Analysis of Interventions for Improving Cervical-Cancer Screening Uptake among Nigerian Women

Cervical-cancer is preventable through early detection of cervical intraepithelial neoplasia that heralds the disease via cervical-cancer screening, yet its mortality is still high especially in developing countries. In Nigeria, researchers have attributed the high cervical-cancer mortality to low uptake of cervical-cancer screening predicated on wrong perception and low knowledge of cervical-cancer and cervical-cancer screening; lack of cervical-cancer screening programme; inadequate community support for cervical-cancer screening and gap in screening skills among health-workers where opportunistic cervical-cancer screening exists. This study aims to identify context-specific interventions for improving cervical-cancer screening uptake and reducing cervical-cancer burden in Nigeria. Secondary data was used for the study. Literature were obtained from Global Health, Popline and PubMed databases; WHO and other relevant websites using Eldis search engine; and from libraries in the University of Leeds and WHO in Geneva. Interventions for improving cervical-cancer screening uptake were analyzed using a set of appraisal criteria which include; technical and cost effectiveness, organizational, gender, cultural and political feasibility to determine their applicability and transferability in Nigeria. Broad interventions identified are; intervention aimed at correcting perception, improving knowledge and increasing access to cervical-cancer screening. Reducing the burden and impact of cervical-cancer in Nigeria will depend on implementation of these interventions by stakeholders

Knowledge, Attitude and Practice of Gynecologists at Public Teaching Hospitals in Sana'a city towards Cervical Cancer Screening, -Yemen, 2020

Background: Cervical cancer is the fourth most prevalent cancer among women causing 250, 0000 annual deaths worldwide. The available data, although limited, indicates that 8.5 million Yemeni women are at risk of developing cervical cancer and most cases are diagnosed at late stages causing deaths from this illness which could be prevented through screening. There is limited evidence about the awareness of health staff in Yemen about the importance, eligibility criteria, role and availability of cervical cancer screening as well as their attitude toward it and their utilization of this service either for themselves or their patients. The aim: to assess the knowledge, attitude, and practice (KAP) of gynecologists toward cervical cancer screening as well as barriers of implementing this screening service in Yemen. Methods: All physicians who provide gynecology and obstetrics care at the four main public teaching hospitals in Sana’a city were targeted in this cross-sectional study. The data was collected using a validated self-administered questionnaire. Findings: Gynecologists in the main public teaching hospitals in the capital of Yemen have a satisfactory knowledge of importance of screening of cervical cancer and positive attitude toward this service. However, their awareness and positive attitude are not well-reflected in the utilization of cervical cancer services, either for themselves or their patients. Barriers of using cervical cancer services include unawareness and misconceptions of gynecologists. Conclusion: The identified gap in gynecologists’ KAP and barriers should be addressed to enhance the neglected cervical cancer screening in Yemen toward better control of this serious preventable disease

Factors related to knowledge, attitudes, and behaviors regarding cervical cancer among Yemeni women

Background Cervical cancer (CxCa), although preventable, is still among the most prevalent cancers in women. Mortality from this cancer is high, especially in low-income countries where preventive strategies are often lacking. We studied the knowledge, attitudes, and practices regarding CxCa among Yemeni women. Methods This cross-sectional study was conducted in 2019 among 399 women in five major hospitals in Sanaa, the capital city of Yemen. Data were collected through face-to-face interviews using structured questionnaires. We used logistic regression models to analyze the likelihood of hearing about CxCa, believing that CxCa is treatable and preventable, awareness of the Pap smear test, and ever having this test, in relation to participant’s age, education level, working outside the household, and family history of CxCa. Results Only 66.7% of the women had heard of CxCa. Women with higher education, working outside the household, and with a family history of CxCa were more likely to be aware of CxCa. Working outside the household was the only variable related to a higher likelihood of knowing that CxCa is a treatable and preventable. Furthermore, women with a family history of CxCa were more likely to have knowledge about Pap smear test and were more likely to have Pap smear test in the past. Conclusion This study identified a low awareness of CxCa and its prevention among Yemeni women. In order to reduce the burden of CxCa in Yemen and save women’s lives, it is necessary to raise women’s awareness of this disease, especially among those with lower education and those not involved in work outside their homes

