Seroprevalence of markers of hepatitis C virus exposure and associated factors in adults aged 18-39 years in the Arctic Russian city of Arkhangelsk: a cross-sectional study.

Hepatitis C, caused by the hepatitis C virus (HCV), is a major public health issue in Russia. The aim of our study was to assess the seroprevalence of markers of HCV exposure and factors associated with HCV seropositivity among the general population aged 18-39 years in the city of Arkhangelsk, Northwest Russia. A social research agency applied a quota sampling method to recruit study participants using cell phone numbers. All participants (n = 1243) completed a self-administered questionnaire and provided a blood sample. Sixty-five participants (5.2%, 95% confidence interval [CI] 4.9-5.5) tested positive for HCV IgM+G antibodies, and of these, 55 (84.6%) did not know that they were exposed to HCV. In multivariable logistic regression analysis, HCV seropositivity was significantly associated with older age, a history of injecting drug use, and having ever received a blood transfusion. To reach the goal of the World Health Organisation's Global Health Sector Strategy on Viral Hepatitis, regional preventive programmes should include measures to reduce injecting drug use as well as scaling up harm-reduction and treatment programs for drug addicts.

Seroprevalence of Markers of Hepatitis B Virus Infection, Associated Factors, and Vaccination Status in Young Adults in Arkhangelsk, Northwest Russia: A Population-Based Cross-Sectional Study.

Russia had a high incidence of hepatitis B virus (HBV) infection before the vaccination campaigns of 1997, 2001, 2007, which targeted newborns, adolescents, and adults, respectively. The aim of our study was to assess the prevalence of serological markers of HBV infection, associated factors, and vaccination status among young adults in Arkhangelsk, Northwest Russia. In this cross-sectional, population-based study, we used a quota sampling method to recruit 1243 adults aged 18⁻39 years. Participants completed a self-administrated questionnaire and were tested for hepatitis B markers. Associations between positivity for markers and selected sociodemographic and behavioral factors were studied by logistic regression. 10.9% of our participants were positive for at least one marker of hepatitis B, 1.2% were positive for HBsAg, and 42.1% were negative for all markers. In multivariable logistic regression analyses, age 30⁻34 years; lack of self-reported vaccination; and having ≥2 sexual partners in the last 6 months were associated with positivity for markers of hepatitis B. Hepatitis B vaccination was confirmed in 46.9% of participants. Although half of our study sample was vaccinated, four in 10 were still susceptible to infection and more than one participant in 100 showed evidence of an active infection.

The HPV vaccine: knowledge and attitudes among public health nurses and general practitioners in Northern Norway after introduction of the vaccine in the school-based vaccination programme.

OBJECTIVE: To investigate knowledge of and attitudes to human papillomavirus (HPV) infection, HPV vaccination, cervical cancer, related sources of information and factors associated with willingness to vaccinate one's own daughter among primary health care (PHC) personnel. DESIGN: Cross-sectional study. SETTING: PHC. SUBJECTS: All public health nurses (PHNs) and general practitioners (GPs) in Northern Norway were invited to answer a structured electronic questionnaire; 31% participated (N = 220). MAIN OUTCOME MEASURES: Self-reported and actual knowledge, information sources, attitudes and willingness to vaccinate their (tentative) daughter. RESULTS: 47% of respondents knew that HPV infection is a necessary cause of cervical cancer. PHNs had higher self-reported and actual knowledge about HPV vaccination and cervical cancer than GPs. PHNs used the Norwegian Institute of Public Health's numerous information sources on HPV, while GPs had a low user rate. 88% of PHNs and 50% of GPs acquired information from the pharmaceutical industry. 93% PHNs and 68% of GPs would vaccinate their 12-year-old daughter. In a multivariate logistic regression analysis, willingness to vaccinate one's daughter was positively associated with younger age, being PHN (OR = 5.26, 95%CI 1.74-15.94), little concern about vaccine side effects (OR = 3.61, 95%CI 1.10-11.81) and disagreement among experts (OR = 7.31, 95%CI 2.73-19.60). CONCLUSIONS: Increased knowledge about HPV infection and vaccination is needed, particularly among GPs. Those least concerned about side effects and disagreements among experts were most likely to vaccinate their daughter. These findings are of interest for public health authorities responsible for the Norwegian vaccination and cervix cancer screening programmes, and providers of training of PHC personnel. Key points One year after introduction of HPV vaccination among 12-year-old schoolgirls in Norway, a cross-sectional study in Northern Norway among general practitioners (GPs) and public health nurses (PHNs) showed that • barely half of PHC professionals knew the causal relationship between HPV infection and cervical cancer • PHNs and GPs had higher self-reported than actual knowledge about HPV vaccination and cervical cancer nearly all PHNs and two thirds of GPs wanted to vaccinate their 12-year-old daughter. Those most concerned about side effects and disagreement among experts were less likely to vaccinate.

