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Ally ZM, Moshi L, Musoke R, Mbwana MS, Bakari HM, Salim SM, Karia LF, Karia MF, Kapola AJ, Manayon GM, Ally HM, Fussi HF, Ramadhani HO. Trend of genital ulcers and discharge and associated factors among survey respondents in Tanzania, 2004-2022: Analysis of demographic health surveys. PLoS One 2025; 20:e0319467. [PMID: 40238802 PMCID: PMC12002491 DOI: 10.1371/journal.pone.0319467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Accepted: 02/03/2025] [Indexed: 04/18/2025] Open
Abstract
INTRODUCTION Sexually transmitted infections (STIs) continue to pose a significant public health challenge worldwide, with over 1 million new cases reported daily. STI's are known to negatively impact sexual and reproductive health, increases risk of HIV transmission and acquisitions, as well as impacting mental health, personal wellbeing, and relationships. Information on the trend of STIs using nationally representative data in Tanzania is lacking. We evaluated trends in the prevalence of genital ulcers and discharge using the 2004, 2010 and 2022 Tanzania Demographic Health Survey (TDHS) data. MATERIALS AND METHODS The TDHS are nationally representative, cross-sectional household surveys that used a two-stage cluster-based sampling design, selecting enumeration areas followed by households. Participants aged 15-49 years who responded to questions on whether they have ever had genital ulcers and/or discharge in the last 12 months prior to the survey were included in this analysis. Survey collected sociodemographic characteristics, HIV testing, STIs symptoms, number of sex partners and recency of sexual activity. We quantified weighted prevalences, and hierarchical mixed effects multilevel logistic regression models that accounted for survey weights, stratification and clustering were used to compute adjusted odds ratios (aOR) and 95% confidence intervals (CI) for factors associated with genital ulcers/discharge. RESULTS Among 46,481 participants with a median age of 27 (interquartile range: 20-36) years, the overall prevalence of genital ulcers/discharge was 6.7%; (4.3% in 2004, 5.0% in 2010 and 9.3% in 2022). Generally, there was an increased trend in genital ulcers/discharge with the increase being higher between 2010 and 2022 compared to 2004 and 2010. In the full adjusted model, females (aOR=1.68: 95%CI 1.48-1.90) had higher odds of genital ulcers/discharge. Divorced/separated/widowed, young individuals, being sexually active 4 weeks prior to the survey and higher number of lifetime sex partners were all associated with higher odds of genital ulcers/discharge. CONCLUSIONS There was an increase in the trend of prevalence of genital ulcers/discharge in Tanzania with women and divorced/separated or widowed individuals being disproportionally affected. Identifying reasons for the increase in these STI related symptoms is paramount to strategize and address challenges. Policymakers should prioritize funding for STI diagnostic tools and community education programs. Additionally, healthcare facilities should incorporate routine STI screenings, particularly for high-risk groups like women and those with multiple sexual partners, to curb the rising prevalence.
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Affiliation(s)
| | - Lynn Moshi
- Aga Khan Hospital, Dar es salaam, Tanzania
| | | | | | | | | | | | | | | | | | | | | | - Habib Omari Ramadhani
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
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Fortas C, Harimanana AN, Rasoanandrianina SB, Rasoanaivo TF, Razanadranaivo HL, Mangahasimbola RT, Rasolon DT, Rafetrarivony LF, Rasolofomanana TT, Rabarisoa L, Huynh BT, Randremanana RV, Crucitti T. Sexually transmitted infections and bacterial vaginosis in women of child-bearing age in Antananarivo, Madagascar: prevalence and risk factors from a cross-sectional study. BMC Infect Dis 2025; 25:262. [PMID: 39994573 PMCID: PMC11849146 DOI: 10.1186/s12879-025-10578-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 01/30/2025] [Indexed: 02/26/2025] Open
Abstract
BACKGROUND Recent data on sexually transmitted infections (STIs) and bacterial vaginosis (BV) in the general population of Madagascar is scarce. Our objective is to estimate the Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Trichomonas vaginalis (TV), Mycoplasma genitalium (MG), and BV prevalence among women and to determine associated risk factors. METHODS We recruited women aged 18-45 years consulting at a hospital in Antananarivo in a cross-sectional study. We collected socio-demographic and behavioral data. Vaginal swabs were collected for each individual. STIs were detected by qPCR and BV using the Nugent score. We explored factors associated with having an STI using logistic regressions. RESULTS Of the 501 recruited women, 242 (48%) were married. Only one woman in three ever used condoms. The prevalence of CT was 11.8% (95% Confidence Interval: 9.0, 14.6), NG: 4.2% (2.4, 5.9), TV: 14.8% (11.7, 17.9), MG: 8.2% (5.8, 10.6), and BV: 39.6% (35.3, 43.9). Factors associated with an STI were having sex in exchange for favors (adjusted Odds Ratio (aOR): 4.25, 95%CI: 1.27, 16.6), BV (aOR: 2.14, 95%CI: 1.34, 3.47) or intermediate vaginal microbiota (aOR: 2.10, 95%CI: 1.19, 3.72), and being in a non-marital relationship compared to married (aOR: 1.86, 95%CI: 1.16, 2.98). CONCLUSIONS To address the high prevalence of STIs, prevention programs should target women who are more likely to engage in sex in exchange for favors and empower them with negotiation skills on condom use. Given the elevated prevalence of dysbiosis and its association with STIs, it is crucial to prioritize research efforts toward a comprehensive understanding of this relationship.
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Affiliation(s)
- Camille Fortas
- Unit of epidemiology and modelling of bacterial escape to antimicrobials (EMAE), Institut Pasteur, Université Paris Cité, Paris, France.
- Anti-infective evasion and pharmacoepidemiology team, Université Paris-Saclay, UVSQ, CESP, Inserm, Montigny-le-Bretonneux, France.
| | - Aina Nirina Harimanana
- Unit of Epidemiology and Clinical Research, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | | | | | | | | | - Dimitri Toky Rasolon
- Unit of Epidemiology and Clinical Research, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | | | | | - Laurah Rabarisoa
- Unit of Experimental Bacteriology, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Bich-Tram Huynh
- Unit of epidemiology and modelling of bacterial escape to antimicrobials (EMAE), Institut Pasteur, Université Paris Cité, Paris, France
- Anti-infective evasion and pharmacoepidemiology team, Université Paris-Saclay, UVSQ, CESP, Inserm, Montigny-le-Bretonneux, France
| | | | - Tania Crucitti
- Unit of Experimental Bacteriology, Institut Pasteur de Madagascar, Antananarivo, Madagascar
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Salari N, Olfat N, Ghasemi H, Larti M, Beiromvand M, Mohammadi M. The global prevalence of Chlamydia trachomatis genital infection in pregnant women: a meta-analysis. Arch Gynecol Obstet 2025; 311:529-542. [PMID: 39821423 PMCID: PMC11890251 DOI: 10.1007/s00404-024-07928-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2024] [Accepted: 12/30/2024] [Indexed: 01/19/2025]
Abstract
BACKGROUND Chlamydia trachomatis genital infection is one of the most common sexually transmitted bacterial infections with severe detrimental effects on pregnant women and fetuses. CTGI increases the risk of ectopic pregnancy, exogenous fetal infection, and respiratory complications such as bronchitis and pneumonia. According to the different published reports, this systematic review and meta-analysis study aimed to evaluate the global prevalence of CTGI in pregnant women. METHODS Initial searching was applied using valid databases of PubMed, ScienceDirect, Embase, WoS, Scopus, and Google Scholar using MeSH keywords (by October 2023). Following duplicate detection and data exclusion, the Title and Abstract of other remaining papers were evaluated (primary screening). Full-texts of selected papers were assessed (secondary screening) and eligible studies were included for data extraction (total No of investigated pregnant women and the number of positive cases). The PRISMA approach was used for paper selection, and the quality assessment was determined according to the STROBE checklist. Data meta-analysis, heterogeneity, publication bias, and the factors affecting heterogeneity index were analyzed using CMA software. The findings were presented in the Forest Plot diagram and Static tables. Besides, heterogeneity was analyzed using I2 test and diffusion bias was demonstrated in Funnel Plot. RESULTS Among 1061 selected articles, 44 eligible investigations were enrolled for meta-analysis. The global prevalence of chlamydia trachomatis genital infection (CTGI) was found 8.4% (95% CI 5.8 - 12.1). Meta-regression analysis showed that following the increase in sample size and year of paper publication, the prevalence of Chlamydia trachomatis genital infection in pregnant women decreased significantly (p < 0.05). CONCLUSION The global prevalence of Chlamydia trachomatis genital infection in pregnant women is considerably influenced by some interfering factors including Age, Socioeconomic status, Geographic region, and Individual behaviors. Thus, the implementation of more comprehensive health programs for prevention, screening, and treatment seems necessary, especially for high-risk pregnant cases.
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Affiliation(s)
- Nader Salari
- Department of Biostatistics, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Newsha Olfat
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Hooman Ghasemi
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mozhdeh Larti
- East Midlands Centre for Forensic Mental Health, Nottinghamshire Healthcare NHS Foundation Trust, Arnold Lodge, Leicester, UK
| | - Mahan Beiromvand
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Masoud Mohammadi
- Research Center for Social Determinants of Health, Jahrom University of Medical Sciences, Jahrom, Iran.
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Mukavhanyedzi D, Rukasha I. Sexually transmitted pathogens in asymptomatic women at Rethabile clinic, Limpopo, South Africa. S Afr J Infect Dis 2024; 39:618. [PMID: 39650258 PMCID: PMC11622116 DOI: 10.4102/sajid.v39i1.618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 08/04/2024] [Indexed: 12/11/2024] Open
Abstract
Background Health care for sexually transmitted infections (STIs) is often inadequate, especially for women, because of the asymptomatic nature of many STIs, which can lead to a false sense of health. Thus, there is limited data on the prevalence of STIs in pregnant women in low and middle-income countries. Objectives The study aimed to determine the prevalence of STIs in asymptomatic pregnant women attending antenatal Rethabile Community Health Centre, Limpopo, South Africa. Method A cross-sectional analysis of asymptomatic pregnant women at Rethabile Community Health Centre between March 2023 and November 2023 was conducted to determine the prevalence of seven STIs, detected from self-collected vaginal swab specimens using HAIN fluoroType STI-multiplex Polymerase Chain Reaction (PCR) test for nine targets covering seven major STIs. Results The study found that Ureaplasma urealyticum was the most prevalent pathogen (43%) followed by Chlamydia trachomatis (41%), and Trichomonas vaginalis (10%). The less common pathogens detected were Mycoplasma Genitalium (5%) and Neisseria gonorrhoeae (2%). Conclusion High STI prevalence among asymptomatic pregnant women at Rethabile Community Health Centre necessitates diagnostic screening over syndromic management because of a lack of reporting for symptoms. Contribution The paper examines the epidemiology of STIs in Limpopo, South Africa, focusing on healthy, asymptomatic populations. It emphasises the need for laboratory screening, particularly in pregnant women, over empiric treatment because of high chances of missing infections.
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Affiliation(s)
- Dembe Mukavhanyedzi
- Department of Pathology, Faculty of Health Sciences, School of Medicine, University of Limpopo, Polokwane, South Africa
| | - Ivy Rukasha
- Department of Pathology, Faculty of Health Sciences, School of Medicine, University of Limpopo, Polokwane, South Africa
- Department of Microbiology, National Health Laboratory Service, Polokwane, South Africa
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Klein JMA, Runge I, Pannen AK, Wakuma T, Abera SF, Adissie A, Unverzagt S, Schmitt M, Waterboer T, Höfler D, Thomssen C, Kantelhardt EJ. Prevalence of bacterial vaginosis, sexually transmitted infections and their association with HPV infections in asymptomatic women attending antenatal care in Ethiopia. Ecancermedicalscience 2024; 18:1783. [PMID: 39430093 PMCID: PMC11489113 DOI: 10.3332/ecancer.2024.1783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Indexed: 10/22/2024] Open
Abstract
Sexually transmitted infections (STIs) and human papillomavirus (HPV) infections are common among women of reproductive age and can lead to infertility, adverse pregnancy outcomes, neonatal infections and cervical cancer. In countries with limited medical coverage, untreated infections contribute to high morbidity. This study aimed to expand the current knowledge on the prevalence of bacterial vaginosis (BV) and STIs in pregnant Ethiopian women and assess the association of these conditions with HPV infections. Socio-demographic data and vaginal lavage samples were collected from 779 asymptomatic women aged 18 to 45 years (median age, 25.9 years) attending antenatal care in seven centres across Ethiopia. Multiplex polymerase chain reaction was used to test for BV, Chlamydia trachomatis, Trichomonas vaginalis, Neisseria gonorrhoeae, herpes simplex virus types 1 and 2 (HSV-1/2), Mycoplasma, Ureaplasma, Candida species and HPV. Overall, 26.8% (95% confidence interval (CI): 23.7-29.9) of women tested positive for BV or one of the following STIs: C. trachomatis, T. vaginalis, N. gonorrhoeae, Mycoplasma genitalium, HSV-1/2 or Ureaplasma urealyticum. Additionally, 22.1% tested positive for at least one high-risk HPV type. Chlamydia trachomatis and HSV-2 were significantly more common among women who were positive for HPV and high-risk HPV. This study reveals a high prevalence of asymptomatic pregnant women who are positive for BV, STIs or HPV, putting them at risk of adverse pregnancy outcomes, secondary infertility or cervical cancer in a country with limited medical coverage. Screening and treating these women could be crucial in reducing morbidity.
