Outcomes from integrating anti-cervical cancer teachings into the curriculum of high schools in a South-Eastern Nigerian State.

BACKGROUND: Quests for the global elimination of cervical cancer and its related SDG goals by 2030 are achievable if realistic approaches for improving outcomes in LMICs are entrenched. Targeting teenage high schoolers in these countries, which largely lack universally-affordable anti-cervical cancer measures, can be a game-changer. This paper evaluates a 2019 Harvard-endorsed measure that integrated relevant teachings into the curricula of some Nigerian high schools, in what was a global-first. METHOD: A 12-month, quasi-experimental (pre-and-post-tests) research that evaluated the impact of the above initiative on three public schools randomly selected from a pool of 261 in South-east Nigeria. The intervention was "exposure" to anti-cervical teachings, which included "repetitions" and "examination/assessments" designed to enhance "engagement". Both genders were among the 2,498 recruited participants. Data collections with questionnaires were at three different intervals over 12 months. RESULTS: At Phase-1 (baseline), there were 1,699 (68.0%) responses, while Phases 2 (one-month post-intervention) and 4 (12-month post-intervention) had 1,797 (71.9%) and 500 (20.0%) responses, respectively. COVID-19 lockdowns washed out Phase-3 (six-month post-intervention). The majority in all groups were aged 15-19 years. Males dominated in phases 1 (55.9%) and 2 (67.3%), and females (65.6%) in Phase 4. Overall, there were increased knowledge on "General Awareness", "HPV Vaccinations", "Risk Factors" and "Symptoms", particularly between Phases 2 and 1. Levels at Phase-4 were higher than at Phase-2, with the exception of "Pap Smears", as knowledge gained in half of its assessing items became negative (reversed) at Phase-4. These observed changes were non-different between gender, age groups, and classes of high schools. Relative to Phase 2, knowledge changes at Phase-4 for questions associated with established myths ("spiritual attacks"; OR 0.39; CI 0.29-0.52 and "enemy poisons"; OR 0.49; CI 0.37-0.65) were reversed, even though they were originally increased significantly between Phases 2 and 1. CONCLUSION: Anti-cervical cancer enlightenment interventions to teenage high school students were largely effective, but appears guaranteed if engagement-enhancing measures are maintained over time. Extra efforts should be put into debunking prevailing myths.

Targeting cervical cancer campaigns on teenage high schoolers in resource-limited economies: lessons from an intervention study of Nigerian senior secondary school girls.

BACKGROUND: Given the dearth of government-sponsored programmes, preventive lifestyles and practices are the realistic hopes for millions of women in developing countries against cervical cancer. Early interventions for teenage high school girls have been advocated recently, but evidence-base for sustainable activities at this demographic is lacking. This article reduces this gap by determining the impact of two cervical cancer education techniques. METHOD: This is a 6-month interventional cohort study of 432 female high school students in South-eastern Nigeria. RESULTS: A total of 317 (73.4%) and 301 (69.7%) valid responses were received from the pre-intervention (16.8 ± 1.5 years) and post-intervention (17.2 ± 1.6 years) surveys, respectively. About 213 (70.8%) were fully engaged with the interventions. Logistic regression revealed that participants who were 'engaged' with the interventions, either through symposium attendance or by reading of the printed handouts, showed significant improvements across multiple cervical cancer parameters regarding knowledge on 'pap smears' (analysed with four items), 'HPV vaccine' (two items) and 'risk factors' (two items). Improvements in Knowledge of 'early symptoms' were not improved, with 'post-coital bleeding' [odds ratio (OR) = 0.95; P = 0.87] and 'being asymptomatic' (OR = 0.69; P = 0.32) remaining statistically similar between the engaged and the unengaged. If 'engagement' with either intervention was disregarded, a chi-square analysis identified no significant improvement in knowledge on any parameter. CONCLUSION: Ensuring 'engagement' with intervention campaigns is vital to achieving effective and sustainable cervical cancer knowledge. Engagement may be achieved by repeating the education activities across all the years/classes that make up high school in each developing country, along with formal examinations at each level.

Knowledge and attitudes about cervical cancer and its prevention among female secondary school students in Nigeria.

OBJECTIVE: To ascertain the level of awareness and attitudes towards cervical cancer among secondary school students in Nigeria. METHOD: Cross-sectional survey of 432 female senior secondary school students in south-eastern Nigeria. RESULTS: A total of 321 (74.3%) responses were valid; 42.7% had heard of cervical cancer, 32.8% of screening, 23.2% of Pap smears and 22.0% of HPV/HPV vaccinations. No widely available reliable source of information exists. General knowledge about Pap smears (41.8%) and HPV (43.1%) was poor, as was specific knowledge about their benefits, timing and frequency, and about HPV vaccinations, but associated attitudes were moderately positive at 60.2% and 65.1%, respectively. Awareness of cervical cancers increases knowledge about when to start screening (OR = 2.30; P = 0.02) and about early symptoms of cervical cancer (OR = 2.56; P = 0.001). CONCLUSION: Overall knowledge of cervical cancer is poor, but attitudes are positive. Awareness campaigns are therefore necessary, and are expected to be effective. Campaigns should target teenage females, and commencing teaching in high schools of developing countries, through materials included in their academic curricula, is recommended.