The predictors of adolescents’ smoking in Egypt, the global youth tobacco survey findings

This study secondary analysed the last Global Youth Tobacco Survey (GYTS) implemented in Egypt which is a cross-sectional school-based survey used self-administered questionnaire to research smoking among a national representative sample of (2,141) adolescents aged 13–15 years. The study identified that male adolescents are more likely to smoke than female adolescents in Egypt. The likelihood of adolescents’ smoking in Egypt was significantly associated with age; low educational level of fathers; having no weekly pocket of money; poor self-confidence to refuse friends’ smoking offers; absence of restriction on selling cigarettes to adolescents near their schools; and observing teachers’ smoking inside schools. Whereas accessing information, through schools, about smoking consequences prevents adolescents’ smoking. Adolescence is critical period for experimenting and continue smoking. The study identified some personal, parenteral, and school related factors that influence adolescents’ smoking in Egypt. These factors should be considered in designing smoking prevention program that targets adolescents

National mapping of schistosomiasis, soil-transmitted helminthiasis and anaemia in Yemen: Towards better national control and elimination

Background Schistosomiasis (SCH) and soil-transmitted helminthiasis (STH) are known to be endemic in Yemen. However, the distribution of both diseases had not previously been assessed by a well-structured national mapping study covering all governorates. The main aim of this study was, therefore, to map the prevalence of SCH and STH in Yemen in order to better inform implementation of effective national control and elimination interventions. The assessment of the distribution of anaemia was also included as a well-known consequence of infection with both SCH and STH. Secondarily, the study aimed to provide a broad indication of the impact of large-scale treatment on the distribution of infection. Methodology and principal findings To achive these aims, 80,432 children (10–14 years old) from 2,664 schools in 332 of Yemen’s 333 districts were included, in 2014, into this national cross-sectional survey. Countrywide, 63.3% (210/332) and 75.6% (251/332) of districts were found to be endemic for SCH and STH respectively. More districts were affected by intestinal than urogenital SCH (54.2% and 31.6% respectively). SCH infection was mostly mild and moderate, with no districts reporting high infection. One quarter (24.4%) of Yemeni districts had high or moderate levels of Ascaris lumbricoides infection. Infection with Trichuris trichiura was the second most common STH (44.9% of districts infected) after A. lumbricoides (68.1%). Hookworm was the least prevalent STH (9.0%). Anaemia was prevalent in 96.4% of districts; it represented a severe public health problem (prevalence ≥ 40%) in 26.5% of districts, and a mild to moderate problem in two thirds of the districts (33.7% and 36.1% respectively). Conclusion This study provided the first comprehensive mapping of SCH, STH, and anaemia across the country. This formed the basis for evaluating and continuing the national control and elimination programme for these neglected tropical diseases in Yemen

Adolescents

Adolescent mortality is low compared to other age groups. However, mortality data do not provide an accurate picture of adolescents' health challenges, since they do not reflect behaviors that make adolescents more susceptible to severe and lifelong adverse consequences in later life. Global forces are affecting the health and wellbeing of the younger generation in unprecedented ways. Humanity and the next generation are being shaped by population mobility, global communication, economic growth, and ecosystem sustainability. Therefore, adolescence has become increasingly recognized as an essential phase of life for achieving human potential. Individuals acquire the physical, cognitive, emotional, social, and economic resources during adolescence that lay the foundation for their health, wellbeing, and social interaction as adults. We can benefit today, in decades to come, and for future generations by managing these resources and investing in adolescent health and wellbeing. We propose a set of general considerations that should inform adolescent health interventions. Interventions should promote resilience in addition to responding to specific health challenges; be comprehensive; involve a number of sectors; be “adolescent-friendly”; address gender issues; include the most disadvantaged adolescents; and be theory-based

Factors in use of family planning services by Syrian women in a refugee camp in Jordan

