The every woman study™ low- and middle-income countries edition protocol: A multi-country observational study to assess opportunities and challenges to improving survival and quality of life for women with ovarian cancer.

BACKGROUND: Ovarian cancer is a challenging disease to diagnose and treat effectively with five-year survival rates below 50%. Previous patient experience research in high-income countries highlighted common challenges and opportunities to improve survival and quality of life for women affected by ovarian cancer. However, no comparable data exist for low-and middle-income countries, where 70% of women with the disease live. This study aims to address this evidence gap. METHODS: This is an observational multi-country study set in low- and middle-income countries. We aim to recruit over 2000 women diagnosed with ovarian cancer across multiple hospitals in 24 countries in Asia, Africa and South America. Country sample sizes have been calculated (n = 70-96 participants /country), taking account of varying national five-year disease prevalence rates. Women within five years of their diagnosis, who are in contact with participating hospitals, are invited to take part in the study. A questionnaire has been adapted from a tool previously used in high-income countries. It comprises 57 multiple choice and two open-ended questions designed to collect information on demographics, women's knowledge of ovarian cancer, route to diagnosis, access to treatments, surgery and genetic testing, support needs, the impact of the disease on women and their families, and their priorities for action. The questionnaire has been designed in English, translated into local languages and tested according to local ethics requirements. Questionnaires will be administered by a trained member of the clinical team. CONCLUSION: This study will inform further research, advocacy, and action in low- and middle-income countries based on tailored approaches to the national, regional and global challenges and opportunities. In addition, participating countries can choose to repeat the study to track progress and the protocol can be adapted for other countries and other diseases.

Cervical cancer management in a low resource setting: A 10-year review in a tertiary care hospital in Kenya.

Background: Cervical cancer is one of the leading causes of cancer mortality among women in Kenya due to late presentations, poor access to health care, and limited resources. Across many low- and middle-income countries infrastructure and human resources for cervical cancer management are currently insufficient to meet the high population needs therefore patients are not able to get appropriate treatment. Objective: This study aimed to describe the clinicopathological characteristics and the treatment profiles of cervical cancer cases seen at Moi Teaching and Referral Hospital (MTRH). Methods: This was a retrospective cross-sectional study conducted at MTRH involving the review of the electronic database and medical charts of 1541 patients with a histologically confirmed diagnosis of cervical cancer between January 2012 and December 2021. Results: Of the 1541 cases analyzed, 91% were squamous cell carcinomas, 8% were adenocarcinomas, and 1% were other histological types. Thirty-eight percent of the patients were HIV infected and less than 30% of the women had health insurance. A majority (75%) of the patients presented with advanced-stage disease (stage IIB-IV). Only 13.9% received chemoradiotherapy with curative intent; of which 33.8% received suboptimal treatment. Of the 13% who received surgical treatment, 45.3% required adjuvant therapy, of which only 27.5% received treatment. Over 40% of the women were lost to follow-up. Conclusion: Most of the patients with cervical cancer in Kenya present at advanced stages with only a third receiving the necessary treatment while the majority receive only palliative treatment or supportive care.

Epidemiological profile and clinico-pathological features of pediatric gynecological cancers at Moi Teaching & Referral Hospital, Kenya.

