Frontiers in reproductive health最新文献

Background: Currently, male infertility represents a serious disease burden worldwide, and China is one of the most affected countries. The aim of this study was to examine the evolution of the disease burden of male infertility in China during the period 1990-2021 and to project the trend for 2022-2036.

Methods: By screening and processing data from the Global Burden of Disease 2021, this study obtained data on the prevalence, disability-adjusted life years and corresponding rates and age-standardised rates of male infertility between 1990 and 2021. To assess the trend in the burden of male infertility over the past 30 years, the annual percentage change and the average annual percentage change were calculated from the above data using Joinpoint regression models. In addition, age-period-cohort models were used to estimate the independent effects of age, period and cohort factors on male infertility, and Bayesian projection models were used to predict the trend in the disease over the next 15 years.

Result: In both 1990 and 2021, the burden of male infertility tended to increase and then decrease with age, with the heaviest burden in the 35-39 age group. Meanwhile, the Joinpoint model found statistically significant average annual percentage changes in age-standardised prevalence and age-standardised disability-adjusted life years of 0.14% and 0.19%, respectively. In addition, the trend for both was a gradual increase over time until 1994 and a gradual decrease over time after 1994. In the age-period-cohort analysis model, age, period and cohort effects indicated that 35-39 years, 1997-2001 and 1945-1949 were the years with the highest risk of male infertility. Finally, the Bayesian projection model suggested that the disease burden of male infertility in China would show a decreasing trend over the next 15 years.

Conclusion: From 1990 to 2021, the disease burden of male infertility in China generally increased. However, thanks to a number of factors, including China's proactive health policies and effective management, the burden of disease has continued to decrease in the last decade and is projected to continue declining from 2022 to 2036. To sustain this positive trend, it remains essential for China to maintain and strengthen effective management and control of male infertility.

Background: Teenage pregnancy is a significant public health issue and is strongly associated with risky sexual behaviors such as early sexual initiation, unprotected sex, and multiple sexual partners. According to the 2014 World Health Organization report, 11% of all births worldwide were to teenagers aged 15-19 years, with more than 95% of these pregnancies occurring in low- and middle-income countries, particularly in sub-Saharan Africa, which bears much of this burden. In Rwanda, the prevalence of teenage pregnancy has risen from 4.1% in 2005 to 7.3% in 2014, indicating a growing concern. However, there is limited and inconsistent evidence on the factors contributing to teenage pregnancy. Hence, our study aimed to investigate the factors associated with teenage pregnancy. This research seeks to provide valuable insights for targeted interventions, which are urgently needed in light of the increasing rates.

Methods: We employed a cross-sectional study design, utilizing data from the 2019/2020 Rwanda Demographic Health Survey of 3,258 eligible participants aged 15-19 years. To identify factors associated with teenage pregnancy, we performed a bivariate logistic regression analysis. The significant variables from the bivariate analysis were then exported into multivariate logistic regression models, with the results presented as odds ratios (ORs) along with 95% confidence intervals (CIs) and a significance threshold set at 5%.

Results: Our findings indicated that teenagers aged 18-19 years were more likely to experience pregnancy compared to those younger than 17 (OR = 4.2; 95% CI: 2.16-8.37). Adolescents who had engaged in sexual activity 95 times or more had a significantly higher likelihood of becoming pregnant than those with less frequent sexual activity (OR = 13.53; 95% CI: 5.21-35.12). Furthermore, adolescents with parents with a secondary education were 80% less likely to become pregnant compared to those with parents with a primary or no education (OR = 0.2; 95% CI: 0.07-0.63).

Conclusion: Our study revealed that teenage pregnancy is shaped by several individual factors including age and sexual behavior, along with parental education levels. These findings underscore the critical need for targeted sexual education and enhanced family support systems to mitigate teenage pregnancies. Further, longitudinal studies are essential for establishing causality and guiding effective policy development.

Background: In 2023, an estimated 1.3 million people newly acquired HIV. In the same year, 3.5 million individuals received pre-exposure prophylaxis (PrEP), falling short of the UNAIDS target of 21.2 million by 2025. With over 90% of global PrEP programming supported by PEPFAR, a better understanding of disparities in PrEP provision is needed to inform PEPFAR's approach to reach and deliver prevention services and achieve UNAIDS 95-95-95 goals in all populations by 2025. The objective of this paper is to assess unmet PrEP need in PEPFAR-supported countries.

