Barriers to uptake of cervical cancer screening services in low-and-middle-income countries: a systematic review.

OBJECTIVES: Low-and-middle-income countries (LMICs) bear a disproportionate burden of cervical cancer mortality. We aimed to identify what is currently known about barriers to cervical cancer screening among women in LMICs and propose remedial actions. DESIGN: This was a systematic review using Medical Subject Headings (MeSH) terms in Google Scholar, PubMed, Scopus, and Web of Science databases. We also contacted medical associations and universities for grey literature and checked reference lists of eligible articles for relevant literature published in English between 2010 and 2020. We summarized the findings using a descriptive narrative based on themes identified as levels of the social ecological model. SETTING: We included studies conducted in LMICs published in English between 2010 and 2020. PARTICIPANTS: We included studies that reported on barriers to cervical cancer screening among women 15 years and older, eligible for cervical cancer screening. RESULTS: Seventy-nine articles met the inclusion criteria. We identified individual, cultural/traditional and religious, societal, health system, and structural barriers to screening. Lack of knowledge and awareness of cervical cancer in general and of screening were the most frequent individual level barriers. Cultural/traditional and religious barriers included prohibition of screening and unsupportive partners and families, while social barriers were largely driven by community misconceptions. Health system barriers included policy and programmatic factors, and structural barriers were related to geography, education and cost. Underlying reasons for these barriers included limited information about cervical cancer and screening as a preventive strategy, poorly resourced health systems that lacked policies or implemented them poorly, generalised limited access to health services, and gender norms that deprioritize the health needs of women. CONCLUSION: A wide range of barriers to screening were identified across most LMICs. Urgent implementation of clear policies supported by health system capacity for implementation, community wide advocacy and information dissemination, strengthening of policies that support women's health and gender equality, and targeted further research are needed to effectively address the inequitable burden of cervical cancer in LMICs.

Effects of Maternal Suicidal Ideation on Child Cognitive Development: A Longitudinal Analysis.

This study aimed to assess the association between suicidal ideation among mothers living with HIV in Zimbabwe and the cognitive development of their children. Participants were mother-child dyads recruited from two rural districts in Zimbabwe. Data were collected at baseline and 12 months follow-up. Suicidal ideation was assessed using item-10 from the Edinburgh postnatal depression scale. Mixed-effects linear regression was used to assess the association of child cognitive outcomes at follow-up (using the Mullen scales of early learning) with maternal suicidal ideation. Mothers with suicidal ideation at baseline (n = 171) tended to be younger, unmarried, experienced moderate to severe hunger, had elevated parental stress and depression symptoms compared with non-suicidal mothers (n = 391). At follow-up, emerging maternal suicidal ideation was associated with poorer child cognitive outcomes (adjusted mean difference - 6.1; 95% CI - 10.3 to - 1.8; p = 0.03). Suicidal ideation affects child cognitive development and should be addressed, particularly in HIV positive mothers.

Evaluating the effectiveness of a multi-component intervention on early childhood development in paediatric HIV care and treatment programmes: a randomised controlled trial.

BACKGROUND: HIV infection in a family may affect optimum child development. Our hypothesis is that child development outcomes among HIV-exposed infants will be improved through a complex early childhood stimulation (ECS) programme, and income and loans saving programme for HIV positive parents. METHODS: The study was a cluster-randomized controlled trial in 30 clinic sites in two districts in Zimbabwe. Clinics were randomised in a 1:1 allocation ratio to the Child Health Intervention for Development Outcomes (CHIDO) intervention or Ministry of Health standard care. The CHIDO intervention comprises three elements: a group ECS parenting programme, an internal savings and lending scheme (ISALS) and case-management home visits by village health workers. The intervention was aimed at caregiver-child dyads (child aged 0-24 months) where the infant was HIV exposed or infected. The primary outcomes were cognitive development (assessed by the Mullen Scales of Early Learning) and retention of the child in HIV care, at 12 months after enrolment. A comprehensive process evaluation was conducted. DISCUSSION: The results of this cluster-randomised trial will provide important information regarding the effects of multi-component interventions in mitigating developmental delays in HIV-exposed infants living in resource-limited environments. TRIAL REGISTRATION: This trial is registered with the Pan African Clinical Trials Registry ( www.pactr.org ), registration number PACTR201701001387209; the trial was registered on 16th January 2017 (retrospectively registered).

Changes in the humoral immune responses after chemotherapy in single and co-infected individuals with Schisosoma haematobium and Plasmodium falciparum.

OBJECTIVE: To determine the effects of chemotherapy on the humoral immune responses in single and coinfected individuals with Schistosoma haematobium and Plasmodium falciparum. DESIGN: Prospective assessment of the humoral immune responses after treatment with praziquantel for schistosomiasis and chloroquine for malaria. SETTING: The study was carried out in four rural schools in Goromonzi and Mtoko districts 50km and 143km away from Harare respectively where both schistosomiasis and malaria are endemic. SUBJECTS: 555 school children aged 8 to 19 years; 298 from Goromonzi and 257 from Mtoko. MAIN OUTCOME MEASURES: Standard ELISA assays were carried out on the sera for immmunoglobin A (IgA), immmunoglobin E (IgE), immmunoglobin M (IgM) and immmunoglobin G (IgG) against the Schistosoma haematobium soluble worm antigen (SWA), soluble egg antigen (SEA), cercaria antigen (CERCA) and the Plasmodium falciparum malaria antigen (MALA). Eosinophil count was also done on Giemsa stained smears. RESULTS: Treatment resulted in a decrease of sera IgA levels against SEA in those individuals that had schistosomiasis only and there was a significant increase of sera IgE against the cercaria antigen (p < 0.05). Those that had malaria whether singly or coinfected sera IgE against MALA decreased but sera IgE against SEA increased. Sera IgE against SEA increased significantly (p < 0.05) in those that had neither infections who had been given praziquantel treatment. Eosinophilia was evident in parasitic infections. CONCLUSION: Schistosomiasis is a problem in rural settings as in all the four schools > 50% of the pupils were infected, whilst those that were < 15 years of age had high egg intensities. There was a rise in sera IgE antibodies against SEA and CERCA in all the cases that were treated with praziquantel, an indication that treatment does alter the immune response favouring resistance to infection by Schistosoma haematobium. Those that had malaria singly or coinfected produced high levels of sera IgE against SEA an indication that malaria infection influences the cytokine environment to favour production of IgE isotypes against the schistosome egg antigen.

Making sense of kidney transplantation: a view from African recipients.

This study investigated the experiences of African patients who have undergone a kidney transplant within the past 10 yr, either from a live donor or from a cadaver. Little is known about kidney transplantation among African patients, in particular about psychological and social responses to the process. The study examined how these patients made (and still make) sense of the transplant experience, and hence attribute a particular subjective meaning to the factors and variables which have been at play during the course of the transplant. Semi-structured interviews were conducted with 14 African patients (8 women and 6 men), from the Renal Unit of Groote Schuur Hospital, Cape Town. The interviewees were selected from the records of the Unit. Several themes accounted for the frameworks of meaning that patients attributed to the transplant process. These are: religion and indigenous belief systems; the role of the extended family; patients' respective routes to the hospital; feelings about the transplant; and experiences in the hospital.