Attitudes towards and health consequences of female genital mutilation/cutting: A qualitative study among Somali and Kurdish immigrants and descendants in Denmark

Objectives: There is lack of in-depth knowledge of how immigrants who originate from countries where female genital mutilation/cutting (FGM/C) historically is practiced, perceive the practice after migrating to Europe. The aim of this study was to explore the attitude towards FGM/C among immigrants and descendants and the health consequences of living with FGM/C. Study design: Qualitative methods were used in the form of semi-structured interviews and focus group discussions. Female and male immigrants and descendants in Denmark from Somalia or Kurdish of Iraq/Iran participated in the study. The interview/focus group discussion guides were developed by the European Institute for Gender Equality. Purposely sampling was used, and participants were recruited by use of snowballing through gatekeepers and women’s societies working within the Somali and Kurdish communities. Results: Sixteen persons participated in the study. No descendants had been cut, but all female immigrants had been cut prior to migrating and did not wish to pass on the practice. FGM/C was perceived as a harmful practice with severe sexual and mental health consequences. Women with Somali origin experienced that the practice was falsely associated with their origin, which led to stigmatisation. Women with Kurdish origin lacked healthcare support when suffering sexual consequences of FGM/C. It was generally perceived that the Danish healthcare system lacked cultural sensitivity. Conclusion: FGM/C is negatively perceived among Somali and Kurdish immigrants and descendants in Denmark and not practiced among these groups. The Danish healthcare system should adopt a more culturally sensitive approach when addressing sexual health among immigrants and descendants. Denmark and other European countries should work towards destigmatising the immigrant communities when it comes to FGM/C. Larger European studies with primary data are needed to generalise the findings of this study

One-way SMS and healthcare outcomes in Africa: Systematic review of randomised trials with meta-analysis.

BackgroundThe impact of one-way SMS on health outcomes in Africa is unclear. We aimed to conduct a systematic review of one-way SMS randomised trials in Africa and a meta-analysis of their effect on healthcare appointments attendance and medicine adherence.MethodsPubMed, Embase, CENTRAL, The Global Health Library, ClinicalTrials.gov, ICTRP, and PACTR were searched for published and unpublished trials in Africa without language restriction (up to April 2018). Trials reporting effect estimates on healthcare appointment attendance and medicine adherence were assessed for risk of bias and included in meta-analyses using random-effects models. Other outcomes were reported descriptively. The protocol is registered in PROSPERO, ID:CRD42018081062.ResultsWe included 38 one-way SMS trials conducted in Africa within a broad range of clinical conditions. Eighteen trials were included in the meta-analyses, and four were assessed as overall low risk of bias. One-way SMS improved appointment attendance, OR:2·03; 95% CI:1·40-2·95 (12 trials, 6448 participants), but not medicine adherence, RR:1·10; 95% CI:0·98-1·23 (nine trials, 4213 participants). Subgroup analyses showed that one-way SMS had the highest impact on childhood immunization attendance, OR:3·69; 95% CI:1·67-8·13 (three trials, 1943 participants). There was no clear evidence of one-way SMS improving facility delivery, knowledge level (reproductive/antenatal health, hypertension), diabetes- and hypertension management.ConclusionIn an African setting, the clinical effect of one-way SMS is uncertain except for appointment attendance where the effect seems to vary depending on which clinical condition it is used in

Text messages to increase attendance to follow-up cervical cancer screening appointments among HPV-positive Tanzanian women (Connected2Care): study protocol for a randomised controlled trial

