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. After initial community outreach activities, interested women aged 18–49 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). 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. 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.

中文翻译：

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马达加斯加农村地区女性生殖器血吸虫病、人乳头状瘤病毒感染和宫颈癌：一项横断面研究

资源有限地区的妇女健康可以受益于高负担疾病的综合管理，例如女性生殖器血吸虫病（FGS）和人乳头瘤病毒（HPV）相关宫颈癌。在马达加斯加等血吸虫病流行国家，缺乏 FGS 和 HPV 患病率数据以及这两种疾病的预防措施。本研究旨在估计马达加斯加农村地区 FGS 和 HPV 的患病率，并检查相关风险因素，以确定改善妇女健康的机会。经过初步的社区外展活动，马罗沃伊区的三个初级卫生保健中心于 2021 年连续招募了 18-49 岁感兴趣的女性。FGS是通过阴道镜检查发现的。阴道镜图像由两名独立专家进行双盲审查。对宫颈阴道灌洗样本进行基于 Luminex 珠的检测，以进行 HPV 分型。使用具有 95% 置信区间 (CI) 的单变量和多变量二元泊松回归估计所选因素与 FGS 和 HPV 阳性之间关联的粗略 (CPR) 和调整患病率 (APR)。在 500 名登记的女性中，302 名拥有 FGS 和 HPV 诊断的完整信息，因此有资格进行分析。在样本中，检测到 189 例（62.6%，95% CI：56.9–68.1）例 FGS。共有 129 名女性（42.7%，95% CI：37.1–48.5）HPV 检测呈阳性。总共有 80 名女性（26.5%，95% CI：21.6–31.8]）这两种情况检测呈阳性。FGS 和 HPV 阳性之间没有观察到关联，而既往妊娠（APR = 0.65，95% CI：0.43–0.78）和年龄较大（APR = 0.59，95% CI：0.42–0.81）与 HPV 感染呈负相关与没有怀孕过的人和较年轻的年龄组相比。研究结果表明，FGS 和 HPV 在马达加斯加农村地区非常流行。这两种情况同时流行，需要紧急调整公共卫生战略，以改善妇女的健康，例如初级保健的综合服务。