Frontiers in reproductive health最新文献

Introduction: HIV prevention is paramount for adolescent girls and young women (AGYW) in Uganda, and oral pre-exposure prophylaxis (PrEP) is not always a suitable option. With emerging novel HIV prevention products (e.g., ring, injectables), there are opportunities to explore AGYW preferences to inform strategies for integrating PrEP choice into routine care.

Methods: From January-September 2024, we recruited AGYW aged 16-25 years from community sites in Kampala, Uganda for a cross-sectional discrete choice experiment (DCE) to determine the most preferred attributes and levels of multi-product PrEP programs. The DCE was developed via literature review, informal conversations with AGYW, and cognitive interviewing among AGYW using a prototype instrument. In the final iteration, attributes (and levels) included: method of PrEP information dissemination (WhatsApp, brochure, in-person consultations), PrEP counseling delivery (virtual, group, in-person counselling), proximity of PrEP location (nearer to or far from work/school/home), type of facility (private or government clinic, pharmacy), availability of additional services (STI testing and treatment, family planning, no additional services), client wait times (5, 30, 90 min), and associated costs (small, none). Participants responded 9 times to the question "Which PrEP program would encourage you to use PrEP?" and each time a different set of randomly-assigned choices of 2 scenarios were presented. Multinomial logit modeling was used to estimate preference weights and importance scores.

Results: Of 343 AGYW screened, 300 consented to participate (median age: 21 years, IQR: 20-23), with 38.3% having oral PrEP experience and 71.7% reporting recent condomless sex. "Access to other services" in conjunction with PrEP dispensing had the greatest influence on PrEP program choice (importance score: 27%) with preferences for STI testing and treatment (preference weight: 0.39, 95% CI: 0.32, 0.47) and family planning (PW: 0.14, 95% CI: 0.07, 0.21) greater than stand-alone PrEP programs. The type of facility offering PrEP (importance score: 9.7%), method used for PrEP information dissemination (importance score: 10.2%), and proximity of the PrEP location (importance score: 6.9%) were not very influential.

Discussion: Young women's preference for PrEP services to be offered in conjunction with STI and/or reproductive health services indicates an opportunity to integrate current and future PrEP delivery within these existing services.

Introduction: Hypertensive disorders of pregnancy represent a leading cause of maternal and perinatal morbidity and mortality worldwide. However, prevalence estimates of preeclampsia, eclampsia, and HELLP syndrome vary considerably across studies and regions.

Objective: To determine the global prevalence of preeclampsia, eclampsia, and HELLP (Hemolysis, Elevated Liver enzymes, and Low Platelet count) syndrome, analyze their geographical distribution, and evaluate temporal and methodological trends.

Methodology: A systematic review with meta-analysis was conducted. SCOPUS, Web of Science, PubMed, and EMBASE databases were searched through May 2025. Observational studies reporting prevalence data using standardized diagnostic criteria were included. Prevalences were pooled using a random-effects model with Freeman-Tukey double arcsine transformation. Subgroup analyses by diagnostic criteria and countries and meta-regressions by publication year and sample size were performed.

Results: Seventy studies on preeclampsia (2,465,570 participants), 21 on eclampsia (9,782,257 participants), and nine on HELLP syndrome (133,611 participants) were analyzed. The global prevalence of preeclampsia was 4.43 (95% CI: 3.73-5.20), with significant differences between ACOG (4.68%) and ISSHP (3.66%) criteria. For eclampsia, the prevalence was 0.43% (95% CI: 0.19%-0.76%), while the estimate for HELLP syndrome is 0.39% (95% CI: 0.16%-0.72%), which must be interpreted with considerable caution as it is derived from a limited pool of only nine studies. Marked regional disparities were identified, with higher prevalences in low-income countries. Meta-regression for preeclampsia revealed a non-significant increasing trend over time (p = 0.23) and a significant inverse correlation with sample size (p < 0.01). For eclampsia, neither the temporal trend (p = 0.68) nor the association with sample size (p = 0.65) was statistically significant.

