Maternal mortality and stillbirths remain critical public health issues globally, especially in sub-Saharan Africa. Delays in reaching emergency obstetric care (EmOC) facilities contribute to these poor health outcomes. Geographic information systems have been used as a vital tool in public health for mapping geographical access barriers to health services, yet, translating geographic information systems evidence into clear, actionable policy messages remains challenging. This article presents a theory-driven evaluation of an integrated Knowledge Translation (KT) project in Benin City, Edo State, Nigeria. Using an adapted Armstrong et al. framework, the project embedded geographic information systems evidence on EmOC accessibility into service planning. The KT strategy included four interconnected strategies: training, evidence summaries, tailored support, and targeted communication alongside multi-stakeholder co-design via an Implementation Management Team, aiming to increase capacity for evidence use and foster an organisational culture for sustained application. This KT process successfully catalysed data-driven dialogues, achieving measurable outcomes across multiple levels. The provision of training and evidence summaries resulted in stakeholders reporting increased competence in interpreting spatial data and applying its insights (individual level). Concurrently, the provision of tailored support and targeted communication contributed to organisational level embedding of evidence use and promoted institutional ownership. All four strategies culminated in concrete system-level reforms, including the official implementation of a new EmOC referral policy and the state’s commitment to upgrading Primary Healthcare Centres in hotspot areas and introducing tricycle ambulances. The E4OnTIME model offers a rigorous blueprint for accelerating evidence-informed policy to reduce geographical disparities in maternal and newborn health.

Abstract Background Timely access to comprehensive emergency obstetric care (CEmOC) can be vital for ensuring maternal and newborn survival. However, pregnant women in need of CEmOC may not initially present at a CEmOC facility, thereby necessitating inter-facility referral. We assessed inter-facility travel time between potential referring non-CEmOC facilities and receiving CEmOC facilities in the 15 largest Nigerian cities. Methods Data was sourced from the 2018 Nigeria Health Facility Registry, with additional facilities verified in 2022. We applied Google Maps Platform’s internal Directions Application Programming Interface (API) to derive driving times from each 600m2 S2 cell to their respective nearest CEmOC facilities. Geographic coordinates of non-CEmOC facilities were mapped to S2 cells to retrieve travel time to public CEmOC facilities. Travel times were estimated from each S2 cell to the nearest CEmOC facilities by ownership (public and private) under peak traffic scenario (weekdays 18–20 h) and off-peak traffic scenario (weekends 01–03 h). Based on the shortest inter-facility travel time, each non-CEmOC facility was paired with a public CEmOC facility. Median travel time and percentage of non-CEmOC facilities located > 30 and > 60 min to the nearest public CEmOC facility were estimated. Sensitivity analysis comparing the API’s travel time estimates for randomly-selected 10% of non-CEmOC facilities with those from other methods was conducted. Results Altogether, 4,563 and 1,963 non-CEmOC and CEmOC facilities were included, respectively. Percentage of non-CEmOC facilities located > 30 min to the nearest public CEmOC was highest in Port Harcourt (51%) and lowest in Maiduguri (6%). All non-CEmOC facilities were located ≤ 60 min from the nearest public CEmOC facility in Aba, Owerri, and Ilorin. Median number of non-CEmOC facilities connected to a public CEmOC facility was 27, with five public CEmOC facilities connected to > 100 non-CEmOC facilities. For some non-CEmOC facilities, the nearest public CEmOC facilities are in a contiguous city or state. Conclusions Inter-facility referrals in large Nigerian cities show substantial variation in travel time and uneven referral loads, revealing critical pressure points that may delay timely access to CEmOC. Integrating travel time metrics into maternal health planning is essential for improving the efficiency, equity, and resilience of resource-constrained urban referral systems.

