Update on HPV Vaccination Policies and Practices in 17 Eastern European and Central Asian Countries and Territories.

BACKGROUND: In 2021, a survey was conducted as part of the regional program of the United Nations Population Fund (UNFPA) Regional Office for Eastern Europe and Central Asia (EECA) to assess the policies and practices relating to HPV vaccination and cervical cancer screening in the 17 countries and territories included in this region. Since then, very substantial progress has been made with HPV vaccination across the region so another survey was conducted establish the current situation. METHODS: A 10 question survey covering the policies, plans and practices for HPV vaccination was prepared. As cervical cancer prevention is a priority for the UNFPA, its offices in the 17 countries and territories included in this study are well placed to identify the people who can provide authoritative data for this survey. Working with the UNFPA offices, the questionnaires were sent to these national experts in May 2023, with data collected until 30 June 2023. All countries and territories returned completed questionnaires. RESULTS: In the period from 30 June 2021 to 30 June 2023, the number of countries and territories that have implemented or are implementing HPV vaccination programs has doubled. As of 30 June 2021, only 6 of 17 countries and territories had implemented national HPV vaccination programmes, and by 30 June 2023, another 6 could be added to this list. Of the 4 countries with sub-optimal vaccination coverage rates in 2021, none showed substantial improvement over the 2-year period. CONCLUSIONS: The implementation of HPV vaccination programs across the region is progressing very rapidly with ≈70% of the countries and territories implementing or having implemented national programs. However, greater attention needs to be given to ensuring that both the old and the new programs will achieve high coverage rates.

Women healthcare professionals' experiences and needs regarding the COVID-19 pandemic from a gender perspective.

BACKGROUND: Accounting for 70% of healthcare workers worldwide, and 56% in Turkey, women continue to be the frontline fighters in the battle against the COVID-19 pandemic. Their needs may be overlooked as a result of their growing responsibilities both in their professional and private lives. This descriptive study aimed at identifying the gendered needs and experiences of women healthcare workers in Turkey throughout the pandemic. METHOD: This study consists of 1082 healthcare professionals' responses of various positions across several provinces and facilities, collected through a web-based survey of 50 questions. RESULTS: Almost all participants (94%) expressed feeling anxious over the pandemic regardless of their working units. Four out of ten (38%) respondents noted working for 41 h or more on average weekly, and most of the participants who worked for long hours were assigned in COVID-19 units. Non-clinical personnel reported less difficulty in work/life balance. 64% of the respondents reported not having gone through any training on COVID-19, and eight out of ten (81%) said they had information needs. Research findings suggest that 92% of participants' needs remained unmet. While 74% of the respondents pointed out not having an income that is worthwhile, 72% referred to the need for psychosocial support, 58% need for support in domestic work and 37% support for child care as their primary needs. CONCLUSION: Results of the research highlighted the gendered needs of women healthcare professionals during the COVID-19 pandemic, and disseminate protective and preventive health policies and practices through a gender responsive approach.

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.

A community-based survey on Syrian refugee women's health and its predictors in Sanliurfa, Turkey.

Reproductive characteristics, mental health symptoms, micronutrient deficiencies, and symptoms of sexually transmitted infections (STIs) were determined among married Syrian refugee women aged 15-49 years who were living outside of camps in 2015, using probability sampling. Of the 458 participants, 51.3 percent married before the age of 18 years. Early-age marriages and number of desired children increased after the war. In multivariable analyses, education (adjusted odds ratio [aOR] = 1.2; 95% confidence interval [CI] = 1.2-1.3) and length of stay in Sanliurfa (aOR = 1.2; 95% CI = 1.1-1.2) were independently associated with early marriage. Approximately 16 percent of women were pregnant, and 26.7 percent of them had not received prenatal care; 47.7 percent had had a pregnancy loss; 50.8 percent reported symptoms of STIs. Of those who were sexually active, 37.8 percent were not using contraception. The prevalence of iron, B12, and folic acid deficiencies was 50 percent, 45.6 percent, and 10.5 percent, respectively. Early marriage (aOR = 2.2; 95% CI = 1.4-3.5) and number of desired children (aOR = 5.03; 95% CI = 3.2-7.9) were associated with not using contraception. Most (89.7 percent) women reported at least two mental health symptoms; lack of social support (aOR = 2.6; 95% CI = 1.3-5.3), language barrier (aOR = 2.3; 95% CI = 1.01-5.2), and B12 deficiency (aOR = 1.8; 95% CI = 1.01-3.4) were associated with such symptoms. The findings demonstrate the need for reproductive health and psychosocial services.

Prevalence of Violence: Male and Female Seasonal Agricultural Workers' Approach to Violence in Turkey.

