Cervical cancer is the second most common cancer in women worldwide and the leading cause of cancer deaths in developing countries. While incidence and mortality rates of cervical cancer have fallen significantly in developed countries, 83% of all new cases that occur annually and 85% of all deaths from the disease occur in developing countries. Cervical cancer is the most common cancer among women in sub-Saharan Africa. The incidence is on the increase in some countries. Knowledge and awareness of this disease on the continent are very poor and mortality still very high. Facilities for the prevention and treatment of cervical cancer are still very inadequate in many countries in the region. Governments in sub-Saharan Africa must recognise cervical cancer as a major public health concern and allocate appropriate resources for its prevention and treatment, and for research. Indeed, cervical cancer in this region must be accorded the same priority as HIV, malaria, tuberculosis and childhood immunisations.

In sub-Saharan Africa, invasive cervical cancer (ICC) incidence and mortality are among the highest in the world. This crosssectional epidemiological study assessed human papillomavirus (HPV) prevalence and type distribution in women with ICC in Ghana, Nigeria, and South Africa. Cervical biopsy specimens were obtained from women aged 21 years with lesions clinically suggestive of ICC. Histopathological diagnosis of ICC was determined by light microscopy examination of hematoxylin and eosin stained sections of paraffin-embedded cervical specimens; samples with a confirmed histopathological diagnosis underwent HPV DNA testing by polymerase chain reaction. HPV-positive specimens were typed by reverse hybridization line probe assay. Between October 2007 and March 2010, cervical specimens from 659 women were collected (167 in Ghana, 192 in Nigeria and 300 in South Africa); 570 cases were histologically confirmed as ICC. The tumor type was identified in 551=570 women with ICC; squamous cell carcinoma was observed in 476=570 (83.5%) cases. The HPV-positivity rate in ICC cases was Key words: human papillomavirus, invasive cervical cancer, sub-Saharan Africa Abbreviations: ADC: adenocarcinoma; CI: confidence interval; DEIA: DNA enzyme immune assay; FIGO: federation of gynecology and obstetrics; HPV: human papillomavirus; ICC: invasive cervical cancer; LiPA 25 : line probe assay using 25 type-specific hybridization probes; SCC: squamous cell carcinoma; PCR: polymerase chain reaction Conflicts of interest: LD declares to have received institutional grants from GlaxoSmithKline group of companies and also declares to have received institutional grants from another pharmaceutical company (there is also one pending grant). Further, LD declares to have received payment for lectures and also receives royalties for a book chapter. IA declares to have received payment from GlaxoSmithKline group of companies for travel, food and accommodation and also declares to have served as a member of IDMC for other clinical studies. IA also has received payment for participating at a workshop. RA declares to have received payment from GlaxoSmithKline group of companies towards administrative and laboratory fees and also declares to have received payment for public lectures on cervical cancer. GD declares that her institution (University of Pretoria) received payments (direct and indirect costs) for including patients into the current trial as well as payments for travel for the purpose of meetings. TS declares to have received institutional grants, travel support and honorarium for lectures and articles written for the GlaxoSmithKline group of companies and other pharmaceutical companies; TS is also part of the HPV advisory board. LS declares to have received institutional grant. EW declares to have received payment from GlaxoSmithKline group of companies towards administrative and laboratory fees and travel support for this study. He also declares to have received payments for a cervical cancer advocacy project and for conducting a training ...

The knowledge of and the perceived susceptibility to HPV infection and HPV-related diseases among female students in the University of Lagos were generally low. The need for a well-designed HPV-educational program to bridge the knowledge gap cannot be overemphasized.

