HPV Vaccination and Cervical Cancer Screening Policies and Practices in 18 Countries, Territories and Entities across Eastern Europe and Central Asia.

BACKGROUND: To assess readiness to achieve the WHO Global Strategy targets for HPV vaccination and cervical screening and to guide capacity building, the current status of these services in 18 Eastern European and Central Asian countries, territories and entities (CTEs) was evaluated. METHODS: In order to assess the current status of HPV vaccination and cervical cancer screening in these 18 CTEs, a 30 question survey tool was developed, covering: national policies, strategies and plans for cervical cancer prevention; status of cancer registration; status of HPV vaccination; and current practices for cervical cancer screening and treatment of precancerous lesions. As cervical cancer prevention comes within the mandate of the United Nations Fund for Population Development (UNFPA), the UNFPA offices in the 18 CTEs have regular contact with national experts who are directly involved in cervical cancer prevention actions and are well placed to provide the data required for this survey. Working through the UNFPA offices, the questionnaires were sent to these national experts in April 2021, with data collected from April to July 2021. All CTEs returned completed questionnaires. RESULTS: Only Armenia, Georgia, Moldova, North Macedonia, Turkmenistan and Uzbekistan have implemented national HPV vaccination programmes, with only the last 2 of these reaching the WHO target of 90% of girls fully vaccinated by age 15, while rates in the other 4 range from 8%-40%. Cervical screening is available in all CTEs but only Belarus and Turkmenistan have reached the WHO target of 70% of women screened once by age 35 and again by age 45, while rates elsewhere range from 2%-66%. Only Albania and Turkey follow the WHO recommendation to use a high-performance screening test, while the majority use cervical cytology as the main screening test and Kyrgyzstan, Tajikistan, Turkmenistan and Uzbekistan use visual inspection. No CTEs currently operate systems to coordinate, monitor and quality assure (QA) the entire cervical screening process. CONCLUSIONS: Cervical cancer prevention services in this region are very limited. Achieving the WHO Global Strategy targets by 2030 will require substantial investments in capacity building by international development organisations.

Migrant children in transit: health profile and social needs of unaccompanied and accompanied children visiting the MSF clinic in Belgrade, Serbia.

BACKGROUND: Thousands of children migrate to Europe each year in search of safety and the promise of a better life. Many of them transited through Serbia in 2018. Children journey alone or along with their family members or caregivers. Accompanied migrant children (AMC) and particularly unaccompanied migrant children (UMC) have specific needs and experience difficulties in accessing services. Uncertainty about the journey and daily stressors affect their physical and mental health, making them one of the most vulnerable migrant sub-populations. The aim of the study is to describe the demographic, health profile of UMC and AMC and the social services they accessed to better understand the health and social needs of this vulnerable population. METHODS: We conducted a retrospective, descriptive study using routinely collected program data of UMC and AMC receiving medical, mental and social care at the Médecins sans Frontières clinic, in Belgrade, Serbia from January 2018 through January 2019. RESULTS: There were 3869 children who received medical care (1718 UMC, 2151 AMC). UMC were slightly older, mostly males (99%) from Afghanistan (82%). Skin conditions were the most prevalent among UMC (62%) and AMC (51%). Among the 66 mental health consultations (45 UMC, 21 AMC), most patients were from Afghanistan, with 98% of UMC and 67% of AMC being male. UMC as well as AMC were most likely to present with symptoms of anxiety (22 and 24%). There were 24 UMC (96% males and 88% from Afghanistan) that received social services. They had complex and differing case types. 83% of UMC required assistance with accommodation and 75% with accessing essential needs, food and non-food items. Several required administrative assistance (12.5%) and nearly a third (29%) legal assistance. 38% of beneficiaries needed medical care. Most frequently provided service was referral to a state Centre for social welfare. CONCLUSION: Our study shows that unaccompanied and accompanied migrant children have a lot of physical, mental health and social needs. These needs are complex and meeting them in the context of migration is difficult. Services need to better adapt by improving access, flexibility, increasing accommodation capacity and training a qualified workforce.

Social determinants of malnutrition among Serbian children aged <5 years: ethnic and regional disparities.

OBJECTIVES: To assess the association between growth indicators of Serbian children aged <5 years of Roma and non-Roma populations and social determinants of health. METHODS: This study used a cross-sectional secondary data analysis design to measure national and Roma population samples from the MICS 4 (UNICEF) performed in 2010 in Serbia. A total of 4,978 questionnaires were observed with children aged <5 years. Logistic regression analysis was performed to identify association between social determinants of health and growth indicators. RESULTS: Roma children were more than three times more likely to exhibit stunted and/or severely stunted than non-Roma children from the lowest wealth quintile. Non-Roma children residing outside of the Belgrade region had a lower risk of stunted compared to children residing within the Belgrade region, while the risk of stunted among Roma children was nearly twofold greater than those residing in southern and eastern Serbia than in the Belgrade region. CONCLUSIONS: Our findings clarified the necessity to establish ethnically and regionally sensitive programs to solve the malnutrition problems.