Barriers and recommendations for a cervical cancer screening program among women in low-resource settings in Lagos Nigeria: a qualitative study.

BACKGROUND: Cervical cancer is the fourth most common cancer in women globally despite being a largely treatable and preventable malignancy. Developing countries account for over 80% of all new cases. Women residing in low-resource settings such as those residing in slums have a higher risk of cervical cancer, and lower uptake of cervical cancer screening. Diverse barriers influence the uptake of cervical cancer screening among women in low-resource settings. OBJECTIVES: This qualitative study was done prior to the introduction of a cervical cancer screening program in two slum areas in Lagos Nigeria and explored women's knowledge about cervical cancer, and their perceived barriers and recommendations for the program. METHOD: Four focus group discussions(FGD) were conducted among 35 women between the ages of 21-65 years residing in two urban slums in Lagos, Nigeria from February to April 2019. Each FGD was limited to 8-10 participants of women of similar ages. Voice recordings were transcribed verbatim and thematic analysis was done. RESULTS: Most of the women were not aware of cervical cancer and none knew the symptoms or risk factors of cervical cancer. The participants felt that the cervical cancer screening program would be well accepted in the community, however, expressed concerns about the cost of the screening test and the sex of the person performing the test. The recommendations proffered for a successful cervical cancer screening program include; reducing the cost of the test or providing the test free of charge, having people that speak the local language as part of the team, using female health care providers, using a private location within the community or nearby primary health center, and publicizing the program with the use of SMS, phone calls, town crier, and health talks. It was recommended that organizing health education sessions would help improve women's poorly perceived susceptibility to cervical cancer. CONCLUSION: Interventions to increase uptake of cervical cancer screening among women in low resource settings need to improve knowledge of cervical cancer and address barriers to cervical cancer screening such as cost, distance, and as much as possible, sex of the healthcare provider should be considered.

Utilisation and preferences of family planning services among women in Ikosi-Isheri, Kosofe Local Government area, Lagos, Nigeria.

BACKGROUND: Despite women's adequate knowledge and the obvious unmet need for family planning (FP), contraceptive prevalence in Nigeria is low. A greater understanding of the barriers to FP that informs service utilisation and preferences is needed to improve service delivery. AIM: This study was aimed at assessing the use and preferences of FP services among women. SUBJECTS AND METHODS: A community-based, descriptive, cross-sectional survey was carried out among 367 women (15-49 years of age) residing in Ikosi-Isheri, Kosofe local government area, who were selected by multistage sampling method. Data were collected using a pre-tested, semi-structured, interviewer-administered questionnaire and were analysed using SPSS software version 20. Frequency distributions and cross tabulations were generated. The Chi-square and Fisher's exact tests were used to determine associations, and the level of significance was set at P ≤ 0.05. RESULTS: Although 64.0% were aware of FP, only 26.4% had ever used FP services. The contraceptive prevalence was 17.9%. Traditional or religious restrictions were given as the reasons for not using FP (40.9%). The preferred FP services were those offered at primary healthcare centres (45.2%) and teaching hospitals (33.9%) because of proximity (38.7%), privacy (14.5%) and health workers being female (22.6%). Age, level of education and marital status were associated with the utilisation of FP services (P < 0.001, P = 0.020 and P < 0.001, respectively). CONCLUSION: Although awareness was high, uptake was low. Government health facilities were preferred. Primary healthcare should be strengthened, and FP services should be scaled up to make FP more accessible. Services should be closer to where people live while providing the privacy they desire.

Male involvement in female partners' screening for breast and cervical cancers in Southwest Nigeria.

