Sexual Reproductive Health and Rights Repository (Aga Khan University)
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Explaining socioeconomic inequality in cervical cancer screening uptake in Malawi
Get PDFBackground:
Cervical cancer is a prevalent public health concern and is among the leading causes of death among women globally. Malawi has the second highest cervical cancer prevalence and burden in the world. Due to the cervical cancer burden, the Malawi government scaled up national cancer screening services in 2011, which are free for all women. This paper is the first study to examine the socioeconomic inequality in cervical cancer screening uptake using concentration indices, in Malawi. Furthermore, it decomposes the concentration index to examine how each factor contributes to the level of inequality in the uptake of cervical cancer screening.
Methods:
The data used in this paper were obtained from the nationally representative Malawi Population HIV Impact Assessment (MPHIA) household survey, which was conducted in 2015. Concentration curves were constructed to explore whether there was any socioeconomic inequality in cervical cancer screening and, if so, its extent. This was complemented by concentration indices that were computed to quantify the magnitude of socioeconomic inequality. A decomposition analysis was then conducted to examine the factors that explained/were associated with greater socioeconomic inequality in cervical cancer screening. The methodology in this paper followed that of previous studies found in the literature and used the wealth index to measure socioeconomic status.
Results:
The results showed that the concentration curves lay above the line of equality, implying a pro-rich inequality in cervical cancer screening services. Confirming the results from the concentration curves, the overall concentration index was positive and significant (0.142; %95 CI = 0.127, 0.156; p < 0.01). The magnitude was lower in rural areas (0.075; %95CI = 0.059, 0.090; p < 0.01) than in urban areas (0.195; %95CI = 0.162, 0.228 p < 0.001). After undertaking a decomposition of the concentration index, we found that age, education, rural or urban location, and wealth status account for more than 95% of the socioeconomic inequality in cervical cancer uptake.
Conclusion:
Despite the national scale-up of free cancer care at the point of use, cervical cancer screening uptake in Malawi remains pro rich. There is a need to implement parallel demand-side approaches to encourage uptake among poorer groups. These may include self-testing and mobile screening centres, among others
Person-centered care during childbirth and associated factors among mothers who gave birth at health facilities in Hawassa city administration Sidama Region, Southern Ethiopia
Get PDFIntroduction:
Person-centered care is a pivotal component of strategies to improve the utilization of maternity care during childbirth. However, there is limited information on the level of person-centered care during childbirth in Ethiopia. Therefore, this study aimed to assess the level of person-centered care during childbirth and associated factors in Hawassa city administration health facilities Sidama region, Ethiopia.
Method:
Institutional based cross-sectional study was conducted among randomly selected health facilities in Hawassa city administration from September 5 to October 30, 2021. A multistage sampling technique was employed to enroll the study participants. Data were collected through face-to-face interviews using a structured questionnaire. After data collection, it was checked for completeness and consistencies then coded and entered into Epi data version 4.4.2 and exported to SPSS version 25 for analysis. Descriptive statistics were generated to describe the study findings. Then simple and multivariable linear regressions were computed. All predictor variables with P-value ≤ 0.25 in the simple linear regression were fitted into the multivariable linear regression model and a P < 0.05 was considered statistically significant. Finally, the result of the study was presented in texts, tables, and figures.
Result:
The mean score of person-centered care during childbirth in Hawassa city was 56 with 95% of CI: [55.1, 57] and with SD ± 11.2. Giving birth at private health institutions (β = 4.3, 95% CI: (2.37, 6.22) and childbirth which was attended by a care provider who had provided ANC for mothers initially (β = 5.48, 95% CI: 3.15, 7.81) had significantly higher positive betas on person-centered care during childbirth. However, mothers who didn’t get a formal education (β = -3.00, 95% CI: (-5.27, -.73) and mothers with a dead pregnancy outcome (β = -7.04, 95% CI: -10.4, -3.66) decreases the person-centered care during childbirth.
Conclusion:
This paper showed that person-centered care during childbirth was low compared with other studies. It shall be beneficial if the city administration health facilities implement midwife-led care to improve person-centered care during childbirth
Menstrual and reproductive factors and risk of breast cancer in Iranian female population: a systematic review and meta-analysis
Get PDFBackground:
Breast cancer (BC) is the most frequent cancer in Iranian females. Due to the changes in lifestyle and reproductive risk factors, the BC incidence rate has been rapidly increasing. Knowing risk factors of BC could significantly contribute to improve preventive behaviors. To investigate the relationship between menstrual and reproductive factors and BC in Iranian female population.
Methods:
Web of Science, PubMed, Scopus, and SID as well as references of included studies were searched. Among relevant published observational studies, 27 studies met the inclusion criteria. Pooled risk estimates for the risk factors were determined using random-effects models due to the presence of substantial heterogeneity (P < 0.05).