A prospective cohort study on risk factors of musculoskeletal complaints (pain and/or stiffness) in a general population. The Tromsø study.

BACKGROUND: Female gender has been associated with musculoskeletal complaints (MSCs), but there are limited studies on how other factors may influence women and men differently. The aim of this prospective cohort study was to explore possible predictors of MSCs in women and men free of MSCs at baseline. METHODS: The present study included participants from the population-based Tromsø study, with baseline data from 1994-1995 and follow-up data from 2007-2008. MSCs were defined as having pain and/or stiffness in muscles and joints for 3 consecutive months during the past year. Predictors of MSCs were examined through binary logistic regression analyses and presented as odds ratios with 95% confidence intervals. RESULTS: At baseline 4,496 participants reported no MSCs and among these 2,015 (44.8%) and 441 (9.8%) participants reported mild or severe MSCs, respectively, at follow-up. Female gender predicted MSCs in multivariable logistic regression analyses (odds ratio [OR] 1.46, 95% confidence interval [CI]: 1.29-1.66). Educational level of primary/secondary school (OR 1.73, 95% CI: 1.46-2.05) was the strongest predictor of MSCs, followed by poor self-perceived health (OR 1.62, 95% CI: 1.30-2.02). Other predictors were BMI ≥30 kg/m2 (OR 1.39, 95% CI: 1.10-1.77) and smoking (OR 1.33, 95% CI: 1.16-1.52). Age and physical activity level were not significantly associated with MSCs. Gender-stratified analyses revealed that mental health complaints (i.e., depression and/or anxiety) predicted MSCs in men (OR 2.03, 95% CI: 1.18-3.50), but not in women. Current smoking (OR 1.43, 95% CI: 1.16-1.76) and poor self-perceived health (OR 1.90, 95% CI: 1.34-2.71) showed slightly higher odds ratios among women than men, but the gender differences were not significant. CONCLUSION: The present study demonstrates that several negative health determinants are predicting subsequent MSCs. However, the examined risk factors could not explain the higher prevalence of MSCs in women.

Seroprevalence and correlates of herpes simplex virus type 2 infection among young adults in Arkhangelsk, Northwest Russia: a population-based cross-sectional study.

