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Knowledge of human papillomavirus vaccine as a determinant of uptake among guardians of adolescent girls: A single hospital experience in Nairobi, Kenya
Full text linkAbstract : Cervical cancer is one of the most common preventable cancers, causing significant morbidity and mortality in women, especially in Sub-Saharan Africa. Despite the availability of free HPV vaccination, the proportion of adolescent girls vaccinated against HPV remains low.
Methods: Our aim was to identify knowledge and factors influencing HPV vaccine uptake among parents of adolescent girls and to determine the proportion of adolescent girls vaccinated within three months after the provision of additional information on cervical cancer and HPV vaccine. We undertook a mixed methods study design, with an initial cross-sectional part followed by a prospective cohort study among guardians of adolescent girls aged 9–18 years attending Aga Khan University Hospital Nairobi, Kenya. Guardians of adolescent girls who had not received the HPV vaccine were provided with standardized written information regarding cervical cancer, HPV vaccine availability, and utility. Guardians were then contacted three months later to evaluate subsequent HPV vaccine uptake.
Results: A total of 432 guardians participated in the study. The majority (94.7 %) knew about cervical cancer, 84.9 % of them had heard about the HPV vaccine, and 48 % were aware of the free vaccination campaign. Only 13.2 % (n = 57) of the participants reported that their daughters had been vaccinated prior to this study. Factors associated with vaccine uptake included the level of knowledge (p ≤ 0.001) and the age of the parents (p = 0.030). Reasons commonly cited for not taking the vaccine included lack of information (73 %), lack of awareness (45 %), safety concerns (13 %) and concerns about affordability (7 %). A total of 306 participants were followed up three months later, and 9.2 % (n = 28) of them reported that their daughters had been vaccinated.
Conclusion: The knowledge of the HPV vaccine was good at 67 %. However, uptake of the HPV vaccine was low in this study population despite providing them with additional information about the HPV vaccine. Higher levels of parental knowledge and older age were associated with a greater likelihood of HPV vaccine uptake. Innovative methods to reassure hesitant parents about HPV vaccination for their daughters are urgently needed in the Kenyan general population
Outcomes of pregnant ICU patients with severe covid-19 pneumonia in Qatar during the three waves of the covid-19 pandemic: A retrospective cohort study
Full text linkIntroduction: Pregnant women are considered a high-risk group for COVID-19 infection/pneumonia as they are known to be more vulnerable to viral infections. They require close monitoring and appropriate timely intervention to minimize the impact on both the mother and the fetus. Although the more prevalent Omicron variant led to fewer severe infections and fewer intensive care unit (ICU) admissions globally during the third wave, the effect on pregnant women and pregnancy outcomes was unknown. The vaccination campaign was thoroughly established by the third wave of the pandemic in Qatar. This retrospective descriptive cohort study investigates the characteristics, hospital stay, interventions, vaccination status, and fetal and maternal outcomes of patients admitted to the ICU with severe COVID-19 pneumonia during each of the three COVID-19 waves in Qatar.
Methods: The inclusion criteria were all pregnant patients with a positive polymerase chain reaction antigen test result and/or defined radiological changes at the time of admission that subsequently required admission to the ICU for 24 hours or more. Data were collected from the medical records and chart reviews of patients admitted to Hamad Medical Corporation with COVID-19 pneumonia from March 1, 2020 to February 28, 2022.
Results: The study included a total of 54 pregnant women. In contrast, during the third wave, the number of patients admitted to the ICU was significantly less than in the first wave. The mean gestational age at presentation for each of the three waves was 213.5, 212, and 245 days, respectively. No pregnant women were vaccinated during the first two waves. However, during the third wave, 90.9% of patients admitted to the ICU were vaccinated. The average length of stay in hospital was (mean ± standard deviation) 22.0 ± 27.6, 15.5 ± 7.8, and 5.0 ± 6.3 days for each of the waves, respectively, and the average length of ICU stay was 13.4 ± 20.9, 6.3 ± 5.5, and 3 ± 2.5 days, respectively. The most common chest X-ray finding on admission was bilateral infiltrates. During the third wave, only one patient required a high-flow nasal cannula. As the severity of the disease increased, the patients received more invasive respiratory support and had a higher likelihood of a preterm delivery. Vaccination status correlated with a significantly higher birth weight (mean weight 3.14 kg). However, it was not associated with better maternal outcome.
Conclusion: This extension study of the COVID-19 patients admitted to the ICU in Qatar during all three waves suggests that those admitted to the ICU with COVID-19 pneumonia are more likely to require close monitoring and appropriate interventions to minimize adverse outcomes for both the mother and the fetus. Our data may suggest that vaccination in these patients may contribute to reducing the use of respiratory support modalities for those admitted to the ICU and shortening the length of hospital stay. Overall, there was no statistical significance between vaccination and maternal outcome
Self-inflicted chronic laparoscopic wounds in endometriosis - Unveiling major depressive disorder- A case report.
Full text linkBackground: There is no case in literature reporting an adolescent with endometriosis with major depressive disorder manifesting as chronic laparoscopic wounds. Major depressive disorder in patients with endometriosis is a common occurrence, but self-directed violence is rare.