Abstract Background Cervical cancer is a major health concern in Tanzania, caused by poor attendance for cervical cancer screening and follow-up of women at risk. Mobile telephone health interventions are proven effective tools to improve health behaviour in African countries. So far, no knowledge exists on how such interventions may perform in relation to cervical cancer screening in low-income settings. This study aims to assess the degree to which a Short Message Service (SMS) intervention can increase attendance at appointments among women who have tested positive for high-risk (HR) Human Papillomavirus (HPV) during cervical cancer screening. Methods/design Connected2Care is a non-blinded, multicentre, parallel-group, randomised controlled trial. Tanzanian women testing positive to HR HPV at inclusion are randomly assigned in an allocation ratio of 1:1 to the SMS intervention or the control group (standard care). In a period of 10 months, the intervention group will receive 15 one-directional health educative text messages and SMS reminders for their appointment. The total sample size will be 700 with 350 women in each study arm. Primary outcome is attendance rate for follow-up. Secondary objectives are cost-effectiveness, measured through incremental ratios, and knowledge of cervical cancer by a 16-item true/false scale questionnaire at baseline and follow-up. Barriers against implementing the intervention will be assessed in a mixed-methods sub-population study. Discussion This study may provide information on the potential effects, costs, and barriers in implementing an SMS intervention targeting a group of women who are followed up after testing positive for HR HPV and are, therefore, at increased risk of developing cervical cancer. This can guide decision-makers on the effective use of mobile technology in a low-income setting. Trial status: recruiting. Trial registration ClinicalTrials.gov, ID: NCT02509702 . Registered on 15 June 2015

Incident detection of human papillomavirus:a prospective follow-up study among Tanzanian women with a focus on HIV status

ABSTRACT: Background: The causative role of human papillomavirus (HPV) in cervical carcinogenesis is well established; however, prospective studies examining high-risk(HR)-HPV acquisition among adult women in HIV-prevalent settings are limited. Methods: We conducted a prospective study among women (25–60 years) attending cervical cancer screening in Tanzania. Cervical specimens obtained at enrolment and follow-up were tested for HPV. Participants were interviewed on lifestyle and tested for HIV. Results: Among 3805 eligible women, 3074 (80.8%) attended follow-up (median time between the 2 examinations, 17.3 months); 307 had missing HPV results at enrolment or follow-up, leaving 2767 study participants. Among 2253 women initially HR-HPV negative, 184 acquired HR-HPV—incidence: 54.5 per 1000 person-years (95% CI:47.1–62.9); among HIV-positive women 75.2 per 1000 person-years (95% CI:54.5–103.7), HIV-negative 50.9 per 1000 person-years (95% CI:43.3–60.0). HPV52 and HPV16 were the most frequently acquired types. In multivariable regression analysis, HIV positivity, low CD4 count, younger age, and multiple sexual partners were associated with increased odds of HPV acquisition. Conclusion: HPV acquisition was higher among HIV-positive than HIV-negative women, especially women with low CD4 counts. Improvement of immune status among HIV-positives may decrease HPV acquisition. Nonavalent HPV vaccination should be considered given the pattern of HR-HPV types acquired

Video consultations and safety app targeted pregnant women exposed to intimate partner violence in Denmark and Spain: An intervention study nested in a cohort (STOP study).

Background: Intimate partner violence (IPV) during pregnancy is a public health issue with wide-ranging consequences for both the mother and fetus, and interventions are needed. Therefore, the Stop Intimate Partner Violence in Pregnancy (STOP) cohort was established with the overall aim to identify pregnant women exposed to IPV through digital screening and offer women screening positive for IPV a digital supportive intervention. Objective: The aim of this study was to (1) introduce the design and profile of the STOP cohort study, (2) assess the feasibility of implementing digital IPV screening among pregnant women, and (3) assess the feasibility of implementing a digital supportive intervention targeting pregnant women exposed to IPV. Methods: Pregnant women attending antenatal care in the Region of Southern Denmark and in Andalucía, Spain were offered digital screening for IPV using validated scales (Abuse Assessment Screen and Women Abuse Screening Tool). Women who screened positive were eligible to receive a digital supportive intervention. The intervention consisted of 3-6 video consultations with an IPV counselor and a safety planning app. In Denmark, IPV counselors were antenatal care midwives trained by a psychologist specialized in IPV, whereas in Spain, the counselor was a psychologist