Conclusions: Hypertensive disorders of pregnancy affect 4.43% (95% CI: 3.73%-5.20%) of pregnancies globally for preeclampsia, 0.43% (95% CI: 0.19%-0.76%) for eclampsia, and 0.39% (95% CI: 0.16%-0.72%) for HELLP syndrome, with considerable variations according to regions and diagnostic criteria. The upward trend underscores the need to strengthen epidemiological surveillance systems and preventive programs, especially in high-prevalence areas.

Purpose: Male infertility is an increasingly recognized global public health issue. Despite its impact, comprehensive assessments of long-term trends and regional disparities remain limited. Our study focuses on evaluating global and regional trends, particularly in South Asia, in disability-adjusted life years (DALYs) and prevalence of male infertility, and forecasting future patterns.

Methods: Data from the Global Burden of Disease 2021 were analyzed for the period 1990-2021 to assess trends in DALYs and prevalence. The estimated annual percentage change (EAPC) was used to quantify changes over time. The Autoregression, Integrated, and Moving Average (ARIMA) model was applied to forecast future prevalence and DALYs trends in South Asia.

Results: Globally, DALYs due to male infertility increased by 17.79% (EAPC 0.51%), and prevalence rose by 16.90% (EAPC 0.50%). South Asia showed a higher burden, with DALYs increasing by 45.66% (EAPC 1.40%) and prevalence by 47.19% (EAPC 1.50%). India showed the greatest rise, with DALYs and prevalence increasing by 55.87% and 58.82%, respectively. The most affected was the 25-29 years age group. A positive association was observed between male infertility burden and sociodemographic index (SDI) values across South Asia. Forecasts predict a continued rise in prevalence, while DALYs may slightly decline by 2030.

Conclusion: Male infertility is increasing worldwide, with South Asia experiencing the most pronounced burden. While rising trends suggest improved detection, healthcare inequalities persist. Targeted interventions are essential to mitigate the growing impact of male infertility in the region.

Background: Although antiretroviral therapy (ART) effectively suppresses HIV, incomplete immune reconstitution affects 20%-30% of adherent patients. Chinese Medicine (CM) demonstrates potential as a complementary therapy for human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS), yet its long-term impact on immune recovery remains unestablished. This network meta-analysis (NMA) aimed to compare CM interventions for enhancing CD4⁺ T-cell counts and overall efficacy in HIV/AIDS management.

Methods: We systematically searched PubMed, Embase, Web of Science, and the Cochrane Library from inception to 27 August 2024 for randomized controlled trials (RCTs) and observational studies on CM for HIV/AIDS. Bayesian NMA was conducted using R 4.2.2 with BUGSnet 1.1.0 package. Surface under cumulative ranking (SUCRA) probabilities ranked interventions. Risk of bias was assessed with Cochrane ROB 2.0 for RCTs and Newcastle-Ottawa Scale for observational studies (PROSPERO: CRD42024560340).

Results: A total of 34 studies (n = 8,933 participants) evaluating 16 interventions were included. Key findings: For CD4⁺ restoration, Chinese herbal formulae plus ART significantly outperformed ART alone (MD = 163 cells/μL, 95% Bayesian credible interval [CrI]: 3.93-326.46), ranking first (SUCRA = 0.92). Single herbs plus ART ranked second for CD4⁺ recovery (MD = 178.54, 95% CrI: -188.57-553.24; SUCRA = 0.85). In overall treatment efficacy (survival/quality of life), Chinese herbal formulae plus Western medical therapy demonstrated the highest SUCRA (0.96).

Conclusion: CM-ART combinations-particularly Chinese herbal formulae with ART-optimize immune reconstitution in HIV/AIDS. Chinese herbal formulae plus ART represents the most effective CD4⁺ restoration strategy. These findings support integrating evidence-based CM into HIV care, but pharmacokinetic interactions and long-term safety require validation through multicenter trials.

Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024560340, PROSPERO CRD42024560340.

Introduction: This study utilized data from the Global Burden of Disease (GBD) 2021 study to conduct a comprehensive analysis of the global burden of polycystic ovary syndrome (PCOS) from 1990 to 2021.

Methods: We reported the trends of prevalence, incidence, years lived with disability (YLDs), and disability-adjusted life years (DALYs) in 204 countries and regions, stratified by age and sociodemographic index (SDI). All estimates were presented as absolute numbers and age-standardized rates (ASR) per 100,000 population, with 95% uncertainty intervals [95% UI] and estimated annual percentage changes (EAPCs) with 95% confidence intervals [95% CI]. In addition, we examined the association between high body mass index (BMI) exposure and PCOS, including its comorbidity burden across different age groups, taking into account regional variations in high BMI exposure.

Results: In 2021, the global age-standardized prevalence rate (ASPR) of PCOS was 867.7 per 100,000 [95% UI: 618.7-1,195.3], representing a significant increase of 0.75 compared with 1990 [95% CI: 0.71-0.78]. The total number of PCOS cases reached 69.5 million [95% UI: 49.5-95.7 million]. The highest incidence was observed in adolescent females aged 15-19 years and in women of childbearing age aged 30-34 years. Low- and middle-SDI regions exhibited faster increases in incidence (EAPC: 1.76 [95% CI: 1.71-1.81]) compared with high-SDI regions, where incidence remained relatively stable (EAPC: 0.03 [95% CI: -0.14-0.2]). Among countries, the United States had the highest ASPR (1,958.7 per 100,000 [95% UI: 1,463.5-2,556.9]), while Central Europe had the lowest (111.7 per 100,000 [95% UI: 77-159.2]). Southeast Asia showed the fastest-growing PCOS burden (EAPC: 2.22 [95% CI: 2.11-2.32]). Among women exposed to high BMI, the PCOS burden demonstrated age- and region-specific heterogeneity. The overall disease burden decreased with age, particularly when high BMI exposure was below the 40th percentile (P40). Endometrial cancer burden increased with high BMI exposure in women aged 20-44 years, peaking during childbearing age, while the burden plateaued or declined in women aged 44-54 years and those over 55. Ovarian cancer showed an inverted U-shaped association across most age groups, peaking at BMI P40-60 in perimenopausal women. Mental disease burden was positively and synergistically associated with PCOS, with the highest impact at BMI P30-60. In contrast, metabolic disease burden was significantly elevated in postmenopausal women, exhibiting a pattern distinct from that of PCOS.

Conclusion: These findings highlight the urgent need for stratified interventions targeting high-risk populations. Personalized screening and preventive measures can effectively mitigate long-term reproductive and metabolic complications associated with PCOS.

Background: Metabolic syndrome (MetS) among people living with HIV (PLHIV) is an emerging concern in Africa, but its underlying causes remain unclear. This study is a systematic review and meta-analysis of observational studies published between January 2000 and June 2025 to synthesize evidence on the determinants of MetS among PLHIV in Africa.

Methods: PubMed, Web of Science, Scopus, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were searched for studies reporting determinants of MetS among PLHIV in Africa. Two reviewers independently screened and extracted data, and the risk of bias was assessed with the Newcastle-Ottawa Scale.

Results: Thirty-six studies were included, while 23 were meta-analyzed. Female sex was strongly associated with MetS [Pooled odds ratios (PORs) = 2.86, 95% CI: 1.74-4.72], as was alcohol consumption (POR = 1.46, 95% CI: 1.04-2.03) and elevated BMI (>25 kg/m²) (POR = 4.27, 95% CI: 1.83-9.33). HIV-positive status showed significant effect (OR = 1.04, 95% CI: 1.01-1.09), while smoking (POR = 0.88, 95% CI: 0.48-2.70) and physical activity (POR = 0.98, 95% CI: 0.35-2.80) were not significantly associated. Substantial heterogeneity was observed for BMI, smoking, and physical activity.