The objective of this study is to determine the male and female seasonal agricultural workers' perception of violence, prevalence of violence, frequency of victimization, and their related factors. Quantitative and qualitative data were used, and 89.5% of women were exposed to violence that included the restriction of their human rights. The sample consisted of 1,211 women and 1,064 men. Their marital status, duration of work, and attention to their health affected the violence exposure. Arabic people who were unmarried, had a poor educational background, and poor health perception approved of the physical violence.

[Investigation of the prevalence of Trichomonas vaginalis among female Syrian refugees with the complaints of vaginitis aged between 15-49 years]. / Vajinit yakinmalari olan 15-49 yas arasindaki Suriyeli mülteci kadinlarda Trichomonas vaginalis sikliginin arastirilmasi.

Since the Syrian civil war began in 2011, most of the Syrian refugees have immigrated to Turkey due to its open gate policy and the width of the border. By the end of 2015, it was estimated that there were 2.5 million Syrian refugees in Turkey. Many of the Syrian refugees live in Sanliurfa due to its location on the border with Syria. Trichomonas vaginalis, apart from viral agents is the most common parasite among sexually transmitted infection agents. The aim of this study was to determine the prevalence of T.vaginalis among female married Syrian refugees living outside of the camps in Sanliurfa city center, aged between 15-49 years with complaints of vaginitis. This multi-purpose survey was carried out between February and March of 2015, in collaboration with the United Nations Population Fund and Harran University. This study was approved under the heading of "General Health Status of Female Syrian Refugees" by the Ethics Committee of Harran University Faculty of Medicine. A total of 460 Syrian refugees house were selected using the probability cluster sampling method, with a 95% confidence level and a 5% confidence interval with a design effect. Two women refused to participate in the study, and the response rate was 99.6%. Two Syrian nurses, one laboratory technician, and one interpreter who knew Kurdish and Arabic were hired for the field survey. A structured questionnaire written in Turkish was translated to Arabic and used to collect the sociodemographic data during face to face interviews. According to the questionnaire data, the women with the complaints of vaginal discharge, unusual vaginal bleeding and/or dyspareunia were invited to the Gynecology Department of Harran University Research and Training Hospital for a medical examination. During gynecological examination, swab samples obtained from posterior fornix were evaluated by direct microscopy and Giemsa staining methods for the presence of T.vaginalis trophozoites. Of 458 women who have participated the questionnaire survey, 232 (50.6%) have declared that they had vaginitis complaints. Accordingly, 157 symptomatic and non-pregnant women were invited to the hospital, however only 89 (56.7%) accepted the invitation. T.vaginalis infection was detected in 19 (21.3%) by direct microscopy, and in 32 (36%) by Giemsa staining of the samples taken during the examination of those 89 women (mean age: 31.6 ± 8.7 years). In the gynecological examination, 56.2% (50/89) of the women were clinically diagnosed as vaginitis. A statistically significant association was detected between T.vaginalis positivity and the cases with or without the clinical vaginitis diagnosis (p< 0.001). Our data indicated that the prevalence of T.vaginalis (36%) detected in the female Syrian refugees is higher than the prevalence (3-13%) of our general population, but it is close to the prevalence (40%) in groups with risky behaviors (sex workers). In conclusion, health screening studies and health educations about safe sex life for Syrian refugees would be useful in the prevention of sexually transmitted diseases.

Reproductive health education of conscripts in Turkish Armed Forces: first evaluation of training courses.

BACKGROUND: In the frame of the Reproductive Health Program of Turkish Armed Forces, conscripts have been given 1-day participatory, interactive courses by the field military medical trainers in all military garrisons. METHODS: Pre- and posttest knowledge levels of soldiers were tested by 25 true-false questions. Demographic characteristics and test scores were routinely transferred from the training rooms to the reproductive health database by authorized field trainers using the network of the army. Two hundred forty-eight thousand seven hundred ninety-six soldiers with perfect entrance of data have been selected for descriptive analyses. RESULTS: Of all the soldiers, 39.2% were born in 1984. Primary school graduates have constituted the largest group with 34.4%. Only 7.4% of the soldiers were married. The mean precourse score was 65.7% +/- 15.4%, while the postcourse score was 83.5 +/- 12.73% (SD) (p < 0.001). Those who used to live in the east region of Turkey have obtained significantly lower scores on both pre- and posttests in comparison to scores of those who used to live in other regions (p < 0.001). Groups based on five educational levels have obtained significantly different scores, ascending gradually from uneducated to the higher educational level (p < 0.001). The ratio of increase in knowledge was highest in the groups with the lowest educational level and unmarried (p < 0.001). CONCLUSION: Training courses seem to succeed in increasing the knowledge of conscripts, particularly of those with a low socioeconomic and cultural status. However, it requires time to determine whether this increase in knowledge level with promote behavioral change positively and will improve young males' own and their partners' reproductive health status.