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Affiliation(s)
- Johanna M. A. Klein
- Department of Gynaecology, Martin Luther University Halle-Wittenberg, Halle (Saale) 06097, Germany
- Global Health Working Group, Martin Luther University Halle-Wittenberg, Halle (Saale) 06097, Germany
| | - Isabel Runge
- Department of Gynaecology, Martin Luther University Halle-Wittenberg, Halle (Saale) 06097, Germany
- Global Health Working Group, Martin Luther University Halle-Wittenberg, Halle (Saale) 06097, Germany
| | - Ann-Katrin Pannen
- Department of Gynaecology, Martin Luther University Halle-Wittenberg, Halle (Saale) 06097, Germany
- Global Health Working Group, Martin Luther University Halle-Wittenberg, Halle (Saale) 06097, Germany
| | - Tariku Wakuma
- Global Health Working Group, Martin Luther University Halle-Wittenberg, Halle (Saale) 06097, Germany
- Aira Hospital, Aira, Ethiopia
| | - Semaw Ferede Abera
- Department of Radiation Oncology, Faculty of Medicine, Martin Luther University Halle-Wittenberg, Halle (Saale) 06097, Germany
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Adamu Adissie
- Global Health Working Group, Martin Luther University Halle-Wittenberg, Halle (Saale) 06097, Germany
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa 1000, Ethiopia
| | - Susanne Unverzagt
- Institute of General Practice and Family Medicine, Center of Health Sciences, Martin Luther University Halle-Wittenberg, Halle (Saale) 06097, Germany
| | - Markus Schmitt
- Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg 69120, Germany
| | - Tim Waterboer
- Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg 69120, Germany
| | - Daniela Höfler
- Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg 69120, Germany
| | - Christoph Thomssen
- Department of Gynaecology, Martin Luther University Halle-Wittenberg, Halle (Saale) 06097, Germany
- Global Health Working Group, Martin Luther University Halle-Wittenberg, Halle (Saale) 06097, Germany
| | - Eva Johanna Kantelhardt
- Department of Gynaecology, Martin Luther University Halle-Wittenberg, Halle (Saale) 06097, Germany
- Global Health Working Group, Martin Luther University Halle-Wittenberg, Halle (Saale) 06097, Germany
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Rucinski KB, Mbita G, Atkins K, Majani E, Komba A, Casalini C, Drake M, Makyao N, Galishi A, Mlawa Y, Wamoyi J, Schwartz S, Baral S, Curran K. Transactional sex and age-disparate sexual partnerships among adolescent girls and young women in Tanzania. FRONTIERS IN REPRODUCTIVE HEALTH 2024; 6:1360339. [PMID: 39055125 PMCID: PMC11269161 DOI: 10.3389/frph.2024.1360339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 05/28/2024] [Indexed: 07/27/2024] Open
Abstract
Introduction Adolescent girls and young women (AGYW) continue to experience a high incidence of HIV in southern and eastern Africa, even in the context of large-scale HIV prevention interventions. In Tanzania, AGYW account for the largest proportion of new infections and have a higher risk of HIV acquisition than males of comparable age. Methods We used routinely collected data from the PEPFAR/USAID-funded Sauti Project, a large combination HIV prevention program, to examine the relationship between transactional sex and sex with older partners among AGYW in Tanzania (2015-2020). Out-of-school AGYW 15-24 years completed a vulnerability index and were tested for HIV. We estimated weighted prevalence ratios (PR) and 95% confidence intervals (CI) for the associations of transactional sex (sex exchanged for money/services/gifts outside of sex work) and sex with older partners (≥5-years older, ≥10-years older) with prevalent HIV. Age cutoffs of 5 and 10 years were used to align partner age differences with age-disparate and intergenerational sex, respectively. We assessed potential synergism between exposures, and subgroup analyses explored associations among girls 15-19. Results Sixty seven thousand three hundred fifty seven AGYW completed the vulnerability index and 14,873 had captured HIV testing records. Median age was 20 years (IQR 18-22). Transactional sex and age-disparate sex were common (35% and 28%, respectively); 13% of AGYW reported both behaviors. HIV prevalence was associated with both transactional sex (PR: 1.28; 95% CI 1.00-1.63) and age-disparate sex (PR:1.26, 95% CI 0.99-1.60). In common referent analysis, transactional sex remained strongly associated with HIV, even in the absence of age-disparate sex (PR 1.41; 95% CI 1.02-1.94). Discussion Evidence of statistical synergism was not present, suggesting both transactional sex and age-disparate sex operate through similar pathways to increase HIV risk. Increased specificity within HIV prevention programs is needed to better meet the sexual and reproductive health needs of AGYW at high risk of HIV in Tanzania, including investment in tailored youth-friendly strategies for AGYW who have been marginalized from the current HIV response.
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Affiliation(s)
- Katherine B. Rucinski
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD, United States
| | - Gaspar Mbita
- Jhpiego, Monrovia, Liberia
- Athena Institute, Vrije Universiteit, Amsterdam, Netherlands
| | - Kaitlyn Atkins
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, United States
| | - Esther Majani
- Embassy of Switzerland in Tanzania, Dar es Salaam, Tanzania
| | | | | | | | | | - Anthony Galishi
- National Malaria Control Program, Ministry of Health, Dodoma, Tanzania
| | | | - Joyce Wamoyi
- National Institute of Medical Research, Mwanza, Tanzania
| | - Sheree Schwartz
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, United States
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, United States
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Mnyippembe A, Sheira LA, McCoy SI, Njau PF, Packel LJ, Hassan K, Solorzano-Barrera C, Maokola W, Kang Dufour MS, Sabasaba A, Liu J. Supporting young women's health through girl-friendly drug vendors in Lake Zone, Tanzania: protocol for the AmbassADDOrs for Health cluster-randomised controlled trial. BMJ Open 2024; 14:e078755. [PMID: 38851225 PMCID: PMC11163605 DOI: 10.1136/bmjopen-2023-078755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 05/15/2024] [Indexed: 06/10/2024] Open
Abstract
INTRODUCTION Adverse sexual and reproductive health (SRH) outcomes, such as unplanned pregnancies and HIV infection, disproportionately affect adolescent girls and young women (AGYW; aged 15-24 years) in east Africa. Increasing uptake of preventive SRH services via innovative, youth-centred interventions is imperative to addressing disparities in SRH outcomes. METHODS AND ANALYSIS From 2018 to 2019, we used human-centred design to co-develop a theoretically driven HIV and pregnancy prevention intervention for AGYW at private drug shops called Accredited Drug Dispensing Outlets (ADDOs) in Tanzania. The result, Malkia Klabu (Queen Club), was a customer loyalty programme designed to strengthen ADDOs' role as SRH providers while encouraging uptake of critical SRH prevention products among AGYW. Malkia Klabu members had access to free contraceptives and oral HIV self-test (HIVST) kits and earned punches on a loyalty card for other shop purchases; punches were redeemable for small prizes. Our pilot among 40 shops showed that intervention ADDOs had higher AGYW patronage and distributed more HIVST kits and contraceptives to AGYW relative to business-as-usual (ie, client purchasing) comparison shops. We will conduct a cluster-randomised controlled trial (c-RCT) among 120-140 ADDOs in 40 health catchment areas in Shinyanga and Mwanza Regions (Lake Zone), Tanzania. ADDO shop recruitment includes a 1-month run-in with a tablet-based electronic inventory management system for tracking shop transactions, followed by enrolment, randomisation and a 24-month trial period. Our c-RCT evaluating the human-centred design-derived intervention will assess population impact on the primary outcomes of HIV diagnoses and antenatal care registrations, measured with routine health facility data. We will also assess secondary outcomes focusing on mechanisms of action, evaluate programme exposure and AGYW behaviour change in interviews with AGYW, and assess shop-level implementation strategies and fidelity. ETHICS AND DISSEMINATION Ethical approval was granted from both the University of California, San Francisco and the Tanzanian National Institute for Medical Research. Study progress and final outcomes will be posted annually to the National Clinical Trials website; study dissemination will occur at conferences, peer-reviewed manuscripts and local convenings of stakeholders. TRIAL REGISTRATION NUMBER NCT05357144.
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Affiliation(s)
- Agatha Mnyippembe
- Health for a Prosperous Nation, Dar es Salaam, United Republic of Tanzania
| | - Lila A Sheira
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
- Institute for Health Aging, Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, San Francisco, California, USA
| | - Sandra I McCoy
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Prosper F Njau
- Ministry of Health and Social Welfare, Dar es Salaam, United Republic of Tanzania
| | - Laura J Packel
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
- Institute for Health Aging, Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, San Francisco, California, USA
| | - Kassim Hassan
- Health for a Prosperous Nation, Dar es Salaam, United Republic of Tanzania
| | - Camila Solorzano-Barrera
- Institute for Health Aging, Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, San Francisco, California, USA
| | - Werner Maokola
- Ministry of Health and Social Welfare, Dar es Salaam, United Republic of Tanzania
| | | | - Amon Sabasaba
- Health for a Prosperous Nation, Dar es Salaam, United Republic of Tanzania
| | - Jenny Liu
- Institute for Health Aging, Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, San Francisco, California, USA
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Ebogo-Belobo JT, Kenmoe S, Mbongue Mikangue CA, Tchatchouang S, Robertine LF, Takuissu GR, Ndzie Ondigui JL, Bowo-Ngandji A, Kenfack-Momo R, Kengne-Ndé C, Mbaga DS, Menkem EZ, Kame-Ngasse GI, Magoudjou-Pekam JN, Kenfack-Zanguim J, Esemu SN, Tagnouokam-Ngoupo PA, Ndip L, Njouom R. Systematic review and meta-analysis of seroprevalence of human immunodeficiency virus serological markers among pregnant women in Africa, 1984-2020. World J Crit Care Med 2023; 12:264-285. [PMID: 38188451 PMCID: PMC10768416 DOI: 10.5492/wjccm.v12.i5.264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 09/19/2023] [Accepted: 11/08/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV) is a major public health concern, particularly in Africa where HIV rates remain substantial. Pregnant women are at an increased risk of acquiring HIV, which has a significant impact on both maternal and child health. AIM To review summarizes HIV seroprevalence among pregnant women in Africa. It also identifies regional and clinical characteristics that contribute to study-specific estimates variation. METHODS The study included pregnant women from any African country or region, irrespective of their symptoms, and any study design conducted in any setting. Using electronic literature searches, articles published until February 2023 were reviewed. The quality of the included studies was evaluated. The DerSimonian and Laird random-effects model was applied to determine HIV pooled seroprevalence among pregnant women in Africa. Subgroup and sensitivity analyses were conducted to identify potential sources of heterogeneity. Heterogeneity was assessed with Cochran's Q test and I2 statistics, and publication bias was assessed with Egger's test. RESULTS A total of 248 studies conducted between 1984 and 2020 were included in the quantitative synthesis (meta-analysis). Out of the total studies, 146 (58.9%) had a low risk of bias and 102 (41.1%) had a moderate risk of bias. No HIV-positive pregnant women died in the included studies. The overall HIV seroprevalence in pregnant women was estimated to be 9.3% [95% confidence interval (CI): 8.3-10.3]. The subgroup analysis showed statistically significant heterogeneity across subgroups (P < 0.001), with the highest seroprevalence observed in Southern Africa (29.4%, 95%CI: 26.5-32.4) and the lowest seroprevalence observed in Northern Africa (0.7%, 95%CI: 0.3-1.3). CONCLUSION The review found that HIV seroprevalence among pregnant women in African countries remains significant, particularly in Southern African countries. This review can inform the development of targeted public health interventions to address high HIV seroprevalence in pregnant women in African countries.
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Affiliation(s)
- Jean Thierry Ebogo-Belobo
- Center for Research in Health and Priority Pathologies, Institute of Medical Research and Medicinal Plants Studies, Yaounde 00237, Cameroon
| | - Sebastien Kenmoe
- Department of Microbiology and Parasitology, University of Buea, Buea 00237, Cameroon
| | | | | | | | - Guy Roussel Takuissu
- Centre for Food, Food Security and Nutrition Research, Institute of Medical Research and Medicinal Plants Studies, Yaounde 00237, Cameroon
| | | | - Arnol Bowo-Ngandji
- Department of Microbiology, The University of Yaounde I, Yaounde 00237, Cameroon
| | - Raoul Kenfack-Momo
- Department of Biochemistry, The University of Yaounde I, Yaounde 00237, Cameroon
| | - Cyprien Kengne-Ndé
- Epidemiological Surveillance, Evaluation and Research Unit, National AIDS Control Committee, Douala 00237, Cameroon
| | - Donatien Serge Mbaga
- Department of Microbiology, The University of Yaounde I, Yaounde 00237, Cameroon
| | | | - Ginette Irma Kame-Ngasse
- Center for Research in Health and Priority Pathologies, Institute of Medical Research and Medicinal Plants Studies, Yaounde 00237, Cameroon
| | | | | | - Seraphine Nkie Esemu
- Department of Microbiology and Parasitology, University of Buea, Buea 00237, Cameroon
| | | | - Lucy Ndip
- Department of Microbiology and Parasitology, University of Buea, Buea 00237, Cameroon
| | - Richard Njouom
- Department of Virology, Centre Pasteur du Cameroun, Yaounde 00237, Cameroon
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9
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Oladele DA, Iwelunmor J, Gbajabiamila T, Obiezu-Umeh C, Okwuzu JO, Nwaozuru U, Musa AZ, Tahlil K, Idigbe I, Ong J, Tang W, Tucker J, Ezechi O. An Unstructured Supplementary Service Data System to Verify HIV Self-Testing Among Nigerian Youths: Mixed Methods Analysis of Usability and Feasibility. JMIR Form Res 2023; 7:e44402. [PMID: 37747780 PMCID: PMC10562967 DOI: 10.2196/44402] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 07/10/2023] [Accepted: 07/17/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND Mobile health (mHealth) interventions among adolescents and young adults (AYAs) are increasingly available in African low- and middle-income countries (LMICs). For example, the unstructured supplementary service data (USSD) could be used to verify HIV self-testing (HIVST) among AYAs with poor bandwidth. OBJECTIVE The aim of this study is to describe the creation of an USSD platform and determine its feasibility and usability to promote the verification of HIVST results among AYAs in Nigeria. METHODS We developed and evaluated a USSD platform to verify HIVST results using a user-centered approach. The USSD platform guided AYAs in performing HIVST, interpreting the result, and providing linkage to care after the test. Following the usability assessment, the USSD platform was piloted. We used a mixed methods study to assess the platform's usability through a process of quantitative heuristic assessment, a qualitative think-aloud method, and an exit interview. Descriptive statistics of quantitative data and inductive thematic analysis of qualitative variables were organized. RESULTS A total of 19 AYAs participated in the usability test, with a median age of 19 (IQR 16-23) years. There were 11 females, 8 males, and 0 nonbinary individuals. All individuals were out-of-school AYAs. Seven of the 10 Nielsen usability heuristics assessed yielded positive results. The participants found the USSD platform easy to use, preferred the simplicity of the system, felt no need for a major improvement in the design of the platform, and were happy the system provided linkage to care following the interpretation of the HIVST results. The pilot field test of the platform enrolled 164 out-of-school AYAs, mostly young girls and women (101, 61.6%). The mean age was 17.5 (SD 3.18) years, and 92.1% (151/164) of the participants reported that they were heterosexual, while 7.9% (13/164) reported that they were gay. All the participants in the pilot study were able to conduct HIVST, interpret their results, and use the linkage to care feature of the USSD platform without any challenge. A total of 7.9% (13/164) of the AYAs had positive HIV results (reactive to the OraQuick kit). CONCLUSIONS This study demonstrated the usability and feasibility of using a USSD system as an alternative to mobile phone apps to verify HIVST results among Nigerian youth without smartphone access. Therefore, the use of a USSD platform has implications for the verification of HIVST in areas with low internet bandwidth. Further pragmatic trials are needed to scale up this approach.