BACKGROUND: Breast and cervical cancers are in the top 10 most common cancers in women globally and the most common cancers in Nigerian women. The incidences have been rising steadily over the years. Involvement of men as key players in reproductive health issues has been receiving global attention especially in low and middle-income countries. AIM: To assess male involvement in their female partners' screening for breast and cervical cancers in Southwest, Nigeria. METHOD: This was a community-based, cross-sectional study that employed a multi-stage sampling method to select 254 men who were married or in steady relationships in Lagos State, Southwest Nigeria. Data were collected from June to October 2018 using a semi-structured interviewer-administered questionnaire, analyzed using Epi Info version 3.5.1 and summarized with mean and standard deviation. Chi-square test was used for bivariate statistics, and the p-value of ≤0.05 was considered statistically significant. Multivariable logistic regression was used for predictor variables of male involvement in screening. RESULTS: 29.5% of the respondents had good knowledge of breast and cervical cancers and screening and majority (85.5%) had a positive attitude towards screening. Only few, 19.3% and 15.7% had provided money for breast and cervical cancer screening respectively. Most men, 75% and 87.4% respectively had not accompanied their wife/female partner for breast and cervical cancer screening, while almost half (49.2%) and one-third (33.5%) respectively, had encouraged their female partners to screen for breast and cervical cancers. Overall, only about half, 138 (54.3%) of the men were considered 'involved' in their female partners' screening for breast and cervical cancers. Male involvement was significantly associated with screening for female cancers (χ2 = 77.62, p = 0.001). Older age group (AOR = 2.64, 95% CI: 1.3-4.9), higher educational attainment (AOR = 3.51, 95% CI: 1.14-10.73), and positive attitude (AOR = 2.48, 95% CI:1.16-5.33) were found to be the predictors of male involvement. CONCLUSION: Community-based programs for males, especially the younger and less educated, should be implemented to increase their involvement. It is also suggested that mass media messages be spread and online platforms be explored in order to increase men's awareness and participation in female cancer screening.

Tuberculosis preventive practices among treatment supporters in Lagos, Nigeria.

Context: Tuberculosis (TB) treatment support is one of the recommended strategies to enhance treatment adherence and outcomes. Treatment supporters are at risk of contracting TB and adequate knowledge of TB and good preventive practices are required for their protection. Aims: This study aimed at assessing the knowledge and preventive practices of TB treatment supporters at Directly Observed Treatment Short-course (DOTS) centers in Lagos Mainland Local Government Area of Lagos state, Nigeria. Settings and Design: This cross-sectional study was conducted among 196 TB treatment supporters selected from five DOTS centers in Lagos. Methods: Data were obtained using an adapted pretested questionnaire. Statistical Analysis Used: Bivariate and multivariate analyses were performed to determine the factors associated with self-protection practices. A P < 0.05 was considered statistically significant. Results: The mean age of the participants was 37.3 ± 12.1 years. More than half of the respondents were females (59.2%) and immediate family members (61.3%). Overall, 22.5% had good knowledge of TB, while 53.0% had positive attitudes toward TB. Only 26.0% adequately protected themselves from infection. The caregiver's level of education (P = 0.001) and their relationship to the patient (P = 0.001) were significantly associated with good preventive practices in bivariate analysis. Not being related to the patient was a predictor of adequate TB prevention practices (adjusted odds ratio = 2.852; P = 0.006; 95% confidence interval = 1.360-5.984). Conclusions: This study revealed low levels of TB knowledge and fair preventive practices, especially among caregivers who are relatives. There is, therefore, a need to improve population literacy about TB and its prevention and a more focused orientation of relatives who volunteer as treatment supporters, through health education, with periodic monitoring during clinic visits, of how they prevent TB.