Methods: We analyzed FY2023 Monitoring, Evaluation, and Reporting (MER) results from 48 PEPFAR-supported countries to calculate PrEP-to-need ratios (PnR) by geography and population. PnR offers an ecological measure to identify disparities and missed opportunities for PrEP programming. PnR was calculated as the ratio of PrEP users to the number of positive HIV tests. PrEP users are defined through new initiations (PrEP_NEW) and re-initiations or continuation (PrEP_CT). HTS_TST_POS measures the number of positive HIV tests and was used as a proxy for new diagnoses. PnR was also calculated using Naomi-estimated 2023 HIV incidence, where available. A higher PnR indicates more PrEP users relative to PrEP need in a population.

Results: In FY23, 1,760,888 people initiated PrEP, and 1,736,144 people tested positive for HIV. PnR ranged from 0.12 (India) to 6.46 (Brazil), and 19 (40%) countries had fewer PrEP users than positive HIV tests (PnR <1.0). By population, people 15-24 years old, people who inject drugs, and transgender populations had the highest median PnR. When examining estimated HIV incidence, Mozambique and South Africa reported lower than average PnR and higher than average HIV incidence.

Conclusion: PrEP use relative to population need varied greatly by country and subpopulation across PEPFAR programs, suggesting a need for greater advocacy, inclusivity, accessibility, and integrated prevention programming. PnR may be a useful indicator of population PrEP coverage and unmet need, and can inform effective, data-driven, and person-centered PEPFAR prevention programming and policies. Tailoring PrEP scale-up strategies by age, sex, key population, and geography is crucial to achieving UNAIDS targets and ending the AIDS epidemic as a public health threat for all by 2030.

Introduction: Adolescent girls are more sensitive to hormonal imbalance with major impact on their nutritional, reproductive, physical, psychosocial, and academic wellbeing. This study explored adolescent girls' knowledge and perceptions of causes and management of symptoms of hormonal imbalance.

Materials and methods: Using a qualitative approach, focus group discussions were conducted with 116 assented in-school adolescent girls aged 10-19 years between 3rd and 19th October 2022. Two urban and two rural communities in two regions were purposively selected for the study. Using a convenient sampling approach, participants were recruited from Upper Primary, Junior, and Senior High schools. Data was analyzed thematically using both inductive and deductive approaches.

Results: Senior High School participants had a fair understanding of hormonal imbalance in both regions. Symptoms were perceived to include headaches, heavy and painful periods, and pimples, most of which participants alluded to experiencing. Perceived causes included natural process of adolescent growth, consumption of unhealthy diets, use of cosmetics and medications. Perceived reproductive effects included infertility, pregnancy disorders, breastfeeding challenges, and low sexual drive. Physiological effects included extreme fatigue, loss of appetite and impaired growth. Psychosocial and academic effects included mood swings/irritability, low self-esteem, poor inter-personal relationship, poor concentration in class and irregular school attendance. Female relatives and friends were mostly consulted for advice. Self-medication, dietary modification, physical activities, and personal hygiene were adopted to manage perceived symptoms. Self-medication was common, but physical activities and dietary modification were also adopted by most participants to manage symptoms.

Conclusion: It is recommended that Ghana Education Service should formally incorporate hormonal-related issues into its School Health Education Programmes to enhance knowledge, attitudes, and management among adolescent girls at all levels of education.

Research question: Male infertility accounts for almost half of all infertility cases worldwide, with idiopathic male infertility accounting for up to 30% of the cases. Sperm proteomics has revealed critical molecular pathway changes in men with infertility. However, the sperm mitochondrial proteome remains poorly understood. We attempted to answer the following question: Do patients with idiopathic primary male infertility exhibit a proteomic signature associated with mitochondrial dysfunction that could be used as a target for future mechanistic investigations?