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Affiliation(s)
- David Ayoola Oladele
- Department of Behavioral Science and Health Education, Saint Louis University, Saint Louis, MO, United States
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Juliet Iwelunmor
- Department of Behavioral Science and Health Education, Saint Louis University, Saint Louis, MO, United States
| | - Titilola Gbajabiamila
- Department of Behavioral Science and Health Education, Saint Louis University, Saint Louis, MO, United States
| | - Chisom Obiezu-Umeh
- Department of Behavioral Science and Health Education, Saint Louis University, Saint Louis, MO, United States
| | - Jane Ogoamaka Okwuzu
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Ucheoma Nwaozuru
- Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Adesola Zaidat Musa
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Kadija Tahlil
- Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Ifeoma Idigbe
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Jason Ong
- Melbourne Sexual Health Centre (MSHC), University of Melbourne, Melbourne, Australia
| | - Weiming Tang
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Joseph Tucker
- Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Oliver Ezechi
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria
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10
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Chikwari CD, Simms V, Kranzer K, Dauya E, Bandason T, Tembo M, Mavodza C, Machiha A, Mugurungi O, Musiyandaka P, Mwaturura T, Tshuma N, Bernays S, Mackworth-Young C, Busza J, Francis SC, Hayes RJ, Ferrand RA. Evaluation of a community-based aetiological approach for sexually transmitted infections management for youth in Zimbabwe: intervention findings from the STICH cluster randomised trial. EClinicalMedicine 2023; 62:102125. [PMID: 37593222 PMCID: PMC10430193 DOI: 10.1016/j.eclinm.2023.102125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/02/2023] [Accepted: 07/17/2023] [Indexed: 08/19/2023] Open
Abstract
Background Young people are at high risk of sexually transmitted infections (STIs). We report STI testing uptake, prevalence and incidence within a community-based integrated HIV and sexual and reproductive health service for youth, being evaluated in a cluster randomised trial in Zimbabwe. Methods This paper reports the intervention findings of the cluster randomised trial whereby STI testing was offered to all service attendees (16-24 years) in 12 intervention clusters over 12 months between October 5, 2020, and December 17, 2021, in Zimbabwe. Testing for Chlamydia trachomatis [CT] and Neisseria gonorrhoeae [NG] was offered to males and females with results available in one week and follow-up of test-positive clients by telephone. Trichomonas vaginalis [TV] testing was offered to females only with same day results and treatment. Youth testing positive for any STI were offered partner notification slips and free treatment for partners. This trial was registered with ISRCTN Registry, ISRCTN15013425. Findings Overall, 8549/9891 (86.1%) eligible youth accepted CT/NG testing. Prevalence of CT and NG was 14.7% (95% CI 13.6-15.8) and 2.8% (95% CI 2.2-3.6) respectively. Combined prevalence of CT, NG or TV in women was 23.2% (95% CI 21.5-25.0). After adjusting for cluster, age and sex, the odds of NG were increased in those living with HIV (aOR 3.14, 95% CI 2.21-4.47). The incidence rate among those who initially tested negative for CT or NG was 25.6/100PY (95% CI 20.6-31.8). CT/NG treatment uptake was 924/1526 (60.6%). TV treatment uptake was 483/489 (98.8%). A partner returned for treatment for 103/1807 clients (5.7%). Interpretation Our findings show high acceptability of STI testing among youth. STI prevalence was high particularly among females and youth with HIV, underscoring the need for integration of HIV and STI services. Funding MRC/ESRC/DFID/NIHR (MR/T040327/1) and Wellcome Trust (206316/Z/17/Z).
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Affiliation(s)
- Chido Dziva Chikwari
- MRC International Statistics & Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Victoria Simms
- MRC International Statistics & Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Katharina Kranzer
- Biomedical Research and Training Institute, Harare, Zimbabwe
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Ethel Dauya
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Tsitsi Bandason
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Mandikudza Tembo
- MRC International Statistics & Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
- Biomedical Research and Training Institute, Harare, Zimbabwe
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Constancia Mavodza
- Biomedical Research and Training Institute, Harare, Zimbabwe
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Anna Machiha
- AIDS and TB Unit, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Owen Mugurungi
- AIDS and TB Unit, Ministry of Health and Child Care, Harare, Zimbabwe
| | | | | | | | - Sarah Bernays
- School of Public Health, University of Sydney, Sydney, Australia
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Constance Mackworth-Young
- Biomedical Research and Training Institute, Harare, Zimbabwe
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Joanna Busza
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Suzanna C. Francis
- MRC International Statistics & Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Richard J. Hayes
- MRC International Statistics & Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Rashida A. Ferrand
- Biomedical Research and Training Institute, Harare, Zimbabwe
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
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11
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Kim HY, Rohr J, Leyna GH, Killewo J, Tomita A, Tanser F, Bärnighausen T. High prevalence of self-reported sexually transmitted infections among older adults in Tanzania: results from a list experiment in a population-representative survey. Ann Epidemiol 2023; 84:48-53. [PMID: 37201669 PMCID: PMC10524221 DOI: 10.1016/j.annepidem.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 03/27/2023] [Accepted: 05/02/2023] [Indexed: 05/20/2023]
Abstract
PURPOSE Self-report of sensitive or stigmatized health states is often subject to social desirability and interviewer biases. To reduce such biases, we estimated the rate of sexually transmitted infections (STIs) using a list experiment. METHODS This population-representative study was nested within the Dar es Salaam Urban Cohort Study, a Health and Demographic Surveillance System (HDSS) in the Ukonga ward of Dar es Salaam, Tanzania. Men and women aged ≥40years were randomly assigned to receive a list of either four control items (i.e., the control group) or four control items plus an additional item on having had a disease through sexual contacts in the past 12months (i.e., the treatment group). We calculated the mean difference in the total number of items to which respondents answered "yes" in the treatment versus control group and compared this prevalence estimate to the one measured by the direct question. RESULTS A total of 2310 adults aged ≥40years were enrolled in the study: 32% were male and 48% were aged 40-49years. The estimated prevalence of having STIs in the past 12months was 17.8% (95% confidence interval [CI] 12.3-23.3) in the list experiment, almost 10 times higher than the estimated prevalence of 1.8% (95%CI 1.3-2.4) based on the direct question (P < .001). STI prevalence remained high after adjusting for age, the number of lifetime sex partners, alcohol consumption and smoking in multivariate linear regression (15.6%; 95% CI 7.3-23.9). CONCLUSIONS We found a substantially higher prevalence of STIs among older adults in urban Tanzania when we based our estimation on a list experiment rather than a direct question in a population-representative survey. List experiments should be considered to elimnate social desirability and interviewer biases in surveys of sensitive or stigmatized health states. The very high prevalence of STIs highlights the need for improved access to STI screening, prevention and treatment for older adults in urban Africa.
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Affiliation(s)
- Hae-Young Kim
- Department of Population Health, New York University Grossman School of Medicine, New York; Africa Health Research Institute, Durban, KwaZulu-Natal, South Africa.
| | - Julia Rohr
- Center for Population and Development Studies, Harvard University TH Chan School of Public Health, Cambridge, MA
| | - Germana Henry Leyna
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Japhet Killewo
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Andrew Tomita
- KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), Durban, KwaZulu-Natal, South Africa; Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Frank Tanser
- Centre for Epidemic Response and Innovation, School of Data Science and Computational Thinking, Stellenbosch University, Stellenbosch, South Africa; School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Till Bärnighausen
- Africa Health Research Institute, Durban, KwaZulu-Natal, South Africa; Center for Population and Development Studies, Harvard University TH Chan School of Public Health, Cambridge, MA; Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
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12
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Mcdonald U, Nyawale H, Kajura A, Mujuni F, Chibwe E, Silago V, Msemwa B, Minja CA, Daffa Z, Karim M, Byasharila EC, Chongo AE, Mshana SE, Mirambo MM. High Seropositivity of Markers of Viral Infections among Women with Unfavorable Pregnancy Outcomes in Mwanza, Tanzania: The Urgent Need for Control Interventions. East Afr Health Res J 2023; 7:25-31. [PMID: 37529500 PMCID: PMC10388644 DOI: 10.24248/eahrj.v7i1.705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 04/12/2023] [Indexed: 08/03/2023] Open
Abstract
Background Viral infections such as Human cytomegalovirus (HCMV), Rubella virus (RV) and Herpes simplex virus-2(HSV-2) are implicated in causing adverse pregnancy outcomes with limited data from Africa. Here we report the magnitude of these viruses among women with unfavorable pregnancy outcomes (WUP) in Mwanza, Tanzania. Methods A cross sectional study involving 198 WUP was conducted between March and June 2019 in Mwanza. Enzyme linked immunosorbent assay was used to detect HCMV and RV IgM and IgG antibodies while immunochromatographic test was used to detect HSV-2 IgM and IgG antibodies. Data were analyzed by using STATA version13.0. Results The median age of enrolled women was 28(IQR, 24-34) years. Of these 194(98%) were HCMV IgG seropositive while only 2(2.1%) were IgM seropositive. Out of 180 women tested for RV, 175(96.7%) were IgG seropositive while only 1(1.2%) was RV IgM seropositive. Regarding HSV2; out of the 146 women tested, 21(14.4%) were seropositive for HSV2 IgG, and only 3(2.1%) were HSV-2 IgM seropositive. Having primary education (p=.046) and being married (p=.035) were significantly associated with HSV-2 IgG seropositivity. Conclusion A substantial proportion of WUP have markers of viral infections for potential pathogens that might be associated with unfavorable pregnancy outcomes necessitating further studies to establish causal effect relationship.
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Affiliation(s)
- Ulimbakisye Mcdonald
- Department of Obstetrics and Gynecology, Weill Bugando School of Medicine, Catholic University of Health and Allied sciences, Mwanza, Tanzania
| | - Helmut Nyawale
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Alphaxard Kajura
- Department of Obstetrics and Gynecology, Weill Bugando School of Medicine, Catholic University of Health and Allied sciences, Mwanza, Tanzania
| | - Fridolin Mujuni
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Elieza Chibwe
- Department of Obstetrics and Gynecology, Weill Bugando School of Medicine, Catholic University of Health and Allied sciences, Mwanza, Tanzania
| | - Vitus Silago
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Betrand Msemwa
- Institute of Allied Health Sciences, Catholic University of Health and Allied sciences, Mwanza, Tanzania
| | - Caroline A Minja
- Department of Biochemistry and Molecular Biology, Weill Bugando School of Medicine, Catholic University of Health and Allied sciences, Mwanza, Tanzania
| | - Zawadi Daffa
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Mahmud Karim
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Evidence C. Byasharila
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Alda Ester Chongo
- Department of Biological Sciences, Eduardo Mondlane University, Maputo, Mozambique
| | - Stephen E. Mshana
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Mariam M. Mirambo
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
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13
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Monteiro IP, Azzi CFG, Bilibio JP, Monteiro PS, Braga GC, Nitz N. Prevalence of sexually transmissible infections in adolescents treated in a family planning outpatient clinic for adolescents in the western Amazon. PLoS One 2023; 18:e0287633. [PMID: 37352297 PMCID: PMC10289307 DOI: 10.1371/journal.pone.0287633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 06/09/2023] [Indexed: 06/25/2023] Open
Abstract
Sexually transmitted infections (STIs) are among the most common public health problems worldwide, especially among adolescents and young adults, who account for almost 50% of all STI patients. Studies on the subject in the western Amazon are limited. This study aimed to evaluate the prevalence of STIs (chlamydia, gonorrhea, trichomoniasis, herpes simplex virus, syphilis, human immunodeficiency virus [HIV], hepatitis B, and hepatitis C) in adolescents treated at a family planning outpatient clinic in the western Amazon: Porto Velho, Rondônia, Brazil. A total of 196 adolescents were enrolled. During the gynecological examination, endocervical samples were collected to test for four STIs (chlamydia, gonorrhea, trichomoniasis, and herpes simplex virus), and blood samples were collected for the detection of HIV, syphilis, and hepatitis B and C. The mean age was 17.3 ± 1.5 years, the age at sexarche was 14.4 ± 1.6 years, and 54.6% of participants had their first sexual intercourse at 14 years or younger. Only 1.0% of the adolescents used condoms in all sexual relations, and 19.9% had casual partner(s) in the last year. In the evaluation of prevalence, we found that 32% of the adolescents had at least one STI, with the most prevalent being chlamydia (23%), followed by trichomoniasis (5.6%), herpes simplex (4.6%), and gonorrhea (3.1%). No positive cases of hepatitis B, hepatitis C, or HIV were detected, but 1% of the adolescents tested positive for syphilis. These indicators will support more effective health care strategies aimed at improving the quality of life of populations in this region of the western Amazon. In conclusion, our findings demonstrated high rates of STIs in the studied patients, reinforcing the need to expand epidemiological studies to implement more appropriate public policies and intervention strategies to prevent STIs in adolescents and other vulnerable populations in the western Amazon.