Résumé Contexte: Le soutien au traitement de la tuberculose (TB) est l'une des stratégies recommandées pour améliorer l'observance du traitement et les résultats. Traitement les supporters courent le risque de contracter la tuberculose et une connaissance adéquate de la tuberculose et de bonnes pratiques préventives sont nécessaires pour leur protection. Objectifs: Cette étude visait à évaluer les connaissances et les pratiques préventives des accompagnants du traitement de la tuberculose au traitement directement observé Centres de formation courte (DOTS) dans la zone de gouvernement local de Lagos Mainland, dans l'État de Lagos, au Nigéria. Réglages et conception : Cette section transversale L'étude a été menée auprès de 196 agents de soutien au traitement de la tuberculose sélectionnés dans cinq centres DOTS à Lagos. Méthodes: Les données ont été obtenues à l'aide de un questionnaire prétesté adapté. Analyse statistique utilisée : Des analyses bivariées et multivariées ont été effectuées pour déterminer les facteurs associés aux pratiques d'autoprotection. Un P < 0.05 était considéré comme statistiquement significatif. Résultats: L'âge moyen des participants était 37.3 ± 12.1 ans. Plus de la moitié des répondants étaient des femmes (59.2 %) et des membres de la famille immédiate (61.3 %). Dans l'ensemble, 22.5 % avaient bonne connaissance de la tuberculose, tandis que 53.0 % avaient des attitudes positives à l'égard de la tuberculose. Seuls 26.0% se sont protégés de manière adéquate contre l'infection. Les le niveau d'instruction de l'aidant (P = 0.001) et sa relation avec le patient (P = 0.001) étaient significativement associés à une bonne prévention. pratiques en analyse bivariée. Ne pas être apparenté au patient était un facteur prédictif de pratiques adéquates de prévention de la tuberculose (rapport de cotes ajusté = 2.852 ; P = 0.006 ; Intervalle de confiance à 95 % = 1.360­5.984). Conclusions: Cette étude a révélé de faibles niveaux de connaissances sur la tuberculose et des pratiques préventives équitables, surtout chez les soignants qui sont des proches. Il est donc nécessaire d'améliorer les connaissances de la population sur la tuberculose et sa prévention et de une orientation plus ciblée des proches qui se portent volontaires pour soutenir le traitement, par le biais d'une éducation à la santé, avec un suivi périodique pendant la cliniquevisites, de la façon dont ils préviennent la tuberculose. Mots-clés: Lagos, Nigéria, soutien au traitement, tuberculose.

Tuberculosis stigma: Assessing tuberculosis knowledge, attitude and preventive practices in surulere, Lagos, Nigeria.

Context: Tuberculosis (TB), though preventable and curable, remains a global health problem, ranked one of the top causes of death worldwide, despite the World Health Organization's strategies. This may be due to the stigma surrounding the disease. Aim: This study assesses TB stigma in light of knowledge, attitudes, and preventive practices among individuals in an urban community. Settings and Design: This was a descriptive, cross-sectional study among 317 residents of Surulere, Lagos, Nigeria, selected by multi-stage sampling. Subjects and Methods: Data were collected using a pretested, semi-structured, interviewer-administered questionnaire and analyzed using Epi InfoTM version 7.2.2.6 2018 (Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA). Statistical Analysis Used: Descriptive variables were summarized as frequencies, and the Chi-square test was used to test the associations. The level of significance was predetermined at P ≤0.05. Results: Most participants were between the age group of 21 and 40 years. Approximately 9 out of every 10 respondents (91.8%) were aware of TB. Overall, only 2.4% of respondents had good knowledge of TB, more than half (59.1%) had positive attitudes toward TB, about one-third (37.1%) had good preventive practices and 22.7% of respondents expressed TB stigma, 63.6% would show no compassion or desire to help people with TB while 64.3% would rather people with TB were never employed. However, good knowledge translated into less stigma (P <0.001). Conclusions: Most participants were aware of TB, although knowledge, attitude, and practice levels were poor. Knowledge was found to reduce TB stigma, reinforcing the need for improved community literacy regrading TB. This has the potential to influence health-seeking behavior and promote better TB prevention, detection, and treatment outcomes.

RésuméContexte: La tuberculose (TB), bien qu'évitable et curable, reste un problème de santé mondial, classé parmi les causes de décès dans le monde, malgré les stratégies de l'Organisation mondiale de la santé. Cela peut être dû à la stigmatisation entourant la maladie. Objectif: Cette étude évalue la stigmatisation de la tuberculose à la lumière des connaissances, des attitudes et des pratiques préventives chez les individus d'une communauté urbaine. Paramètres et conception: il s'agissait d'une étude transversale descriptive menée auprès de 317 résidents de Surulere, Lagos, Nigéria, sélectionnés par échantillonnage. Sujets et méthodes: Les données ont été collectées à l'aide d'un questionnaire pré-testé, semi-structuré et administré par un intervieweur et analysées en utilisant Epi Info 7.1. Analyse statistique utilisée: les variables descriptives ont été résumées sous forme de fréquences, et le test du chi carré a été utilisé pour tester le les associations. Le niveau de signification était prédéterminé à P ≤ 0,05. Résultats: La plupart des participants étaient âgés de 21 à 40 ans. Environ 9 répondants sur 10 (91,8%) étaient au courant de la tuberculose. Dans l'ensemble, seulement 2,4% des répondants avaient une bonne connaissance de la tuberculose, plus de la moitié (59,1%) avaient des attitudes positives à l'égard de la tuberculose, environ un tiers (37,1%) avaient de bonnes pratiques préventives et 22,7% des répondants ont exprimé la tuberculose stigmatisation, 63,6% ne montreraient ni compassion ni désir d'aider les personnes atteintes de tuberculose, tandis que 64,3% préféreraient que les personnes atteintes de tuberculose ne soient jamais employées. Cependant, une bonne connaissance se traduit par moins de stigmatisation (P <0,001). Conclusions: la plupart des participants étaient au courant de la tuberculose, bien que l'attitude et les niveaux de pratique étaient médiocres. On a constaté que les connaissances réduisaient la stigmatisation de la tuberculose, renforçant la nécessité d'améliorer l'alphabétisation communautaire reclassement de la tuberculose. Cela a le potentiel d'influencer les comportements de recherche de santé et de promouvoir une meilleure prévention, détection et traitement de la tuberculose.

