Qualitative insights into a same day self-collect HPV screen-and-treat program for early detection and treatment of cervical precancer in Papua New Guinea

Papua New Guinea has among the highest cervical cancer incidence and mortality rates globally and has been plagued by repeated unsuccessful cervical cancer screening, and treatment programs. The World Health Organization (WHO) recently recommended same-day (single visit) human papillomavirus (HPV) screen and treat for primary cervical screening in low- and middle-income countries (LMIC). The acceptability and experience of participation in same day HPV screen-and-treat programs has not previously been evaluated in Papua New Guinea or any other high-burden settings. As part of a larger field prospective single-arm intervention study, my doctoral research examines key social constructs that could impact the acceptability of a same day point-of-care HPV screen-and-treat program from the perspectives of women, health care workers, and policymakers in Papua New Guinea. Through this research, I identify the factors and expound on key stakeholders’ experiences to determine the requirements to successfully build an acceptable, sustainable, patient-centred, HPV diagnostic testing and treatment program in the country now and into the future. In the first study (chapter 3), I conducted a global qualitative meta-synthesis on the use of and acceptability of the use of self-collection for HPV-based screening. As part of a prospective field study in Papua New Guinea, I led a qualitative sub-study (chapters 4-6) using different qualitative data analysis methods to explore the acceptability of point-of-care HPV screening and same-day treatment. Using purposive sampling a total of 88 semi-structured interviews were conducted with women attending the screen-and-treat service (n=62), health care workers (n=20), and policymakers (n=6). Key findings in chapter 4 highlighted the socio-cultural factors positively impacting women’s engagement in the screening program. Chapter 5 expands on the narratives of women who have tested positive for oncogenic HPV and highlights how having access to same day treatment transformed these women’s experiences of diagnosis. Chapter 6 emphasizes critical perspectives of health care workers and key informants and their experiences with the provision of self-collected HPV-based screen-and-treat services and its impact on acceptability. In chapter 7 I discuss the implications of these novel findings for developing strategies and policies to ensure sustained acceptability of the program as well as sound financial, and human resources for health to increase the coverage of same day self-collected HPV-based screen-and-treat in Papua New Guinea. These findings and recommendations will inform practice and policies for the rollout of HPV-based screen-and-treat locally, and in similar high burden settings

Barriers and facilitators to HIV and syphilis rapid diagnostic testing in antenatal care settings in low-income and middle-income countries: a systematic review.

BACKGROUND: Testing and treatment during pregnancy is a well-established and cost-effective prevention strategy, which relies largely on use of rapid diagnostic tests (RDTs). Yet, in many low-income and-middle-income countries, the uptake of RDTs is suboptimal. A qualitative meta-synthesis was conducted to identify the barriers and enablers to use of HIV and syphilis RDTs among pregnant women in low-income and middle-income countries. METHODS: This review was conducted using PRISMA guidelines. Eligible studies included peer-reviewed publications, which used qualitative methods to explore HIV and syphilis RDT in antenatal care clinics in low-income and middle-income countries. Studies focusing on perspectives of pregnant women, healthcare workers and/or stakeholders were included. We used an inductive approach informed by a modified socioecological model to synthesise the data. RESULTS: 62 manuscripts met the eligibility criteria. For pregnant women, initial acceptance of the RDT and continuation in antenatal care depends on the perception that engaging in testing will be a beneficial experience for their baby and themselves, often influenced by the provision of services that are gender-sensitive, confidential, respectful, flexible and considers their well-being into the future. Local sociocultural beliefs about pregnancy and diseases, awareness of diseases and gender roles in society also influenced RDT acceptability among pregnant women. For healthcare workers, the ability to provide high-quality RDT care required ongoing training, accurate and easy to use tests, support from supervisors and communities, sufficient resources and staffing to provide services, and reliable salary. At the stakeholder level, well-developed guidelines and health system infrastructures were imperative to the delivery of RDT in antenatal clinics. CONCLUSION: Our findings highlight clear gaps to the provision of sustainable and culturally acceptable maternal HIV and/or syphilis screening using RDTs. In addition, greater attention needs to be paid to community stakeholders in promoting the uptake of RDT in antenatal clinics. PROSPERO REGISTRATION NUMBER: CRD42018112190

Prevalence and factors associated with maternal and neonatal sepsis in sub-Saharan Africa: a systematic review and meta-analysis

