Female genital mutilation/cutting : changes and trends in knowledge, attitudes, and practices among health care professionals in The Gambia

Altres ajuts: The completion of this study has been made possible thanks to the work of Wassu Gambia Kafo personnel, with special regards to the training and research team members, who offered their expertise and professionalism. We would also like to thank the HCPs who agreed to participate in the research and the close collaboration of the Gambian health and academic institutions, whose collaboration was fundamental for its development. Likewise, we acknowledge Diputación Foral de Álava/Arabako Foru Aldundia, "La Caixa" Foundation and the Catalan Agency for Development Cooperation (ACCD) for having the confidence and providing the financial support that has made this study possible.Female genital mutilation/cutting (FGM/C) is a harmful traditional practice that affects two out of three girls in The Gambia, seriously threatening their life and well-being with severe health consequences. By tracking the reference values established in former research conducted between 2009 and 2011, the objectives of this study are to explore trends and to measure and assess changes in knowledge, attitudes, and practices regarding FGM/C among health care professionals (HCPs) in The Gambia. A cross-sectional descriptive study was designed to collect and analyze data from an overall stratified sample consisting of 1,288 HCPs including health professionals and students throughout the six regions of The Gambia. Data were collected by the implementation of a self-administered written knowledge, attitudes, and practices questionnaire between 2012 and 2014. The results of this study showed that 76.4% of HCPs are eager to abandon FGM/C, and 71.6% of them regard it as a harmful practice with negative consequences on life and health. HCPs reported more knowledge and favorable attitudes towards FGM/C abandonment, being better able to identify the practice, more aware of its health complications, and more concerned in their essential role as social agents of change. However, 25.4% of HCPs still embraced the continuation of the practice, 24.4% expressed intention of subjecting their own daughters to it, and 10.5% declared to have performed it within their professional praxis. Findings confirm progress in knowledge and attitudes regarding FGM/C among HCPs, who are better skilled to understand and manage the consequences. Nevertheless, discrepancies between information, intention, and behavior unveil resistance in practice and proves that FGM/C medicalization is increasing. Thus, there is an urgent need to support HCPs in the integration of FGM/C preventive interventions within the public health system, to address arguments favoring medicalization, and to use data to design appropriate strategies

Population-based prevalence survey of follicular trachoma and trachomatous trichiasis in the Casamance region of Senegal.

BACKGROUND: Trachoma, caused by ocular infection with Chlamydia trachomatis, is the leading infectious cause of blindness worldwide. We conducted the first population-based trachoma prevalence survey in the Casamance region of Senegal to enable the Senegalese National Eye Care Programme (NECP) to plan its trachoma control activities. The World Health Organization (WHO) guidelines state that any individual with trachomatous trichiasis (TT) should be offered surgery, but that surgery should be prioritised where the prevalence is >0.1%, and that districts and communities with a trachomatous inflammation, follicular (TF) prevalence of ≥10% in 1-9 year-olds should receive mass antibiotic treatment annually for a minimum of three years, along with hygiene promotion and environmental improvement, before re-assessing the prevalence to determine whether treatment can be discontinued (when TF prevalence in 1-9 year-olds falls 1% in all districts. CONCLUSION: With a prevalence <5%, TF does not appear to be a significant public health problem in this region. However, TF monitoring and surveillance at sub-district level will be required to ensure that elimination targets are sustained and that TF does not re-emerge as a public health problem. TT surgery remains the priority for trachoma elimination efforts in the region, with an estimated 1819 TT surgeries to conduct

Female genital mutilation/cutting : changes and trends in knowledge, attitudes, and practices among health care professionals in The Gambia

