Towards a better estimation of prevalence of female genital mutilation in the European Union: a situation analysis.

BACKGROUND: Female genital mutilation (FGM) is a harmful cultural practice that is predominantly documented in Africa, but also occurs in other parts of the world. Due to migration, women who have undergone FGM can also be found in the European Union (EU). Due to a lack of systematic representative surveys on the topic in EU, the prevalence of FGM and the number of women and children subjected to the practice remains unknown. However, information on the magnitude of the problem in the EU is necessary for policy makers to design and track preventive measures and to determine resource allocation. METHODS: Between March 2015 and May 2015, we performed a situation analysis consisting of a critical interpretive synthesis and SWOT-analysis of available at the time peer reviewed and grey literature document on national prevalence studies on FGM in the EU. Studies estimating the prevalence of FGM and the number of girls and women subjected to the practice in the EU were mapped to analyse their methodologies and identify their Strengths, Weakness, Opportunities and Threats (SWOT). Distinction was made between direct and indirect estimation methods. RESULTS: Thirteen publications matched the prioritized inclusion criteria. The situation analysis showed that both direct and indirect methodologies were used to estimate FGM prevalence and the number of girls and women subjected to FGM in the EU. The SWOT-analysis indicated that due to the large variations in the targeted population and the available secondary information in EU Member States, one single estimation method is not applicable in all Member States. CONCLUSIONS: We suggest a twofold method for estimating the number of girls and women who have undergone FGM in the EU. For countries with a low expected prevalence of women who have undergone FGM, the indirect method will provide a good enough estimation of the FGM prevalence. The extrapolation-of-FGM-countries-prevalence-data-method, based on the documented FGM prevalence numbers in DHS and MICS surveys, can be used for indirect estimations of girls and women subjected to FGM in the EU. For countries with a high expected prevalence of FGM in the EU Member State, we recommend to combine both a direct estimation method (e.g. in the form of a survey conducted in the target population) and an indirect estimation method and to use a sample design as developed by the FGM-PREV project. The choice for a direct or indirect method will ultimately depend on available financial means and the purpose for the estimation.

Diagnostic hepatitis C testing of people in treatment for substance use disorders in Belgium between 2011 and 2014 : a cross-sectional study.

BACKGROUND: Hepatitis C prevalence figures for people who use drugs in Belgium are scarce, and particularly for people who inject drugs. The current study refines the existing HCV estimates by focussing on diagnostic HCV testing practices for this population at risk. METHODS: The analysis is the result of a descriptive crosssectional study, based on data extracted from the linkage between a database of people in treatment for substance use disorders in Belgium and a database of the Belgian health insurance companies. By using national nomenclature codes for HCV tests, the number of people in treatment for substance use disorders who were tested on HCV, were estimated. RESULTS: 18,880 out of 30,905 patients (61.1%) in treatment for substance use disorders between 2011 and 2014 have been screened at least once for HCV between 2008 and 2015. 58.0% of those who had never injected and 59.1% of those with an unknown injecting status were tested for HCV, compared to 86.5% of the patients who had recently injected and 84.5% of those who had ever injected. 36.8% of the people who had recently injected were tested for HCV RNA. CONCLUSIONS: This study supports the need of a continued effort of health care providers to identify people infected with HCV. For a population at risk such as people who use drugs, regular screening is needed to reach the goal set by WHO of near viral elimination of HCV by 2030.

Hepatitis C virus (HCV) prevalence estimation in the adult general population in Belgium : a meta-analysis.

BACKGROUND AND STUDY AIMS: Although multiple HCV prevalence studies were recently performed in the general population from Belgium, they suffer from a lack of geographical representativeness, an insufficient number of participants or a lack of inclusion of high prevalence groups. The aim of this study is to provide robust information on the HCV burden. METHODS: Recently performed HCV prevalence studies in the general, adult population were included in this study, based on well-defined selection criteria. A meta-analysis was performed to estimate the seroprevalence, the prevalence of participants with viremia and the prevalence estimation for people with viremia which were unaware of their status. RESULTS: Eight studies fulfilled the criteria for inclusion of the quantitative prevalence estimation. Based on the meta-analysis on these 8 studies, we estimated an HCV seroprevalence of 1.01% [95% CI : 0.66-1.42%], representing a total of 90,722 adult, HCV seropositives of which 64,412 individuals (0.71%) were confirmed seropositive. Based on the RNA presence, an estimated viremic prevalence of 0.33% [95% CI : 0.21-0.47 %] was determined, corresponding with 29,642 individuals. This is 46,0% of the true HCV seropositive residents. Further, based on the availability of patient information in 5 out of the 8 studies, a prevalence of 0.18% [95% CI : 0.07-0.33] representing 16,168 individuals from the adult Belgian population are unaware of their HCV status. CONCLUSIONS: We believe that the quantitative measurement by the meta-analysis will be more reliable for their use in the design of a screening strategy or in the development of prevention campaigns as compared to the prevalence estimations performed at local level.