Results:
All of the selected studies had case–control design. There was a positive relationship between maternal age at first pregnancy and risk of BC (OR = 1.79 95% CI: 1.36–2.35). Also, menopausal status was associated with higher risk of BC (OR = 1.60 95% CI: 1.18–2.17), whereas, there was no association between menarche age and increased risk of BC (OR = 0.55 95% CI: 0.29–1.03). History of abortion (OR = 1.21 95% CI: 0.97–1.5), nulliparity (OR = 1.43 95% CI: 0.89–2.31), and breastfeeding history (OR = 0.68 95% CI: 0.42–1.09) were not associated with BC risk.
Conclusions:
Our findings suggest that age at the first pregnancy and menopausal status were significantly associated with BC risk among Iranian women, whereas menarche age, nulliparity, and history of breastfeeding were not. In regard to the history of abortion, our findings revealed no association with BC, but in high-quality studies, this relationship was significant
Effect of applicator removal from target volume for cervical cancer patients treated with Venezia high-dose-rate brachytherapy applicator
Get PDFPurpose:
The volume of Venezia applicator with vaginal caps can be relatively large compared to target volumes. This study investigated the dosimetric and radiobiological effects of applicator volume removal for cervical cancer patients treated with Venezia (VZ) and tandem and split-ring (TSR) applicators used in the clinic.
Material and methods:
A total of 40 patients (101 plans) with stage IIA-IIIC cervical cancer were retrospectively reviewed. Thirty patients were treated with VZ and ten patients were treated with TSR. Applicators were contoured on planning CTs where target contours were involved. Applicator contours were subtracted from the target contours. External beam radiation therapy (EBRT) and brachytherapy doses were calculated in biologically equivalent doses in 2 Gy fractions (EQD2) and combined using full parameter addition for dose-volume histogram (DVH) parameters of composited dose. D90%, D50%, V100%, V150%, V200%, and tumor control probability (TCP) were evaluated and compared for targets after applicator exclusion.
Results:
The average volume changes in gross tumor volume (GTV), high-risk clinical target volume (HR-CTV), and intermediate-risk clinical target volume (IR-CTV) after VZ applicator exclusion were 1.4 ±1.5 cm3, 15.7 ±6.6 cm3, and 33.8 ±15.1 cm3, respectively. VZ exclusion resulted in significant changes (p < 0.05) in small volume parameters (D50%) and high-dose parameters (V150% and V200%) for HR-CTV and IR-CTV. Dosimetric impact of TSR exclusion on targets was not significant. There was no significant change in TCP after applicator exclusion.
Conclusions:
Venezia applicator with vaginal caps has significant impact on small volume and high-dose DVH parameters of the target. Applicator contour exclusion is recommended for dosimetric evaluation when Venezia applicator is used
Prevalence and associated factors of sexually transmitted infections among methamphetamine users in Eastern China: a cross-sectional study
Get PDFBackground:
The reported incidence of sexually transmitted infections (STIs) in China has been increasing over the last decades, especially among drug users, which has become one of the main burdens of public health in China. This study was conducted to estimate the prevalence and associated factors of STIs among non-injecting methamphetamine (MA) users in Eastern China.
Methods:
A cross-sectional survey was conducted among 632 MA users in Eastern China in 2017. Demographic characteristics, sexual behaviors, behaviors of MA use and sexual health knowledge were collected through questionnaire. First pass urine specimens were collected and detected for deoxyribonucleic acid (DNA) of Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) with Nucleic Acid Amplification Technology (NAAT), while blood specimens were collected and detected for antibodies of Human immunodeficiency virus (HIV), Herpes simplex virus type-2 (HSV-2), and syphilis with enzyme-linked immune sorbent assay (ELISA).
Results:
Among the 632 MA users, 464 (73.42%) were males, 60.92% were < 35 years of age, 546 (86.39%) were Shandong residents. 317 (50.16%, 95% CI 46.26–54.06%) participants were tested positive for at least one kind of STIs, including 242 (38.29%, 95% CI 34.50–42.08%) for HSV-2, 107 (16.93%, 95% CI 14.01–19.85%) for active syphilis, 46 (7.28%, 95% CI 5.25–9.31%) for treated syphilis, 40 (6.33%, 95% CI 4.43–8.23%) for CT, 6 (0.95%, 95% CI 0.19–1.71%) for HIV, and 3 (0.47%, 95% CI 0.06–1.00%) for NG infection. 99 (15.66%, 95% CI 12.83–18.49%) participants were co-infected with two kinds of STIs, including 91 (14.40%, 95% CI 11.66–17.14%) participants were co-infected with HSV-2 and syphilis. 14 (2.22%, 95% CI 1.07–3.37%) participants were co-infected with three kinds of STIs, and 4 HIV positive participants were co-infected with both syphilis and HSV-2. In the multiple logistic regression analysis, the results showed that females (adjusted OR [AOR] = 7.30, 95% CI 4.34–12.30) and individuals ≥ 35 years of age (AOR = 2.97, 95% CI 2.04–4.32) were more likely to test positive for STIs among MA users, whereas participants who acquired sexual health knowledge primarily from the Internet (AOR = 0.57, 95% CI 0.40–0.82) and those whose regular partners did not use drugs (AOR = 0.59, 95% CI 0.37–0.94) were less likely.
