Female genital schistosomiasis, human papilloma virus infection, and cervical cancer in rural Madagascar: a cross sectional study.

IF 8.1 1区医学

Infectious Diseases of Poverty Pub Date : 2023-09-25 DOI:10.1186/s40249-023-01139-3

Jean-Marc Kutz, Pia Rausche, Tahinamandranto Rasamoelina, Sonya Ratefiarisoa, Ravo Razafindrakoto, Philipp Klein, Anna Jaeger, Rivo Solotiana Rakotomalala, Zoly Rakotomalala, Bodo Sahondra Randrianasolo, Sandrine McKay-Chopin, Jürgen May, Rapahel Rakotozandrindrainy, Dewi Ismajani Puradiredja, Elisa Sicuri, Monika Hampl, Eva Lorenz, Tarik Gheit, Rivo Andry Rakotoarivelo, Daniela Fusco

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Abstract

Background: Women's health in resource-limited settings can benefit from the integrated management of high-burden diseases, such as female genital schistosomiasis (FGS) and human papilloma virus (HPV)-related cervical cancer. In schistosomiasis-endemic countries such as Madagascar, data on FGS and HPV prevalence are lacking as well as preventive measures for both conditions. This study aims to estimate the prevalence of FGS and HPV in rural Madagascar, and to examine associated risk factors to identify opportunities for improving women's health.

Methods: After initial community outreach activities, interested women aged 18-49 years were recruited consecutively in 2021 at three primary health care centers in the district of Marovoay. FGS was detected by colposcopy. Colposcopy images were double-blind reviewed by two independent specialists. A Luminex bead-based assay was performed on cervical vaginal lavage specimens for HPV typing. Crude (CPR) and adjusted prevalence ratios (APR) of associations between selected factors and FGS and HPV positivity were estimated using univariable and multivariable binary Poisson regression with 95% confidence intervals (CIs).

Results: Among 500 women enrolled, 302 had complete information on FGS and HPV diagnosis, and were thus eligible for analysis. Within the sample, 189 (62.6%, 95% CI: 56.9-68.1) cases of FGS were detected. A total of 129 women (42.7%, 95% CI: 37.1-48.5) tested positive for HPV. In total, 80 women (26.5%, 95% CI: 21.6-31.8]) tested positive for both conditions. No association was observed between FGS and HPV positivity, while previous pregnancy (APR = 0.65, 95% CI: 0.43-0.78) and older age (APR = 0.59, 95% CI: 0.42-0.81) are showing a negative association with HPV infection compared to no previous pregnancy and younger age groups.

Conclusions: The results of the study show that FGS and HPV are highly prevalent in rural Madagascar. The concurrent prevalence of these two conditions requires urgent adaptations of public health strategies to improve women's health, such as integrated services at primary level of care.

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马达加斯加农村女性生殖器血吸虫病、人类乳头状瘤病毒感染和宫颈癌症：一项横断面研究。

背景：在资源有限的环境中，妇女的健康可以受益于高负担疾病的综合管理，如女性生殖器血吸虫病（FGS）和人乳头瘤病毒（HPV）相关的宫颈癌症。在马达加斯加等血吸虫病流行国家，缺乏FGS和HPV流行率的数据，也缺乏针对这两种情况的预防措施。本研究旨在评估马达加斯加农村女性生殖器切割和人乳头状瘤病毒的患病率，并检查相关的风险因素，以确定改善妇女健康的机会。方法：在最初的社区外展活动之后，2021年，在Marovoy区的三个初级卫生保健中心连续招募了18-49岁的感兴趣的女性。阴道镜检查发现FGS。两位独立专家对阴道镜图像进行了双盲审查。对宫颈阴道灌洗标本进行基于Luminex珠的HPV分型测定。采用95%置信区间（CI）的单变量和多变量二元泊松回归估计了所选因素与FGS和HPV阳性之间关系的粗患病率（CPR）和调整患病率（APR）。在样本中，检测到189例（62.6%，95%置信区间：56.9-68.1）FGS病例。共有129名女性（42.7%，95%置信区间：37.1-48.5）的HPV检测呈阳性。总共有80名女性（26.5%，95%CI:21.6-31.8]）在这两种情况下检测呈阳性。未观察到FGS与HPV阳性之间的相关性，而既往妊娠（APR = 0.65，95%可信区间：0.43-0.78）和年龄较大（APR = 0.59，95%CI:0.42-0.81）显示出与HPV感染的负相关。结论：研究结果表明，FGS和HPV在马达加斯加农村高度流行。这两种疾病同时流行，需要紧急调整公共卫生战略，以改善妇女的健康，例如初级保健的综合服务。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Infectious Diseases of Poverty INFECTIOUS DISEASES-

自引率

1.20%

发文量

368

期刊介绍： Infectious Diseases of Poverty is an open access, peer-reviewed journal that focuses on addressing essential public health questions related to infectious diseases of poverty. The journal covers a wide range of topics including the biology of pathogens and vectors, diagnosis and detection, treatment and case management, epidemiology and modeling, zoonotic hosts and animal reservoirs, control strategies and implementation, new technologies and application. It also considers the transdisciplinary or multisectoral effects on health systems, ecohealth, environmental management, and innovative technology. The journal aims to identify and assess research and information gaps that hinder progress towards new interventions for public health problems in the developing world. Additionally, it provides a platform for discussing these issues to advance research and evidence building for improved public health interventions in poor settings.