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Affiliation(s)
- Ida Peréa Monteiro
- Municipal Health Department, Mãe Esperança Municipal Maternity, Porto Velho, Rondônia, Brazil
| | - Camila Flávia Gomes Azzi
- Molecular Biology Laboratory, Central Laboratory of Public Health of Rondônia, Porto Velho, Rondônia, Brazil
| | - João Paolo Bilibio
- Faculty of Medicine, Centro Universitário de Brusque–UNIFEBE, Brusque, Santa Catarina, Brazil
| | | | - Giordana Campos Braga
- Department of Social Medicine, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Nadjar Nitz
- Faculty of Medicine, Interdisciplinary Laboratory of Biosciences, University of Brasília, Brasília, Brazil
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14
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Msemwa B, Mushi MF, Kidenya B, Okamo B, Keenan K, Sabiiti W, Miyaye DN, Konje ET, Silago V, Mirambo MM, Mwanga JR, Gillespie S, Maldonado-Barragan A, Sandeman A, Holden M, Mshana SE. Urogenital pathogens in urine samples of clinically diagnosed urinary tract infected patients in Tanzania: A laboratory based cross-sectional study. IJID REGIONS 2023; 7:170-175. [PMID: 37069922 PMCID: PMC10105482 DOI: 10.1016/j.ijregi.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 12/19/2022] [Accepted: 12/20/2022] [Indexed: 12/28/2022]
Abstract
Background Urogenital pathogens such as Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium and Trichomonas vaginalis have been reported to cause pyuria, however they are not routinely cultured from urine samples of patients clinically diagnosed to have urinary tract infections (UTI). In this study, pathogen specific PCR was done to identify the urogenital pathogens in the urine samples among clinically diagnosed UTI patients with negative routine urine culture. Methods A cross-sectional study was conducted involving 227 archived urine samples from clinically diagnosed UTI patients with positive leucocyte esterase but negative urine culture results. The urogenital pathogens were detected using pathogen specific singleplex PCR. Data were cleaned and analyzed using STATA version 15. Results The median age of patients was 31[IQR 23 - 51] years and the majority (174, 76.7%) were females. Two thirds of patients had history of antibiotic use two weeks prior to recruitment (154, 67.8%). A total of 62(27.3%) urine samples were positive for at least one urogenital pathogen. Of 62 positive samples, 9 had two urogenital pathogens and 1 had three urogenital pathogens. The most predominant urogenital pathogen detected was Neisseria gonorrhoeae 25(34.2%) and Trichomonas vaginalis 24(32.9%). Being female (aOR 2.4; 95% CI: 1.04 - 5.49; p-value 0.039) and having history of using antibiotics in the past two weeks (aOR 1.9; 95%CI: 1.04 - 3.60; p-value 0.036) was independently associated with the presence of urogenital pathogens. Conclusion More than a quarter of female patients with clinical symptoms of UTI and routine urine culture negative results were infected with urogenital pathogens mainly Neisseria gonorrhoeae and Trichomonas vaginalis. Further research with a larger sample set in a range of settings is required to understand the implications of these finding generally.
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Affiliation(s)
- Betrand Msemwa
- Department of Medical Laboratory Sciences, Catholic University of Health and Allied Sciences, Bugando, P. O. Box 1464 Mwanza
| | - Martha F Mushi
- Department of Microbiology and Immunology, Catholic University of Health and Allied Sciences, Bugando, P. O. Box 1464 Mwanza
| | - Benson Kidenya
- Department of Biochemistry and Molecular biology, Catholic University of Health and Allied Sciences, Bugando, P. O. Box 1464 Mwanza
| | - Bernard Okamo
- Department of Biochemistry and Molecular biology, Catholic University of Health and Allied Sciences, Bugando, P. O. Box 1464 Mwanza
| | - Katherine Keenan
- Geography and Sustainable Development, University of St Andrews, St Andrews, UK
| | - Wilber Sabiiti
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Donald N Miyaye
- National Institute for Medical Research, Mwanza Centre, P. O. Box 1462 Mwanza
| | - Eveline T Konje
- Department of Epidemiology and Biostatistics, and Behavioral Sciences, Catholic University of Health and Allied Sciences, Bugando, P. O. Box 1464 Mwanza
| | - Vitus Silago
- Department of Microbiology and Immunology, Catholic University of Health and Allied Sciences, Bugando, P. O. Box 1464 Mwanza
| | - Mariam M Mirambo
- Department of Microbiology and Immunology, Catholic University of Health and Allied Sciences, Bugando, P. O. Box 1464 Mwanza
| | - Joseph R Mwanga
- School of Public Health, Catholic University of Health and Allied Sciences, Bugando, P. O. Box 1464 Mwanza
| | | | | | - Alison Sandeman
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Mathew Holden
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Stephen E Mshana
- Department of Microbiology and Immunology, Catholic University of Health and Allied Sciences, Bugando, P. O. Box 1464 Mwanza
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15
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Chola M, Hlongwana KW, Ginindza TG. Mapping Evidence Regarding Decision-Making on Contraceptive Use among Adolescents in Sub-Saharan Africa: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2744. [PMID: 36768107 PMCID: PMC9915938 DOI: 10.3390/ijerph20032744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 01/23/2023] [Accepted: 02/01/2023] [Indexed: 06/18/2023]
Abstract
This scoping review mapped and synthesised existing evidence on the influence of individual, parental, peer, and societal-related factors on adolescents' decisions to use contraception in sub-Saharan Africa (SSA). Peer-reviewed and review articles published before May 2022, targeting adolescents aged 10-19 years were searched in PubMed, MEDLINE with Full Text via EBSCOhost, PsychINFO via EBSCOhost, CINAHL with Full Text via EBSCOhost, Google Scholar, Science Direct, and Scopus databases. Seven studies were included and analysed using thematic analysis based on the social-ecological model (SEM) and reported using the preferred reporting items for systematic reviews and meta-analyses (PRISMA). Individual (fear of side effects, fear of infertility), parental (parental disappointment and disapproval), peer (social stigma), partner (association with promiscuity and multiple sexual partners), societal and community (contraceptive use disapproval and stigma), and institutional and environmental factors (lack of privacy and confidentiality) influence contraceptive decisions among adolescents. These also include a lack of accurate information, social exclusion, negative health provider attitudes, and a lack of infrastructure that provides privacy and safe spaces. Identifying and addressing core issues within the context of local cultural practices that restrict contraceptive use is important. Holistic, inclusive approaches that promote the well-being of adolescents must be utilised to provide a conducive environment that ensures privacy, confidentiality, safety, and easy access to contraceptive services.
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Affiliation(s)
- Mumbi Chola
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4041, South Africa
- Department of Epidemiology and Biostatistics, School of Public Health, University of Zambia, Lusaka 10101, Zambia
| | - Khumbulani W. Hlongwana
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4041, South Africa
- Cancer & Infectious Diseases Epidemiology Research Unit (CIDERU), College of Health Sciences, University of KwaZulu-Natal, Durban 4041, South Africa
| | - Themba G. Ginindza
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4041, South Africa
- Cancer & Infectious Diseases Epidemiology Research Unit (CIDERU), College of Health Sciences, University of KwaZulu-Natal, Durban 4041, South Africa
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16
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High Prevalence of Sexually Transmitted and Reproductive Tract Infections (STI/RTIs) among Patients Attending STI/Outpatient Department Clinics in Tanzania. Trop Med Infect Dis 2023; 8:tropicalmed8010062. [PMID: 36668969 PMCID: PMC9863565 DOI: 10.3390/tropicalmed8010062] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/30/2022] [Accepted: 01/06/2023] [Indexed: 01/18/2023] Open
Abstract
We determined the prevalence and reported risk factors associated with sexually transmitted and reproductive tract infections (STI/RTIs) among patients who presented with genital symptoms in STI/outpatient department (OPD) clinics in two regional referral hospitals and six health centres in six regions in Tanzania. Methods: The patients were consecutively recruited, and the data collection was conducted in eight health care facilities from 2014 to 2016. Genital swabs were collected for the detection of the aetiological pathogens of STI/RTIs. Results: A total of 1243 participants were recruited in the study; the majority (1073, 86%) were women. The overall median age was 27.8. The prevalence of Neisseria gonorrhoeae was 25.7% (319/1243), with proportions of 50.9 and 21.5% for men and women, respectively, of Chlamydia trachomatis 12.9% (160/1241) and Mycoplasma genitalium 4.7% (53/1134). Unmarried men were more often likely to be infected with gonococcal infections as compared to their women counterparts (57.9 vs. 24.1%) p < 0.001. The majority presented with genital discharge syndrome (GDS) 93.6% (1163/1243), genital ulcer disease (GUD) 13.0% (162/1243) and GDS + GUD 9.6% (119/1243). GDS was more common in the health centres, 96.1% (1195/1243), vs. the regional referral hospitals, 92.2% (1146/1243) (p = 0.01), but those reported to the regional referral hospitals were more likely to be infected with N. gonorrhoeae (OR = 2.5) and C. trachomatis (OR = 2.1) than those from the health centres (p < 0.001). The prevalence of bacterial vaginosis (BV) and vaginal candidiasis (VC) was 24.1 and 10.4%, respectively. Interestingly, unmarried and BV-positive women were less likely to be infected with VC (p = 0.03), though VC was strongly inversely associated with an N. gonorrhoeae infection (p < 0.001). High proportions of N. gonorrhoeae (51.1%) and C. trachomatis (23.3%) were found in the Dodoma and Dar es Salaam regions, respectively. M. genitalium (7.6%) was found to be the highest in Mwanza. Conclusion: We reported a high prevalence of STI/RTIs. The findings suggest that these infections are common and prevalent in STI/OPD clinics in six regions of Tanzania. We recommend surveillance to be conducted regularly to elucidate the true burden of emerging and classical STI/RTIs by employing modern and advanced laboratory techniques for the detection and monitoring of STI/RTIs in low- and high-risk populations, including the community settings.
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Nowshin N, Kapiriri L, Davison CM, Harms S, Kwagala B, Mutabazi MG, Niec A. Sexual and reproductive health and rights of "last mile" adolescents: a scoping review. Sex Reprod Health Matters 2022; 30:2077283. [PMID: 35666196 PMCID: PMC9176670 DOI: 10.1080/26410397.2022.2077283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Abstract
Globally, significant progress has been made in the realm of adolescent sexual and reproductive health. We conceptualised "last mile" adolescents as having two or more of the following factors of identity: refugee, Indigenous, 2SLGBTQIA+, out of school, rurally or remotely located, slum dwelling, incarcerated or previously incarcerated, HIV/AIDS infected, and living with a disability. We conducted a scoping review with an aim to synthesise evidence and identify research gaps in the literature pertaining to the sexual and reproductive health and rights (SRHR) of last mile adolescents. We conducted searches in three databases (Embase, Global Health, and Medline). Fifty-four publications met our inclusion criteria. Our results revealed that the state of evidence on the SRHR of last mile adolescents is poor. Very few studies used qualitative and mixed-method inquiry. The number of studies carried out in North America, Europe, and Oceania were limited. We found insufficient disaggregated data with respect to SRHR-related knowledge, behaviour, and access to services. Adopting an intersectional lens is critical to uncover the multiplicative effects of last mile adolescents' factors of identity on their SRHR. National data systems should be strengthened to enable the collection of quality disaggregated data which can play a vital role in identifying SRHR inequities affecting last mile adolescents. Research priorities should be realigned to generate data globally on the SRHR of last mile adolescents whose lives are marked by intersecting vulnerabilities.
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Affiliation(s)
- Nahela Nowshin
- PhD Student, Department of Health, Aging and Society, McMaster University, Hamilton, ON, Canada. Correspondence:
| | - Lydia Kapiriri
- Associate Professor, Department of Health, Aging and Society, McMaster University, Hamilton, ON, Canada
| | - Colleen M Davison
- Associate Professor, Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
| | - Sheila Harms
- Associate Professor, Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Betty Kwagala
- Associate Professor, Department of Population Studies, Makerere University, Kampala, Uganda
| | | | - Anne Niec
- Professor, Department of Pediatrics, McMaster University, Hamilton, ON, Canada
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Folayan MO, Sam-Agudu NA, Harrison A. Exploring the why: risk factors for HIV and barriers to sexual and reproductive health service access among adolescents in Nigeria. BMC Health Serv Res 2022; 22:1198. [PMID: 36151543 PMCID: PMC9508705 DOI: 10.1186/s12913-022-08551-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 09/07/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Early sexual debut, low educational attainment, history of rape and transactional and intergenerational sex have been associated with HIV infection among Nigerian adolescents, especially females. We sought to understand the "why", and how to mitigate against these determinants and barriers to addressing adolescent sexual and reproductive health (SRH) and HIV prevention needs. METHODS This qualitative study generated data from 49 focus group discussions with male and female adolescents living with and without HIV, healthcare workers, members of civil society organizations working with young people, and parents of adolescents living with HIV. Participants were recruited from all six geopolitical zones in Nigeria. Data was analysed with ATLAS.ti software. Hermeneutic units were created, and codes developed from focus group transcripts. Network View Manager was used to create maps of codes, memos and quotations, and relevant quotes were retrieved from transcripts. RESULTS Four major themes were identified, relating to individual, parental, community and government roles in reducing the risk of HIV and unplanned pregnancy among adolescents in Nigeria. Individual factors influencing sexual risk behaviours of adolescents include peer pressure, poor risk perception for HIV, and misconceptions about the efficacy of contraceptives and condoms. Respondents entrusted State responsibilities such as facilitation of HIV-affected adolescents' access to education, rather, to individuals, parents and the community; and placed the blame for rape on rape survivors. Findings also highlighted the inadequacy of health systems to address adolescents' needs for treatment of sexually transmitted infections and to provide appropriate education on secondary HIV prevention for those living with HIV. CONCLUSION Rigorous studies are needed to understand dynamics between adolescents' risk behavior, HIV risk perception, parental roles in mitigating HIV risk in adolescents, and the role of communities and government in HIV prevention and treatment for adolescents in Nigeria.