Conclusions:
This study found that the prevalence of HSV-2 and syphilis are alarming high among non-injecting MA users in Shandong Province in Eastern China. The prevention and control intervention of STIs among MA users in Shandong were needed, especially on females and MA users ≥ 35 years of age
Cervical Cancer in Women with HIV in Latin America and the Caribbean: Update and Steps Towards Elimination
Get PDFWhose voices matter? using participatory, feminist and anthropological approaches to centre power and positionality in research on gender-based violence in emergencies
Get PDFAn expansive view of 'rigorous' research is needed, particularly when studying complex health and human rights issues in settings where the imbalance of power between research participants, users and producers is heightened. This article examines how applying participatory, feminist and anthropological methods in gender-based violence research can hold researchers accountable to both acknowledging and explicitly addressing these power disparities. Applying these approaches throughout the research process takes time - to build trust and share stories rather than 'extract' data, to engage in collective meaning-making with those whose lived experiences are a form of expertise, and to consider how knowledge is represented and with whom it is shared. We provide examples and reflections from Empowered Aid, participatory action research that examines sexual exploitation and abuse in relation to humanitarian aid distributions, and tests ways for making aid safer. The study is grounded in ethnographic research by Syrian and South Sudanese women and girls living as refugees in Lebanon and Uganda, to safely take an active role in asking and answering questions about their own lives
Genital monkeypox superimposed on co-incident sexually transmitted infections in AIDS patient; a case report
Get PDFMonkeypox outbreaks were, until recently, mostly confined to Africa but a currently expanding worldwide outbreak has recently been designated a global emergency by the World Health Organization. Genital manifestation is common and can be confused with sexually transmitted infection (STI), posing a diagnostic challenge. We herein report a case of genital monkeypox superimposed on multiple co-incident STIs in a HIV patient and describe characteristic clinical findings and management
Tailoring a sexual health curriculum to the sexual health challenges seen by midwifery, nursing and medical providers and students in Tanzania
Get PDFBackground:
Tanzania is a country experiencing multiple sexual health challenges, but providers receive no formal training in sexual health.
Aim:
This study aimed to assess (1) what sexual health challenges are commonly seen in clinics in Tanzania, (2) which are raised by patients, (3) which are not addressed and (4) which topics to prioritise for a sexual health curriculum.
Setting:
Healthcare settings in Tanzania.
Methods:
Participants were 60 experienced and 61 student doctors, nurses and midwives working in Dar es Salaam. The authors conducted 18 focus groups stratified by profession (midwifery, nursing or medicine) and experience (practitioners vs. students).
Results:
Providers identified six common sexual health concerns: (1) Human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) and sexually transmissible infection (STI) (especially syphilis and gonorrhoea), (2) sexual violence (including intimate partner violence and female genital mutilation), (3) early and unwanted pregnancy (including early sexual debut and complications from abortion), (4) sexual dysfunctions, (5) key population concerns (e.g. lesbian, gay, bisexual, transgender (LGBT); sex work) and (6) non-procreative sexual behaviour (including pornography and masturbation in males and oral and anal sex practices in heterosexual couples). Across professions, few differences were observed. Homosexuality, sex work, masturbation and pornography were identified as taboo topics rarely discussed. Most participants (81%) wanted one comprehensive sexual health curriculum delivered across disciplines.
Conclusion:
A sexual health curriculum for health students in Tanzania needs to address the most common sexual health concerns of patients. In addition to teaching sexual science and clinical care, skills training in how to address taboo topics is recommended. Students endorsed almost all sexual health topics, which suggests that a comprehensive curriculum is appropriate
Fighting the odds, catalyzing change
Get PDFThe 2021 annual report of the UNFPA-UNICEF Global Programme to End Child Marriage highlights key accomplishments, lessons learned and priorities for the way forward. In 2021, the following programmatic results were achieved:
Close to 2.6 million adolescent girls (aged 10–19) received life skills and comprehensive sexuality education. This number includes vocational training and start-up capital for small economic investments for some girls across the 12 Global Programme countries.
Close to 16 million community members, including adolescent boys and girls, were engaged in meaningful community dialogues on child marriage, the rights of adolescent girls and gender equality.
Addressing harmful masculinities and gender norms was a key focus for the Programme, with over 1.1 million boys and men engaged in dialogues and education sessions.
Over 55 million individuals were reached by traditional mass media and social media messaging on child marriage, the rights of adolescent girls and gender equality.
Dialogues with traditional and religious leaders and other community influencers was a key Programme approach, with over 163,000 people engaged in meaningful discussions and consensus-building to end child marriage.
Currently, 6,067 service delivery points are receiving Programme support to provide quality adolescent-responsive services that meet minimum standards.
Accompanying the annual report are 12 country profiles, giving more details of the results and strategies employed in each of the countries: Bangladesh, Burkina Faso, Ethiopia, Ghana, India, Mozambique, Nepal, the Niger, Sierra Leone, Uganda, Yemen and Zambia