BACKGROUND: Herpes simplex virus type 2 (HSV-2) infection is the most common cause of genital ulcer disease (GUD) worldwide. Mother to child transmission causes high morbidity and mortality among infants. Russia is on the brink of a generalized HIV-epidemic, but Arkhangelsk is still a low-prevalence area. HSV-2 infection is associated with a three-fold increased risk of HIV-infection. The evidence on the seroprevalence of HSV-2 in Russia is limited. The aim of this study was to assess HSV-2 seroprevalence and correlates among young adults in the city of Arkhangelsk. METHODS: 1243 adults aged 18-39 years participated in a cross-sectional population-based study, recruited by a public opinion agency applying a quota sampling method to achieve a data set with similar age- and sex-distribution as the population in Arkhangelsk. All participants completed a standardized, self-administrated questionnaire and were tested for HSV-2. Associations between HSV-2 seropositivity and selected sociodemographic and behavioral factors, and self-reported history of sexually transmitted infections (STIs) were studied by multivariable logistic regression. RESULTS: HSV-2 seroprevalence was 18.8 %: 12.2 % (95 % confidence interval, CI 9.7-15.2) among men and 24.0 % (95 % CI 20.1-27.3) among women. Among men, HSV-2 positivity was associated with being divorced/widowed (OR = 2.85, 95 % CI 1.06-7.70), cohabitation (OR = 2.45, 95 % CI 1.07-5.62), and a history of STIs (OR = 2.11, 95 % CI 1.14-3.91). In women, HSV-2 positivity was associated with high income (OR = 3.11, 95 % CI 1.45-6.71) and having a lifetime number of sexual partners between 2 and 5 (OR = 2.72, 95 % CI 1.14-6.51), whereas sexual debut at age 18 years or older was inversely associated with the outcome (OR = 0.47, 95 % CI 0.31-0.72). In both sexes, increasing age was the strongest correlate of HSV-2 seropositivity in multivariable analyses. CONCLUSION: The HSV-2 seroprevalence was twice as high in women than in men and increased with age in both sexes, and similar to that reported from high-prevalence countries in Europe and the USA. The high prevalence of HSV-2 among women in childbearing age reveals the potential for HSV-2 transmission from mothers to infants and increased risk of acquisition HIV-infection; it also contributes to the burden GUD among both sexes. This emphasizes the public health implications of the HSV-2 epidemic in an urban population in North-West Russia.

Musculoskeletal Complaints (Pain and/or Stiffness) and Their Impact on Mortality in the General Population. The Tromsø Study.

BACKGROUND: The long-term consequences of chronic pain and/or stiffness from the musculoskeletal system (musculoskeletal complaints: MSCs) have not been well explored. The aims of this study were to investigate whether MSCs reported at baseline influence all-cause and cause-specific mortality during 21 years follow-up of a general Northern Norwegian adult population. METHODS: A total of 26,977 men and women aged 25-97 years who participated in the 1994-1995 survey of the Tromsø study (response rate 77%) were included in the present prospective cohort study. Baseline data were collected from the 1994-1995 survey and information on death and emigration was taken from the National Register of Norway. Cox regression analyses were performed to examine if MSCs predicted risk of mortality. RESULTS: 5693 (21.1%) participants died during follow-up. Mean time between entry into the survey and death or emigration was 18.6 years (standard deviation 4.87) for all-cause mortality. There was an increased risk of death among those with MSCs at baseline in the crude Cox regression model. However, the multivariable model revealed no significant association between MSCs at baseline and all-cause mortality by sex (women: hazard ratio [HR] = 0.93, 95% confidence interval [CI]: 0.85-1.01; men: HR = 0.93, 95%CI: 0.85-1.01). Furthermore, no significant associations were found between widespread MSCs at baseline and all-cause mortality in multivariable models (women: HR = 0.90, 95%CI: 0.80-1.01; men HR = 0.87, 95%CI: 0.76-1.00). Analyses on cause-specific mortality did not reveal any significant results. CONCLUSION: MSCs are not independently associated with increased risk of death from cardiovascular disease, cancer, or death from all causes.

Intertester reliability of shoulder complaints diagnoses in primary health care.