Conclusion: Female sex, alcohol consumption, and elevated BMI emerged as consistent determinants of MetS among PLHIV in Africa. These findings highlight the importance of proactively integrating, context-specific strategies for metabolic risk management into HIV care to address the rising burden of cardiometabolic disease in the region.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251066865, PROSPERO CRD420251066865.

Background: In Nepal, sexual relationships outside of the traditional arranged marital system are increasingly common. Despite the availability of modern sexual health care, research on how to effectively deliver sexual health services to unmarried young adults in Nepal is limited.

Objective: This study examined key theoretical correlates between Andersen's Behavioral Model of Health Service Use and actual sexual health service use among unmarried young adults (aged 18 to 25) in Kathmandu, Nepal.

Methods: Unmarried young adults between 18 and 25 were recruited from colleges and universities in the Kathmandu area. A total of 110 women and 93 men completed the survey (n = 203). Using a cross-sectional correlational design, the analysis involved descriptive statistics, bivariate analysis, and logistic regression.

Findings and conclusions: Approximately 37% of participants reported engaging in sexual intercourse, with 55.7% reporting condom use during most recent intercourse. Less than half (39.1%) were aware of available sexual health services, and less than one-third (26.6%) were aware of Human Papillomavirus (HPV). Over a third of participants (40.9%) reported experiencing unwanted sexual contact, and 5.9% had a history of forced sexual intercourse. The actual reported sexual health service use within the past 12 months was 13.9%. Logistic regression analyses showed higher perceived youth friendliness of the health system (OR: 1.19; CI: 1.01-1.39; p < .05), sexual attraction to the same or both sexes (OR: 2.91; 95%; CI: 1.54-5.50; p < .01), higher perceived sexual risk (OR: 1.33; 95%; CI: 1.11-1.59; p < .01), as well as prior health awareness and behaviors (e.g., cigarette consumption, dating app use), were statistically significant correlates of sexual health service use. These findings indicate a need for further research to understand the experiences of Nepalese young adults with sexual healthcare and essential elements of youth-friendly health systems.

Background: Anejaculation (AE) and premature ejaculation (PE) are clinically distinct but mechanistically complex disorders. While both contribute substantially to male sexual health burden, their comparative profiles have not been systematically delineated in large cohorts.

Methods: We retrospectively analyzed 542 men (AE = 249, PE = 293) at a tertiary andrology clinic. All participants underwent vibration perception threshold (VPT) testing at ten standardized sites, spinal MRI reviewed by blinded radiologists, expressed prostatic secretion microscopy with supportive ultrasound for prostatitis, and validated psychological assessments (PHQ-9, GAD-7, SDI-2). Statistical comparisons used Mann-Whitney U tests, chi-squared tests, and multivariate analysis of variance (MANOVA).

Results: AE patients exhibited higher composite VPT thresholds than PE (7.12 ± 1.75 vs. 6.60 ± 1.26, p < 0.001), with MANOVA confirming distinct sensory profiles (Wilks' λ = 0.907, p < 0.001). Cervical-only abnormalities were markedly more frequent in PE (33.4% vs. 2.8%), whereas AE more often showed either no abnormality (45.8% vs. 28.0%) or combined cervical-lumbar involvement (14.5% vs. 7.5%; overall χ ² = 84.46, p < 0.001). Chronic prostatitis was present in nearly half of AE cases but only one fifth of PE (47.4% vs. 20.1%, p < 0.001). Depressive symptoms were modestly higher in AE (PHQ-9: 8.31 ± 5.96 vs. 7.15 ± 5.65, p = 0.024), while sexual desire and anxiety scores did not differ significantly.

