Sexual Reproductive Health and Rights Repository (Aga Khan University)
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Knowledge, attitudes and practices of cervical cancer screening among rural women in KwaZulu-Natal, South Africa
Full text linkIntroduction:
cervical cancer continues to be a major cause of morbidity and mortality among women in the developing world. Despite the national cervical cancer screening programme, findings show low levels of knowledge and practices of cervical cancer screening among rural women in South Africa (SA). The purpose of this study was to determine the knowledge, attitudes and practices of cervical cancer screening among rural women in KwaZulu-Natal, SA.
Methods:
an observational cross-sectional study was performed. The study was conducted at three rural clinics. A systematic sampling technique was used to select 283 women, aged 18-65 years. Data were collected using a standardised structured self-administered questionnaire. Data were analysed using descriptive and analytic statistics.
Results:
findings showed a high level of awareness of cervical cancer (93.3%, n=264) and the Pap smear test (95.1%, n=269). Knowledge of cervical cancer-associated factors, symptoms, screening methods and treatment was poor (28.0%, n=79). An overwhelming majority (81.8%, n=231) displayed a positive attitude towards cervical cancer screening. The practice of cervical cancer screening was fairly good (66.8%, n=189). The results showed that socio-demographics were not statistically significantly associated with knowledge of cervical cancer and cervical cancer screening.
Conclusion:
despite the inadequate knowledge of women, attitudes towards cervical cancer and screening were generally positive. Health care practitioners are encouraged to focus not only on creating awareness but also on improving knowledge so as women will not only undergo screening but appreciate the importance of cervical cancer screening
Status quo and problem analysis of cervical cancer screening program in China: based on RE-AIM framework
Full text linkBackground:
An organized cervical cancer screening program is an effective method to prevent and control cervical cancer. This study aims to find barriers and facilitators in the implementation process of National Cervical Cancer Screening Program in Rural Areas (NACCSPRA) in China through program evaluation, and thus propose suggestions for optimization of the program.
Methods:
Through stratified sampling, 8 provinces (autonomous cities/districts) in eastern, southern, western, northern, and central China were selected for evaluation of NACCSPRA based on the RE-AIM framework. We obtained 15 program providers' experience and perspectives through semi-structured interviews. The data was analyzed using a combination of deductive and inductive analysis methods.
Results:
The study found that NACCSPRA mainly serves women with rural household registration or urban minimum living guarantee. Population mobility and certain demographic characteristics such as low education and poor health awareness are common participation barriers, while program publicity acts as a facilitator. A screening program's direct benefit is to promote early detection and treatment of cervical cancer, and its perceived indirect effect is to raise people's health awareness. The proportion of regions adopting the project is relatively high, and factors affecting employees' participation are screening workload, working environment, welfare benefits, degree of preference for grassroots work, and whether the project is included in the performance appraisal; In terms of implementation, there are disparities in screening methods, network informatization levels, and capital investment in various regions. Poor development of screening information system and insufficient screening funds are significant barriers to improvement of project implementation. In contrast, the overall implementation of follow-up is better; related policies issued by the local government and financial subsidies for poor women ensure the maintenance of the project.
Conclusion:
Shortage of funds is an important problem faced by current screening project, which negatively influences upgrade of cervical cancer prevention strategy, implementors' working environment, and impedes improvement of information network. In addition, defects in population coverage, especially in mobile population also deserves attention. The study found barriers and facilitators of NACCSPRA perceived by project providers and provided a theoretical foundation for project optimization
Single nucleotide polymorphisms of EXOC1, BCL2, CCAT2, and CARD8 genes and susceptibility to cervical cancer in the northern Chinese Han population
Full text linkCervical cancer (CC) is one of the main malignant tumors that threaten the health and lives of women around the world, and its morbidity and mortality rate ranks fourth. At present, most studies on the genetic background of CC focus on genetic polymorphisms. Single nucleotide polymorphisms (SNPs) are considered clinically as potential diagnostic and therapeutic biomarkers for a variety of tumors. Therefore, we aimed to explore the association between SNPs in different genes (EXOC1 gene, BCL2 gene, CCAT2 gene and CARD8 gene) and susceptibility to CC. This study is a case-control study based on women in northern Chinese, which included 492 women with CC and 510 healthy women. This study used multiplex PCR combined with next-generation sequencing to genotype the selected SNPs (rs13117307(C/T) in EXOC1 gene, rs2279115(C/A) in BCL2 gene, rs6983267(G/T) in CCAT2 gene and rs7248320(G/A) in CARD8 gene). The results of the study showed that there was no significant association between the four SNPs and the susceptibility to CC. However, in further stratified analysis, we found that rs13117307 and rs2279115 were significantly related to squamous cell carcinoma antigen (SCC-Ag) levels in women with CC, and rs6983267 was significantly related to the menopausal status of women with CC. Specifically, alleles T of rs13117307 and genoytpe AA of rs2279115 when SCC-Ag is greater than 1.5 ng/ml increase the risk of CC. The genotype TG/TG+TT of rs6983267 increases the risk of CC in premenopausal women. In conclusion, although we did not directly find a significant correlation between four SNPs, rs13117307 in EXOC1 gene,rs2279115 in BCL2 gene, rs6983267 in CCAT2 gene and rs7248320 in CARD8 gene, and CC susceptibility, we found that SNPs rs13117307, rs2279115, rs6983267 were associated with the clinical characteristics of several patients' CC patients. Therefore, this study provides us with new ideas for understanding CC and the diagnosis and treatment of CC in the future
Web-based risk prediction tool for an individual's risk of HIV and sexually transmitted infections using machine learning algorithms: development and external validation study
Full text linkBackground:
HIV and sexually transmitted infections (STIs) are major global public health concerns. Over 1 million curable STIs occur every day among people aged 15 years to 49 years worldwide. Insufficient testing or screening substantially impedes the elimination of HIV and STI transmission.