OBJECTIVE: Shoulder complaints are frequently encountered in general practice, but precise diagnosing is challenging. This study investigated agreement of shoulder complaints diagnoses between clinicians in a primary health care setting. DESIGN: Cross-sectional study. SETTING: Four primary health care clinicians used patients' history and functional examination of the shoulder by selective tissue tension techniques (STTs), to diagnose shoulder complaints. SUBJECTS: 62 patients, aged 18-75 years. MAIN OUTCOME MEASURE: Reliability of diagnoses was assessed by observed intertester agreement and Cohen's kappa. A total of 372 diagnostic pairs were available for intertester comparisons. RESULTS: Six diagnoses were assigned by all clinicians; supraspinatus-, infraspinatus-, subscapularis-tendinopathies; chronic subacromial bursitis; glenohumeral capsulitis, and acromioclavicular joint lesion. The observed agreement on these diagnoses ranged from 0.84 for glenohumeral capsulitis to 0.97 for acromioclavicular joint lesion. Kappa scores were 0.46 (95% CI 0.33, 0.58) for chronic subacromial bursitis; 0.53 (95% CI 0.34, 0.68), 0.59 (95% CI 0.47, 0.70), and 0.68 (95% CI 0.53, 0.82) for infraspinatus -, supraspinatus -, and subscapularis-tendinopathy, respectively. For glenohumeral capsulitis and acromioclavicular lesion kappa scores were 0.66 (95% CI 0.57, 0.73) and 0.78 (95% CI 0.61, 0.90). Kappa scores were higher for individual diagnoses than for individual tests, except for limitation in passive abduction (0.70, 95% CI 0.62, 0.78) and passive lateral rotation (0.66, 95% CI 0.57, 0.73). CONCLUSIONS: Although experienced clinicians showed substantial intertester agreement, precise diagnoses of shoulder complaints in primary health care remain a challenge. The present results call for further research on refined diagnoses of shoulder complaints. Key points Based on medical history and a systematic functional examination by selective tissue tension techniques (STTs), we investigated the agreement of shoulder complaints diagnoses across four primary health care clinicians and 62 patients. • Agreements on diagnoses were generally better than the agreement on individual tests. • Good kappa scores were obtained for the diagnoses glenohumeral capsulitis, rotator cuff tendinopathy, and acromioclavicular lesion. • Further research is necessary to investigate the diagnostic validity of functional shoulder examination by the STTs method.

High prevalence of chronic musculoskeletal complaints among women in a Norwegian general population: the Tromsø study.

BACKGROUND: The aims of this study were to estimate the prevalence and severity of MSCs in the adult general population of Northern Norway, and to study associations between MSCs and various demographic and lifestyle variables. METHODS: Data from the Tromsø 6 survey (2007-2008) of the population-based Tromsø Study were used (12,984 participants, 65.7% participation rate). We included 8,439 participants aged 30-79 years in the analyses. Associations between demographic and lifestyle variables and chronic MSCs (i.e., those lasting for at least 3 consecutive months, hereafter referred to as simply MSCs) was examined using logistic regression analysis. RESULTS: The total age-adjusted prevalence of both mild and severe MSCs was 63.4% and 52.9% in women and men, respectively. In women, the age-adjusted prevalence was 44.0% and 19.4% for mild and severe MSCs, respectively; the corresponding values in men were 40.8% and 12.1%. The highest prevalence was found in the neck/shoulder region (34.2% and 8.9% for mild and severe MSCs, respectively). The prevalence of MSCs in ≥5 body regions was three times higher in women than in men (14.9% vs 5.6%). Current smoking was significantly associated with MSCs (odds ratio [OR]: 1.41, 95% confidence interval [CI]: 1.22-1.62), but showed a stronger effect in women (OR: 1.60, 95% CI: 1.30-1.96) than in men (OR: 1.25, 95% CI: 1.02-1.52). Self-perceived poor health was strongly associated with MSC (OR: 3.73, 95% CI: 3.27-4.24). Moderate vs low level of physical activity was associated with MSCs only in women (OR: 1.37, 95% CI: 1.12-1.67). Other demographic and lifestyle variables associated with MSCs were age (OR: 1.04, 95% CI: 1.01-1.06), body mass index (BMI) >30 kg/m2 (OR: 1.42, 95% CI: 1.23-1.66), low education level (OR: 1.78, 95% CI: 1.53-2.08) and former smoking (OR: 1.21, 95% CI: 1.09-1.35). Marital status, BMI <18.5 kg/m2, high and very high level of physical activity was not associated with MSCs. CONCLUSION: Chronic MSCs are highly prevalent in this Northern Norwegian population, and are strongly related to self-perceived poor health. Women have a higher burden of MSCs than men. Most demographic and lifestyle variables associated with MSCs showed stronger associations in women than in men.

Factors associated with adherence to antiretroviral therapy in HIV-infected patients in Kathmandu District, Nepal.

