR = 4.85; 95% CI: 1.52-15.45; P = 0.008) and CS done at a Health Centre IV (RR = 4.55; 95% CI: 1.2-16.67; P= 0.022). Conclusion: The magnitude of iatrogenic genitourinary fistula in Uganda is high and most follow CS. There is an observed rising trend in iatrogenic fistula over time. The risk factors for iatrogenic fistula following CS are grandmultiparity, repeat CS, CS performed by intern doctors and CS performed at lower health facilities. There is need for routine in service surgical skills (especially cesarean sections) training for obstetric and gynecological surgery providers.
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