03655nas a2200481   4500000000100000008004100001260004400042653002400086653005700110653002100167653001900188653004100207653002500248653002000273653001800293653001500311100001100326700001400337700001800351700001900369700002100388700001200409700001300421700002000434700001900454700002100473700001900494700001000513700002600523700001900549700001300568700001200581700001300593700001200606700002100618700001200639245013400651856008400785300000900869490000700878520227400885022001403159       2023                            d  bSpringer Science and Business Media LLC10aInfectious Diseases10aPublic Health, Environmental and Occupational Health10aGeneral Medicine10aWomen's health10aFemale genital schistosomiasis (FGS)10aHuman papiloma virus10aCervical cancer10aPublic Health10aMadagascar1 aKutz J1 aRausche P1 aRasamoelina T1 aRatefiarisoa S1 aRazafindrakoto R1 aKlein P1 aJaeger A1 aRakotomalala RS1 aRakotomalala Z1 aRandrianasolo BS1 aMcKay-Chopin S1 aMay J1 aRakotozandrindrainy R1 aPuradiredja DI1 aSicuri E1 aHampl M1 aLorenz E1 aGheit T1 aRakotoarivelo RA1 aFusco D00aFemale genital schistosomiasis, human papilloma virus infection, and cervical cancer in rural Madagascar: a cross sectional study  uhttps://link.springer.com/content/pdf/10.1186/s40249-023-01139-3.pdf?pdf=button  a1-140 v123 a<p><strong>Background:</strong>&nbsp;Women’s health in resource-limited settings can benefit from the integrated management of high-burden diseases, such as female genital schistosomiasis (FGS) and human papilloma virus (HPV)-related cervical cancer. In schistosomiasis-endemic countries such as Madagascar, data on FGS and HPV prevalence are lacking as well as preventive measures for both conditions. This study aims to estimate the prevalence of FGS and HPV in rural Madagascar, and to examine associated risk factors to identify opportunities for improving women’s health.</p>

<p><strong>Methods:</strong> After initial community outreach activities, interested women aged 18–49&nbsp;years were recruited consecutively in 2021 at three primary health care centers in the district of Marovoay. FGS was detected by colposcopy. Colposcopy images were double-blind reviewed by two independent specialists. A Luminex bead-based assay was performed on cervical vaginal lavage specimens for HPV typing. Crude (CPR) and adjusted prevalence ratios (APR) of associations between selected factors and FGS and HPV positivity were estimated using univariable and multivariable binary Poisson regression with 95% confidence intervals (CIs).</p>

<p><strong>Results:&nbsp;</strong>Among 500 women enrolled, 302 had complete information on FGS and HPV diagnosis, and were thus eligible for analysis. Within the sample, 189 (62.6%, 95% CI: 56.9–68.1) cases of FGS were detected. A total of 129 women (42.7%, 95% CI: 37.1–48.5) tested positive for HPV. In total, 80 women (26.5%, 95% CI: 21.6–31.8]) tested positive for both conditions. No association was observed between FGS and HPV positivity, while previous pregnancy (APR = 0.65, 95% CI: 0.43–0.78) and older age (APR = 0.59, 95% CI: 0.42–0.81) are showing a negative association with HPV infection compared to no previous pregnancy and younger age groups.</p>

<p><strong>Conclusions:</strong> The results of the study show that FGS and HPV are highly prevalent in rural Madagascar. The concurrent prevalence of these two conditions requires urgent adaptations of public health strategies to improve women’s health, such as integrated services at primary level of care. Graphical Abstract</p>
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