Sexual Reproductive Health and Rights Repository (Aga Khan University)
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Development and validation of the self-efficacy in addressing menstrual needs scale (samns-26) in Bangladeshi schools: a measure of girls' menstrual care confidence
Get PDFObjective: Qualitative studies have described girls' varying levels of confidence in managing their menstruation, with greater confidence hypothesized to positively impact health, education, and social participation outcomes. Yet, measurement of this and other psychosocial components of adolescent girls' menstrual experiences has been weak in global health research, in part due to a dearth of appropriate psychometric tools. We describe the development and validation of the Self-Efficacy in Addressing Menstrual Needs Scale (SAMNS-26).
Methods: We conducted nine focus group discussions with girls in schools in rural and urban Bangladesh to identify tasks involved in menstrual self-care. This informed our creation of an initial pool of 50 items, which were reviewed by menstrual health experts and refined through 21 cognitive interviews with schoolgirls. Using a self-administered survey, we administered 34 refined items plus additional validation measures to a random sample of 381 post-menarcheal girls (ages 9-17) and retested a subsample of 42 girls two weeks later. We examined the measure's dimensionality using exploratory factor analysis and assessed internal consistency, temporal stability, and construct validity.
Results: Exploratory factor analysis suggested a 26-item scale comprising three correlated sub-scales: the 17-item Menstrual Hygiene Preparation and Maintenance (α = 0.86), the 5-item Menstrual Pain Management (α = 0.87), and the 4-item Executing Stigmatized Tasks (α = 0.77). Sub-scales exhibited good temporal stability. SAMNS-26 scores correlated negatively with measures of anxiety, and girls who preferred to stay at home during their periods had lower SAMNS-26 scores than those who did not.
Conclusion: The SAMNS-26 provides a reliable measure of a schoolgirl's confidence in her capabilities to address her menstrual needs. There is initial evidence to support the measure's construct validity in the Bangladesh context as indicated by its relationships with other factors in its theorized nomological network. The tool enables incorporation of self-efficacy into multivariate models for exploring the relationships among antecedents to menstrual experiences and hypothesized impacts on health, wellbeing, and education attainment. Further testing of the tool is recommended to strengthen evidence of its validity in additional contexts
Ten-year trend in emergency department visits for sexually transmitted infections among adolescents: a retrospective cross-sectional study in Italy
Get PDFSexually transmitted infections (STIs) are frequently underdiagnosed, representing a serious public health concern, especially during adolescence and in more vulnerable communities. Aim: to describe the last ten years of emergency department (ED) visits for STIs among adolescents. Methods: a retrospective cross-sectional observation was carried out in the Piedmont region in Italy. Data were retrieved through the Italian National Information System database. ED visits related to specific ICD-9-CM codes carried out on 11 to 19-year-old youths between 2011 and 2020 were investigated. Age-specific, crude, and standardized rates and admission ratios, with 95% confidence intervals (CIs), were calculated to estimate the STI trend. Results: from a total of 1,219,075 ED visits, 339 were related to STIs, representing an increasing ratio of 28 per 100,000 visits, primarily in females. Most infections occurred in girls (83.5%) and among 17 to 19-year-olds (71.5%). A drop in both ED visits and STI cases was observed in 2020. Genital Herpes and Genital Warts were more frequent in girls while Gonorrhea was more frequent in boys. Conclusions: the increasing trend of ED visits for STIs, particularly in girls, represents an emerging relevant public health issue that needs to be urgently tackled
Utilization of cervical cancer screening and factors associated with screening utilization among women aged 30–49 years in Mertule Mariam town, east Gojjam zone, Ethiopia, in 2021: a cross-sectional survey
Get PDFObjective:
To assess the practice of cervical cancer screening and its associated factors among women aged 30–49 years.
Design:
Community-based cross-sectional survey.
Setting:
Mertule Mariam Town, Northwest Ethiopia, 1 May–20 June 2021.
Participants:
Women aged 30–49 years who were living in the study area were eligible for inclusion. A systematic random sampling technique was used to select study participants. A total of 488 respondents participated in the study. Data were collected by using interviewer-administered structured questionnaires. Data were entered into EpiData V.3.1 and then exported to SPSS V.25 for analysis. Bivariable and multivariable logistic regression analyses were done.