PURPOSE: There are a high number of HIV-infected patients receiving antiretroviral therapy (ART) in the Kathmandu District of Nepal, but information on adherence and factors influencing it are scarce in this population. The present study aimed to estimate ART adherence among HIV-infected patients in the Kathmandu District of Nepal, and to determine the factors associated with ART adherence. PATIENTS AND METHODS: This study included 316 HIV-infected patients attending three ART centers in the Kathmandu District. Information on sociodemographic characteristics, socioeconomic status, and ART use for the previous 7 days was collected via interview. Participants were considered adherent if they reported taking ≥95% of their ART as prescribed. The association between explanatory variables and ART adherence was measured using logistic regression and reported as odds ratios (OR) with 95% confidence intervals (CI). RESULTS: Male participants accounted for 64.6% (n=204). Overall ART adherence was 86.7%. ART adherence in men and women were 84.3% and 91.1%, respectively. Age (OR 1.04; 95% CI 1.00-1.09), travel time to ART centers (OR 1.38; 95% CI 1.12-1.71), history of illegal drug use (OR 3.98; 95% CI 1.71-9.24), and adverse effects (OR 4.88; 95% CI 1.09-21.8), were all independently and negatively associated with ART adherence. Use of reminder tools (OR 3.45; 95% CI 1.33-8.91) was independently and positively associated with ART adherence. CONCLUSION: The observed ART adherence in this study is encouraging. Travel time to ART centers, self-reported adverse effects, illegal drug use, and not using reminder tools were the major determinants of ART adherence. Interventions that take these factors into account could further improve ART adherence.

Survival on antiretroviral treatment among adult HIV-infected patients in Nepal: a retrospective cohort study in Far-western region, 2006-2011.

BACKGROUND: Though financial and policy level efforts are made to expand antiretroviral treatment (ART) service free of cost, survival outcome of ART program has not been systematically evaluated in Nepal. This study assesses the mortality rates and determinants among adult HIV-infected patients on ART in Far-western region of Nepal. METHODS: This retrospective cohort study included 1024 (51.2% men) HIV-infected patients aged ≥15 years, who started ART between May 15th 2006 and May 15th 2011 in five ART sites in the Far-western region, Nepal. Follow-up time was calculated from the date of ART initiation to date of death or censoring (loss to follow-up, transferred out, or 15 November 2011). Mortality rates (per 100 person-years) were calculated. Kaplan-Meier and Cox-regression models were used to estimate survival and explore determinants of mortality. RESULTS: The median follow-up time was 19.1 months. The crude mortality rate was 6.3 (95% confidence interval (CI) 5.3-7.6) but more than three-times higher in first 3 months after ART initiation (21.9 (95% CI 16.6- 28.8)). About 12% (83% men) of those newly initiated on ART died during follow-up. The independent determinants of mortality were male sex (hazard ratio (HR) 4.55, 95% CI 2.43-8.51), poor baseline performance scale (bedridden <50% of the day during the past month, HR 2.05, 95% CI 1.19-3.52; bedridden >50% of the day during the past month, HR 3.41, 95% CI 1.67-6.98 compared to normal activity), one standard deviation decrease in baseline bodyweight (HR 1.04, 95% CI 1.01-1.07), and poor WHO clinical stage (stage III, HR 2.96, 95% CI 1.31-6.69; stage IV, HR 3.28, 95% CI 1.30-8.29 compared to WHO clinical stage I or II). CONCLUSIONS: High mortality was observed within the first 3 months of ART initiation. Patients with poor baseline clinical characteristics had higher mortality, especially men. Earlier initiation of ART through expanded testing and counselling should be encouraged in HIV-infected patients.

Self-reported sexually transmitted infections and their correlates among men who have sex with men in Norway: an Internet-based cross-sectional survey.