Design: Patients with idiopathic primary infertility (20-40 years old) referred to the Cleveland Clinic between March 2012 and April 2014 were compared with fertile donor controls. Sperm proteins were analyzed using sodium dodecyl sulphate-polyacrylamide gel electrophoresis page (SDS-PAGE) and liquid chromatography-mass spectrometry (LC-MS), and differentially expressed proteins (DEPs) were identified based on significance test results and fold change thresholds. Protein expression was validated using western blotting.

Results: Proteomic analysis of pooled samples from fertile donors (n = 5) and patients with idiopathic primary infertility (n = 5) identified 1,134 proteins, including 344 DEPs. Mitochondrial dysfunction topped the ingenuity toxicity list. Analysis of expression levels of three mitochondrial proteins known to combat oxidative stress revealed that peroxiredoxin-5 (PRDX5) and superoxide dismutase 2 (SOD2), but not glutathione disulphide reductase, were significantly decreased in patient samples compared with those in fertile-donor samples.

Conclusions: This study revealed an association of downregulated expression of PRDX5 and SOD2 in sperm samples of patients with idiopathic primary male infertility. Our results support future mechanistic studies and development of advanced diagnostic methods to better identify men with mitochondria-related male infertility.

Background: Youth is a period with exposure to high risk of reproductive health (RH) problems. Despite, several strategies designed to solve these problems, youths are experiencing unsafe abortion, unintended pregnancy, and sexually transmitted infections (STIs) so far. The utilization of Youth Friendly Services (YFS) and its determinants has not been well studied in Gambella so far. This study aimed to assess YFS utilization and associated factors among preparatory school students in Gambella town, Southwest Ethiopia.

Methods: Institution based cross-sectional study was conducted on 394 randomly selected preparatory school students in Gambella town from June 1-30/2023. Data were collected through self-administered questionnaire, entered to EpiData version 4.6, and exported to Stata version 17.0 statistical software for analysis. Bivariable and multivariable logistic regression analyses were employed. The p-value of <0.05 with 95% CI was used to declare statistical significance of association between YFS utilization and explanatory variables.

Result: Less than one third (31.2%) of preparatory school students utilized YFS in Gambella town. Being married (AOR: 4.94, CI: 2.14, 11.38), having pocket money (AOR: 2.02, CI: 1.15, 3.56), no payment for YFS (AOR: 2.13, CI: 1.01, 4.50), having knowledge about YFS (AOR: 2.27, CI: 1.29, 4.00), convenient working time (AOR: 2.50, CI: 1.08, 5.83), and sexual experience (AOR: 3.38, CI: 1.90, 6.01) were the factors significantly associated with utilization of YFS in Gambella town.

Conclusion: The study found that utilization of YFS in Gambella town was low. Being married, having pocket money, not asked payment for YFS, knowledge about YFS, convenient working time, and sexual experience were the factors positively affecting utilization of YFS in Gambella town. Therefore, the health decision makers better to design policies aimed to increase youths knowledge about YFS.

Introduction: During adolescence, due to lack of experience, individuals may engage in or tolerate certain non-consensual acts under coercion. There are significant associations between forced sexual intercourse and a range of negative effects on reproductive health, as well as psychological and emotional health. Studies on non-consensual sexual acts among adolescents are rare in the Democratic Republic of Congo (DRC). This study is one of the first to focus on urban adolescents, aiming to assess the prevalence of non-consensual sexual acts and to identify associated factors.

Methods: Data for this study were obtained from the baseline survey of the project "Reducing the Vulnerability of Adolescents and Young Girls to Violence and HIV/AIDS Infection," conducted in 2018 in the provinces of Kinshasa and Kasaï Oriental among adolescents aged 10-24 years. A total of 2,123 adolescents were surveyed (46.8% in Kinshasa and 53.2% in Kasaï Oriental). A structured survey questionnaire was developed in French to collect data. This questionnaire was pre-tested and corrected before use. Non-consensual sexual acts were assessed using three variables: (i) Have you ever experienced non-consensual touching, (ii) Have you ever experienced an attempted forced sexual intercourse, and (iii) Have you ever been physically forced, injured, or threatened to have sexual intercourse. Bivariate and multivariate analyses were conducted on these three variables separately.

