Coverage and Socioeconomic Inequalities in Cervical Cancer Screening in Low- and Middle-Income Countries Between 2010 and 2019.

PURPOSE: Cervical cancer screening is vital in addressing the global burden of cervical cancer. In this study, we describe the coverage and socioeconomic inequalities in the coverage of cervical cancer screening in low- and middle-income countries (LMICs). METHODS: We analyzed data from the women's recode files of the Demographic and Health Surveys conducted in LMICs from 2010 to 2019 with variables on cervical cancer screening. We included women 21 years or older and determined the proportion of women who were screened for cervical cancer by age categories, wealth quintile, type of place of residence, level of education, and marital status. Socioeconomic inequality was measured using the concentration index (CIX) and the slope index of inequality (SII). RESULTS: A total of 269,506 women from 20 surveys in 16 countries were included in the survey. Generally, there was a low coverage of screening, with lower rates among women age 21-24 years, living in rural areas, in the poorest wealth quintile, with no formal education, and who have never been in union with or lived with a man. The CIX and SII values for screening for cervical cancer were positive (pro-rich) for all the countries except Tajikistan in 2012 where they were negative (pro-poor). CONCLUSION: The coverage of cervical cancer screening was low in LMICs with variations by the quintile of wealth (pro-rich) and type of place of residence (pro-urban). To achieve the desired impact of cervical cancer screening services in LMICs, the coverage of cervical cancer screening programs must include women irrespective of the type of place and wealth quintiles.

The prevalence of concurrent pulmonary and extrapulmonary tuberculosis in Uganda: a retrospective study.

Background: Concurrent pulmonary tuberculosis (PTB) and extrapulmonary tuberculosis (EPTB) is associated with poor treatment outcomes yet its epidemiology in Uganda is unknown. The purpose of this study was to determine the prevalence, associated factors, and treatment outcomes of concurrent PTB and EPTB among patients at a national tuberculosis (TB) treatment center located at Mulago National Referral Hospital in Kampala, Uganda. Methods: We conducted a retrospective review of charts for people with TB who were enrolled in care between January 2015 and December 2019. Eligible charts were for people with pulmonary bacteriologically confirmed TB enrolled into care in the period under study. Concurrent PTB and EPTB was defined as PTB and bacteriological, histopathological, and/or radiological features of TB at another noncontiguous sites. Results: Overall, 400 patient charts were eligible, of whom 240 (60.0%) were aged 15-34 years and 205 (51.3%) were female. The prevalence of concurrent PTB and EPTB was 8.5% (34/400) [95% confidence interval (CI): 6.0-11.7%]. People with concurrent PTB and EPTB were more likely to have at least one comorbidity (82.4% versus 37.2%, p < 0.001), of which HIV was the most frequent. Furthermore, people with concurrent PTB and EPTB were more likely to have empyema (15% versus 2.6%, p = 0.028) but less likely to have bronchopneumonic opacification (0.0% versus 15.3%, p = 0.043) on chest x-ray imaging. People with concurrent PTB and EPTB had higher mortality (26.5% versus 6.37%) and a lower cure rate (41.2% versus 64.8%), p = 0.002. Conclusion: Our findings highlight the need for early detection of TB before dissemination particularly among people who use alcohol and people with HIV.