Conclusions: AE and PE display distinct clinical signatures. AE was linked to higher vibration thresholds, greater prevalence of prostatitis, and elevated depressive symptoms, while PE was predominantly associated with isolated cervical spine abnormalities. Recognizing these patterns may refine clinical assessment and guide more individualized management.

Background: In Tanzania, only 34% of pregnant women come for antenatal care (ANC) in first trimester hence miss an opportunity to be checked and get health advice from the health care workers. However, there is scanty of studies which used national representative data to determine the socio-demographic correlates of problem among pregnant women in Tanzania. Therefore, this study aimed at filling the gap.

Methods: This study analysed secondary data involving a weighted sample size of 4,243 pregnant women aged 15-49 years from the 2022 Tanzania Demographic and Health Survey (TDHS). The analysis adapted a two-level multilevel weighted modified Poisson regression model using Stata 18 software. The dependent variable, "ANC in the first trimester of pregnancy" defined as the binary outcome variable. The independent variables included maternal factors and household factors.

Results: The two-level multilevel modified Poisson regression indicated that one year increase in age of a mother at first birth results to 2% increase in prevalence of attending ANC in the first trimester (p-value = 0.019). Those in the richest wealth status had 31% higher prevalence of attending ANC in the first trimester compared to counterparts in poorest wealth status (p-value = 0.011). Those with first pregnancy had 23% higher prevalence of attending ANC in the first trimester compared to those with 24-48 months preceding birth interval (p-value = 0.005). Those with more than 48 months preceding birth interval had 28% higher prevalence of attending ANC in the first trimester compared to counterparts who had 24-48 months preceding birth interval (p-value <0.001). Those living in a household with more than 6 members had 32% less prevalence of attending ANC in the first trimester compared to those living in household with 1-4 members (p-value <0.001). Study participants who reported large walking distance to health facility in their residing communities indicated 24% less prevalence of attending ANC in the first trimester (p-value = 0.007).

Conclusion: ANC attendance in the first trimester of pregnancy was significantly associated with wealth index, household size, preceding birth interval, age at first birth and distance to health facility. Programs aiming at increasing early ANC booking should prioritize activities that improve women's livelihoods, particularly those targeting lower socioeconomic and educational groups.

Polycystic ovary syndrome (PCOS) is a major factor in female infertility. The global burden of PCOS has generally been neglected due to insufficient data. This study aims to comprehensively assess the burden of PCOS among females aged 10-54 years globally from 1990 to 2021, to project trends for the next two decades, and to evaluate the impact of health system levels on PCOS prevalence. The incidence, prevalence, and disability-adjusted life years (DALYs) from the Global Burden of Disease (GBD) 2021 were analyzed, including global, sociodemographic index (SDI), GBD regions, health system levels, and national data. PCOS global burden escalated by 28% from 1990 to 2021. In 2021, the estimated annual percentage changes (EAPC) value of age-standardized rate of prevalence (ASPR), incidence, and DALYs were 0.77 (95% CI: 0.75-0.79), 0.74 (95% CI: 0.70-0.77), and 0.72 (95% CI: 0.68-0.75), respectively. High SDI regions showed elevated prevalence but slower growth (EAPC = 0.09) vs. low SDI regions, which exhibited the highest acceleration (EAPC = 1.23). Especially, the incidence and prevalence in the advanced health system were highest, but the most dramatic upward trend was observed in the basic level. The top three countries for ASPR were Italy (8,113.16 per 100,000 females, 95% CI: 5,757.74-11,265.85), Japan (6,334.11 per 100,000 females, 95% CI: 4,579.73-8,798.66), and New Zealand (5,689.13 per 100,000 females, 95% CI: 4,094.50-7,762.63). The incidence in adolescents aged 10-19 years was highest, warranting particular concern. This study underscored that health systems and adolescents require attention and strengthening as critical measures to control PCOS globally and to increase the fertility of women.