BACKGROUND: The incidences of reportable sexually transmitted infections (STI) among men who have sex with men (MSM) have increased since the late 1990 s in Norway. The objectives of our study were to assess factors, associated with recent selected STI among MSM, living in Norway in order to guide prevention measures. METHODS: We conducted a cross-sectional Internet-based survey during 1-19 October 2007 among members of a MSM-oriented Norwegian website using an anonymous questionnaire on demographics, sexual behaviour, drug and alcohol use, and STI. The studied outcomes were gonorrhoea, syphilis, HIV or Chlamydia infection in the previous 12 months. Associations between self-reported selected STI and their correlates were analysed by multivariable Poisson regression. P value for trend (p-trend), adjusted prevalence ratios (PR) with 95% confidence intervals [] were calculated. RESULTS: Among 2430 eligible 16-74 years old respondents, 184 (8%) reported having had one of the following: syphilis (n = 17), gonorrhoea (n = 35), HIV (n = 42) or Chlamydia (n = 126) diagnosed in the past 12 months. Reporting Chlamydia was associated with non-western background (PR 2.8 [1.4-5.7]), number of lifetime male partners (p-trend < 0.001), unsafe sex under the influence of alcohol (PR 1.8 [1.1-2.9]) and with younger age (p-trend = 0.002). Reporting gonorrhoea was associated with unrevealed background (PR 5.9 [1.3-26.3]), having more than 50 lifetime male partners (PR 4.5 [1.3-15.6]) and more than 5 partners in the past 6 months (PR 3.1 [1.1-8.8]), while mid-range income was protective (PR 0.1 [0.0-0.6]). Reporting HIV was associated with residing in Oslo or Akershus county (PR 2.3 [1.2-4.6]), non-western background (PR 5.4 [1.9-15.3]), unrevealed income (PR 10.4 [1.5-71.4]), number of lifetime male partners (p-trend < 0.001) and being under the influence of selected drugs during sex in the past 12 months (PR 5.2 [2.7-11.4]). In addition, the frequency of feeling drunk was reversibly associated with HIV. CONCLUSIONS: Our study demonstrates different associations of demographic and behavioural factors with different STI outcomes in the study population. Number of lifetime male partners was the most important potential predictor for Chlamydia and HIV. The STI prevention efforts among MSM should focus on Oslo and Akershus, promote safe sex practices and tackle sex-related drug and alcohol use.

Trends in HIV-1 prevalence and risk behaviours over 15 years in a rural population in Kilimanjaro region of Tanzania.

BACKGROUND: Monitoring dynamics in HIV-1 infection and risk behaviours is important in evaluating, adjusting and scaling up prevention programmes. The objective of this study was to estimate trends in the prevalence of HIV-1 infection and risk behaviours over 15 years in a rural village population in Kilimanjaro region of Tanzania using repeated population-based cross-sectional surveys. METHODS: Four rounds of HIV-1 sero-epidemiological and behavioural surveys were completed during 1991 to 2005 in the study village. House-to-house registrations of people aged 15-44 years with an address in the village were conducted before each survey. All consenting individuals were then interviewed for pertinent risk behaviours and tested for HIV-1 seropositivity. RESULTS: Participation proportions ranged from 73.0% to 79.1%. Overall, age and sex-adjusted HIV-1 prevalence increased from 3.2% in 1991 to 5.6 % in 2005 (relative increase 75.0%; ptrend < 0.001). The increase was significant for both men and women (ptrends < 0.001) and more evident among women aged 35-44 years (2.0% to 13.0%, ptrend < 0.001). Among participants aged 15-24 years a decrease in number of sexual partners was observed with a corresponding stable HIV-1 prevalence. Participants aged 25-44 years continued to report multiple sexual partners, and this was corroborated with increased HIV-1 prevalence trend (4.0% to 9.0%, ptrends < 0.001). Among men aged 25-44 years and women aged 15-24 years significant increases in condom use were observed (ptrend < 0.01). CONCLUSION: The HIV-1 prevalence seems to have increased among older participants but remained stable among younger participants. Encouraging trends toward safer sex practices were observed among young participants, while only modest behavioural changes were seen among the older participants. Prevention efforts in rural areas need to be intensified and to address people of all ages.

Chlamydia and gonorrhoea in pregnant Batswana women: time to discard the syndromic approach?