Objective The immediate postpartum period is critical for women and newborns’ health. The COVID-19 pandemic disrupted healthcare to women and newborns. This study assesses change in postpartum length-of-stay during COVID-19 compared to secular trends before the pandemic in 33 countries, and provides a contextual understanding of adaptations made to maternal postpartum length-of-stay during COVID-19 in six comparative country cases. Methods We used an explanatory sequential mixed-methods design: 1) secondary analysis of quantitative longitudinal data from 33 countries, comparing percentage annual change in maternal postpartum length-of-stay before (2010–2019) to percentage change during COVID-19; 2) qualitative consultations with experts from six countries (Belgium, Costa Rica, Malawi, the Netherlands, Nigeria, and Slovakia) providing contextual insights. Results In 27/33 countries, the time women spent in healthcare facilities declined during COVID-19, ranging from −1.7% (-3 hours) in Finland to −17% (-15 hours) in India. In Canada and South Korea, length-of-stay was unchanged, whereas it increased in Nigeria, Mauritania and the Netherlands. These changes resulted from: 1) decisions enabling earlier discharge made by health authorities, healthcare facility managers or healthcare providers, and 2) increase in complexity of case-mix in healthcare facilities, including due to COVID-19 infection among pregnant/postpartum women. Shorter stays were compensated by intensifying pre-discharge education, task-shifting postnatal care to community health-workers, and upscaling midwifery home-visits and telemedicine. Conclusions With or without the pandemic, an overall historical trend of decreasing postpartum length-of-stay exists. In the context of a pandemic, this could have potential implications on quality of care, particularly considering the lack of context-specific evidence informing adaptations.

Background: Perinatal mortality remains unacceptably high in many low-resource settings, with a substantial proportion of these deaths occurring among women presenting with obstetric emergencies. This study assessed the sociodemographic, obstetric and referral predictors of adverse foetal and perinatal outcomes among women managed for obstetric emergencies in Benin City, Edo State, Nigeria. Methods: This cross-sectional study was conducted across the four largest referral hospitals in Benin City using clinical data obtained from women who received EmONC services. Binary logistic regression was applied to assess associations between patient characteristics and outcome. Multivariable logistic regression models were fitted to estimate adjusted odds ratios (AOR) with 95% CIs for the association between explanatory variables and adverse foetal outcomes. To assess potential effect modification, interaction terms were specified between key maternal risk factors (booking status and referral status) and selected EmONC interventions. Results: Among 526 women presenting with obstetric emergencies, 171 (32.6%) experienced adverse perinatal outcomes. The most frequently provided EmONC interventions were caesarean section (70.0%), parenteral antibiotics (66.4%), and uterotonics (41.4%). After controlling for potential confounders, referral status (AOR 2.11; 95% CI: 1.39–3.20) and booking status (AOR 0.25; 95% CI: 0.15–0.44) were strongly associated with adverse outcomes. Interaction analyses assessing modification of the associations between referral or booking status and adverse foetal and perinatal outcomes, showed no significant effects across any of the interventions evaluated. Conclusions: Strengthening antenatal care utilisation and improving the efficiency and coordination of referral pathways for women requiring EmONC are essential for improving perinatal survival.

Introduction In many Nigerian cities, travel to emergency obstetric care (EmOC) remains challenging, and the so-called urban advantage is shrinking. Benin City, Nigeria, has four major referral hospitals providing EmOC, yet maternal mortality remains very high. While facility-based deliveries are common, many women still face significant delays in reaching timely, appropriate care. This study explored women’s and stakeholders’ perspectives on EmOC geographical accessibility in this rapidly urbanising city. Methods This descriptive qualitative study was conducted in four referral hospitals in Benin City, Nigeria. In-depth interviews were conducted with 44 purposively recruited women who had experienced obstetric emergencies, alongside 11 key stakeholders, including health service planners and policymakers. Women were recruited from hospital settings and communities in three local government areas identified as having the poorest geographical access to EmOC. Thematic analysis followed Braun and Clarke’s six-step approach. Results Four themes emerged from our study: 1) travel challenges force some women to use unsafe transport and seek informal care in emergencies, 2) bypassing non-preferred facilities prolonged travel to obstetric care, 3) systemic inefficiencies further complicates EmOC geographical access, and 4) multi-sectoral action needed to improve EmOC geographical access. Women described unsafe roads, lack of transport, and security concerns, particularly at night, leading to delays or resorting to traditional birth attendants. Referral inefficiencies, workforce shortages, and inadequate facility readiness compounded these delays. Participants proposed infrastructure upgrades, birth preparedness, improved insurance coverage, and stronger referral coordination to reduce in-transit delays and ensure equitable access. Discussion Timely access to EmOC in urban settings is undermined by the intersection of spatial inequities, system dysfunction, and unreliable service availability. Addressing these challenges requires integrated infrastructure planning, strengthened referral coordination, and investment in health workforce retention. Without effective implementation of existing policies and targeted support for high-burden areas, maternal health inequities will persist even in urban contexts.

