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Kulier R.,Geneva Foundation for Medical Education and Research | Kapp N.,World Health Organization

Background: The use of ultrasound (US) is common in some settings before an abortion procedure. However, its positive effect on the safety or efficacy (ability to complete abortion) of the procedure has not been established. Our aim was to determine whether the use of pre-procedure US improves safety and/or efficacy of the abortion procedure. Methods: We searched the following databases: Pubmed, Embase, Lilacs and Popline; reference lists of retrieved papers; and Google. We considered any controlled trial comparing women seeking abortion who received pre-procedure US to those who did not. Our outcome measures were efficacy of the abortion, complication rates and side effects. Results: We did not identify any controlled trials or systematic reviews comparing the use of pre-procedure US to no US prior to abortion. Conclusions: Ultrasound is widely used in pregnancy to estimate gestational age and to detect any abnormalities of the pregnancy or uterus. The effect of its use among women undergoing abortion is unclear, and only indirect evidence is available. © 2011 Elsevier Inc. All rights reserved. Source

Eperon I.,University of Geneva | Vassilakos P.,Geneva Foundation for Medical Education and Research | Navarria I.,University of Geneva | Menoud P.-A.,Unilabs SA | And 5 more authors.
BMC Cancer

Background: To evaluate if human papillomavirus (HPV) self-sampling (Self-HPV) using a dry vaginal swab is a valid alternative for HPV testing.Methods: Women attending colposcopy clinic were recruited to collect two consecutive Self-HPV samples: a Self-HPV using a dry swab (S-DRY) and a Self-HPV using a standard wet transport medium (S-WET). These samples were analyzed for HPV using real time PCR (Roche Cobas). Participants were randomized to determine the order of the tests. Questionnaires assessing preferences and acceptability for both tests were conducted. Subsequently, women were invited for colposcopic examination; a physician collected a cervical sample (physician-sampling) with a broom-type device and placed it into a liquid-based cytology medium. Specimens were then processed for the production of cytology slides and a Hybrid Capture HPV DNA test (Qiagen) was performed from the residual liquid. Biopsies were performed if indicated. Unweighted kappa statistics (k{cyrillic}) and McNemar tests were used to measure the agreement among the sampling methods.Results: A total of 120 women were randomized. Overall HPV prevalence was 68.7% (95% Confidence Interval (CI) 59.3-77.2) by S-WET, 54.4% (95% CI 44.8-63.9) by S-DRY and 53.8% (95% CI 43.8-63.7) by HC. Among paired samples (S-WET and S-DRY), the overall agreement was good (85.7%; 95% CI 77.8-91.6) and the κ was substantial (0.70; 95% CI 0.57-0.70). The proportion of positive type-specific HPV agreement was also good (77.3%; 95% CI 68.2-84.9). No differences in sensitivity for cervical intraepithelial neoplasia grade one (CIN1) or worse between the two Self-HPV tests were observed. Women reported the two Self-HPV tests as highly acceptable.Conclusion: Self-HPV using dry swab transfer does not appear to compromise specimen integrity. Further study in a large screening population is needed. © 2013 Eperon et al.; licensee BioMed Central Ltd. Source

Berner A.,University of Geneva | Hassel S.B.,University of Geneva | Tebeu P.-M.,University Center Hospital | Untiet S.,University of Geneva | And 5 more authors.
Journal of Lower Genital Tract Disease

Objective. The study aimed to assess acceptability and preference for self-collected human papillomavirus tests (self-HPV) compared with traditional physician-sampled Pap tests (physician sampling) in a low-resource country. Materials andMethods. Women were recruited through a cervical cancer screening campaign conducted in Cameroon. Written and oral instructions were given to carry out an unsupervised self-HPV, followed by a physician-collected cervical sample for HPV testing and cytology. Subsequently the women were asked to answer a questionnaire. Results. A total of 243 women were prospectively enrolled in this study. Median age of participants was 39 years (range = 25-65 years). Acceptability score was higher for self-HPV (p < .001) compared with physician sampling. Preference was lower for self-HPV than physician sampling (29% vs 62%; p < .001). Most participants thought that physician sampling was more reliable than self-HPV (59% vs 1%; p < .001). Women who preferred physician sampling were significantly more likely to have low knowledge about cervical cancer and a low educational level. Conclusions. Although most of the women were more comfortable and less embarrassed with the self-HPV, they did not trust the method and did prefer physician sampling. The study underlines the need not only to educate women about HPV, cervical cancer, and its prevention but also to reassure them about the accuracy of self-HPV. © 2013, American Society for Colposcopy and Cervical Pathology. Source

Thapa S.,Public Health Institute | Thapa S.,Geneva Foundation for Medical Education and Research | Thapa S.,Patan Academy of Health science | Sharma S.K.,Ipas Nepal
Asia-Pacific Journal of Public Health

In Nepal, following the liberalization of the abortion law, expansion and scaling up of services proceeded in parallel with efforts to create awareness of the legalization status of abortion and provide women with information about where services are available. This article assesses the effectiveness of these programmatic interventions in the early years of the country's abortion program. Data from a 2006 national survey are analyzed with 2 outcome measures - awareness of the legal status of abortion and knowledge of places to obtain abortion services among women ages 15 to 44 years. The variations in the outcomes are analyzed by ecological-development subregion, residence, education, household wealth quintile, age, and number of living children. Bivariate and multivariate logistic regression techniques are used. Overall 32.3% (95% confidence interval = 31.4% to 33.2%) of the respondents were aware of the legal status of abortion and 56.5% (95% confidence interval = 55.5% to 57.4%) knew of a place where they could obtain an abortion. Both outcome measures showed considerable variations by the covariates. Women with secondary or higher level of education had the highest odds ratio of being aware of the law and having knowledge of a source for abortion services. Ecological-development subregions showed the second highest levels of odds ratios. Significant disparities among the population subgroups existed in the diffusion of awareness of the legal status of abortion and having knowledge of a place for abortion services in Nepal. The results point to which population subgroups to focus on and also serve as a baseline for assessing future progress in the diffusion process. © 2012 APJPH. Source

Thapa S.,Public Health Institute | Thapa S.,Geneva Foundation for Medical Education and Research | Thapa S.,Patan Academy of Health science | Neupane S.,Valley Research Group
International Journal of Gynecology and Obstetrics

Objective: To examine the incidence of and risk factors for repeat abortion in Nepal. Methods: Data were analyzed from a survey of 1172 women who had surgical abortions between December 2009 and March 2010 in 2 clinics in Kathmandu, Nepal. Bivariate and multivariate logistic regressions were performed to estimate odds ratios for the risk factors. Results: Among the respondents, 32.3% (95% confidence interval, 29.6-34.9) had repeat abortions. This incidence rose sharply with age and parity, and was higher among those with no intention of having a future child, those attaining primary or secondary level education, and those attending the non-governmental sector clinic. Women with repeat abortion were similar to those with 1 abortion in terms of contraceptive practice. Among women not using contraceptives at the time of the unintended pregnancy, the 3 most commonly cited reasons were ill health, non-compliance with the method intended for use, and dislike of the method. Women with repeat abortion showed a pattern of contraceptive acceptance immediately after the procedure similar to that of women who had 1 abortion. Conclusion: Repeat abortion is emerging as a major public health issue in Nepal, with implications for counseling and provision of abortion, and for family planning services. © 2012 International Journal of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved. Source

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