Anaemia in pregnancy is a common problem in many developing countries. In Nigeria, it is responsible for 11.0% of maternal deaths. This study examined the sociodemographic factors associated with anaemia in pregnancy. Anaemia was defined as a haemoglobin (Hb) level <11 g/dl. Proportions were compared using the chi2 test. A total of 35.3% of the 374 women studied were anaemic. Anaemia was more common in primigravidae than in parous women of parity 2 - 4 (chi2 = 6.87; p = 0.0087). Low socioeconomic status, (chi2 = 24.67, p = 0.00090), short interval between pregnancies (chi2 = 20.34, p = 0.000144), booking in the third trimester (chi2 = 15.4, p = 0.00045) and recent febrile illness (chi2 = 6.80; p = 0.0091) were associated with anaemia. Women who only used haematenics were more anaemic than those who also used anti-malarial chemo-prophylaxis (chi2 = 57.32, p = 0.00001). Anaemia in pregnancy is associated with several social and demographic factors. To reduce the prevalence of anaemia women need to have a good formal education, be economically empowered and good antenatal care must be made available, accessible and affordable to all women.

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Cervical cancer is a relatively rare disease in countries that have instituted and maintained national screening programs, with call and recall of women at various intervals and built-in quality control with appropriate monitoring and evaluation. Unfortunately, this process has failed in most areas of the world where more than 80% of new cases of cervical cancer are diagnosed. Cervical cancer affects women in the prime of their lives causing premature and needless suffering and death in a critically important segment of the world's population, despite being one of the few cancers that can be prevented with simple testing. In the past 15 years innovative approaches to both primary and secondary prevention of cervical cancer have been subjected to a number of large scale, scientifically valid and applicable studies that have opened the way for new approaches. Treatment of cervical cancer in Africa is hampered by the lack of diagnostic and treatment facilities, lack of healthcare infrastructure and poor pathology services. Further, there is a significant brain drain of trained healthcare workers in Africa that exacerbates the problem. Cancer is becoming an increasingly important public health problem as more people live longer. It is time to develop programs for the prevention, early detection, treatment, and palliation of cancer sufferers in Africa. Cancer Epidemiol Biomarkers Prev; 21(9); 1434-8. Ó2012 AACR.

IntroductionPreterm birth is a dire complication of pregnancy that poses huge long-term medical and financial burdens for affected children, their families, and the health care system. The aim of the present study was to identify characteristics associated with preterm births at the Lagos University Teaching Hospital (LUTH), Lagos, Nigeria from 2011 to 2013.MethodsWe obtained Information from 5,561 maternal, fetal/neonatal and obstetric records from the labor ward. We excluded delivery at less than 22 weeks (0.25%), post-term birth at ≥42 weeks gestation (1.3%), and unknown gestation (1.4%). Additionally, we excluded records of multiple births (5.4%) and stillbirths (8.3%) leaving 4,691 records of singleton live-births for analysis. Logistic regression analysis was performed comparing preterm birth (22-36 weeks gestation) to term birth (37-41 weeks gestation). Multiple variable models adjusting for maternal age, parity, fetal position, delivery method and booking status were also evaluated. Multinomial regression was used to identify characteristics associated with preterm birth (PTB) defined as early PTB (22-31 weeks gestation), moderate PTB (32-34 weeks gestation), late PTB (35-36 weeks gestation), compared to term birth (37-41 completed weeks gestation).ResultsFrom our data, 16.8% of the singleton live-birth deliveries were preterm (<37 weeks gestation). Of these, 4.7% were early (22-31 weeks), 4.5% were moderate (32-34 weeks) and 7.7% were late (35-36) PTBs. Older maternal age (≥35 years) [odds ratio (OR) = 1.41], hypertension (OR = 3.44) and rupture of membranes (OR = 4.03) were significantly associated with increased odds of PTB. Women being treated for the prevention of mother-to-child transmission of HIV were at a significantly decreased risk for PTB (OR = 0.70). Sixteen percent of women in this cohort were not registered for antenatal care in LUTH. These non-registered subjects had significantly greater odds of all categories of PTB, including early (odds ratio (OR) = 20.8), moderate (OR = 8.68), and late (OR = 2.15).ConclusionPTB and risks for PTB remain high in Nigeria. We recommend that any high risk pregnancy should be referred to a tertiary center for prenatal care in order to significantly reduce adverse birth outcomes such as PTBs.

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