Globally, cervical cancer is one of the most common cancers among females with 604,000 new cases and 342,000 deaths annually. It is a disease of public health importance. Detection of a tumour-specific antigen may be useful in the detection and early management of the disease. The squamous cell carcinoma antigen, a glycoprotein produced in squamous epithelial cells, could serve as a tumour marker in the diagnosis and management of cervical cancer. The aim of this study was to compare the serum levels of squamous cell carcinoma antigen in women with cervical cancer with normal non-cancerous controls and to identify its clinical and sociodemographic correlates. This was a comparative cross-sectional study between women with histologically confirmed squamous cell carcinoma of the cervix and women without cervical cancer at the University of Benin Teaching Hospital in Nigeria. Eighty women were recruited for the study, which consisted of 40 cases of cervical cancer and a comparative group of 40 women without cervical cancer. Levels of squamous cell carcinoma antigen were determined by enzyme-linked immunosorbent assay (ELISA). Data were analysed using the Statistical Package for Social Sciences (SPSS) for Windows, version 27. There was a statistically significant difference in the mean squamous cell carcinoma antigen levels in women with cervical cancer (0.7 ± 0.5 ng/ml) and those without cervical cancer (0.4 ± 0.2 ng/ml) (p = 0.0003). Using a cut-off value of 0.45, the sensitivity of SCCA was 75

11102 Background: Gynecological cancer-related morbidity and the financial burden of care impact the quality of life of patients. However, the health-related quality of life (HRQoL) and experience of financial toxicity (FT) of affected women in sub-Saharan Africa have not been sufficiently explored. This study assessed predictors of HRQoL and FT, and the effect of FT on HRQoL among women with gynecological cancers in Nigeria. Methods: This hospital-based cross-sectional study investigated consenting women with gynecological cancers receiving care at various stages at five academic hospital centers in southern Nigeria, between June 2022 and September 2024. The main outcomes were HRQoL and FT evaluated using the FACT-G and FACIT-COST tools, respectively. Patients' sociodemographic and clinical characteristics were additionally retrieved using a structured questionnaire. Multivariable linear regression models estimated the associations of patient and disease characteristics with HRQoL and FT, and the effect of FT on HRQoL, adjusting for potential confounders. Ethical approval was obtained from all centers. Results: Overall, 574 women were recruited with a mean FACT-G score of 58 (SD ± 15) and a median FACIT-COST score of 16. Of these, 92.8% experienced FT, with 42.6% having moderate-to-severe FT. After multivariable adjustments, HRQoL was significantly poorer among unemployed women (β = -2.4; 95%CI: -4.8, -0.02; p = .048), women with ovarian (β = -3.4; 95%CI: -6.4, -0.4; p = .028) and uterine cancers (β = -3.8; 95%CI: -7.0, -0.6; p = .021) and choriocarcinoma (β = -7.8; 95%CI: -15, -0.2; p = .045), and women with stages II (β = -4.6; 95%CI: -7.7, -1.6; p = .003), III (β = -5.5, 95%CI: -8.9, -2.2; p = .001), and IV disease (β = -4.6; 95%CI: -8.7, -0.4; p = .031). Conversely, patients in remission had significantly better HRQoL (β = 9.3; 95%CI: 5.0, 14; p < .001). FT was worse with stages III (β = -2.2; 95%CI: -4.0, -0.4; p = .016) and IV disease (β = -5.4; 95%CI: -7.6, -3.2; p < .001), and in women on active treatment (β = -2.9; 95%CI: -4.4, -1.3; p < .001). However, older women (β per 10-year increase in age = 0.6; 95%CI: 0.1, 1.1; p = .029), those with health insurance (β = 3.4; 95%CI: 1.4, 5.5; p < .001), higher income (β per 1000 Naira = 0.02; 95%CI: 0.01, 0.03; p = .004), ovarian cancer (β = 1.9; 95%CI: 0.3, 3.6; p = .021) and choriocarcinoma (β = 6.7; 95%CI: 2.6, 11; p = .001) had lower FT. FT scores varied linearly with HRQoL after adjustments, with better HRQoL per unit lower FT (β = 0.46; 95% CI: 0.3, 0.6; p < .001). This effect was more pronounced in women with a first tumor (β = 0.53; 95% CI: 0.4, 0.7; p < .001), those in pre-treatment (β = 0.69; 95% CI: 0.4, 1.02; p < .001) and those in remission (β = 0.69; 95% CI: 0.04, 1.3; p = .037). Conclusions: Our findings identify possible predictors of HRQoL and FT, and suggest potential benefits of reducing FT on the HRQoL of women with gynecological cancers in Nigeria.