Altres ajuts: The completion of this study has been made possible thanks to the work of Wassu Gambia Kafo personnel, with special regards to the training and research team members, who offered their expertise and professionalism. We would also like to thank the HCPs who agreed to participate in the research and the close collaboration of the Gambian health and academic institutions, whose collaboration was fundamental for its development. Likewise, we acknowledge Diputación Foral de Álava/Arabako Foru Aldundia, "La Caixa" Foundation and the Catalan Agency for Development Cooperation (ACCD) for having the confidence and providing the financial support that has made this study possible.Female genital mutilation/cutting (FGM/C) is a harmful traditional practice that affects two out of three girls in The Gambia, seriously threatening their life and well-being with severe health consequences. By tracking the reference values established in former research conducted between 2009 and 2011, the objectives of this study are to explore trends and to measure and assess changes in knowledge, attitudes, and practices regarding FGM/C among health care professionals (HCPs) in The Gambia. A cross-sectional descriptive study was designed to collect and analyze data from an overall stratified sample consisting of 1,288 HCPs including health professionals and students throughout the six regions of The Gambia. Data were collected by the implementation of a self-administered written knowledge, attitudes, and practices questionnaire between 2012 and 2014. The results of this study showed that 76.4% of HCPs are eager to abandon FGM/C, and 71.6% of them regard it as a harmful practice with negative consequences on life and health. HCPs reported more knowledge and favorable attitudes towards FGM/C abandonment, being better able to identify the practice, more aware of its health complications, and more concerned in their essential role as social agents of change. However, 25.4% of HCPs still embraced the continuation of the practice, 24.4% expressed intention of subjecting their own daughters to it, and 10.5% declared to have performed it within their professional praxis. Findings confirm progress in knowledge and attitudes regarding FGM/C among HCPs, who are better skilled to understand and manage the consequences. Nevertheless, discrepancies between information, intention, and behavior unveil resistance in practice and proves that FGM/C medicalization is increasing. Thus, there is an urgent need to support HCPs in the integration of FGM/C preventive interventions within the public health system, to address arguments favoring medicalization, and to use data to design appropriate strategies

Conjunctival FOXP3 expression in trachoma: do regulatory T cells have a role in human ocular Chlamydia trachomatis infection?

BACKGROUND: Trachoma, caused by ocular infection with Chlamydia trachomatis, remains the leading infectious cause of blindness and in 2002 was responsible for 3.6% of total global blindness. Although transmission can be successfully interrupted using antibiotics and improvements in public and personal hygiene, the long-term success of the control programmes advocated by the World Health Organization are still uncertain. For the complete control and prevention of trachoma, a vaccine would be highly desirable. Currently there are no licensed vaccines for trachoma, and no human vaccine trials have been conducted since the 1960s. A barrier to new attempts to design and introduce a vaccine is the identification of immunologic correlates of protective immunity or immunopathology. We studied important correlates of the immune response in a trachoma-endemic population in order to improve our knowledge of this disease. This is essential for the successful development of a vaccine against both ocular and genital C. trachomatis infection. METHODS AND FINDINGS: We used quantitative real-time PCR for C. trachomatis 16S rRNA to identify conjunctival infection. The expression of IFN-gamma, IDO, IL-10, and FOXP3 mRNA transcripts was measured. We evaluated the role of immune effector and regulatory responses in the control of chlamydial infection and in the resolution of clinical signs of trachoma in endemic communities in Gambia. All host transcripts examined were detectable even in normal conjunctiva. The levels of these transcripts were increased, compared to normal uninfected conjunctiva, when infection was detected, with or without clinical disease signs. Interestingly, when clinical disease signs were present in the absence of infection, the expression of a regulatory T cell transcription factor, FOXP3, remained elevated. CONCLUSIONS: There is evidence of an increase in the magnitude of the local anti-chlamydial cytokine immune responses with age. This increase is coupled to a decline in the prevalence of infection and active trachoma, suggesting that effective adaptive immunity is acquired over a number of years. The anti-chlamydial and inflammatory immune response at the conjunctival surface, which may control chlamydial replication, is closely matched by counter inflammatory or regulatory IL-10 expression. Differences in the level of FOXP3 expression in the conjunctiva may indicate a role for regulatory T cells in the resolution of the conjunctival immune response, which is important in protection from immunopathology. However, the expression of cytokines that control chlamydial replication and those that regulate the conjunctival immune response is not simply juxtaposed; the interaction between the infection and the clinical disease process is therefore more complex

The Frequency of Chlamydia trachomatis Major Outer Membrane Protein-Specific CD8(+) T Lymphocytes in Active Trachoma Is Associated with Current Ocular Infection