Objective:
The aim of our study was to develop an HIV and STI risk prediction tool using machine learning algorithms.
Methods:
We used clinic consultations that tested for HIV and STIs at the Melbourne Sexual Health Centre between March 2, 2015, and December 31, 2018, as the development data set (training and testing data set). We also used 2 external validation data sets, including data from 2019 as external “validation data 1” and data from January 2020 and January 2021 as external “validation data 2.” We developed 34 machine learning models to assess the risk of acquiring HIV, syphilis, gonorrhea, and chlamydia. We created an online tool to generate an individual’s risk of HIV or an STI.
Results:
The important predictors for HIV and STI risk were gender, age, men who reported having sex with men, number of casual sexual partners, and condom use. Our machine learning–based risk prediction tool, named MySTIRisk, performed at an acceptable or excellent level on testing data sets (area under the curve [AUC] for HIV=0.78; AUC for syphilis=0.84; AUC for gonorrhea=0.78; AUC for chlamydia=0.70) and had stable performance on both external validation data from 2019 (AUC for HIV=0.79; AUC for syphilis=0.85; AUC for gonorrhea=0.81; AUC for chlamydia=0.69) and data from 2020-2021 (AUC for HIV=0.71; AUC for syphilis=0.84; AUC for gonorrhea=0.79; AUC for chlamydia=0.69).
Conclusions:
Our web-based risk prediction tool could accurately predict the risk of HIV and STIs for clinic attendees using simple self-reported questions. MySTIRisk could serve as an HIV and STI screening tool on clinic websites or digital health platforms to encourage individuals at risk of HIV or an STI to be tested or start HIV pre-exposure prophylaxis. The public can use this tool to assess their risk and then decide if they would attend a clinic for testing. Clinicians or public health workers can use this tool to identify high-risk individuals for further interventions
Rural and urban/suburban victim professionals’ perceptions of gender-based violence, victim challenges, and safety advice during the covid-19 pandemic
Full text linkThis study surveyed a national sample of victim service professionals (N = 222) and compared rural versus urban/suburban participants’ perceptions of a variety of issues, such as the impact of the pandemic on gender-based violence victimization and safety advice for isolated victims. Increased interference with victim employment and the abuser monitoring of online activities were reported by participants across all communities. However, urban/suburban participants rated the magnitude of all victim challenges as greater, while more rural participants noted child abuse as a particular problem in their communities. The results highlight the importance of community context for improving coordinated responses to gender-based violence (n = 101)
Impact of COVID-19 on male fertility
Full text linkSince January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.COVID-19, the clinical condition caused by the SARS-CoV-2 virus, has been associated with massive cytokine storm and damage to multiple organ systems. Although evidence for the detection of SARS-CoV-2 virus in the testis remains scarce, testicular damage and dysregulation of gonadotropins associated with inflammation has been reported. Additionally, as a result of the rapidly evolving pandemic, frequently updated medical interventions and public policies leading to delays of care can play a role in fertility. This narrative review aims to summarize the current literature on how COVID-19 may influence male fertility
Unusual peritoneal metastasis of late recurrent uterine cervical cancer: a case report and literature review
Full text linkUterine cervical cancer is one of the most common malignancies of the female genital tract. Most recurrent cases of uterine cervical cancer are diagnosed within two years after primary treatment, and late recurrence after a disease-free interval of more than five years is rare. In addition, peritoneal metastases usually present as multifocal discrete nodules in the peritoneal cavity with nodular or diffuse peritoneal thickening. Herein, we report an extremely rare case of late recurrent cervical cancer peritoneal metastasis with an unusual manifestation of a large, solitary necrotic mass in the right subphrenic space on contrast-enhanced CT
Sexually transmitted infections related care-seeking behavior and associated factors among reproductive age women in East Africa: a multilevel analysis of demographic and health surveys
Full text linkBackground: Sexually transmitted infections are serious global public health issue, and their consequences contribute significantly to population morbidity and mortality, especially in Sub-Saharan Africa. However, there is limited information about the sexually transmitted infections related care-seeking behavior in East Africa. Therefore, this study aimed to assess the pooled prevalence of sexually transmitted infections related care-seeking behavior, and associated factors among reproductive-age women in East Africa using the recent Demographic and Health Survey.