Introduction: Endometrial cancer is probably the third commonest gynaecological cancer in sub-Saharan Africa. It occurs more commonly in the post-menopausal women. This research aims to document the clinical profile, histopathological types and survival rate of endometrial cancer patients with a view to improving care in our setting. Materials and methods: This was a retrospective descriptive study of women with endometrial cancer who had surgery from January 1, 2013 to December 31, 2017. Case notes of patients satisfying the inclusion criteria were retrieved and relevant information extracted. The statistical analysis were done using Statistical Package for Social Sciences(SPSS) version 22. Results: Thirty-three cases of endometrial cancer patients were reviewed. The mean age at presentation was 54.3+8years About half of the patients (45.5%) were hypertensive while 21.2% were diabetic. Twenty nine (87.9%) patients presented with abnormal uterine bleeding. All patients had total abdominal hysterectomy with bilateral salpingo-oophorectomy (TAH+BSO). Endometrial adenocarcinoma accounted for the majority of the histopathological type. One year survival following surgery was 97%. Conclusion: When performed for early stage Endometrial cancer, TAH+BSO is associated with a favourable 1 year survival.

Although huge investments have been made to target the leading direct causes of maternal mortality, the default health system configuration in many low-income and middle-income country (LMIC) settings appears to limit the effect of these investments.1Souza JP Day LT Rezende-Gomes AC et al.A global analysis of the determinants of maternal health and transitions in maternal mortality.Lancet Glob Health. 2024; 12: e306-e316Summary Full Text Full Text PDF PubMed Scopus (0) Google Scholar Timely access to lifesaving emergency obstetric care can be affected by inequalities in the geographical distribution of emergency obstetric care facilities, the quality of services, and a paucity of proper transport networks to allow choice of facility in the referral pathway for emergency care. A third of maternal deaths in LMICs are thought to occur as a result of delays experienced while in transit to access emergency obstetric care services.2Tesfay N Tariku R Zenebe A Mohammed F Woldeyohannes F Area of focus to handle delays related to maternal death in Ethiopia.PLoS One. 2022; 17e0274909 Google Scholar, 3Chavane LA Bailey P Loquiha O Dgedge M Aerts M Temmerman M Maternal death and delays in accessing emergency obstetric care in Mozambique.BMC Pregnancy Childbirth. 2018; 18: 71Crossref PubMed Scopus (43) Google Scholar Therefore, detailed exploration of geographical accessibility factors that lead to inequalities in the coverage, access to, and the use of emergency obstetric care services in a high-burden LMIC is necessary. In The Lancet Global Health, Aduragbemi Banke-Thomas and colleagues4Banke-Thomas A Wong KLM Olubodun T et al.Geographical accessibility to functional emergency obstetric care facilities in urban Nigeria using closer-to-reality travel time estimates: a population-based spatial analysis.Lancet Glob Health. 2024; 12: e848-e858Google Scholar assessed the geographical accessibility, based on travel time, of the three nearest functional public and private comprehensive emergency obstetric care facilities for women aged 15–49 years in the 15 largest Nigerian cities. They calculated closer-to-reality travel time estimates relative to traditional model-based approaches, using Google Maps Platform's internal Directions Application Programming Interface, to map geocoded health facilities from both public and private sectors that were known to provide emergency obstetric care services. The median travel time to each facility was identified based on use of motorised transport under eight traffic scenarios covering weekdays and weekends and a range of daily time periods. Their research provides innovative information that will be relevant (eg, within the context of transportation infrastructure) to health system managers and public health practitioners on the dynamics involved in the journey to access emergency obstetric care by pregnant people. In addition, the spatial information provided can be layered onto other variables (eg, population density, poverty distribution, and the existence of informal settlements), which will improve understanding of barriers to the distribution and accessibility of emergency obstetric care across different socioeconomic and ecological strata within urban cities. The calculated median travel time estimates to functional emergency obstetric care facilities, in most of the scenarios they presented, fall within the WHO recommended 2-h intervals for accessing relevant services during obstetric emergencies.5Mubiri P Kajjo D Okuga M et al.Bypassing or successful referral? A population-based study of reasons why women travel far for childbirth in Eastern Uganda.BMC Pregnancy Childbirth. 