Outcome measures:
Prevalence of cervical cancer screening and factors associated with screening utilisation.
Results:
The prevalence of cervical cancer screening was found to be 14.1%. Age (≤16 years) at first sexual intercourse (adjusted OR 14.89, 95% CI 6.21 to 35.74), history of sexually transmitted disease (11.65, 4.56 to 29.78), having multiple sexual partners (11.65, 4.56 to 29.78), having good knowledge about cervical cancer screening (4.72, 2.33 to 9.56) and having a family history of cervical cancer (4.72, 2.33 to 9.56) were statistically significantly associated factors for utilisation of cervical cancer screening.
Conclusion:
Utilisation of cervical cancer screening was low in Northwest Ethiopia. Educational status, age at first sexual intercourse, history of multiple sexual partners, sexually transmitted disease, family history of cervical cancer and knowledge about cervical cancer screening were significant factors for utilisation of cervical cancer screening
Methodological and ethical implications of using remote data collection tools to measure sexual and reproductive health and gender-based violence outcomes among women and girls in humanitarian and fragile settings: a mixed methods systematic review of peer-reviewed research
Get PDFPurpose: This systematic review investigates the methodological and ethical implications of using remote data collection tools to measure sexual/reproductive health (SRH) and gender-based violence (GBV) outcomes among women and girls in humanitarian and fragile settings. Methods: We included empirical studies of all design types that collected any self-reported primary data related to SRH/GBV using information and communication technology, in the absence of in-person interactions, from women and girls in humanitarian and fragile settings. The search was run in March 2021 without filters or limits in Ovid Medline, Embase, Web of Science, Clinicaltrials.gov, and Scopus. Quality was assessed using an adapted version of the MMAT tool. Two reviewers independently determined whether each full text source met the eligibility criteria, and conflicts were resolved through consensus. A-priori extraction fields concerned methodological rigor and ethical considerations. Results: 21 total studies were included. The majority of studies were quantitative descriptive, aiming to ascertain prevalence. Telephone interviews, online surveys, and mobile applications, SMS surveys, and online discussion forums were used as remote data collection tools. Key methodological considerations included the overuse of non-probability samples, lack of a defined sampling frame, the introduction of bias by making eligibility contingent on owning/accessing technology, and the lack of qualitative probing. Ethical consideration pertained to including persons with low literacy, participant safety, use of referral services, and the gender digital divide. Conclusion: Findings are intended to guide SRH/GBV researchers and academics in critically assessing methodological and ethical implications of using remote data collection tools to measure SRH and GBV in humanitarian and fragile settings
Comparison of Sexually Transmitted Infections and Adverse Perinatal Outcomes in Underserved Pregnant Patients Before vs During the COVID-19 Pandemic in Texas
Get PDFIntroduction:
Before the COVID-19 pandemic, the US experienced record high rates of many reportable sexually transmitted infections (STI).1 The association between the pandemic and STI rates among pregnant women remains understudied, especially for underserved populations of racial and ethnic minority groups who have disproportionately experienced COVID-19 infection.2 We sought to determine rates of STI and associated adverse perinatal outcomes among underserved pregnant patients before (July 2019 to February 2020) and during the pandemic (March 2020 to April 2021) in a public health system in Southeastern Texas.
Methods:
A retrospective cohort study was performed of pregnant patients between July 2019 and April 2021 within a public health system in Southeastern Texas. The University of Texas Health Science Center-McGovern Medical School institutional review board approved this study with waiver of informed consent granted because it involved materials that had been previously collected. Medical record review was performed for all patients who underwent routine STI screening during pregnancy and delivered during the study period. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline for cohort studies.
Coprimary outcomes included a comparison of rates of individual and composite STI before the pandemic and during the pandemic along with a composite of STI-associated adverse maternal and neonatal outcomes. Rates of STI according to COVID-19 positive status were also calculated. Demographic, obstetric, and neonatal outcomes were recorded, including antenatal STI and COVID-19 infection (eMethods in the Supplement).
