Acceptability and Outcome of Cervical Cytology in Postnatal Women and Other Nonpregnant Women in Enugu, Nigeria: A Cross-sectional Study

Introduction: Cervical cancer is a leading cause of cancer-related mortality in Sub-Saharan Africa. Although the disease is largely preventable via routine cervical cancer screening, the uptake is ridiculously poor in the sub-region. In Nigeria, current efforts are directed at counselling and screening of eligible women in health care facilities. Therefore, the routine post-natal clinic visit at six weeks postpartum provides a good opportunity to offer cervical cancer screening services. Aim: To compare the acceptability of Pap-test and prevalence of abnormal cervical cytology between post-natal clinic attendees and other non-pregnant women at the University of Nigeria Teaching Hospital Enugu, Nigeria. Materials and Methods: A cross-sectional analytical study was conducted from January to November 2014 in which acceptability and Pap-test results of 172 women attending the post-natal clinic were compared with an equal number of non-pregnant women from gynaecology and family planning clinics of the hospital. Both groups were selected by systematic sampling method. Outcome measures for each group included the prevalence of abnormal Pap-test and the proportion of women that accepted the Pap-test after appropriate cervical cancer education. Statistical analyses were both descriptive and inferential at 95% confidence level. Results: Prior to the study, 44.2% (76/172) of participants in postpartum group, and 47.7% (82/172) in control group were aware of Pap-test (p=0.473); while 9.3% (16/172) and 10.5% (18/172) had used Pap-test in the two groups respectively (p=0.718). All participants in each group accepted the Pap-test after cervical cancer education. Prevalence of cervical Squamous Intraepithelial Lesion (SIL) in the postpartum group was similar to that of the control group (OR: 1.8; 95%CI: 0.75-4.10; p=0.21). The most common SIL in both groups was low-grade squamous intraepithelial lesion. There was no statistically significant difference in the distribution of SIL categories (p>0.05). Conclusion: Acceptability and outcome of Pap-test are similar in post-natal and non-pregnant women in Enugu, Nigeria. Post-natal clinic visit provides an effective opportunity for routine cervical cancer information and screening in Nigeria.