Results: Among all adolescents surveyed, 11.5% reported having experienced non-consensual touching, 15.3% reported having experienced an attempted forced sexual intercourse, and 5.8% reported having been physically forced, injured, or threatened to have sexual intercourse. Among the 575 sexually active adolescents, these proportions were 43.4%, 57.4% and 22.0%, respectively. Prevalences were higher among girls and in the province of Kinshasa. Factors associated with non-consensual sexual acts included gender, cohabitation with biological parents (father and mother), age at first sexual intercourse, communication about sexuality or intimate subjects with a family member, and adolescents' perceptions of the role and place of partners in intimate relationships. A quarter (25.5%) of adolescents who were victims of forced sexual intercourse and were aware of an appropriate institution or person sought help from a professional for the violence they experienced.

Discussion: The results revealed a high prevalence of non-consensual sexual acts, the significance attributed by adolescents to traditional beliefs regarding the dominant role of men in intimate relationships, and the existence of barriers preventing victims of sexual violence from seeking appropriate care. These findings advocate for providing healthcare services tailored to the needs of adolescents and adapted to sociocultural contexts.

[This corrects the article DOI: 10.3389/frph.2024.1444111.].

Objective: To assess sex, age, regional differences, and the changing trend in human immunodeficiency virus and tuberculosis (HIV-TB) in different regions from 1990 to 2021, and project future trends.

Methods: Global Burden of Disease Study 2021 data were analyzed to assess HIV-TB incidence, death, prevalence, and DALY rates from 1990 to 2021, including different types of TB co-infections (drug-susceptible, multidrug-resistant, and extensively drug-resistant). Bayesian age-period-cohort models were used to forecast age-standardized DALY rates through 2035.

Results: In 2021, there were approximately 1.76 million HIV-TB infections and 200,895 deaths globally. The highest burden of HIV-DS-TB and HIV-MDR-TB was found in Southern Sub-Saharan Africa, while HIV-XDR-TB was most prevalent in Eastern Europe. The co-infection burden was highest among individuals aged 30-49. Key risk factors were unsafe sex, drug use, and intimate partner violence, with regional variations. The global burden of HIV-TB remains high, and age-standardized DALY rates are expected to increase in the coming years, especially in regions with low socio-demographic indices (SDI).

Conclusion: The burden of HIV-TB co-infection correlates with the socio-demographic index (SDI): countries with a low SDI have a higher burden. Therefore, clinical diagnosis and treatment in such areas are more challenging and may warrant more attention. High death rates underscore the importance of early management.

Since the introduction of oral pre-exposure prophylaxis (PrEP) in 2016, countries have successfully scaled-up PrEP to populations at risk of HIV acquisition, including key populations, serodiscordant couples and pregnant women. Between 2016 and 2023, there were over 5.6 million oral PrEP initiations globally. Of these, over 1.2 million occurred in South Africa, with nearly 700,000 implemented through USAID/South Africa's PEPFAR program. This case study uses WHO's Building Blocks for Health Systems Strengthening to describe USAID's oral PrEP program in South Africa, reporting experiences and lessons learned in 14 districts across 7 provinces. Key lessons include: (i) Substantial donor financial investment was critical for expanding oral PrEP in South Africa, but sustained leadership and investment from government stakeholders, such as the Department of Health and the National Treasury, have been essential for sustainability. Despite fluctuations in USAID funding, annual PrEP initiations have continued to increase in USAID-supported districts largely due to local leadership. (ii) Health information and supply chain systems required agility to monitor oral PrEP introduction and scale-up. When systems lacked agility, temporary solutions like the development of interim reporting tools were necessary. (iii) Integrating community-based and facility-based service delivery supported client-centered care. Nurses and lay health workers contributed to over 80% of the full-time equivalents supporting PrEP under USAID's human resources for health portfolio. (iv) Integrating sexual and reproductive health services with oral PrEP service delivery provided clients with comprehensive, client-centered care. (v) Other client-centered care included differentiated service delivery options, such as mobile and gazebo modalities, and expanded PrEP choice through implementation science activities for new PrEP products. (vi) USAID-supported PrEP initiations have been highest among females of reproductive age in the general population and men who have sex with men among key populations, priority populations in South Africa. As done in this case study, sharing best practices and lessons learned from USAID/South Africa's oral PrEP program can strengthen the implementation evidence base and inform more efficient PrEP service delivery, particularly as new PrEP products become available.