Improving access to safe, quality surgical care for gynecologic cancers through capacity-building interventions in low- and middle-income countries: A scoping review.

BACKGROUND: Following the launch of the World Health Organization's Strategy to accelerate the elimination of cervical cancer, diagnosis is expected to increase, especially in low- and middle-income countries (LMICs). A well-integrated surgical system is critical to treat cervical cancer. Two major approaches have been employed to build human capacity: task-sharing and training of gynecologic oncologists (GynOncs). OBJECTIVES: This review aimed to explore existing literature on capacity-building for surgical management of early-stage gynecologic cancers. SEARCH STRATEGY: The search strategy was registered on Open Science Framework (doi 10.17605/OSF.IO/GTRCB) and conducted on OVID Medline, Embase, Global Index Medicus, and Web of Science. Search results were exported and screened in COVIDENCE. SELECTION CRITERIA: Studies published in English, Spanish, French, and/or Portuguese conducted in LMIC settings evaluating capacity building, task-sharing, or outcomes following operation by subspecialists compared to specialists were included. DATA COLLECTION AND ANALYSIS: Results were synthesized using narrative synthesis approach with emergence of key themes by frequency. MAIN RESULTS: The scoping review identified 18 studies spanning our themes of interest: capacity building, subspecialized versus non-subspecialized care, and task-shifting/-sharing. CONCLUSIONS: A multilayered approach is critical to achieve the WHO Strategy to Eliminate Cervical Cancer. Capacity-building and task-sharing programs demonstrate encouraging results to meet this need; nevertheless, a standardized methodology is needed to evaluate these programs, their outcomes, and cost-effectiveness.

Pregnancy Rate after Myomectomy and Associated Factors among Reproductive Age Women Who Had Myomectomy at Saint Paul's Hospital Millennium Medical College, Addis Ababa: Retrospective Cross-Sectional Study.

INTRODUCTION: Uterine myoma occurs in 20-50% of reproductive age women. Uterine myomas may be associated with 5-10% of cases of infertility, but it is the sole cause or factor in only 2-3% of all infertility cases. Myomectomy is surgery done to remove myoma regardless of the methods. OBJECTIVE: To assess impact of myomectomy on pregnancy rate and associated factors among reproductive age women who had myomectomy at St. Paul's Hospital Millennium Medical College, in Addis Ababa. Methodology. Hospital-based retrospective cross-sectional study was conducted to determine pregnancy rate after myomectomy and its associated factors. Patients who had myomectomy in SPHMMC from September 2012 to September 2017 were enrolled. Information was retrieved from hospital records and phone interviews with the patients. The strength of statistical association was measured by adjusted odds ratios and 95% confidence intervals. Statistical significance was declared at p value < 0.05. RESULT: Among 180 females participated in this study, 52.2% got pregnant after myomectomy. The result showed that females with age > 35 years were 0.31 times less likely to get pregnant after surgery than those ages 20-25 years [AOR = 0.31 (95% CI: 0.29-0.54)]. People with no infertility before surgery were 1.19 times more likely to be pregnant after surgery than those with unexplained infertility before the surgery [AOR = 1.19 (95% CI: 1.06-1.57)]. People with two uterine incisions were 0.06 times less likely [AOR = 0.06 (95% CI: 0.043-0.51)] while those with three or more than three incisions were 0.02 times less likely [AOR = 0.02 (95% CI: 0.002-0.22)] to get pregnant compared with those with one incision on uterine wall. CONCLUSION: Age, number of incision, and infertility before surgery were significantly associated with rate of pregnancy after myomectomy.