ObjectivesThis study aimed to determine the prevalence and factors associated with maternal and neonatal sepsis in sub-Saharan Africa.MethodsThis systematic review and meta-analysis used the PRISMA guideline on sepsis data in sub-Saharan Africa. The bibliographic search was carried out on the following databases: Medline/PubMed, Cochrane Library, African Index Medicus, and Google Scholar. Additionally, the reference lists of the included studies were screened for potentially relevant studies. The last search was conducted on 15 October 2022. The Joanna Briggs Institute quality assessment checklist was applied for critical appraisal. Estimates of the prevalence of maternal and neonatal sepsis were pooled using a random-effects meta-analysis model. Heterogeneity between studies was estimated using the Q statistic and the I2 statistic. The funnel plot and Egger’s regression test were used to assess the publication bias.ResultsA total of 39 studies were included in our review: 32 studies on neonatal sepsis and 7 studies on maternal sepsis. The overall pooled prevalence of maternal and neonatal sepsis in Sub-Saharan Africa was 19.21% (95% CI, 11.46–26.97) and 36.02% (CI: 26.68–45.36), respectively. The meta-analyses revealed that Apgar score < 7 (OR: 2.4, 95% CI: 1.6–3.5), meconium in the amniotic fluid (OR: 2.9, 95% CI: 1.8–4.5), prolonged rupture of membranes >12 h (OR: 2.8, 95% CI: 1.9–4.1), male sex (OR: 1.2, 95% CI: 1.1–1.4), intrapartum fever (OR: 2.4, 95% CI: 1.5–3.7), and history of urinary tract infection in the mother (OR: 2.7, 95% CI: 1.4–5.2) are factors associated with neonatal sepsis. Rural residence (OR: 2.3, 95% CI: 1.01–10.9), parity (OR: 0.5, 95% CI: 0.3–0.7), prolonged labor (OR: 3.4, 95% CI: 1.6–6.9), and multiple digital vaginal examinations (OR: 4.4, 95% CI: 1.3–14.3) were significantly associated with maternal sepsis.ConclusionThe prevalence of maternal and neonatal sepsis was high in sub-Saharan Africa. Multiple factors associated with neonatal and maternal sepsis were identified. These factors could help in the prevention and development of strategies to combat maternal and neonatal sepsis. Given the high risk of bias and high heterogeneity, further high-quality research is needed in the sub-Saharan African context, including a meta-analysis of individual data.Systematic review registration: PROSPERO (ID: CRD42022382050)

Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine

[This corrects the article DOI: 10.1186/s13054-016-1208-6.]

Skills and language practices in transcultural situations : language learning paths of soninke-french bilingual children

Les enfants de migrants grandissent dans un contexte de bilinguisme ou de plurilinguisme en France et sont souvent considérés comme étant allophones. Le rapport aux langues des enfants varie au cours de leur développement mais peu maîtrisent parfaitement les deux langues. Nous nous sommes intéressés aux enfants grandissant dans des familles migrantes parlant le soninké, langue de tradition orale parlée en Afrique de l'Ouest. Pour ce, à l'aide de l'ELAL d'Avicenne, outil créé et mis en place par une équipe pluridisciplinaire du service de psychopathologie de l'enfant et de l'adolescent de l'hôpital Avicenne, nous avons évalué des enfants âgés de 4 à 6 ans en Mauritanie (soninké) et en France (français et soninké). Les évaluations langagières de ces enfants mises en lien avec leurs histoires familiales et les histoires migratoires de leurs parents, nous ont permis d'amorcer des pistes quant aux facteurs mis en jeu dans la transmission et l'acquisition de la langue soninké en France et de montrer l'importance du bilinguisme, quelque soit le degré, en situation transculturelle.Migrant children grow up in bilingual and multilingual surroundings in France and are often considered as allophones. The relationship of children to languages changes during their development, but few of them master two languages. We were interested in children growing up in immigrant families speaking soninke, which is a West African language of oral tradition. For that, by means the ELAL d'Avicenne, a unique tool created and developed by a multidisciplinary team in the department of child and adolescent psychopathology at Avicenne hospital, we met 4 to 6 year-old children in Mauritania (Soninke) and in France (French and Soninke). Language assessments of these children linked to their family stories and their parents' migration stories, have allowed us to initiate tracks on the factors involved in the acquisition and transmission of, the soninke language in France, and to show the importance of bilingualism, regardless of its degree, in transcultural situations

L'entretien avec les parents pour comprendre l'histoire langagière de la famille

International audienc

L'entretien avec les parents pour comprendre l'histoire langagière de la famille

International audienc

L'entretien avec les parents pour comprendre l'histoire langagière de la famille

International audienc

L'entretien avec les parents pour comprendre l'histoire langagière de la famille

International audienc