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Affiliation(s)
- Morenike O Folayan
- Department of Child Dental Health Obafemi Awolowo University, 22005, Ile-Ife, Nigeria.
| | - Nadia A Sam-Agudu
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria
- Institute of Human Virology and Department of Pediatrics, University of Maryland School of Medicine, Baltimore, USA
- Department of Paediatrics and Child Health, University of Cape Coast School of Medical Sciences, Cape Coast, Ghana
| | - Abigail Harrison
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Brown University, Providence, USA
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Mgopa LR, Ross MW, Lukumay GG, Mushy SE, Mkony E, Massae AF, Mwakawanga DL, Leshabari S, Mohamed I, Trent M, Wadley J, Bonilla ZE, Rosser BRS. Perceptions of Sexual Healthcare Provision in Tanzania: a Key Informant Qualitative Study. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2022; 19:849-859. [PMID: 36172532 PMCID: PMC9514134 DOI: 10.1007/s13178-021-00607-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/11/2021] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Sexual health care services must be standard and unbiased, guided by a structured health care system. There is a scarcity of data on how sexual health care is delivered in Tanzania. METHODS To address this gap, in July 2019 we interviewed eleven key informants: cultural and public health experts, and political, religious, and community leaders, selected from different organizations in Dar es Salaam, Tanzania. Participants were asked for their opinions about clinical practices of health care professionals when providing care to patients, with an emphasis on sexual health. RESULTS Participants' responses were classified into three subcategories: strengths, barriers, and gaps in sexual health care. Availability of services, service delivery to adults, and code of conduct were among the strengths observed in clinical care services. Barriers included the health care provider's attitudes, moral values, and inadequacy in health policies and treatment guidelines. Vulnerable populations including youth were frequently reported to face most challenges when seeking sexual health care services. In terms of gaps, informants emphasized gender equity in sexual health services provision within care settings. CONCLUSION AND IMPLICATION Data indicate that lack of training in sexual health and guidelines for dealing with sexual issues are a barrier to comprehensive health care. These findings can inform the main areas for curriculum developers to focus on, when developing an Afro-centric sexual health curriculum suitable for students in health care professional courses. Moreover, these findings can be useful when developing treatment guidelines and policies that are beneficial to the sexual health wellbeing of individuals.
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Affiliation(s)
- Lucy R. Mgopa
- Department of Psychiatry and Mental Health, School of Medicine, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Michael W. Ross
- Program in Human Sexuality, Department of Family Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Gift Gadiel Lukumay
- Department of Community Health Nursing, School of Nursing, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Stella Emmanuel Mushy
- Department of Community Health Nursing, School of Nursing, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Ever Mkony
- Department of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Agnes F. Massae
- Department of Community Health Nursing, School of Nursing, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Dorkas L. Mwakawanga
- Department of Community Health Nursing, School of Nursing, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Sebalda Leshabari
- Department of Community Health Nursing, School of Nursing, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Inari Mohamed
- Department of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Maria Trent
- Department of Adolescent and Young Adult Medicine, Johns Hopkins University Schools of Medicine and Public Health, Baltimore, MD, USA
| | - James Wadley
- Department of Counselling and Health Services, Lincoln University, Philadelphia, PA, USA
| | - Zobeida E. Bonilla
- Department of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - B. R. Simon Rosser
- Department of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
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Tsega NT, Abebe B, Ebabu T, Asmare T, Kassa M, Haile TT, Seyoum AT, Endalew M, Wondie KY. Sexually transmitted infections and associated factors during pregnancy in Gondar city, Northwest Ethiopia, 2021: A multicenter study. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2022. [DOI: 10.1016/j.cegh.2022.101096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Masatu ES, Kajura A, Mujuni F, Chibwe E, Nyawale HA, Rambau P, Majigo M, Mshana SE, Mirambo MM. High prevalence of sexually transmitted infections among asymptomatic women opting for the intrauterine contraceptive device use in Mwanza, Tanzania: An urgent call for control interventions. SAGE Open Med 2022; 10:20503121221097536. [PMID: 35600700 PMCID: PMC9118402 DOI: 10.1177/20503121221097536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 04/12/2022] [Indexed: 11/15/2022] Open
Abstract
Objective: Placement of intrauterine contraceptive device (IUCD) in asymptomatic woman infected with sexually transmitted infection (STIs) can lead to pelvic inflammatory diseases (PID) and infertility if not well treated. The current study investigated the magnitude of sexually transmitted infections among women opting for IUCD use in the city of Mwanza, Tanzania. Methods: A cross-sectional study involving 150 asymptomatic women was conducted from August to December 2017. Detection of Chlamydia trachomatis antigen from endocervical swabs was done using immunochromatographic rapid tests while sera were used for detection of Treponema pallidum, human immunodeficiency virus (HIV) and herpes simplex virus Type 2 (HSV-2) antibodies. Results: The overall prevalence of STIs was 45/150 (30%, 95% CI: 22–37) while that of individual STIs were 27.3%, 5.3%, and 2.6% for C trachomatis, T pallidum, and HSV-2, respectively. History of dysuria (aOR 6.6; 95% CI 2.3–18.8; p < 0.001) and history of STIs (aOR 4.6; 95%CI 1.0–20.8; p = 0.049) independently predicted presence of STIs. Conclusions: Prevalence of STIs among women opted for IUCD use in the city of Mwanza, Tanzania is alarmingly high and is predicted by past history of dysuria and history of partner’s STIs, calling for the need of screening of the STIs among high-risk women in low- and middle-income countries (LMICs) opting for IUCD use.
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Affiliation(s)
- Emmanuel S Masatu
- Department of Obstetrics and Gynaecology, Weill Bugando School of Medicine, Catholic University of Health and Allied sciences, Mwanza, Tanzania
| | - Alphaxard Kajura
- Department of Obstetrics and Gynaecology, Weill Bugando School of Medicine, Catholic University of Health and Allied sciences, Mwanza, Tanzania
| | - Fridolin Mujuni
- Department of Obstetrics and Gynaecology, Weill Bugando School of Medicine, Catholic University of Health and Allied sciences, Mwanza, Tanzania
| | - Elieza Chibwe
- Department of Obstetrics and Gynaecology, Weill Bugando School of Medicine, Catholic University of Health and Allied sciences, Mwanza, Tanzania
| | - Helmut A Nyawale
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Peter Rambau
- Department of Pathology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Mtebe Majigo
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Stephen E. Mshana
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Mariam M Mirambo
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
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Mwakawanga DL, Mkonyi E, Mushy SE, Trent M, Bonilla Z, Massae AF, Lukumay GG, Mgopa LR, Mohammed I, Wadley J, Ross MW, Leshabari S, Rosser BRS. Would you offer contraception to a 14-year-old girl? Perspectives of health students and professionals in Dar es Salaam, Tanzania. Reprod Health 2021; 18:245. [PMID: 34895267 PMCID: PMC8665521 DOI: 10.1186/s12978-021-01294-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 11/20/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Rates of unplanned adolescent pregnancy and unsafe induced abortions are very high in Sub-Saharan African countries including Tanzania. Despite their availability and accessibility, modern family planning methods are reported to be critically underutilized by adolescents. This study is part of a broader study that aims to develop a curriculum that will be used in training health professionals by investigating the sexual health training needs of health providers and students in Tanzania. AIM This study describes the perceptions of health professionals and students on the provision of contraceptives to adolescents. METHODS Qualitative formative assessment type of research was conducted using 18 focus groups stratified among health professionals and students (midwives, nurses, and medical doctors). Study participants were presented with the theoretical scenario of a 14-year-old girl who sought contraceptive services at a family planning clinic. This theoretical scenario was used to determine how health professionals and students would handle the case. Thematic analysis guided the examination and determination of data results. RESULTS Three main themes emerged from the data, including (1) knowledge about the provision of contraceptives to adolescents, (2) perception of the adolescents' right to contraceptive use, and (3) barriers to the provision of contraceptives to adolescents. Participants stated that having a baseline knowledge of contraceptive services for adolescents and their rights to contraceptives would trigger their decision on offering the contraceptive. On the other hand, being unaware of the reproductive health rights for adolescents, judgmental behavior of providers, as well as religious and cultural dynamics were all found to be major barriers for providers to offer contraceptive services to the 14-year-old adolescent girl in the theoretical scenario. CONCLUSION These findings support the need for comprehensive sexual health education in Tanzanian health professional training programs.
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Affiliation(s)
- Dorkasi L Mwakawanga
- School of Nursing, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Ever Mkonyi
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 S. 2nd St. #300, Minneapolis, MN, 55454, USA
| | - Stella E Mushy
- School of Nursing, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Maria Trent
- Schools of Medicine and Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Zobeida Bonilla
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 S. 2nd St. #300, Minneapolis, MN, 55454, USA
| | - Agnes F Massae
- School of Nursing, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Gift G Lukumay
- School of Nursing, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Lucy R Mgopa
- School of Nursing, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Inari Mohammed
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 S. 2nd St. #300, Minneapolis, MN, 55454, USA
| | - James Wadley
- School of Adult and Continuing Education, Lincoln University, Philadelphia, PA, USA
| | - Michael W Ross
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Sebalda Leshabari
- School of Nursing, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - B R Simon Rosser
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 S. 2nd St. #300, Minneapolis, MN, 55454, USA.
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Whelan J, Abbing-Karahagopian V, Serino L, Unemo M. Gonorrhoea: a systematic review of prevalence reporting globally. BMC Infect Dis 2021; 21:1152. [PMID: 34763670 PMCID: PMC8582208 DOI: 10.1186/s12879-021-06381-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The World Health Organization (WHO) recommends periodic gonorrhoea prevalence assessments in the general population or proxies thereof (including pregnant women, women attending family planning clinics, military recruits, and men undergoing employment physicals for example) and in population groups at increased risk, including men-who-have-sex-with-men (MSM) and sex workers. METHOD We evaluated reported prevalence data, including estimates from proxy general population samples to reflect the WHO recommendations. We describe the outcomes from the general population country-by-country and extend previous reviews to include MSM, sex workers, and extragenital infections. RESULT AND CONCLUSION In our systematic search, 2015 titles were reviewed (January 2010-April 2019) and 174 full-text publications were included. National, population-based prevalence data were identified in only four countries (the United States of America, the United Kingdom, Peru, New Caledonia) and local population-based estimates were reported in areas within five countries (China, South Africa, Brazil, Benin, and Malawi). The remaining studies identified only reported test positivity from non-probability, proxy general population samples. Due to the diversity of the reviewed studies, detailed comparison across studies was not possible. In MSM, data were identified from 64 studies in 25 countries. Rectal infection rates were generally higher than urogenital or pharyngeal infection rates, where extragenital testing was conducted. Data on sex workers were identified from 41 studies in 23 countries; rates in female sex workers were high. Current prevalence monitoring was shown to be highly suboptimal worldwide. Serial prevalence monitoring of critical epidemiological variables, and guidelines to optimize prevalence study conduct and reporting beyond antenatal settings are recommended.
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Affiliation(s)
- Jane Whelan
- Clinical and Epidemiology Research and Development, GSK, Amsterdam, The Netherlands.
| | | | - Laura Serino
- Clinical and Epidemiology Research and Development, GSK, Siena, Italy
| | - Magnus Unemo
- WHO Collaborating Centre for Gonorrhoea and other STIs, Department of Laboratory Medicine, Microbiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Isara A, Baldeh AK. Prevalence of sexually transmitted infections among pregnant women attending antenatal clinics in West Coast Region of The Gambia. Afr Health Sci 2021; 21:585-592. [PMID: 34795711 PMCID: PMC8568222 DOI: 10.4314/ahs.v21i2.13] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Sexually Transmitted Infections (STI) are the second most common cause of healthy life years lost by women in the 15 - 44 years age group in Africa. AIM/OBJECTIVE To determine the prevalence of STIs among pregnant women attending antenatal care (ANC) clinics in the West Coast Region of The Gambia. MATERIALS AND METHODS Blood, urine, and high vaginal swabs samples from 280 pregnant women attending ANC in Brikama District Hospital, Brikama, and Bandung Maternity and Child Health Hospital, Bandung were examined. Serum samples were tested for HIV using western blot technique and for syphilis using the Venereal Disease Research Laboratory (VDRL) test, and rapid plasma regimen. Candida albicans, Group B Streptococcus and Neisseria gonorrhoea were identified using Analytical Profile Index (API). Direct urine microscopy was used to identify C. albicans and Trichomonas vaginalis while Chlamydia trachomatis was identified using Direct Fluorescent Antibody (DFA) test. RESULTS The overall prevalence of STIs was 53.6%. The pathogenic agents isolated were Candida albicans (31.8%), Streptococcus agalactiae (15.0%), Treponema pallidum (6.8%), HIV (5.7%), Trichomonas vaginalis (3.9%), Neisseria gonorrhoea (1.8%) and Chlamydia trachomatis (0.7%). STIs were more prevalent among women in the younger age group of 15 - 24 years (54.7%), unemployed (54.0%), Primipara (62.3%), and in the third trimester of pregnancy (72.7%). CONCLUSION A high prevalence of STIs was found among pregnant women attending ANC in the West Coast region of The Gambia. Public health intervention programmes should be strengthened to promote the sexual and reproductive health of pregnant women in The Gambia.