Background The Syrian conflict presents the fastest growing refugee crisis in the world today, with over four million people now displaced outside the country. Existing literature suggests that family planning services are often still neglected in crisis response efforts. Methods A small-scale qualitative study conducted in May 2013, interviewing Syrian women residing in a Jordanian refugee camp about use and barriers to accessing family planning services. Results The study shows that significant barriers remain, and suggests that international attempts to address refugees’ family planning needs remain inconsistent. Conclusions Several practical measures are identified to address barriers to access, making the article of both practical and academic relevance

Systematic review of intervention functions, theoretical constructs and cultural adaptations of school-based smoking prevention interventions in low-income and middle-income countries

Objective To identify the approaches and strategies used for ensuring cultural appropriateness, intervention functions and theoretical constructs of the effective and ineffective school-based smoking prevention interventions that were implemented in low-income and middle-income countries (LMICs). Data sources Included MEDLINE, EMBASE, Global Health, PsycINFO, Web of Science and grey literature which were searched through August 2022 with no date limitations. Eligibility criteria We included randomised controlled trials (RCTs) with ≥6 months follow-up assessing the effect of school-based interventions on keeping pupils never-smokers in LMICs; published in English or Arabic. Data extraction and synthesis Intervention data were coded according to the Theoretical Domains Framework, intervention functions of Behaviour Change Wheel and cultural appropriateness features. Using narrative synthesis we identified which cultural-adaptation features, theoretical constructs and intervention functions were associated with effectiveness. Findings were mapped against the capability-motivation and opportunity model to formulate the conclusion. Risk of bias was assessed using the Cochrane risk of bias tool. Results We identified 11 RCTs (n=7712 never-smokers aged 11–15); of which five arms were effective and eight (four of the effective) arms had a low risk of bias in all criteria. Methodological heterogeneity in defining, measuring, assessing and presenting outcomes prohibited quantitative data synthesis. We identified nine components that characterised interventions that were effective in preventing pupils from smoking uptake. These include deep cultural adaptation; raising awareness of various smoking consequences; improving refusal skills of smoking offers and using never-smokers as role models and peer educators. Conclusion Interventions that had used deep cultural adaptation which incorporated cultural, environmental, psychological and social factors, were more likely to be effective. Effective interventions considered improving pupils’ psychological capability to remain never-smokers and reducing their social and physical opportunities and reflective and automatic motivations to smoke. Future trials should use standardised measurements of smoking to allow meta-analysis in future reviews

COVID-19 surveillance in fragile health systems, armed conflict and humanitarian crisis, the case of Yemen

Background Yemen is a poor country facing armed conflict which significantly disrupted the Health System. Yemen reported fewer COVID-19 cases than neighbouring countries, yet the case fatality rate (19.6%) remained five times the global average. Conflict typically hinders surveillance, however obtaining representative mortality and morbidity indicators remains essential to efficacious epidemic planning. We aimed to explore challenges hindering COVID-19 surveillance in Yemen and opportunities for addressing them, to increase surveillance effectiveness in such conflict and resource-constraint settings. Methods Qualitative study question guide was used for in-depth interviewswith 30 healthcare workers who worked in Yemen’s surveillance system during the pandemic. Participants were recruited through in-country gatekeepers using a ‘snowball’ sampling technique. Thematic framework analysiswas used. Findings A basic level of preparedness existed following responses to previous epidemics, including activating Rapid Response Teams (RRTs), and electronic disease surveillance. Key challenges included the ongoing conflict, an unstable health system, minimal infrastructure restorations, misinformation, community incompliance, and inadequate laboratory diagnostics or transportation capabilities. Participants recommended addressing these barriers through strengthening RRTs, transportation and laboratory testing capacities, implementing community awareness campaigns, alongside improving primary health care services and inter-governorate governance. Conclusion Active community surveillance by RRTs supplemented with community volunteers is imperative and necessary nationwide. National community awareness campaigns on case detection, reporting, and addressing misinformation are essential to implementing such community surveillance. Increased utilization of mobile laboratories could enhance laboratory testing capacity in underserved areas. For each recommendation to be effectively implemented, the international community must provide sufficient resources and financial aid