BACKGROUND: Chlamydia and gonorrhoea are major causes of morbidity among women in developing countries. Both infections have been associated with pregnancy-related complications, and case detection and treatment in pregnancy is essential. In countries without laboratory support, the diagnosis and treatment of cervical infections is based on the syndromic approach. In this study we measured the prevalence of chlamydia and gonorrhoea among antenatal care attendees in Botswana. We evaluated the syndromic approach for the detection of cervical infections in pregnancy, and determined if risk scores could improve the diagnostic accuracy. METHODS: In a cross-sectional study, 703 antenatal care attendees in Botswana were interviewed and examined, and specimens were collected for the identification of C trachomatis, N gonorrhoeae and other reproductive tract infections. Risk scores to identify attendees with cervical infections were computed based on identified risk factors, and their sensitivities, specificities, likelihood ratios and predictive values were calculated. RESULTS: The prevalence of chlamydia was 8%, and gonorrhoea was found in 3% of the attendees. Symptoms and signs of vaginal discharge did not predict cervical infection, and a syndromic approach failed to identify infected women. Age (youth) risk factor most strongly associated with cervical infection. A risk score with only sociodemographic factors had likelihood ratios equivalent to risk scores which incorporated clinical signs and microscopy results. However, all the evaluated risk scores were of limited value in the diagnosis of chlamydia and gonorrhoea. A cut-off set at an acceptable sensitivity to avoid infected antenatal care attendees who remained untreated would inevitably lead to considerable over-treatment. CONCLUSION: Although in extensive use, the syndromic approach is unsuitable for diagnosing cervical infections in antenatal care attendees in Botswana. None of the evaluated risk scores can replace this management. Without diagnostic tests, there are no adequate management strategies for C trachomatis and N gonorrhoeae in pregnant women in Botswana, a situation which is likely to apply to other countries in sub-Saharan Africa. Screening for cervical infections in pregnant women is an essential public health measure, and rapid tests will hopefully be available in developing countries within a few years.

[The HIV-pandemic in the third world--worse than anticipated?]. / Hivepidemien i den tredje verden--verre enn forventet?

BACKGROUND: The first AIDS cases were discovered 25 years ago in the United States. We describe how the epidemic evolved in the Third World, with emphasis on the current situation and on the African continent, which is most affected. METHODS: The present review article is based on a literature review and own working experience. RESULTS AND INTERPRETATION: In 2005, more than 90 % of HIV-infected persons lived in Third World countries, mainly Africa and Asia. Transmission in Africa is mainly heterosexual and approximately 60 % of the infected are women. Asia has epidemics among intravenous drug users and men who have sex with men, and among sex workers and their customers. Several Asian countries now have generalized epidemics. Urban populations are more affected than rural ones in all geographical areas of the world, with only a few exceptions. Modern HIV treatment saves many lives, but only an increase of preventive measures can reverse the current trends. To obtain a reversal, it is adamant with broad mobilization of affected populations, clear political leadership and prioritisation and a considerable increase in help from developed countries.

Long-term effects of community-based injury prevention on the island of Vaerøy in Norway: a 20-year follow up.

AIM: A multifactorial injury prevention programme started in 1981 and ran for about 10 years in an island community in Norway with a population of about 1,000. A study was undertaken to evaluate effects of the programme over a period of 20 years. METHODS: Injuries were recorded by the one medical doctor on the island for several years during the period 1970-2001. The programme was carried out very intensively from 1981 to 1987. The intensity gradually decreased to a medium level that lasted until about 1994, when it was further reduced to a low level. RESULTS: The injury incidence rate was reduced from 17.7% in 1980 (n = 188) to 9.7% in 1987 (n = 97) with relative risk reduced to 0.55 (95% CI 0.44-0.70, p < 0.0001). In 2001, an incidence rate of 9.6% was observed (n = 91). An even higher reduction was observed for serious injuries. The age groups 15-24 and 65+ showed the most distinct reductions from 1980 to 2001 while minor reduction was observed in children (0-14 years). The incidence rate of traffic injuries was reduced by 77% in spite of an increase in the number of motor vehicles. Occupational, home, and other injuries were reduced by 38%, 35%, and 49% respectively. The incidence rates were 2.6-3.0 times higher for men than for women through the 20-year observation period. CONCLUSION: This study indicates that a long-lasting multifactorial community-based intervention in a small community with defined aims may lead to a considerable and long-lasting reduction in injuries.

Incidence of HIV-1 infection and changes in prevalence of reproductive tract infections and sexual risk behaviours: a population-based longitudinal study in rural Tanzania.