Case presentation: We present the case of an adolescent female with chronic pelvic pain and who was treated with medical management that proved ineffective. She then underwent laparoscopic excision of endometriosis. Post-surgery she continued to experience oozing of a brown colored discharge from the primary umbilical port site, and it became a chronic non-healing wound with associated pelvic pain. Four months later she underwent re-exploration of the umbilical wound and laparoscopy. Subsequently, she had multiple and frequent hospital visits including ward admissions. The laparoscopic wounds remained as flesh wounds for 11 months despite multidisciplinary treatment, including care from a plastic surgeon. Patient was seen by a psychiatrist and diagnosed with major depressive disorder was made. She was started on antidepressants, and subsequently, the wounds healed.
Conclusion: This case report discussed a young adolescent female who underwent surgical treatment for endometriosis but presented with a cryptic manifestation of major depressive disorder- chronic post laparoscopic wounds. This case illustrates the need for early recognition of non-reproductive complications of endometriosis and timely multidisciplinary involvement
Chest X-ray scoring to screen for chronic pulmonary aspergillosis in patients with a history of pulmonary TB
No full textEditorial: Promoting patient-centered care for pediatric rheumatology across Africa
Full text linkPediatric rheumatology remains an evolving field in Africa, where challenges such as limited specialist availability, diagnostic delays, and inadequate public awareness hinder optimal patient care (1). Similarly, research in this field remains scarce, with a significant lack of data needed to define the spectrum and clinical expression of these diseases. Capturing real-world experiences and field reports is invaluable, as it provides critical insights to identify key areas for action and develop strategies to advance research in Africa. This collection of six manuscripts offers valuable perspectives on various aspects of pediatric rheumatic diseases, including caregiver experiences, diagnostic challenges, therapeutic patient education, and regional advancements in the field. Together, these studies contribute to a more comprehensive understanding of the pediatric rheumatology landscape in Africa and underscore opportunities for progress
Muslim Women in STEM: Stories from the East and West
No full textThis chapter investigates the impact of culture and religion on the experiences of Muslim women students and professionals in STEM. By adopting an intersectional lens, the chapter attempts to unravel the complex relationship between religion and gender equity in STEM, the current state of gender representation in STEM, their identity and the subsequent career trajectories. We aim to contest the dominant view of socio-cultural and political inequalities affecting women in STEM belonging to primarily the West who have more established frameworks for promoting and protecting human rights. We also want to bring in the often-neglected representation of women in STEM from the East especially the Muslim women. In doing so, we foreground intersectionality, a critical element in understanding the nuanced ways in which Muslim STEM women in the West and East function
Racial and ethnic disparities in the prevalence, outcomes, and management of infective endocarditis in the United States
No full textIntroduction; Racial/ethnic differences in the prevalence, outcomes, and management of infective endocarditis (IE) remain unclear.
Methods; We assessed racial/ethnic differences in the prevalence, baseline characteristics, surgical intervention (valve replacement/repair), and clinical outcomes of hospitalizations for IE from 2016 to 2021 using the National Inpatient Sample (NIS). A multivariable regression model was used to adjust for potential confounders.
Results; A total of 78,600 hospitalizations for IE were identified, of which 76.7 % included White race, 10.7 % Black race, 7.7 % Hispanic ethnicity, and 4.9 % from other races/ethnicities. The median age was 51 (Interquartile Range [IQR] 34–67), and 41.1 % were female. Black race, Hispanic ethnicity, and other races/ethnicities were not associated with a significant difference in odds of receiving cardiac valve intervention when compared to White race. Black race (aOR 1.40; CI 1.08–1.80) was associated with higher odds of in-hospital mortality compared to White race. Black race, Hispanic ethnicity, and patients of other races/ethnicities were associated with higher odds of acute kidney injury requiring dialysis compared to White patients. Black race and patients of other races/ethnicities were associated with higher odds of cardiogenic shock when compared to White race. Black race was associated with lower odds of spleen infarction when compared to White patients.
Conclusion; Racial/ethnic disparities exist in the prevalence, outcomes, and management of patients hospitalized for IE in the US. Further studies are warranted to identify the reasons for such disparities and to guide policy initiatives to achieve equity
Community colleges in Pakistan: Promoting access and quality education
Full text linkInspired by the access-driven mission of U.S. community colleges and their success in reaching underserved student populations—especially in rural areas—a network of five institutions, Community Colleges (CCs), was recently established by a public sector university in Sindh, Pakistan, with provincial government support. While these institutions provide educational opportunities at the K-12 level rather than at the postsecondary level and thus differ from community colleges in the U.S. and other countries, Pakistan’s CCs are similar to their global counterparts in that they address issues of access and quality education for marginalized communities, especially in rural contexts; aim to create pathways for students to further education and employment; and are grounded in deep connections and partnerships with the local community.Notably, CCs are managed through university-school-government partnerships, a unique collaborative model that provides multilayered support and could inform similar structures in other country contexts. Using a case study of one of the CCs in Sindh, this article explores CCs’ success in addressing issues of low-quality education and expanding access in rural contexts. We have drawn insightful lessons from the analysis that could be useful for stakeholders within and outside Pakistan