The maternal composite included hypertensive disorders, infectious morbidity, emergency postpartum visits, or death. The neonatal composite included neonatal intensive care admission, 5-minute Apgar score less than 7, sepsis, seizures, necrotizing enterocolitis, intraventricular hemorrhage, hydrops fetalis, or death. The χ2 test and multivariable regression were used for analysis. Models were adjusted for insurance, parity, prenatal care, body mass index, and group B Streptococcus status. Statistical significance was set at a 2-sided unpaired P < .05. Data were analyzed using STATA, version 15.0 (StataCorp).
Results:
The study population included 6413 patients (mean [SD] age, 29.2 [6.6] years), of which 87% (5565) had analyzable data. Of these, 2412 patients (43%) delivered before the pandemic and 3153 patients (57%) delivered during the pandemic. There were no significant differences in baseline demographic and obstetrical variables between groups. Seven percent (226 of 5565) tested positive for COVID-19 infection during pregnancy.
There was no increase in composite or individual STI over time, except for syphilis infection, which nearly doubled across periods (prepandemic, 0.9% [22 of 2412] vs postpandemic, 1.5% [48 of 3152]; P < .004) (adjusted relative risk, 1.73; 95% CI, 1.04-2.86) (Table 1). Syphylis infection tripled among individuals with COVID-19 positivity during the pandemic (COVID-19 negativity, 1.3% [39 of 2936] vs COVID-19 positivity, 4.2% [9 of 216]; P < .001) (adjusted relative risk, 2.82; 95% CI, 1.37-5.79) (Table 2).
Between the prepandemic-and during-pandemic periods, there were no differences in the risk of STI-associated composite maternal adverse outcomes (prepandemic, 11.4% [12 of 105] vs postpandemic, 17.9% [29 of 162]; P = .15) (adjusted relative risk, 1.27; 95% CI, 0.67-2.41). There were no differences in the risk of STI-associated composite neonatal adverse outcomes (prepandemic, 14.3% [15 of 105] vs postpandemic,14.5% [23 of 159]; P = .97) (adjusted risk ratio, 1.02; 95% CI, 0.54-1.93)
The perceived effects of COVID-19 pandemic on female genital mutilation/cutting and child or forced marriages in Kenya, Uganda, Ethiopia and Senegal
Get PDFBackground:
The effects of COVID-19 on harmful traditional practices such Female Genital Mutilation/Cutting (FGM/C) and Child or Forced Marriages (CFM) have not been well documented. We examined respondents’ perceptions on how the COVID-19 pandemic has affected FGM/C and CFM in Kenya, Uganda, Senegal, and Ethiopia.
Methods:
A cross-sectional study design with a mixed methods approach was used. Data collection on participants’ perceptions on the effects of COVID-19 on FGM/C and CFM took place between October-December 2020. Household surveys targeting women and men aged 15–49 years in Kenya (n = 312), Uganda (n = 278), Ethiopia (n = 251), and Senegal (n = 208) were conducted. Thirty-eight key informant interviews with programme implementers and policymakers were carried out in Kenya (n = 17), Uganda (n = 9), Ethiopia (n = 8), and Senegal (n = 4).
Results:
In Kenya, the COVID-19 pandemic has contributed to the increase in both FGM/C and CFM cases. Minimal increase of FGM/C cases was reported in Uganda and a significant increase in CFM cases. In Ethiopia, the COVID-19 pandemic had a limited perceived effect on changes in FGM/C and CFM. In Senegal, there were minimal perceived effects of COVID-19 on the number of FGM/C and CFM cases. The pandemic negatively affected implementation of interventions by the justice and legal system, the health system, and civil societies.