This study aimed at describing the prevalence and incidence of HIV-1 and change in the prevalence of reproductive tract infections (RTIs) and sexual risk behaviours in the rural Kilimanjaro region of Tanzania. Two cross-sectional surveys among the total village population of Oria were conducted in 1991 and 1993. All individuals with a permanent address in the village were registered and invited to participate. After informed consent, participants gave blood for HIV-1 testing. Participants aged 15-44 years were interviewed regarding their socio-demographic characteristics and sexual risk behaviours and underwent genital examination and testing for RTIs. In 1991 and 1993, respectively, 3 239 (83.6%) and 2 191 (76.9%) individuals in the village participated. Prevalence of HIV-1 increased from 1.3% to 1.8%, but the difference was not significant (p = 0.17). HIV-1 incidence was 13.0/1000 person-years-at-risk (PYAR) for women and 4.3/1000 PYAR for men (relative risk was 3.0; 95% CI: 1.12-8.16). There was a significant increase in the prevalence of gonorrhoea, bacterial vaginosis and vaginal candidiasis (p < 0.001). The percentage of individuals who reported having multiple sexual partners during the 12 months preceding the survey increased from 12.9% to 24.1% (p < 0.001). The results suggest that RTIs and HIV-1 infections increased in this population in the early 1990s. Women were at higher risk of HIV-1 infection as compared to men. Sexual risk behaviours and RTIs may have contributed to HIV-1 transmission in this community. The data collected may help to inform the future design and evaluation of various intervention measures.

Clinicians' perspective of a training programme in syndromic management of sexually transmitted infections in Northern Tanzania.

This process evaluation study was designed to investigate clinicians' perception of a training programme on syndromic management of sexually transmitted infections (STIs) and their experiences in applying the skills learnt during the course. Out of 136 eligible course participants from Arusha and Kilimanjaro regions, Tanzania, 47 were invited to take part in the study and 40 agreed to participate (85%). The research instruments consisted of a structured interview including open- and close-ended questions, a self-administered questionnaire, and an observation checklist. While the clinicians reported to be satisfied with the course itself, the results revealed insufficient practical training. The clinicians reported problems with condom promotion and partner notification, and frequent shortage of equipment and drugs in the clinics was observed. Future courses on syndromic management of STI should focus on skills training related to health education and counselling, and have a stronger emphasis on practical, clinical work. There is need to address barriers to condom promotion and partner referral.

Self-reported and observed female genital cutting in rural Tanzania: associated demographic factors, HIV and sexually transmitted infections.

OBJECTIVES: To determine (i) the prevalence and type of female genital cutting (FGC) in a rural multi-ethnic village in Tanzania, (ii) its associated demographic factors, (iii) its possible associations with HIV, sexually transmitted infections (STIs) and infertility and (iv) to assess the consistency between self-reported and clinically observed FGC. METHOD: The study was part of a larger community-based, cross-sectional survey with an eligible female population of 1993. All were human immunodeficiency virus (HIV)-tested and asked whether they were circumcised (n = 1678; 84.2%). Participants aged 15-44 years were interviewed (n = 636; 79.7%), and 399 (50.0%) were gynaecologically examined to screen for STIs and determine the FGC status. RESULTS: At a mean age of 9.6 years, 45.2% reported being circumcised. In the age-group 15-44 years, 65.5% reported being cut, while FGC was observed in 72.5% and categorized as clitoridectomy or excision. The strongest predictors of FGC were ethnicity and religion, i.e. being a Protestant or a Muslim. FGC was not associated with HIV infection, other STIs or infertility. A positive, non-significant association between FGC and bacterial vaginosis was found with a crude odds ratio of 4.6. There was a significant decline of FGC over the last generation. An inconsistency between self-reported and clinically determined FGC status was observed in more than one-fifth of the women. CONCLUSION: The data indicate that both women and clinicians might incorrectly report women's circumcision status. This reveals methodological problems in determining women's circumcision status in populations practising the most common type of FGC. The positive association between FGC and bacterial vaginosis warrants further investigation.