2020; 20: 497Crossref Scopus (18) Google Scholar, 6Dotse-Gborgbortsi W Dwomoh D Alegana V Hill A Tatem AJ Wright J The influence of distance and quality on utilisation of birthing services at health facilities in Eastern Region, Ghana.BMJ Glob Health. 2020; 4e002020 Crossref PubMed Scopus (31) Google Scholar, 7WHOUNFPAUNICEFAverting Maternal Deaths and DisabilitiesMonitoring emergency 472 obstetric care: a handbook. WHO Press, Geneva, Switzerland2009Google Scholar Despite this apparently sufficient geographical accessibility, Nigeria remains a major contributor to maternal mortality globally, which is somewhat paradoxical.8WHOUNICEFUNFPAWorld Bank GroupUNDPTrends in maternal mortality 2000 to 2020: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. World Health Organization, Geneva2023: 1-86Google Scholar Mixed (ie, public and private) health-care systems exist in many LMIC settings where public and private sector providers coexist and provide care. The disaggregation of the health facilities in this study into either public or private facilities to assess their geographical accessibility reveals that public facilities were more sparsely distributed than private facilities, which limited their accessibility (with particular relevance to those with low incomes). This finding highlights a need for a closer integration of public and private sectors providing health-care services, to enable equitable geographical access to emergency obstetric care services, which is especially relevant in LMICs, where governments have fewer resources for adequate coverage than high-income countries. There is also need for multi-sectoral collaboration for health impact beyond the health system, such as in developing efficient road infrastructure. We recognise that, beyond geographic accessibility, other factors such as socioeconomic considerations influence access to health-care services especially for private health-care facilities where substantial user fees are charged. Therefore, consideration of the perspectives of health-care consumers are important to clearly understand the individual-level factors that influence decision making by pregnant people during emergencies. The information they provide can help to explain why people choose to bypass the nearest functional emergency obstetric care facility for a farther one during obstetric emergencies. The geographical distribution of health facilities clearly influences their accessibility. The use of navigation tools that model for the dynamics associated with the journey of patients to access care can provide more realistic closer-to-reality time estimates than traditional model-based approaches, better informing health system planning. However, these tools still do not adequately capture the complex interactions that occur between public and private health-care facilities when patients migrate their care from public to private, due to varying degrees of service integration. An intersection between the data on geographical accessibility and other determinants of access to health care could provide a more nuanced perspective and will be an interesting area for future research. We declare no competing interests. Geographical accessibility to functional emergency obstetric care facilities in urban Nigeria using closer-to-reality travel time estimates: a population-based spatial analysisBetter access to comprehensive emergency obstetric care is needed in Nigerian cities and solutions need to be tailored to context. The innovative approach used in this study provides more context-specific, finer, and policy-relevant evidence to support targeted efforts aimed at improving comprehensive emergency obstetric care geographical accessibility in urban Africa. Full-Text PDF Open Access

Cervical cancer remains a global public health problem with the annual number of new cases and deaths projected to increase to 700000 and 400,000 in 2030, respectively. Unfortunately, about 85% of woman affected by cervical cancer are young, undereducated and live in the world’s poorest regions like sub-Saharan Africa including Nigeria. Although high income countries (HIC) have reduced morbidity and mortality from cervical cancer by about 80% using cytology (pap smears) for population-based screening cervices in the past 60 years, many low-middle-income-countries (LMIC) in sub-Saharan Africa have not been able to replicate it due to limited resources and challenges with the personnel, laboratory and logistics requirements, competing health needs and the appropriate political commitment. Addressing the barriers to achieving the 90:70:90 targets by 2030 will help the region towards a sustainable pathway to eliminate cervical cancer by 2120.

