Effects of HIV and age on cervical cancer risk in Malawi: implications for screening

health fairs, and games to promote behavior change. Clinical partners focus on training health care personnel inGBV service delivery. Three of the five clinical partners plan to facilitate access to psychosocial support and develop protocols for the care of child victims. Several of the partners expressed a need for improved coordination among the various social services required for GBV victims. Common challenges include cultural and social barriers, lack of psychosocial support for victims, poor communication between partners and funders, and difficulty monitoring and evaluating partner activities. CDC Mozambique partners reported successful outputs from their GBV activities, such as varied teaching methods and well-trained staff; however, the ability to measure impact remains difficult. With an annual CDC budget of approximately $3.1 million, refocusing support toward integrated services, improving communication among partners and funders, and standardized evaluation tools would allow for greater impact.


Background:
A key strategy of safe motherhood programmes to reduce the maternal mortality is to ensure that pregnant women deliver at a health care facility. Birth preparedness package has been widely promoted and accepted as a demand-creation behavioural intervention to increase the ratio of facility delivery. Studies have been undertaken to measure change in birth preparedness level after this behavioural intervention, rather than measuring the impact on facility delivery. The aim of this study was to assess birth preparedness in expectant mothers and to evaluate its association with facility delivery in a central hills district of Nepal where birth preparedness package has been implemented. Structure/Method/Design: A total of 701 pregnant women of more than 5 months gestation were recruited from randomly selected five urban wards and seven rural illakas in Kaski district of Nepal. Fifteen local female data collectors conducted baseline interview at respondents' houses at recruitment to assess birth preparedness activities and followed them by a second interview within 45 days of delivery. Results (Scientific Abstract)/Collaborative Partners (Programmatic Abstract): Level of birth preparedness was high with 65% of the women reported preparing for at least four of the five arrangements: identification of delivery place, identification of transport, identification of blood donor, money saving, and antenatal care check-up.
Place of delivery was identified for 644 participants: 97 (15%) at homes and 547 (85%) at facilities. The more arrangements made, the more likely were the women to have facility delivery (OR, 1.51; P < 0.001). For those pregnant women who intended to save money, identified a delivery place or identified a potential blood donor, their likelihood of actual delivery at a health facility increased by two-to three-fold. Summary/Conclusion: Intention to deliver in a health care facility as measured by birth preparedness indicators was associated with facility delivery. Birth preparedness package could increase the proportion of facility delivery in the pathway of maternal survival. Background: Background: Cervical cancer is the most common cancer and a leading cause of death among women in Malawi. National guidelines recommend screening women aged 30 to 45 years using visual inspection with acetic acid (VIA) every 5 years; however, no specific recommendations exist for women with HIV.
Objective: Our primary objective was to assess the frequency of high-grade cervical dysplasia (cervical intraepithelial neoplasia [CIN] 2 or CIN 3), and cervical cancer among women referred for colposcopy at a national teaching hospital in Lilongwe, Malawi. Our secondary objective was to examine associations between HIV and age with high-grade cervical dysplasia and cancer. Structure/Method/Design: Methods: We analyzed the Kamuzu Central Hospital pathology database from November 2012 through November 2013. Cervical Pap smear, cervical biopsy, loop electrosurgical excision procedure (LEEP), and uterine specimen reports were included. For women with multiple reports, we analyzed the result with the most advanced diagnosis. We used logistic regression to estimate associations with high-grade dysplasia and cervical cancer (CIN2+). Results (Scientific Abstract)/Collaborative Partners (Programmatic Abstract): Results: We reviewed 1,037 reports of cervical and uterine specimens from 824 unique women. Of these, 194 (23%) were excluded due to unknown HIV status, leaving 630 women in the analytic sample. Median age was 38 years, and 36% were HIVinfected. Twelve percent had high-grade dysplasia and an additional 109 women (17%) had cervical cancer. Thirty-five percent of women diagnosed with cancer and 25% of those with high-grade dysplasia were not within the recommended screening age range. HIV significantly increased the odds of having CIN2+ (adjusted OR, 6.55; 95% CI, 4.43-9.67). For each additional year of age the odds of having CIN2+ increased by 4%. Summary/Conclusion: Conclusion: High-grade dysplasia and cervical cancer were very common in this sample of Malawian women, especially among HIV-positive women. A large proportion of this sample diagnosed with CIN2+ was outside of the recommended screening age range. HIV infection was strongly associated with CIN2+. Expanding cervical cancer screening and treatment services to all HIV-infected women and to sexually active women outside the currently recommended screening ages would likely avert a substantial proportion of cervical cancer cases in Malawi.
Strengthening health system response to gender-based violence though multisectoral collaboration and best practices in evidence collection and documentation R. Mishori 1 , S. Varanasi 2 ; 1 Georgetown University School of Medicine, Family Medicine, Washington, DC/US, 2 Physicians for Human Rights, Program on Gender Based Violence, Boston, MA/US Background: The Program on Sexual Violence in Conflict Zones at Physicians for Human Rights (PHR) builds the capacity of health and legal professionals to document and collect forensic evidence of sexual violence according to best practices in support of women and girl survivors. PHR is currently implementing this program in Kenya, Democratic Republic of the Congo (DRC), Uganda, South Sudan, and Central African Republic (CAR).
Health professionals are crucial first responders to survivors of sexual violence, yet many receive little training in the documentation of court-admissible forensic evidence. PHR's program

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O p p o r t u n i t i e s a n d I n n o v a t i o n s i n W o m e n ' s H e a l t h G l o b a l l y