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Characterizing a sexual health and HIV risk stratification scale for sexually active adolescent girls and young women (AGYW) in Tanzania. PLoS One 2021; 16:e0248153. [PMID: 33735253 PMCID: PMC7971553 DOI: 10.1371/journal.pone.0248153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 02/20/2021] [Indexed: 11/30/2022] Open
Abstract
Adolescent girls and young women (AGYW) aged 15 to 24 years face disproportionately high risks of acquiring HIV and other sexually transmitted infections (STIs). A sexual health risk stratification tool can support the development and implementation of tailored HIV and STI prevention services for sub-groups of at-risk AGYW. Data were collected among sexually active AGYW aged 15 to 24 years in Tanzania between April 2015 and March 2017. Exploratory and confirmatory factor analyses were conducted to construct and assess the latent structure of a ten-item scale for rapid assessment of sexual health risks. Items with high factor loadings and minimal cross loadings were retained in the final scale. Scale performance was appraised against condomless sex (defined as unprotected vaginal or anal intercourse) reported by AGYW for construct validity. A three-factor structure of vulnerability to HIV among AGYW was supported with subscales for socioeconomic vulnerability; lack of adult support; and sexual behavioral risks. The chi-square goodness-of-fit test, root mean square error of approximation, comparative fit index, and Tucker-Lewis index indicated a strong goodness-of-fit of the three-factor scale. Cronbach alphas (0.55 for socioeconomic vulnerability, 0.55 for lack of support, and 0.48 for sexual risk) indicated sub-optimal internal consistency for all sub-scales. The factor-item and factor-factor correlations identified in these analyses were consistent with the conceptual framework of vulnerability of HIV infection in AGYW, suggesting good construct validity. The scale also demonstrated a statistically significant association with condomless sex and could be potentially used for sexual health risk stratification (OR = 1.17, 95% CI: 1.12, 1.23). The sexual health and HIV risk stratification scale demonstrated potential in identifying sexually active AGYW at high risk for HIV and other STIs. Ultimately, all AGYW in Tanzania are not at equal risk for HIV and this scale may support directing resources towards those at highest risk of HIV.
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Kapiga S, Hansen CH, Downs JA, Sichalwe S, Hashim R, Mngara J, van Dam GJ, Corstjens PLAM, Kingery JR, Peck RN, Grosskurth H. The burden of HIV, syphilis and schistosome infection and associated factors among adults in the fishing communities in northwestern Tanzania. Trop Med Int Health 2021; 26:204-213. [PMID: 33159819 DOI: 10.1111/tmi.13520] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To quantify the burden of HIV, syphilis and schistosome infection and associated risk factors among adults living in seven fishing communities of Lake Victoria in northwest Tanzania. METHODS Cross-sectional study conducted between 2015 and 2016 in the selected communities. In each community, we randomly selected a sample of adults from the general population and from three putative risk groups including the following: (i) fishermen, (ii) fish processors and traders, and (iii) women working in the recreational facilities. Participants were interviewed to obtain information about potential risk factors, and venous blood was collected for detection of HIV, syphilis and schistosome infections. We used logistic regression models to quantify the associations between potential risk factors and HIV, and also between schistosome infection and HIV. RESULTS We enrolled 1128 people from selected fishing communities. The overall prevalence of HIV, syphilis and schistosome infection was 14.2%, 15.6% and 83.1%, respectively. Female recreational facility workers had the highest prevalence of HIV (30.4%) and syphilis (24%). The odds of being HIV infected were generally higher in all age categories. Transactional sex was commonly reported and especially receiving gifts for sex was found to be strongly associated with HIV (adjusted OR = 2.50; 95% CI: 1.44-4.34, P = 0.008). Confirmed serological syphilis was associated with increased odds of having HIV infection. HIV was not associated with schistosome infection in a combined dataset and when we examined this separately for men and women alone. CONCLUSIONS We observed a high burden of HIV, syphilis and schistosome infections in the fishing communities. Targeted efforts to treat and control infections have the potential to improve health among their residents.
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Affiliation(s)
- Saidi Kapiga
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
- Department of Infectious Diseases Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Christian H Hansen
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Jennifer A Downs
- Department of Medicine, Weill Bugando School of Medicine, Mwanza, Tanzania
- Center for Global Health, Weill Cornell Medicine, New York, NY, USA
| | - Simon Sichalwe
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
| | - Ramadhan Hashim
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
| | - Julius Mngara
- National Institute for Medical Research, Mwanza, Tanzania
| | - Govert J van Dam
- Department of Parasitology, Leiden University Medical Center, Leiden, the Netherlands
| | - Paul L A M Corstjens
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, the Netherlands
| | - Justin R Kingery
- Department of Medicine, Weill Bugando School of Medicine, Mwanza, Tanzania
- Center for Global Health, Weill Cornell Medicine, New York, NY, USA
| | - Robert N Peck
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
- Department of Medicine, Weill Bugando School of Medicine, Mwanza, Tanzania
- Center for Global Health, Weill Cornell Medicine, New York, NY, USA
| | - Heiner Grosskurth
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
- MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK
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The Prevalence of Chlamydia trachomatis and Three Other Non-Viral Sexually Transmitted Infections among Pregnant Women in Pemba Island Tanzania. Pathogens 2020; 9:pathogens9080625. [PMID: 32751883 PMCID: PMC7459925 DOI: 10.3390/pathogens9080625] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 07/24/2020] [Accepted: 07/28/2020] [Indexed: 11/20/2022] Open
Abstract
Efforts to map the burden of infections globally have shown a high prevalence of genital infections, including Chlamydia trachomatis, in sub-Saharan Africa. This retrospective study aimed to investigate the prevalence of selected non-viral genital infections among pregnant women in Pemba Island, Tanzania. Vaginal swabs were collected during pregnancy and stored in eNAT buffer. Detection of C. trachomatis, Neisseria gonorrheae, Trichomonas vaginalis, and Mycoplasma genitalium pathogens was performed by PCR using validated detection kits. Vaginal samples of 439 pregnant women between 16 and 48 years were tested. In fifty-five (12.5%) of them, at least one genital pathogen was detected. The most prevalent pathogen was T. vaginalis (7.1%), followed by C. trachomatis (4.6%) and M. genitalium (2.1%). None of the vaginal samples tested positive for N. gonorrheae. Consequently, among positive samples, 7.3% were for C. trachomatis and at least one other genital pathogen. This study provides insights on the burden of the four studied genital infections, and on the coinfections among pregnant women in Pemba Island, Tanzania. These results offer a starting point that can be useful to design further research in the field of maternal and child health in Pemba Island.
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Ng'wamkai G, Msigwa KV, Chengula D, Mgaya F, Chuma C, Msemwa B, Silago V, Majigo M, Mshana SE, Mirambo MM. Treponema pallidum infection predicts sexually transmitted viral infections (hepatitis B virus, herpes simplex virus-2, and human immunodeficiency virus) among pregnant women from rural areas of Mwanza region, Tanzania. BMC Pregnancy Childbirth 2019; 19:392. [PMID: 31664945 PMCID: PMC6820934 DOI: 10.1186/s12884-019-2567-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Accepted: 10/22/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Sexually transmitted infections (STIs) is a global health problem with increased risk and morbidities during pregnancy. This study investigated the magnitude of viral STIs among pregnant women from three rural hospitals/clinics providing antenatal care in Mwanza region, Tanzania. METHODS Between February and May 2018, a total of 499 pregnant women were enrolled and tested for Human immunodeficiency virus (HIV), Herpes simplex virus-2 (HSV-2), Hepatitis B virus (HBV) and Hepatitis C virus (HCV) using rapid immunochromatographic tests and for syphilis using non-treponemal and treponemal antibody test. RESULTS The median age of enrolled women was 25 (IQR: 22-31) years. Seventy eight (15.6, 95% CI: 12-18) of women tested had at least one sexually transmitted viral infection. Specific prevalence of HIV, HBV, HCV, HSV-2 IgG and HSV-2 IgM were found to be 25(5.0%), 29(5.8%), 2(0.4%), 188(37.7%) and 24(4.8%), respectively. The odds of having viral infection was significantly high among women with positive T. pallidum serostatus (adjusted odd ratio (aOR): 3.24, 95%CI; 1.2-85). By multivariable logistic regression analysis, history of STIs predicted HSV-2 IgM seropositivity (aOR: 3.70, 95%CI: 1.43-9.62) while parity (aOR: 1.23, 95%CI: 1.04-1.46) predicted HBV infection and syphilis positive results (aOR: 8.63, 95%CI: 2.81-26.45) predicted HIV infection. CONCLUSION A significant proportion of pregnant women in rural areas of Mwanza region has at least one sexually transmitted viral infection which is independently predicted by positive T. pallidum serostatus. The strengthening and expansion of ANC screening package to include screening of STIs will ultimately reduce the viral STIs among pregnant women hence reduce associated morbidities and mortalities.
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Affiliation(s)
- Gilbert Ng'wamkai
- Department of Obstetrics and Gynecology, Bugando Medical Centre, P.O. Box 370, Mwanza, Tanzania
| | - Kalista V Msigwa
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied sciences, P.O. Box 1464, Mwanza, Tanzania
| | - Damas Chengula
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied sciences, P.O. Box 1464, Mwanza, Tanzania
| | - Frank Mgaya
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied sciences, P.O. Box 1464, Mwanza, Tanzania
| | - Clotilda Chuma
- Department of Obstetrics and Gynecology, Bugando Medical Centre, P.O. Box 370, Mwanza, Tanzania
| | - Betrand Msemwa
- Institute of Allied Health Sciences, Catholic University of Health and Allied sciences, P.O. Box 1464, Mwanza, Tanzania
| | - Vitus Silago
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied sciences, P.O. Box 1464, Mwanza, Tanzania
| | - Mtebe Majigo
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Stephen E Mshana
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied sciences, P.O. Box 1464, Mwanza, Tanzania
| | - Mariam M Mirambo
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied sciences, P.O. Box 1464, Mwanza, Tanzania.
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Rowley J, Vander Hoorn S, Korenromp E, Low N, Unemo M, Abu-Raddad LJ, Chico RM, Smolak A, Newman L, Gottlieb S, Thwin SS, Broutet N, Taylor MM. Chlamydia, gonorrhoea, trichomoniasis and syphilis: global prevalence and incidence estimates, 2016. Bull World Health Organ 2019; 97:548-562P. [PMID: 31384073 PMCID: PMC6653813 DOI: 10.2471/blt.18.228486] [Citation(s) in RCA: 958] [Impact Index Per Article: 159.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 04/08/2019] [Accepted: 05/03/2019] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To generate estimates of the global prevalence and incidence of urogenital infection with chlamydia, gonorrhoea, trichomoniasis and syphilis in women and men, aged 15-49 years, in 2016. METHODS For chlamydia, gonorrhoea and trichomoniasis, we systematically searched for studies conducted between 2009 and 2016 reporting prevalence. We also consulted regional experts. To generate estimates, we used Bayesian meta-analysis. For syphilis, we aggregated the national estimates generated by using Spectrum-STI. FINDINGS For chlamydia, gonorrhoea and/or trichomoniasis, 130 studies were eligible. For syphilis, the Spectrum-STI database contained 978 data points for the same period. The 2016 global prevalence estimates in women were: chlamydia 3.8% (95% uncertainty interval, UI: 3.3-4.5); gonorrhoea 0.9% (95% UI: 0.7-1.1); trichomoniasis 5.3% (95% UI:4.0-7.2); and syphilis 0.5% (95% UI: 0.4-0.6). In men prevalence estimates were: chlamydia 2.7% (95% UI: 1.9-3.7); gonorrhoea 0.7% (95% UI: 0.5-1.1); trichomoniasis 0.6% (95% UI: 0.4-0.9); and syphilis 0.5% (95% UI: 0.4-0.6). Total estimated incident cases were 376.4 million: 127.2 million (95% UI: 95.1-165.9 million) chlamydia cases; 86.9 million (95% UI: 58.6-123.4 million) gonorrhoea cases; 156.0 million (95% UI: 103.4-231.2 million) trichomoniasis cases; and 6.3 million (95% UI: 5.5-7.1 million) syphilis cases. CONCLUSION Global estimates of prevalence and incidence of these four curable sexually transmitted infections remain high. The study highlights the need to expand data collection efforts at country level and provides an initial baseline for monitoring progress of the World Health Organization global health sector strategy on sexually transmitted infections 2016-2021.