Parental willingness to vaccinate adolescent daughters against human papilloma virus for cervical cancer prevention in Western Nigeria.

INTRODUCTION: cervical cancer, which is vaccine preventable, is the commonest gynaecological cancer worldwide. This study aimed to assess parental willingness to vaccinate adolescent girls against human papillomavirus (HPV) for cervical cancer prevention. METHODS: this was a descriptive cross-sectional study among 301 parents of adolescent girls who reside in Surulere Local Government Area in Lagos, Nigeria. A pretested, semi-structured interviewer-administered questionnaire was used to collect data and analysis was done using Epi-info™ version 7. The chi-square (or Fisher's exact) test and the t-test were used to test for associations between categorical and continuous variables respectively. The level of significance was set at 0.05. RESULTS: over half (53.5%) of the respondents had heard of cervical cancer. Of these, two thirds (62.1%) were aware that it could be prevented, 19.0% had good knowledge of cervical cancer prevention, only 4% had their daughters vaccinated though 79.2% were willing to vaccinate. The poor vaccine uptake was mostly due to lack of awareness of vaccination centres and the high cost of the vaccine. Willingness was significantly associated with level of education (p = 0.047) and knowledge of HPV vaccination (p < 0.001), however once aware, most parents were willing to get their daughters vaccinated. CONCLUSION: awareness about cervical cancer prevention was high though uptake was low. A high level of education and good knowledge of cervical cancer prevention were facilitators of willingness to vaccinate, though once aware parents were willing. Creating awareness and educating parents about cervical cancer prevention is essential in improving the uptake of the vaccine.

Tuberculosis preventive practices among treatment supporters in Lagos, Nigeria

Context: Tuberculosis (TB) treatment support is one of the recommended strategies to enhance treatment adherence and outcomes. Treatment supporters are at risk of contracting TB and adequate knowledge of TB and good preventive practices are required for their protection. Aims: This study aimed at assessing the knowledge and preventive practices of TB treatment supporters at Directly Observed Treatment Short-course (DOTS) centers in Lagos Mainland Local Government Area of Lagos state, Nigeria. Settings and design: This cross-sectional study was conducted among 196 TB treatment supporters selected from five DOTS centers in Lagos. Methods: Data were obtained using an adapted pretested questionnaire. Statistical analysis used: Bivariate and multivariate analyses were performed to determine the factors associated with self-protection practices. A P < 0.05 was considered statistically significant. Results: The mean age of the participants was 37.3 ± 12.1 years. More than half of the respondents were females (59.2%) and immediate family members (61.3%). Overall, 22.5% had good knowledge of TB, while 53.0% had positive attitudes toward TB. Only 26.0% adequately protected themselves from infection. The caregiver's level of education (P = 0.001) and their relationship to the patient (P = 0.001) were significantly associated with good preventive practices in bivariate analysis. Not being related to the patient was a predictor of adequate TB prevention practices (adjusted odds ratio = 2.852; P = 0.006; 95% confidence interval = 1.360-5.984). Conclusions: This study revealed low levels of TB knowledge and fair preventive practices, especially among caregivers who are relatives. There is, therefore, a need to improve population literacy about TB and its prevention and a more focused orientation of relatives who volunteer as treatment supporters, through health education, with periodic monitoring during clinic visits, of how they prevent TB.