ObjectiveTo determine the prevalence and factors associated with disrespect and abuse during childbirth among women who delivered in a University Teaching Hospital using a validated tool. MethodsThis was a cross-sectional study conducted at the Department of Obstetrics and Gynecology, University of Benin Teaching Hospital. Participants included women who presented for the 6-week postnatal visit. The primary outcome was the experience of disrespect and abuse by the women in any of the thematic domains in the tool, namely friendly care, abuse-free care, timely care, discrimination-free care, abandonment, and non-consented care. ResultsIn all, 200 participants were enrolled in the study. The prevalence of disrespect and abuse among the study population was 36.5%. Verbal abuse and untimely care were the commonest (15.5%). Nurses were mostly the perpetrators of disrespect and abuse. Maternal age, parity, and marital status among others were not significantly predictive of disrespect and abuse by respondents. ConclusionDisrespect and abuse from health workers during childbirth is a prevalent problem among women who delivered in the hospital. This undesirable experience of childbirth needs to be addressed by stakeholders in maternal health.

IntroductionMost cervical cancer patients in LMICs tend to present at an advanced stage with associated health and psychological difficulties. This can affect their quality of life (QOL). There is limited published data about the QOL of women with cervical cancer in LMICs. AIM: To evaluate the QOL among women newly diagnosed with cervical cancer.MethodsThis was a cross-sectional study of the QOL in women recently diagnosed Cervical Cancer (treatment naïve) using a validated tool, the Quality of Life Questionnaire domains (EORTC QLQ30) administered by trained assistants. The study was conducted from May 2022 to April 2023 in 6 tertiary health facilities, selected by multistage stratified sampling technique in 120 eligible consenting participants. The QOL score was graded into 5 categories: (≤15 - very good,16–30– Good, 31–60– poor, 61–75– very poor, and ≥76– worst). All data were exported into SPSS version 26 for analysis. Ethical approval was obtained.ResultsThe commonest age range (23.33%) was 44–49 years, 64.17% were married and 59.17% had monthly income less than $33.2. Stage 4 (39.83%) and 3 (33.90%) disease were commonest. Most (71.67%) had poor quality of life while 20% had good quality of life. Half of the participants rated their perception of quality of life as poor and very poor (36.67% & 13.33% respectively). Depression(53.3%), difficulty controlling bowel (30%), and painful sex (20.8%) were common complaints.Conclusion/ImplicationsMajority of women newly diagnosed with cervical cancer in Nigeria had poor QOL. This needs to be a consideration when planning their treatment

Introduction/Background Most Cervical Cancer patients in LMICs usually present in advanced stages of the disease which is associated with health and psychological difficulties affecting their quality of life. Methodology A prospective longitudinal study with a two-point assessment of the QOL of participants at the time of diagnosis of cervical cancer and after treatment. Participants were recruited from one randomly selected tertiary-level health facility in each of the six geopolitical zones in Nigeria. The study lasted for twelve months. Newly diagnosed cervical cancer patients were recruited consecutively after informed consent and ethical clearance. QOL was assessed using Quality of Life Questionnaire domains (EORTC QLQ30). The primary outcome was QOL at diagnosis of Cervical cancer and after treatment. The Secondary outcome was the relationship between sociodemographic factors, clinical variables, and QOL. The quality of life were graded into 5(15 & less- very good,16–30 – Good, 31–60 – poor,61 -75 – very poor and 76 & higher – worst) Statistical analysis was done using SPSS 25 Results A total of 157 newly diagnosed Cervical Cancer patients were recruited. While 23(14.6%) participants were lost to follow-up, 134 (85.4%) were utilized for the comparison of QoL between the two periods. The commonest age at presentation was 46-55 years (33.1%). Most patients presented at an advanced stage {stage 3 (51%), stage 2 (29.3%), stage 4 (8.3%]. The majority presented with poor QoL {1.9% (good), 60.5% (poor), 14.6% (very poor), and 15.7% (worst QoL)}. A significant improvement in QoL (p=0.040) was recorded after treatment (5.2% - good, 79.9% - poor, 11.2% - very poor, and only 3.7% recorded worst QoL). Conclusion Quality of life of newly diagnosed cervical cancer patients in Nigeria is poor though treatments improve quality of life in some of the patients. There is a need for more studies, especially in LMICs on the quality of life for gynecological cancer Disclosures The study was funded by Gynecologic Cancer InterGroup (GCIG), Cervical Cancer Research Network (CCRN)

