Department of Infectious Disease Epidemiology, Bernhard-Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany.
German Center for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany.
Infect Dis Poverty. 2023 Sep 25;12(1):89. doi: 10.1186/s40249-023-01139-3.
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.
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).
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.
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.
在资源有限的环境下，女性健康可以受益于高负担疾病的综合管理，例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。在马达加斯加等血吸虫病流行的国家，缺乏关于 FGS 和 HPV 流行率的数据，也缺乏针对这两种疾病的预防措施。本研究旨在估计马达加斯加农村地区 FGS 和 HPV 的流行率，并研究相关的危险因素，以确定改善妇女健康的机会。
在最初的社区外展活动之后，2021 年在马罗瓦伊区的三个初级保健中心连续招募了年龄在 18-49 岁之间的感兴趣的妇女。FGS 通过阴道镜检查检测。阴道镜图像由两名独立的专家进行双盲复查。对宫颈阴道灌洗液标本进行 Luminex 珠基分析，以进行 HPV 分型。使用单变量和多变量二项式 Poisson 回归，使用 95%置信区间（CI）估计选定因素与 FGS 和 HPV 阳性之间的关联的粗（CPR）和调整后患病率比（APR）。
在 500 名入组的妇女中，有 302 名妇女的 FGS 和 HPV 诊断信息完整，因此符合分析条件。在样本中，检测到 189 例（62.6%，95%CI：56.9-68.1）FGS 病例。共有 129 名妇女（42.7%，95%CI：37.1-48.5）HPV 检测呈阳性。共有 80 名妇女（26.5%，95%CI：21.6-31.8）同时检测到两种疾病呈阳性。FGS 与 HPV 阳性之间未观察到关联，而与无既往妊娠（APR=0.65，95%CI：0.43-0.78）和年龄较大（APR=0.59，95%CI：0.42-0.81）相比，既往妊娠和年轻年龄段与 HPV 感染呈负相关。
该研究结果表明，FGS 和 HPV 在马达加斯加农村地区高度流行。这两种疾病的同时流行需要紧急调整公共卫生策略，以改善妇女健康，例如在初级保健层面提供综合服务。