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Affiliation(s)
- Jane Rowley
- Department of Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Stephen Vander Hoorn
- School of Mathematics and Statistics, University of Melbourne, Melbourne, Australia
| | | | - Nicola Low
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Magnus Unemo
- WHO Collaborating Centre for Gonorrhoea and Other STIs, Örebro University, Örebro, Sweden
| | - Laith J Abu-Raddad
- Department of Healthcare Policy and Research, Weill Cornell Medical College - Qatar, Doha, Qatar
| | - R Matthew Chico
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, England
| | - Alex Smolak
- Department of Healthcare Policy and Research, Weill Cornell Medical College - Qatar, Doha, Qatar
| | - Lori Newman
- Enteric and Sexually Transmitted Infections Branch, National Institute of Allergy and Infectious Diseases, Washington DC, United States of America
| | - Sami Gottlieb
- Department of Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Soe Soe Thwin
- Department of Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Nathalie Broutet
- Department of Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Melanie M Taylor
- Department of Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
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Risk-Taking Behaviors and Sexual Violence Among Secondary School Students in Tanzania. J Community Health 2019; 44:749-755. [DOI: 10.1007/s10900-019-00673-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Guerra AB, Siravenha LQ, Laurentino RV, Feitosa RNM, Azevedo VN, Vallinoto ACR, Ishak R, Machado LFA. Seroprevalence of HIV, HTLV, CMV, HBV and rubella virus infections in pregnant adolescents who received care in the city of Belém, Pará, Northern Brazil. BMC Pregnancy Childbirth 2018; 18:169. [PMID: 29769062 PMCID: PMC5956583 DOI: 10.1186/s12884-018-1753-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 04/19/2018] [Indexed: 11/15/2022] Open
Abstract
Background Prenatal tests are important for prevention of vertical transmission of various infectious agents. The objective of this study was to describe the prevalence of human immunodeficiency virus (HIV), human T-lymphotropic virus (HTLV), hepatitis B virus (HBV), cytomegalovirus (CMV), rubella virus and vaccination coverage against HBV in pregnant adolescents who received care in the city of Belém, Pará, Brazil. Methods A cross-sectional study was performed with 324 pregnant adolescents from 2009 to 2010. After the interview and blood collection, the patients were screened for antibodies and/or antigens against HIV-1/2, HTLV-1/2, CMV, rubella virus and HBV. The epidemiological variables were demonstrated using descriptive statistics with the G, χ2 and Fisher exact tests. Results The mean age of the participants was 15.8 years, and the majority (65.4%) had less than 6 years of education. The mean age at first intercourse was 14.4 years, and 60.8% reported having a partner aged between 12 and 14 years. The prevalence of HIV infection was 0.3%, and of HTLV infection was 0.6%. Regarding HBV, 0.6% of the participants had acute infection, 9.9% had a previous infection, 16.7% had vaccine immunity and 72.8% were susceptible to infection. The presence of anti-HBs was greater in adolescent between 12 and 14 years old (28.8%) while the anti-HBc was greater in adolescent between 15 and 18 years old (10.3%). Most of the adolescents presented the IgG antibody to CMV (96.3%) and rubella (92.3%). None of the participants had acute rubella infection, and 2.2% had anti-CMV IgM. Conclusions This study is the first report of the seroepidemiology of infectious agents in a population of pregnant adolescents in the Northern region of Brazil. Most of the adolescents had low levels of education, were susceptible to HBV infection and had IgG antibodies to CMV and rubella virus. The prevalence of HBV, HIV and HTLV was similar to that reported in other regions of Brazil. However, the presence of these agents in this younger population reinforces the need for good prenatal follow-up and more comprehensive vaccination campaigns against HBV due to the large number of women susceptible to the virus.
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Affiliation(s)
- Aubaneide Batista Guerra
- Reference Unit Specialized in Maternal-Child and Adolescent Care, Belém, Pará, Brazil.,Virology Laboratory, Institute of Biological Sciences, Federal University of Pará, Augusto Correa 1, Guamá, 66, Belém, Pará, 075-110, Brazil.,Biology of Infectious and Parasitic Agents Graduate Program, Federal University of Pará, Belém, Pará, Brazil
| | - Leonardo Quintão Siravenha
- Virology Laboratory, Institute of Biological Sciences, Federal University of Pará, Augusto Correa 1, Guamá, 66, Belém, Pará, 075-110, Brazil.,Biology of Infectious and Parasitic Agents Graduate Program, Federal University of Pará, Belém, Pará, Brazil
| | - Rogério Valois Laurentino
- Virology Laboratory, Institute of Biological Sciences, Federal University of Pará, Augusto Correa 1, Guamá, 66, Belém, Pará, 075-110, Brazil.,Biology of Infectious and Parasitic Agents Graduate Program, Federal University of Pará, Belém, Pará, Brazil
| | - Rosimar Neris Martins Feitosa
- Virology Laboratory, Institute of Biological Sciences, Federal University of Pará, Augusto Correa 1, Guamá, 66, Belém, Pará, 075-110, Brazil
| | - Vânia Nakauth Azevedo
- Virology Laboratory, Institute of Biological Sciences, Federal University of Pará, Augusto Correa 1, Guamá, 66, Belém, Pará, 075-110, Brazil
| | - Antonio Carlos Rosário Vallinoto
- Virology Laboratory, Institute of Biological Sciences, Federal University of Pará, Augusto Correa 1, Guamá, 66, Belém, Pará, 075-110, Brazil.,Biology of Infectious and Parasitic Agents Graduate Program, Federal University of Pará, Belém, Pará, Brazil
| | - Ricardo Ishak
- Virology Laboratory, Institute of Biological Sciences, Federal University of Pará, Augusto Correa 1, Guamá, 66, Belém, Pará, 075-110, Brazil.,Biology of Infectious and Parasitic Agents Graduate Program, Federal University of Pará, Belém, Pará, Brazil
| | - Luiz Fernando Almeida Machado
- Virology Laboratory, Institute of Biological Sciences, Federal University of Pará, Augusto Correa 1, Guamá, 66, Belém, Pará, 075-110, Brazil. .,Biology of Infectious and Parasitic Agents Graduate Program, Federal University of Pará, Belém, Pará, Brazil.
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Masha SC, Cools P, Crucitti T, Sanders EJ, Vaneechoutte M. Molecular typing of Trichomonas vaginalis isolates by actin gene sequence analysis and carriage of T. vaginalis viruses. Parasit Vectors 2017; 10:537. [PMID: 29084570 PMCID: PMC5663105 DOI: 10.1186/s13071-017-2496-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 10/23/2017] [Indexed: 11/15/2022] Open
Abstract
Background The protozoan parasite Trichomonas vaginalis is the most common non-viral, sexually transmitted pathogen. Although T. vaginalis is highly prevalent among women in Kenya, there is lack of data regarding genetic diversity of isolates currently in circulation in Kenya. Methods Typing was performed on 22 clinical isolates of T. vaginalis collected from women attending the antenatal care clinic at Kilifi County Hospital, Kenya, in 2015. Genotyping followed a previously proposed restriction fragment length polymorphism (RFLP) scheme, which involved in silico cleavage of the amplified actin gene by HindII, MseI and RsaI restriction enzymes. Phylogenetic analysis of all the sequences was performed to confirm the results obtained by RFLP-analysis and to assess the diversity within the RFLP genotypes. Additionally, we determined carriage of the four different types of Trichomonas vaginalis viruses (TVVs) by polymerase chain reaction. Results In silico RFLP-analysis revealed five actin genotypes; 50.0% of the isolates were of actin genotype E, 27.3% of actin genotype N, 13.6% of actin genotype G and 4.5% of actin genotypes I and P. Phylogenetic analysis was in agreement with the RFLP-analysis, with the different actin genotypes clustering together. Prevalence of TVVs was 43.5% (95% confidence interval, CI: 23.2–65.5). TVV1 was the most prevalent, present in 39.1% of the strains and 90% of the T. vaginalis isolates which harbored TVVs had more than one type of TVV. None of the isolates of actin genotype E harbored any TVV. Conclusion The presence of five actin genotypes in our study suggests notable diversity among T. vaginalis isolates occurring among pregnant women in Kilifi, Kenya. Isolates of the most prevalent actin genotype E lacked TVVs. We found no association between T. vaginalis genotype, carriage of TVVs and symptoms. Further studies with higher number of strains should be conducted in order to corroborate these results. Electronic supplementary material The online version of this article (10.1186/s13071-017-2496-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Simon C Masha
- Centre for Geographic Medicine Research - Coast, Kenya Medical Research Institute (KEMRI), P.O. Box 230-80108, Kilifi, Kenya. .,Laboratory Bacteriology Research, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan, 185 9000, Ghent, Belgium. .,Department of Biological Sciences, Faculty of Pure and Applied Sciences, Pwani University, P.O. BOX 195-80108, Kilifi, Kenya.
| | - Piet Cools
- Laboratory Bacteriology Research, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan, 185 9000, Ghent, Belgium
| | - Tania Crucitti
- HIV/STI Reference Laboratory, Department of Clinical Sciences, Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerpen, Belgium
| | - Eduard J Sanders
- Centre for Geographic Medicine Research - Coast, Kenya Medical Research Institute (KEMRI), P.O. Box 230-80108, Kilifi, Kenya
| | - Mario Vaneechoutte
- Laboratory Bacteriology Research, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan, 185 9000, Ghent, Belgium
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Wanje G, Masese L, Avuvika E, Baghazal A, Omoni G, Scott McClelland R. Parents' and teachers' views on sexual health education and screening for sexually transmitted infections among in-school adolescent girls in Kenya: a qualitative study. Reprod Health 2017; 14:95. [PMID: 28806985 PMCID: PMC5557423 DOI: 10.1186/s12978-017-0360-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 08/04/2017] [Indexed: 11/15/2022] Open
Abstract
Background To successfully develop and implement school-based sexual health interventions for adolescent girls, such as screening for Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis, it is important to understand parents’ and teachers’ attitudes towards sexual health education and acceptability of sexually transmitted infection (STI) screening interventions. Methods In this qualitative study, we approached parents and teachers from three high schools to participate in in-depth interviews (IDIs) and focus-group discussions (FGDs). Parents and teachers were asked about their general knowledge of STIs and sexual health education. In addition, they were asked whether they would support utilizing outreach to schools to facilitate provision of sexual health education and screening for STIs in adolescent girls. Data were audio-recorded, transcribed, and translated into English. An initial coding matrix was developed and refined throughout the coding process. Transcripts were coded by two researchers and analyzed using the content analysis approach. Results We conducted 10 IDIs (5 parents and 5 teachers) and 4 FGDs (2 with parents, 2 with teachers, total of 26 participants). Most parents reported few or no discussions regarding STIs with their adolescent girls. Parents were more comfortable discussing consequences of sexual activity including loss of virginity and the potential for pregnancy. Parents tended to place responsibility for sexual health education with teachers. The teachers, in turn, provided basic sexual and reproductive health education including puberty, abstinence, and overview of STIs. Both parents and teachers found the idea of screening for STIs in adolescent girls to be acceptable, and were comfortable with research staff contacting girls through informational meetings at schools. Parents felt that adolescents’ STI screening results should be shared with their parents. Conclusion In this African setting, parents and teachers provide limited sexual health education, with a focus on negative consequences including loss of virginity, pregnancy, and risk for STIs. Nonetheless, both parents and teachers were supportive of STI screening for adolescent girls, beginning with school-based informational meetings for the girls. Research and programs that aim to provide STI screening in this setting must offer treatment and address the issue of whether results will be disclosed to parents.
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Affiliation(s)
- George Wanje
- From the University of Nairobi Institute of Tropical and Infectious Diseases (UNITID), University of Nairobi, P.O Box 91276 - 80103, Mombasa, Kenya.
| | - Linnet Masese
- Department of Medicine, University of Washington, HMC Box 359909, 325 9th Avenue, Seattle, WA, 98104-2499, USA
| | - Ethel Avuvika
- From the University of Nairobi Institute of Tropical and Infectious Diseases (UNITID), University of Nairobi, P.O Box 91276 - 80103, Mombasa, Kenya
| | - Anisa Baghazal
- Ministry of Medical Services, Mombasa County Department of Health, P.O Box 90441 - 80100, Mombasa, Kenya
| | - Grace Omoni
- School of Nursing Sciences, University of Nairobi, Kenyatta National Hospital, P.O Box 20804 - 00202, Nairobi, Kenya
| | - R Scott McClelland
- From the University of Nairobi Institute of Tropical and Infectious Diseases (UNITID), University of Nairobi, P.O Box 91276 - 80103, Mombasa, Kenya.,Department of Epidemiology, University of Washington, HMC Box 359909, 325 9th Avenue, Seattle, WA, 98104-2499, USA.,Department of Medicine, University of Washington, HMC Box 359909, 325 9th Avenue, Seattle, WA, 98104-2499, USA.,Department of Global Health, University of Washington, HMC Box 359909, 325 9th Avenue, Seattle, WA, 98104-2499, USA
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Moodley D, Sartorius B, Madurai S, Chetty V, Maman S. Pregnancy Outcomes in Association with STDs including genital HSV-2 shedding in a South African Cohort Study. Sex Transm Infect 2017; 93:460-466. [PMID: 28396556 DOI: 10.1136/sextrans-2017-053113] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 03/02/2017] [Accepted: 03/14/2017] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Genital herpes simplex virus-2 (HSV-2) shedding in pregnant women in association with neonatal herpes infection has been widely studied but there is limited evidence of its association with pregnancy outcomes. METHODS In this retrospective observational study, we included a subgroup of pregnant women who were enrolled in a randomized control behavioural intervention study that was conducted in South Africa in 2008-2010. In pregnancy, women had a HIV rapid test done and a genital swab taken to test for curable STIs and HSV-2 DNA. Subsequent visits were scheduled for 6, 10, 14 weeks and 9 months post-delivery. Pregnancy outcomes were documented at the 6-week or 10-week postpartum visit. Women were treated syndromically for curable STIs. RESULTS Among 615 women included in this data analysis, 36.6% (n=225) tested HIV positive and 8.3% (n=51) tested positive for genital HSV-2 shedding during pregnancy. Women <24 years and HIV-1 seropositive women were 1.5 and 2.5 times more likely to test positive for HSV-2 genital shedding respectively. STI treatment records were available for 158/205 (77.1%) women; all 87 women with symptomatic STIs were treated the same day, and 50/71 (70.4%) asymptomatic women received treatment at the subsequent visit. Remaining 21 (29.6%) asymptomatic women did not receive treatment because they failed to return for antenatal follow-up. In a multivariable regression analysis, genital HSV-2 shedding, HIV-1, Neisseria gonorrhoea, Chlamydia trachomatis and Trichomanas vaginalis were not associated with preterm deliveries, still births and low birth weight. However with stratification by treatment for a STI, asymptomatic women who were not treated were 3.3 times more likely to deliver prematurely (33.3%; n=6/18) when compared to women who were treated during pregnancy (13.2%; n=15/114) (p=0.042). CONCLUSIONS Genital HSV-2 shedding in pregnancy does not appear to alter pregnancy outcomes. Untreated curable STIs (T.vaginalis, C.trachomatis, N.gonorrhoea) were more likely associated with preterm births.