Methods: This study was based on recent Demographic and Health Survey of 8 East African countries from 2008/09 to 2018/2019. A total weighted sample of 12,004 reproductive-age women who reported sexually transmitted infections or symptoms of sexually transmitted infections in the last 12 months wereincluded. A multi-level mixed-effect logistic regression model was used and a P-value of < 0.05 was considered a statistically significant level for identification of individual and community level factors and AOR with a 95% l CI was computed.
Result: The overall prevalence of sexually transmitted infections related care-seeking behavior among reproductive-age women in East African countries was 54.14% [95% CI: 53.25%, 55.03%]. In multilevel analysis: being age 25-34 [AOR = 1.27 95%CI: 1.15-1.41], 35-49 [AOR = 1.26 95%CI: 1.13-1.41], women who attained secondary or above education [AOR = 1.27, 95% CI: 1.09, 1.47], being in rich household [AOR = 1.27, 95% CI 1.14, 1.41], women who were currently pregnant [AOR = 1.29, 95% CI 1.13, 1.47], who had been tested for HIV [AOR = 1.99, 95% CI 1.70, 2.33], women who had one and more than one sexual partner [AOR = 1.18, 95% CI 1.05, 1.34], women who lived in urban area [AOR = 1.16, 95% CI: 1.03, 1.31] and who perceived distance from the health facility was not a big problem was [AOR = 1.13, 95% CI 1.04, 1.23] were significantly associated with sexually transmitted infections related care-seeking behavior.
Conclusion: sexually transmitted infections related care-seeking behavior is relatively low as compared with other studies.. This study revealed that individual-level variables such as women's age, educational status, household wealth index, pregnancy status, ever been tested for HIV, number of sexual partners, and community-level variables such as residence and distance from a health facility were associated with sexually transmitted infections related care-seeking behavior. Therefore, public health interventions targeting uneducated women, poor households, and adolescents, as well as improving counseling and awareness creation during HIV/AIDS testing and Antenatal care visits, are vital to improving sexually transmitted infections care seeking behavior
Rooming-in and breastfeeding duration in first-time mothers in a modern postpartum care center
Full text linkUncertainty concerning the associations between rooming-in and breastfeeding duration remains at postpartum care centers. This cross-sectional study investigated the associations between the rooming-in policy and continual exclusive breastfeeding among first-time mothers at a postpartum center. Of the 160 participants, only 12.5% (n = 20) implemented full rooming-in. At 3-month follow-up, 85% (n = 17) of those individuals were exclusively breastfeeding. At the same time point, no participant practicing partial rooming-in (n = 140) was exclusively breastfeeding. The generalized estimating equation analysis indicated that full (24 h) rooming-in was statistically associated with continual exclusive breastfeeding 1 month postpartum (odds ratio (OR) = 0.90, p < 0.001) and 3 months postpartum (OR = 0.73, p < 0.001). Significant factors associated with a first-time mother’s willingness to practice full rooming-in included vaginal delivery, a prenatal decision to practice breastfeeding, and undergoing prenatal classes on both rooming-in and breastfeeding. Success with continual exclusive breastfeeding in the postpartum period is dependent on full rooming-in. The findings serve as a reference for promoting exclusive breastfeeding for the first 6 months, as recommended by the World Health Organization
Diet and male fertility: the impact of nutrients and antioxidants on sperm energetic metabolism
Full text linkDiet might affect male reproductive potential, but the biochemical mechanisms involved in the modulation of sperm quality remain poorly understood. While a Western diet is considered a risk factor for male infertility, the Mediterranean diet seems to protect against male infertility; moreover, the role of a vegetarian habitus in the preservation of sperm quality is controversial. The aim of this review is to analyze the molecular effects of single nutrients on sperm quality, focusing on their involvement in biochemical mechanisms related to sperm bioenergetics. It appears that diets rich in saturated fatty acids (SFA) and low in polyunsaturated fatty acids (PUFA) negatively affect sperm quality, whereas unsaturated fatty acids supplementation ameliorates sperm quality. In fact, the administration of PUFA, especially omega-3 PUFA, determined an increase in mitochondrial energetic metabolism and a reduction in oxidative damage. Carbohydrates and proteins are also nutritional modulators of oxidative stress and testosterone levels, which are strictly linked to sperm mitochondrial function, a key element for sperm quality. Moreover, many dietary natural polyphenols differentially affect (positively or negatively) the mitochondrial function, depending on their concentration. We believe that an understanding of the biochemical mechanisms responsible for sperm quality will lead to more targeted and effective therapeutics for male infertility