Conclusions:
The pandemic has had varied perceived effects on FGM/C and CFM across the four countries. Generally, the pandemic has negatively affected implementation of interventions by the various sectors that are responsible for preventing and responding to FGM/C and CFM. This calls for innovative approaches in intervening in the various communities to ensure that women and girls at risk of FGM/C and CFM or in need of services are reached during the pandemic. Evidence on how effective alternative approaches such as the use of call centres, radio talk shows and the use of local champions as part of risk communication in preventing and responding to FGM/C and CFM amid COVID-19 is urgently required
Eliminating cervical cancer from low- and middle-income countries: an achievable public health goal
Get PDFMental and sexual health perspectives of the international classification of diseases (icd-11) compulsive sexual behavior disorder
Get PDFAfter introduction of compulsive sexual behavior disorder (CSBD) in the ICD-11, many questions regarding etiology, classification and diagnostic criteria remain unanswered, providing rationale for further research. In this commentary, we critically review the ongoing discussion reflected in some relevant articles, and try to point out the risks of oversimplification of the broad clinical phenomenon, as well as attract attention to the neglected aspects, such as psychosexual development, intimacy disorder and the role of sexological expertise in the assessment and treatment of individuals presenting with out-of-control sexual behaviors. We also advocate for multimodal, transtheoretical approach and suggest that CSBD may be reconsidered as a condition related to sexual health
Performance of the human papillomavirus E6/E7 mRNA assay in the primary screening of cervical cancer: opportunistic screening in Fujian, China
Get PDFPurpose:
A high-risk human papillomavirus E6/E7 mRNA (HR-HPV mRNA) assay is widely used in cervical cancer screening in China. However, it is still unclear whether stand-alone HR-HPV mRNA testing is sufficient for primary screening. The purpose of this study was to investigate the feasibility of a stand-alone HR-HPV mRNA assay for primary screening of cervical cancer.
Methods:
Women aged 21 and older were recruited in Fujian Province, China, from January 2020 to January 2022. Cervical exfoliated cells were collected for cervical cytology and HR-HPV mRNA assays, and women with positive results on either assay were referred for colposcopy. The screening effectiveness of the assay was calculated based on the cervical histology. When comparing the efficacy of the different screening strategies, only women aged 25 and older were included.
Results:
A total of 9927 women were recruited. This study identified 217 cases of high-grade squamous intraepithelial disease or worse (HSIL+). The overall age-specific HR-HPV infection rate showed a U-shaped distribution. The sensitivity of the HR-HPV mRNA assay to identify CIN2+ and CIN3+ was 97.2% and 97.9%, respectively, which was significantly higher than that of cytology (82.9% and 88.6%, P<0.001 and 0.002). The sensitivity of the HR-HPV mRNA primary screening strategy to identify CIN2+ and CIN3+ was 92.2% and 94.3%, respectively, which was similar to the co-testing strategy (P=0.336 and 0.394) and higher than the cytology primary screening (P=0.002 and 0.048). In addition, the HR-HPV primary screening strategy had a lower referral rate for colposcopy than cytology primary screening (5.4% vs 6.6%, P<0.001), and the screening cost was lower than co-testing (55,140 per 1000 screened women, P<0.001).
Conclusion:
In conclusion, the detection of CIN2+/CIN3+ by HR-HPV mRNA is both specific and sensitive. It may be suitable for primary screening of cervical cancer in China
Survival outcome of cervical cancer patients treated by image-guided brachytherapy: a ‘real world’ single center experience in Thailand from 2008 to 2018
Get PDFThe objective of our study was to evaluate the survival outcome of cervical cancer patients treated using image-guided brachytherapy (IGBT). From 2008 to 2018, 341 patients with cervical cancer were treated by radical radiotherapy. IGBT (by computed tomography [CT] or transabdominal ultrasound [TAUS]) was used to treat all of these patients. The characteristic data and patient status after treatment were recorded. All data were evaluated for survival outcome analysis. From a total of 341 patients, 295 patients were analyzed and 46 patients were excluded due to data missing in the survival outcomes. At the median follow-up time of 48 months (IQR 30–80 months), The 4-year local control, progression-free survival and overall survival rates were 89.5%, 74.9% and 69.1%, respectively. For overall survival, the size (> 5 cm), pathology (non-SCCA), stage (stage III–IV by FIGO 2009), lymph node (LN) (presented) and overall treatment time (OTT) (> 56 days) showed statistical significance in univariate analysis while non-SCCA pathology, advanced stage, presented LN and longer OTT showed statistical significance in multivariate analysis. In conclusion, our analysis reports a 4-year overall survival rate of 69.1%. Non-SCCA pathology, advanced stage disease, LN presence and longer OTT showed worse prognostic factors in multivariate analysis