Suffering in silence: Graduate student infertility.

While fertility is a widely studied public health issue, infertility among college students is rarely examined. Research on fertility among college students focuses primarily on pregnancy prevention. Often constructed as hyper-fertile, cohorts of women in graduate studies are struggling with fertility issues and left to suffer in silence. Objective: This study aimed to identify barriers to access and gaps in available reproductive services to college attending women. Methods: This multi-method, exploratory study employed online surveys (n = 37), semi-structured interviews (n = 5), and an assessment of fertility-related school health services available at universities nationally to understand issues related to infertility, including experience with and access to services. Results: A near absence of fertility-related care on college campuses emerged nationally, while a clear need among female graduate students emerged locally. Perceptions of poor treatment and dismissal of concerns were prominent issues. Conclusions: Findings suggest the need for self-advocacy, while highlighting the potential role of university and community supports for women suffering from the dual burden of being a student while struggling with fertility related issues.

Epidemiology of cutaneous and mucocutaneous leishmaniasis in Nicaragua.

Leishmaniasis is a major neglected tropical disease which contributes a huge economic burden on already meager economic resources. The World Health Organization (WHO) has estimated an annual incidence of 700,000--1,000,000 patients and about 20,000-30,000 deaths per year. Approximately 66,941 patients of cutaneous leishmaniasis are reported annually in the Americas. In recent years, Nicaragua has presented alarmingly high numbers of patients and elevated incidence rates. Unfortunately, there are no detailed spatial descriptions on the epidemiological situation of leishmaniasis in this country. The objective of this study is to present descriptive data about the epidemiology of leishmaniasis in Nicaragua in the context of the distribution of this neglected tropical disease (NTD) in the Americas. This paper also provides an epidemiological update on different forms of leishmaniasis found in the three administrative regions of Nicaragua and its municipalities. Health authorities from the Ministry of Health of Nicaragua (MINSA) provided the entomological and epidemiological information for the different forms of the disease from 2001 to 2018. Prevalence, incidence rates, clinical classification of disease, age groups, sex, and geographic distribution by municipality and department are described in this study. Approximately 90%-95% of the national patients corresponded to CL and 5-10% correspond to MCL. The disease is distributed in the three regions of the country, with a higher burden in the Departments of Jinotega, Matagalpa and Atlántico Norte. The municipalities with the highest proportion of patients were El Cuá (23.92%), Waslala (14.16), Santa Maria de Pantasma (9.62%), Rancho Grande (9.03%) and Siuna (7.67%). There is an expansion of spatial distribution of CL and MCL in the North Central and South Atlantic regions of the country. These results could inform interventional strategies to address the burden of leishmaniasis in Nicaragua, which would improve the likelihood of meeting the goals for the Leishmaniasis Plan of Action for the Americas.