Background: The main pediatric (0-18 years) gynecologic cancers include stromal carcinomas (juvenile granulosa cell tumors and Sertoli-Leydig cell tumors), genital rhabdomyosarcomas and ovarian germ cell. Outcomes depend on time of diagnosis, stage, tumor type and treatment which can have long-term effects on the reproductive career of these patients. This study seeks to analyze the trends in clinical-pathologic presentation, treatment and outcomes in the cases seen at our facility. This is the first paper identifying these cancers published from sub-Saharan Africa. Method: Retrospective review of clinico-pathologic profiles and treatment outcomes of pediatric gynecologic oncology patients managed at MTRH between 2010 and 2020. Data was abstracted from gynecologic oncology database and medical charts. Results: Records of 40 patients were analyzed. Most, (92.5%, 37/40) of the patients were between 10 and 18 years. Ovarian germ cell tumors were the leading histological diagnosis in 72.5% (29/40) of the patients; with dysgerminomas being the commonest subtype seen in 12 of the 37 patients (32.4%). The patients received platinum-based chemotherapy in 70% of cases (28/40). There were 14 deaths among the 40 patients (35%). Conclusion: Surgery remains the main stay of treatment and fertility-sparing surgery with or without adjuvant platinum-based chemotherapy are the standard of care with excellent prognosis following early detection and treatment initiation. LMICs face several challenges in access to quality care and that affects survival of these patients. Due to its commonality, ovarian germ cell cancers warrant a high index of suspicion amongst primary care providers attending to adnexal masses in this age group.

Predictors of Bacterial Vaginosis among Pregnant Women Attending Antenatal Clinic at Tertiary Care Hospital in Tanzania: A Cross Sectional Study.

BACKGROUND: Bacterial vaginosis (BV) is one of the most common genital tract infections in pregnancy associated with an increased risk of pregnancy losses, maternal and perinatal morbidity and mortality. Different social behavioural and obstetric factors can contribute to the development of BV. Determining the predictors of BV could be the best way of identifying women at high risk of developing the disease. METHODS: This was a cross-sectional study conducted between December 2017 and February 2018 to determine the prevalence and predictors of BV among pregnant women attending antenatal Clinic (ANC) at Muhimbili National Hospital (MNH), Tanzania. Participants were recruited using systematic random sampling. For each consented participant, a pretested questionnaire was filled, a pelvic examination was done and a sample was collected. BV was diagnosed using Nugent's score. Data was analysed using Statistical Package for Social Scientists (SPSS) version 23.0. Bivariate and multivariate logistic regression analysis was done to determine factors that were independently associated with BV. RESULTS: 178 (26.7%) pregnant women out of 667 were diagnosed positive for BV. In the bivariate analysis (Table 3), age (COR 1.71; 95% CI, 1.16-2.52), level of education (COR 4.08, 95% CI, 2.84-5.84), gravidity (COR, 1.52, 95% CI; 1.04-2.23), parity (COR 1.69, 95% CI; 1.18-2.42), vaginal douching (COR 2.89, 95% CI; 1.96-4.27), HIV status (COR 9.37, 95%CI; 4.12-21.28), history of STI (COR 2.49 95% CI; 1.46-4.25), LTSP (COR 2.76, 95% CI; 1.68-4.54) and age of first coitus (COR 3.19, 95% CI; 2.24-4.56) were significantly associated with BV. After adjusting for confounders in multivariate analysis, the following risk factors remained significantly associated with BV; age of 21-29 years (AOR, 2.22, 95%CI; 1.45-3.49), primary education level (AOR 3.97, 95% CI; 2.63-5.98), vaginal douching (AOR 3.68, 95% CI; 2.35-5.76), HIV status (AOR 6.44, 95% CI; 2.62-15.88), STI infection (AOR 2.34, 95% CI; 1.25-4.37), more than one LTSP (AOR 2.69, 95% CI; 1.53-4.74) and age of less than 18 years of first coitus (AOR 2.16, 95% CI; 1.42-3.30). CONCLUSION: The prevalence of BV in pregnant women was found to be high. Age of less than 30 years, primary education level and below, vaginal douching, HIV infection, STI, more than one lifetime sexual partners and early age of sexual debut were found to be significant predictors of BV. The high prevalence of BV in our population should necessitate policy makers to include screening and treatment of BV in the future policy of antenatal care package, as BV is associated with significant maternal and neonatal morbidity and mortality. Women should also be educated on harmful effects of certain behavioural practices such as vaginal douching that predispose to BV. In addition symptoms of BV such as abnormal vaginal discharge during pregnancy are inconsistent, under reported and often overlooked. Therefore, a high-risk approach can be used for screening and treatment of asymptomatic women.