Background: Cervical cancer is the fourth most common cancer among women globally, with quality of life (QOL) being a major concern for patients with cervical cancer, especially in low- and middle-income countries (LMICs). This is largely due to the advanced nature of the disease at presentation. Although there are a higher number of studies focusing on the QOL of high-income countries, the QOL of cervical cancer patients in LMICs is not available. The aim of this study is to evaluate QOL among women with cervical cancer in Nigeria using a 2-point assessment. Methods: A multi-center prospective cohort study will be conducted in 6 tertiary health facilities randomly selected from the 6 geopolitical zones of Nigeria and consisting of a 2-point assessment of the QOL of participants at the time of diagnosis of cervical cancer and after treatment. Women who were recently diagnosed with histologically confirmed cervical cancer (treatment naïve) will be included. QOL will be assessed using Quality of Life Questionnaire domains (EORTC QLQ30) as developed by the European Organization for Research and Treatment of Cancer (EORTC). In addition to the QOL assessment, relevant and clinicopathological variables will be obtained using a self-structured data extraction sheet designed for this study. All data will be anonymized and will be analyzed using SPSS version 25. Levels of QOL will be calculated using EORTC QLQ30. Ethical approval was obtained from National Health Research Ethics Committee (NHREC/01/01/2007-08/11/2021). Discussion: In view of the paucity of data on QOL in LMICs like Nigeria, where most women with cervical cancer present with advanced disease, this research was designed to help in formulating evidence-based interventions to improve the QOL and treatment outcomes provided to women with cervical cancer in Nigeria and other LMICs. The study is expected to fill these knowledge gaps.

Background : Ovarian malignancy is rare in pregnancy and constitutes 3 – 6% of all ovarian tumours associated with pregnancy. It is usually asymptomatic, detected during routine antenatal ultrasound scan. Treatment is mainly surgical. The aim of this report is to share our experience in the management of a referred case of papillary serous cystadenocarcinoma of the ovary disguising as degenerating uterine fibroid in pregnancy. The diagnostic challenges and treatment are highlighted with a view to improving care in our setting. Case presentation: A 29 year old gravida 2 para 1 with one living child was referred to our unit at 25 weeks gestation with complaint of progressive painful abdominal distension with dyspnoea noticed in the index pregnancy. Ultrasound scans were suggestive of uterine fibroid in pregnancy with degenerative changes for which she had conservative management. Due to worsening symptoms, she had laparotomy and a huge ovarian mass was removed alongside the affected ovary. Histology confirmed Serous Papillary Cyst Adenocarcinoma of the ovary. She is doing well on adjuvant chemotherapy. Conclusion: A high index of suspicion for ovarian malignancies in pregnancy, coupled with complementing MRI (when available) with ultrasound to differentiate degenerating uterine fibroids is suggested/recommended.

Context: Premature rupture of membranes (PROM) is a significant event as it may lead to maternal complications, increased operative procedure, neonatal morbidity, and mortality. Aim: To determine the predictors of successful vaginal delivery in pregnant women undergoing stimulation of uterine contractions following premature rupture of membranes (PROM). Settings and Design: This prospective cohort study was conducted at the University of Benin Teaching Hospital, Benin City, Nigeria. Materials and Methods: Seventy-four pregnant women between the gestational ages of 37 weeks and 41 weeks with a live singleton fetus in cephalic presentation and no contraindication to vaginal delivery who had stimulation of uterine contractions following term PROM were included in this study. The main outcome measure was the route of delivery. Statistical Analysis: The analysis was done with IBM statistical package for social science (SPSS) Statistics v21, and a P value ≤0.05 was considered statistically significant. Results: Sixty-two (83.8%) women had a vaginal delivery. The mean age and gestational age were 29.76 ± 3.69 years and 39.04 ± 1.15 weeks, respectively. The chance of vaginal delivery was increased with BMI <30 (RR = 9.091, 95% CI = 1.827–45.246). The duration between rupture of membranes and commencement of stimulation of uterine contractions was ≤8 h (RR = 4.889, 95% CI = 1.307–18.293) also increasing the chance of achieving vaginal delivery. The time interval to 4 cm cervical dilatation ≤4 h (RR = 4.167, 95% CI = 1.141–15.215) and time interval to delivery ≤8 h (RR = 12.222, 95% CI = 2.433–61.402) also favored vaginal delivery. Conclusion: When uterine contractions are stimulated for PROM at term, vaginal delivery is predicted by maternal BMI <30, duration of rupture of membrane ≤ 8 h, and time interval to 4 cm cervical dilatation ≤4 h. Also, it was found was that vaginal delivery becomes less likely when the time interval from stimulation to delivery exceeds 8 h.