Vaginal douching in Zambia: a risk or benefit to women in the fight against cervical cancer: a retrospective cohort study

Antimicrobial resistance of Neisseria gonorrhoeae isolated from patients attending sexually transmitted infection clinics in Urban Hospitals, Lusaka, Zambia

BACKGROUND

Neisseria gonorrhoeae, the causative agent for sexually transmitted infection (STI) gonorrhoea, has emerged with a significant public health impact on acquiring resistance to antimicrobials available for treatment. The resistance of N. gonorrhoeae limit treatment options and contributed to high morbidity associated with gonorrhoea. Data on antimicrobial resistance (AMR) profiles in N. gonorrhoeae is scares in Zambia. This study aimed to determine the antibiotic susceptibilities in N. gonorrhoeae isolates from Lusaka, Zambia.

METHODS

A prospective cross-sectional study was conducted on 630 STI patients who presented with urethral or vaginal discharge from 2019 to 2020. Urethral and endocervical secretions were cultured on Modified Thayer Martin agar and incubated at 36 °C ± 1 °C in 5% CO2 for 24 h. Identification of N. gonorrhoeae isolates was achieved by Gram stain, oxidase, nitrocefin disk, BactiCard Neisseria, and Viteck® Compact. The AMR profiles were determined using E-test. Statistical significant was determined by Pearson's Chi-square test, Mann-Whitney U test, or logistic regression with p-values of < 0.05 indicating significance.

RESULTS

A total of 630 patients were recruited of which 46% (290/630) with the median of 29 years and interquartile range (IQR) of 19-39 years were male. The median of the females was 26 years and IQR of 15-37 years. Neisseria gonorrhoeae was isolated from 19.4% (122/630) patients of which 72.9% (89/122) were male, with highest prevalence of isolation in the age category of 25-34 years. The prevalence of resistance was high to penicillin (85.2%), tetracycline (68.9%) and ciprofloxacin (59.8%) with MIC90 of 32 µg/mL, 8 µg/mL, and 8 µg/mL respectively. The isolates had reduced susceptibility to cefixime (1.6%), spectinomycin (4.9%) and (4.9%) for azithromycin. All isolates were susceptible to ceftriaxone. Risk factors associated with AMR were douching in females (AOR 6.69, 95% CI; 1.11-40.31, p = 0.039), female gender (AOR 7.64, 95% CI; 1.11-52.33, p = 0.048), HIV-positivity (AOR 26.59, 95% CI; 3.67-192.7, p = 0.005), no condom use or unprotected sex (AOR 5.48, 95% CI; 1.17-22.75 p = 0.026), sex trading (AOR 4.19, 95% CI; 1.55-11.33, p = 0.010), and over-counter treatment of ciprofloxacin (AOR 3.44, 95% CI; 1.17-22.75, p = 0.023).

CONCLUSION

The N. gonorrhoeae resistance to penicillin, tetracycline and ciprofloxacin was high necessitating revision of the treatment guidelines. However, no resistance to ceftriaxone was detected. Therefore, monitoring of antibiotic resistance remains critical in Zambia.

Determinants of Menstrual Hygiene Management Practices among Schoolgirls: A Cross-Sectional Study in the Savannah Region of Ghana

Introduction. Menstruation is crucial in the reproductive lives of all women. The advent of menses in most settings is accompanied by physical and psychological health, religious, social, and cultural implications. The research intends to identify determinants of menstrual hygiene management (MHM) practices among adolescent girls in Junior High Schools in the West Gonja Municipality of the Savannah Region of Ghana. Methods. The study employed an analytical cross-sectional design with 430 adolescent schoolgirls selected through multistage sampling techniques. A structured questionnaire was used to collect data and analyzed using STATA version 14. A logistic regression model was run to determine the predictors of MHM practices. Results. The study discovered that 63.7% of the girls had sufficient knowledge of menstruation and menstrual hygiene. Almost all girls (97%) used some form of absorbent materials during menses, with over half of these girls (58.6%) using commercial sanitary pads, 30.5% using cloth, 3.7% using cotton, and 4.2% using tissue papers with 3.0% reported not using any absorbent material. Only 44.4% reported reusing their absorbent materials. Out of which, the majority (88.5%) of the schoolgirls cleaned their reusable absorbent material using soap and water with 77.5% drying absorbent materials in the sun. Overall, 84.9% practiced good MHM. Type of school [Adjusted Odds Ratio (AOR) =6.0; 95% Confidence Interval (CI) (2.64-13.59)], pocket money [AOR =2.5; 95% CI (1.27-4.86)], and residence [AOR =2.8 95% CI (1.55-5.18)] were the most significant determinants of menstrual hygiene management practice. Conclusion. About two-thirds of the schoolgirls are knowledgeable in menstrual hygiene but access to management materials is problematic whereas approximately half of the girls have access to sanitary pads and the rest resort to the use of cloth and cotton. Pocket money and residential status were the most important predictors of the menstrual hygiene management. The government initiative to provide schoolgirls with sanitary pads could go a long way to improve menstrual hygiene management if implemented across all schools in Ghana, particularly in rural areas.

The association between douching, genital talc use, and the risk of prevalent and incident cervical cancer

While human papillomavirus is the primary cause of cervical cancer, other factors may influence susceptibility and response to the virus. Candidates include douching and talcum powder applied in the genital area. We used Cox proportional hazards models to estimate confounder-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) in the Sister Study (2003-2009), a US cohort of women aged 35-74. We considered pre-baseline (n = 523) and incident (n = 31) cervical cancers. Douching at ages 10-13 was positively associated with pre-baseline cervical cancer (HR 1.32, 95% CI 0.86-2.03), though the association was not statistically significant. We did not observe an association between adolescent talc use and pre-baseline cervical cancer (HR 0.95, 95% CI 0.76-1.19). Douching in the year before enrollment was positively associated with incident cervical cancer (HR 2.56, 95% CI 1.10-5.99). The association between recent genital talc use and incident cervical cancer was positive, but not statistically significant (HR 1.79, 95% CI 0.78-4.11). The observed positive association between douching and incident cervical cancer is consistent with previous retrospective case-control studies. In the first study to examine genital talc use and cervical cancer, we did not see evidence of an association.