Chlamydia-specific cytotoxic T lymphocytes are able to control model infections but may be implicated in disease pathogenesis. HLA-A2 peptide tetramers to Chlamydia trachomatis major outer membrane protein 258-266 (MOMP258-266) and MOMP260-268 were used to characterize HLA class I-restricted CD8(+) T cells in Gambian children aged 4 to 15 years with clinical signs of active trachoma and/or infection with C. trachomatis. The frequencies of circulating HLA-A2 tetramer binding cells (TBC) were determined in whole blood samples by flow cytometric analysis. Initial screening of subjects with an anti-HLA-A2 antibody confirmed the presence of either HLA-A2 or HLA-A28. These were subsequently further divided by molecular subtyping. The C. trachomatis-specific HLA-A2 peptide tetramers were able to bind T cells with receptors from subjects which were restricted by either the HLA-A2 or the HLA-A28 restriction element. In this population, the median value of C. trachomatis-specific CD8(+) T cells was 0.02%, with frequencies of up to 3.71% of CD8(+) T cells reactive with a single tetramer in a minority of subjects. TBC were detected more often in subjects who were infected at the ocular surface, and their presence was associated with infection episodes of longer duration. Detection of C. trachomatis-specific TBC was not associated with the presence of disease or with the estimated load of ocular C. trachomatis infection at the time of sample collection. High frequencies of C. trachomatis-specific cells did not predict subsequent appearance or resolution of the clinical disease signs of active trachoma

Correlations between Right Eye Conjunctival Gene Transcript Levels Reveal Linked Cytokine Responses and the Relationship to Control of Pathogen Load

<div><p>Abundance of <i>IFN-γ, IL-10,</i> and <i>IDO</i> relative to <i>HPRT</i> expression after log₁₀ transformation. Correlation coefficients were calculated by Spearman's rank correlation and trend lines fitted by locally weighted polynomial regression.</p> <p>(A) Strong positive correlation between the conjunctival expression of <i>IDO</i> and <i>IFN-γ</i> in individuals with infection (<i>n =</i> 69) or without infection (<i>n =</i> 238).</p> <p>(B) Strong positive correlation between the expression of <i>IFN-γ</i> and counter inflammatory <i>IL-10</i> in infected (<i>n =</i> 69) and uninfected individuals (<i>n =</i> 238).</p> <p>(C) Relative abundance of <i>IDO</i> and the load of pathogen (chlamydial 16S rRNA) in the conjunctiva. A weak positive correlation was found between pathogen load and <i>IDO</i> expression in clinically normal individuals (<i>n =</i> 42) (mean pathogen loads are lower in this group; <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0030266#pmed-0030266-t002" target="_blank">Table 2</a>). In contrast, the relationship between <i>IDO</i> expression and pathogen load is weakly negative or absent in individuals with co-incident clinical signs of trachoma (<i>n</i> = 29) (pathogen loads are highest in this group; <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0030266#pmed-0030266-t002" target="_blank">Table 2</a>).</p> <p>CT, <i>C. trachomatis.</i></p></div

Age Modulation on Right Eye Conjunctival mRNA Expression: Analysis of Covariance

<p>Individuals were categorised using a combination of the presence of clinical signs of active trachoma (TF/TI) and the detection of chlamydial 16S rRNA. Regression models were fitted for the expression of each human mRNA assayed and age (years) within each category. The regression lines for individuals in each category are shown for each of the mRNAs, <i>IDO</i> (top left), <i>IFN-γ</i> (bottom left), <i>IL-10</i> (top right), and <i>FOXP3</i> (bottom right). Green line: clinically normal, uninfected individuals; blue line: clinically normal, infected individuals; red line: clinically diseased, infected individuals; and orange line: clinically diseased, uninfected individuals.</p

Conjunctival Cytokine mRNA Expression in the Right Conjunctivae of Study Participants

<p>RNA was extracted from conjunctival swabs and reverse transcribed, and specific cytokine transcripts were amplified by PCR. Cytokine mRNA expression was normalized against the housekeeping gene <i>HPRT</i>. The response of each individual is shown with the median value (red bar) and the 25th and 75th percentiles (blue bars) for each group. Data were tested for significance by ANOVA and adjusted for age. Individuals are categorised using a combination of the presence of clinical signs of active trachoma (TF/TI) and the detection of chlamydial 16S rRNA. <i>IFN-γ</i> (A) and <i>IDO</i> (B) mRNAs were increased in infected individuals, and they were further increased in those in whom clinical signs coincided with infection compared to clinically normal, uninfected individuals. <i>IL-10</i> mRNA (C) was increased only in those who had clinical infections, while <i>FOXP3</i> mRNA (D) was increased in both clinically infected and clinically diseased, uninfected individuals.</p