The Perception of People Living with Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome toward Human Immunodeficiency Virus Infection: A Single-Center Experience.

BACKGROUND: The prevention and control of human immunodeficiency virus (HIV) infection depend on the prevention of new infections as well as treating currently infected individuals. Adequate knowledge of HIV infection among person living with HIV/acquired immunodeficiency syndrome (AIDS) (PLWHA) may be an important tool in reducing spread of the virus. OBJECTIVE: The objective of the study was to evaluate knowledge and attitude of PLWHA on HIV infection. METHODOLOGY: This was a cross-sectional study conducted at the Chukwuemeka Odumegwu Ojukwu Teaching Hospital. Knowledge of infection, spread, control, and effect was sought from HIV-positive respondents using a structured questionnaire. Information about their attitude and beliefs was also obtained. Collected data were analyzed using the Statistical Package for Social Sciences for Windows, Version 21.0. RESULTS: A total of 70 HIV-positive patients, including 23 (32.9%) males and 47 (67.1%) females with a mean age of 37.7 years were participated. The overall knowledge on HIV transmission, clinical effects, complications, and controls was good in 15.7%, average in 72.9%, and poor in 11.4%. Knowledge of means of transmission was appropriate in majority of them. Majority of 66 (94.3%) patients showed a positive attitude to life. CONCLUSION: Most of the HIV-positive patients had average knowledge on HIV, and majority had a positive attitude to life.

Sustainable and cost-effective teenage breast awareness campaigns: Insights from a Nigerian high school intervention study.

BACKGROUND: With limited government-sponsored breast screening programmes in developing countries, breast awareness remains the only realistic survival hope for millions. Poor levels of knowledge and preventive practices remain in these countries, and early enlightenment to empower teenage high school girls has been advocated for, recently. This study evaluates ways to ensure sustainability for such an approach. METHOD: A 6-month longitudinal, interventional cohort study of 432 high school female students in South-eastern Nigeria. The efficacies of a video-assisted face-to-face intervention, as well as the use of printed handouts, were evaluated. RESULTS: A total of 317 (73.4%) and 301 (69.7%) valid responses were received from the pre-intervention (16.8 ± 1.5 years) and post-intervention (17.2 ± 1.6 years) surveys, respectively. Logistic regression revealed that participants who were "engaged" with the campaigns, either through symposium attendance or by reading handouts, showed significant improvements on most aspects of knowledge regarding the cancer's early symptoms and risk factors, as well as breast self-examination (BSE). However, the monthly practice of BSE was not significantly increased (Attendees: OR = 1.44, P = 0.18; Handout-readers: OR = 1.52; P = 0.17). Also, when "engagement" to the respective empowerment activities was disregarded, a chi-squared analysis comparing the pre-intervention and post-intervention groups showed significant improvements on specific knowledge regarding risk factors and early symptoms of breast cancer, as well as BSE techniques and regular monthly practice: χ2 (1, N = 596) = 46.703, P < 0.001. Across multiple parameters, the impact of exclusive face-to-face participation was not different to that from the reading of handouts. CONCLUSION: Face-to-face and handout were both effective and of similar impact. However, sustained impact on monthly BSE is doubtful. To surmount this, strategies to ensure ongoing engagements are vital. Perhaps adjusting existing high school curricula to allow repeated yearly teachings on breast cancer and BSE, along with in-built-in evaluation systems like examinations and quizzes, are ways of ensuring engagement.

HIV prevention cascade theory and its relation to social dimensions of health: a case for Nigeria.

BACKGROUND: Nigeria has the second largest HIV epidemic in the world and one of the highest rates of new infection in sub-Saharan Africa. Within the last three decades, majority of HIV programs in Nigeria were treatment strategies with few prevention approaches. The persistence of HIV prevalence despite the treatment blueprint has led to a concerted call to HIV Prevention Cascade (HPC) theory which ensures continuous sophisticated interrelationship that stretches beyond the biomedical interventions of treatment. To our knowledge, there is no previous review on HPC theory in Nigerian context. OBJECTIVES: The aim of this review was to explore and outline the HIV/AIDS prevention cascade theory in relation to the achievement of the global 90-90-90 target set by the United Nations Programme on HIV and AIDS and suggest possible avenues to maximize on strengths and weaknesses of HPC in Nigeria. METHODS: In this mini-review, the authors utilized standardized search measures in the review of published articles in credible domains across the HPC in PubMed, Research gate, Google Scholar, Mendeley Reference Manager and Cochrane Library from January 1980 to December 2018. Referenced sections of the articles identified were used to hand-search additional references not retrieved by the initial search engines. The authors performed an evaluation of selected studies on three cascade theories: epidemiological, behavioral and social science with an integration of the supply, demand and adherence sides. RESULTS: We included nine review articles reporting three different cascade theories. Only one included study applied the cascade theories exclusively in Nigerian context. We could only conduct narrative synthesis. CONCLUSION: There is scarceness of currently published evidence on HPC in Nigerian context. HPC allows for a paradigm shift and sequential process of events to eliminate the epidemic of HIV using HIV prevention perspectives in Nigerian settings. Since data are sparse, more research is needed on HPC theory.