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Affiliation(s)
- Dhayendre Moodley
- Department of Obstetrics and Gynaecology, University of KwaZulu-Natal, Durban, South Africa
| | - Benn Sartorius
- Discipline of Public Health Medicine, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | | | - Vani Chetty
- Department of Obstetrics and Gynaecology, University of KwaZulu-Natal, Durban, South Africa
| | - Suzanne Maman
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Kamala BA, Rosecrans KD, Shoo TA, Al-Alawy HZ, Berrier F, Bwogi DF, Miller KS. Evaluation of the Families Matter! Program in Tanzania: An Intervention to Promote Effective Parent-Child Communication About Sex, Sexuality, and Sexual Risk Reduction. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2017; 29:105-120. [PMID: 28467161 DOI: 10.1521/aeap.2017.29.2.105] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The Families Matter! Program (FMP) is a curriculum-based intervention designed to give parents and other primary caregivers the knowledge, skills, comfort, and confidence to deliver messages to their 9-12-year-old children about sexuality and practice positive parenting skills. A pre- and post-intervention evaluation study on FMP outcomes was conducted with 658 parent participants and their preadolescent children in two administrative wards in Tanzania in 2014. There was an increase in the proportion of study participants (parent-preadolescent pairs) that had positive attitudes toward sex education. On parent-child communication, the majority of participants (59-87%) reported having had more sexuality discussions. On communication responsiveness about sexual issues, scores improved in the period between surveys, with parents showing more improvements than preadolescents. Our results corroborate evidence from previous FMP evaluations, lending support to the conclusion that FMP is successful in promoting attitude and behavior change among parents and preadolescents in different cultural contexts.
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Affiliation(s)
| | - Kathryn D Rosecrans
- Allan Rosenfield Global Health Fellow with the Association of Schools and Programs of Public Health, and Centers for Disease Control and Prevention, Dar es Salaam, United Republic of Tanzania
| | | | | | - Faith Berrier
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - David F Bwogi
- Centers for Disease Control and Prevention, Tanzania
| | - Kim S Miller
- Centers for Disease Control and Prevention, Atlanta, Georgia
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Ramadhani MY, Mirambo MM, Mbena H, Kihunrwa A, Mshana SE. High prevalence of Chlamydia trachomatis infection among infertile women in Mwanza city, Tanzania: a need to introduce screening and treatment programme. Sex Transm Infect 2017; 93:111. [PMID: 28213576 DOI: 10.1136/sextrans-2016-052795] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Revised: 10/11/2016] [Accepted: 10/15/2016] [Indexed: 11/03/2022] Open
Affiliation(s)
- Mansour Y Ramadhani
- Department of Obstetrics and Gynaecology, Weill Bugando School of Medicine, Mwanza, Tanzania
| | - Mariam M Mirambo
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Mwanza, Tanzania
| | - Happiness Mbena
- Department of Obstetrics and Gynaecology, Weill Bugando School of Medicine, Mwanza, Tanzania
| | - Albert Kihunrwa
- Department of Obstetrics and Gynaecology, Weill Bugando School of Medicine, Mwanza, Tanzania
| | - Stephen E Mshana
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Mwanza, Tanzania
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Chaponda EB, Chico RM, Bruce J, Michelo C, Vwalika B, Mharakurwa S, Chaponda M, Chipeta J, Chandramohan D. Malarial Infection and Curable Sexually Transmitted and Reproductive Tract Infections Among Pregnant Women in a Rural District of Zambia. Am J Trop Med Hyg 2016; 95:1069-1076. [PMID: 27672205 DOI: 10.4269/ajtmh.16-0370] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 08/09/2016] [Indexed: 11/07/2022] Open
Abstract
Malarial infection and curable sexually transmitted and reproductive tract infections (STIs/RTIs) are important causes of adverse birth outcomes. Reducing the burden of these infections in pregnancy requires interventions that can be easily integrated into the antenatal care (ANC) package. However, efforts to integrate the control of malarial infection and curable STIs/RTIs in pregnancy have been hampered by a lack of evidence related to their coinfection. Thus, we investigated the prevalence of coinfection among pregnant women of rural Zambia. A prospective cohort study was conducted in Nchelenge District, Zambia, involving 1,086 first ANC attendees. We screened participants for peripheral malarial infection and curable STIs/RTIs (syphilis, Chlamydia, gonorrhea, trichomoniasis, and bacterial vaginosis), and collected relevant sociodemographic data at booking. Factors associated with malarial and STI/RTI coinfection were explored using univariate and multivariate regression models. Among participants with complete results (N = 1,071), 38.7% (95% confidence interval [CI] = 35.7-41.6) were coinfected with malaria parasites and at least one STI/RTI; 18.9% (95% CI = 16.5-21.2) were infected with malaria parasites only; 26.0% (95% CI = 23.5-28.8) were infected with at least one STI/RTI but no malaria parasites, and 16.4% (95% CI = 14.1-18.6) had no infection. Human immunodeficiency virus (HIV)-infected women had a higher risk of being coinfected than HIV-uninfected women (odds ratio [OR] = 3.59 [95% CI = 1.73-7.48], P < 0.001). The prevalence of malarial and STI/RTI coinfection was high in this population. An integrated approach to control malarial infection and STIs/RTIs is needed to reduce this dual burden in pregnancy.
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Affiliation(s)
- Enesia Banda Chaponda
- Department of Biological Sciences, University of Zambia, Lusaka, Zambia. .,Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - R Matthew Chico
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jane Bruce
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Charles Michelo
- Department of Public Health, University of Zambia School of Medicine, Lusaka, Zambia
| | - Bellington Vwalika
- Department of Obstetrics and Gynaecology, University of Zambia School of Medicine, Lusaka, Zambia
| | - Sungano Mharakurwa
- Faculty of Health Sciences, Africa University, Mutare, Zimbabwe.,Department of Medical Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Mike Chaponda
- Department of Clinical Sciences, Tropical Diseases Research Centre, Ndola, Zambia
| | - James Chipeta
- Department of Paediatrics and Child Health, University of Zambia School of Medicine, Lusaka, Zambia
| | - Daniel Chandramohan
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Medline A, Joseph Davey D, Klausner JD. Lost opportunity to save newborn lives: variable national antenatal screening policies for Neisseria gonorrhoeae and Chlamydia trachomatis. Int J STD AIDS 2016; 28:660-666. [PMID: 27440873 DOI: 10.1177/0956462416660483] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Unfavorable pregnancy outcomes caused by Chlamydia trachomatis or Neisseria gonorrhoeae infection are well known. The first step in addressing antenatal C. trachomatis and N. gonorrhoeae infection is a national policy to screen all pregnant women for C. trachomatis and N. gonorrhoeae, regardless of symptoms. The aim of this study was to inform policy makers on the presence of antenatal screening recommendations for C. trachomatis and N. gonorrhoeae infection. We conducted a three-part study from June 2015 to February 2016. We analyzed English and French language information online on Ministry of Health websites regarding C. trachomatis and N. gonorrhoeae antenatal screening. We referenced both primary official country and regional policy documents. We contacted the Ministry of Health directly if the information on the national antenatal screening was outdated or unavailable. In parallel, we sent a survey to the regional representative from the World Health Organization to help collect country-level data. Fourteen countries have current policies for antenatal screening of C. trachomatis and/or N. gonorrhoeae infection: Australia, the Bahamas, Bulgaria, Canada, Estonia, Japan, Germany, Latvia, New Zealand, Democratic People's Republic of Korea, Romania, Sweden, the United Kingdom, and the United States. Australia, New Zealand, and Latvia and the United States restricted antenatal screening to women ≤25 years old and those of higher risk. Several countries responded that they had policies to treat pregnant women with symptoms. This is the currently recommended WHO guideline but is not the same as universal screening. North Korea had policies in place which were not implemented due to lack of personnel and/or supplies. National level policies to support routine screening for C. trachomatis and N. gonorrhoeae infection to prevent adverse pregnancy and newborn outcomes are uncommon.
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Affiliation(s)
- Alexandra Medline
- 1 Columbia University Mailman School of Public Health, New York, NY, USA
| | - Dvora Joseph Davey
- 2 David Geffen School of Medicine, UCLA, Program in Global Health, Division of Infectious Disease, Los Angeles, CA, USA.,3 Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Jeffrey D Klausner
- 2 David Geffen School of Medicine, UCLA, Program in Global Health, Division of Infectious Disease, Los Angeles, CA, USA
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Wagenlehner FM, Brockmeyer NH, Discher T, Friese K, Wichelhaus TA. The Presentation, Diagnosis, and Treatment of Sexually Transmitted Infections. DEUTSCHES ARZTEBLATT INTERNATIONAL 2016; 113:11-22. [PMID: 26931526 PMCID: PMC4746407 DOI: 10.3238/arztebl.2016.0011] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 11/17/2015] [Accepted: 11/17/2015] [Indexed: 12/23/2022]
Abstract
BACKGROUND The reported incidence of sexually transmitted infections (STIs) in Germany is rising. For example, the number of new reported cases of syphilis rose from 3034 in 2010 to 4410 in 2012. METHODS This review is based on pertinent articles retrieved by a selective search in MEDLINE, and on guidelines and systematic reviews from Germany and abroad. RESULTS We discuss sexually transmitted infections presenting with genital, anal, perianal, or oral ulcers, urethritis, cervicitis, urethral or vaginal discharge, or genital warts. We also discuss sexually transmitted infection with HIV and the hepatitis C virus (HCV). Acquired sexually transmitted infections elevate the risk of transmission of other sexually transmitted infections; thus, patients presenting for the diagnosis or treatment of any kind of sexually transmitted infection should be evaluated for others as well. For most of these diseases, treatment of the patient's sexual partner(s) is indicated. Diagnostic nucleic acid amplification techniques are over 90% sensitive and specific and are generally the best way to detect the responsible pathogen. Factors impeding effective treatment include antibiotic resistance (an increasing problem) and the late diagnosis of HIV and HCV infections. CONCLUSION Sexually transmitted infections are common around the world, and any such infection increases the patient's risk of contracting other types of sexually transmitted infection. Molecular genetic diagnostic techniques should be made widely available.
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Affiliation(s)
- Florian M.E. Wagenlehner
- Department of Urology, Pediatric Urology and Andrology, Medical Faculty of the Justus Liebig University Giessen
| | - Norbert H. Brockmeyer
- Department of Dermatology, Venerology and Allergology, St. Josef-Hospital of the Medical Faculty, Ruhr-University Bochum
| | - Thomas Discher
- Medizinische Klinik und Poliklinik II, Justus-Liebig-Universität, Giessen
| | - Klaus Friese
- Department of Obstetrics and Gynecology of the Ludwig-Maximilians-Universität München
| | - Thomas A. Wichelhaus
- Institute for Medical Microbiology and Infection Control, Goethe University Frankfurt am Main
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Hokororo A, Kihunrwa AF, Kalluvya S, Changalucha J, Fitzgerald DW, Downs JA. Barriers to access reproductive health care for pregnant adolescent girls: a qualitative study in Tanzania. Acta Paediatr 2015; 104:1291-7. [PMID: 25473729 PMCID: PMC4456338 DOI: 10.1111/apa.12886] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Revised: 09/17/2014] [Accepted: 12/01/2014] [Indexed: 11/29/2022]
Abstract
AIMS In Tanzania, approximately 25% of adolescents give birth and 50% more become sexually active during adolescence. We hypothesised that reproductive health education and services for adolescent girls are inaccessible and conducted this study to gain insights into their perceptions of sexually transmitted infections (STIs) and barriers to reproductive health service utilisation in rural Mwanza, Tanzania. METHODS We conducted nine focus groups among pregnant adolescents aged 15-20 years. Data were transcribed, translated and coded for relevant themes using NVivo10 software for qualitative data analysis. RESULTS Most participants were aware of the dangers of STIs to themselves and their unborn babies, but did not perceive themselves as at risk of acquiring STIs. They viewed condoms as ineffective for preventing STIs and pregnancies and unnecessary for those in committed relationships. Stigma, long waiting times, and lack of privacy in the clinics discouraged adolescent girls from seeking reproductive health care. CONCLUSION Reproductive health care for adolescent girls who are not pregnant is practically nonexistent in Tanzania. Healthcare access for pregnant young women is also limited. Targeted changes to increase clinic accessibility and to provide reproductive health education to all rather than only pregnant women have the potential to address these gaps.
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Affiliation(s)
- Adolfine Hokororo
- Department of Pediatrics and Child Health, Bugando Medical Centre, Box 1370,Mwanza, Tanzania
| | - Albert F. Kihunrwa
- Department of Obstetrics and Gynecology, Bugando Medical Centre, Box 1370,Mwanza, Tanzania
| | - Samuel Kalluvya
- Department of Internal Medicine, Bugando Medical Centre, Box 1370, Mwanza, Tanzania
| | - John Changalucha
- National Institute for Medical Research, Box 1460, Mwanza, Tanzania
| | - Daniel W Fitzgerald
- Center for Global Health, Weill Cornell Medical College, 402 E. 67 Street, Second Floor, New York, NY, 10065, USA
| | - Jennifer A. Downs
- Department of Internal Medicine, Bugando Medical Centre, Box 1370, Mwanza, Tanzania
- Center for Global Health, Weill Cornell Medical College, 402 E. 67 Street, Second Floor, New York, NY, 10065, USA
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Cassell JA. Highlights from this issue. Sex Transm Infect 2015. [DOI: 10.1136/sextrans-2015-052402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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