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Nodding Syndrome (NS) occurs within a wide spectrum of epilepsies seen in onchocerciasis endemic areas of sub-Saharan Africa. It has debilitating consequences on affected individuals and increases the socio-economic, physical and psychological burden on care-givers and their households, diminishing their standing within the community. Social science research on the disproportionate burden of the disease on females is limited. Based on ethnographic research over 3 years in northern Uganda, we explored the burden of being ill and care-giving for persons with NS from a gendered perspective. We found that NS-affected females were at greater risk of physical and psychological abuse, sexual violence, unwanted pregnancies, sexually transmitted infections and stigma, in a context of deteriorating socio-economic conditions. Primary care-givers of the NS-affected, mostly women, struggled to make ends meet and were subjected to stigma and abandonment. Targeted interventions, including legal protection for affected females, stigma reduction, and psycho-social and financial support are needed.

ObjectivesCervical cancer is the leading cause of cancer-related mortality among women in sub-Saharan Africa (SSA). Data on human papillomavirus (HPV) epidemiology in adolescent girls in SSA are essential to inform HPV vaccine policy recommendations for cervical cancer prevention. We assessed the burden of HPV infection, and risk factors for infection, among adolescent girls around the time of sexual debut.MethodsCross-sectional study of secondary school girls aged 17–18 years in Tanzania. Consenting participants provided samples for HPV and STI testing. Vaginal swabs were tested for 37 HPV genotypes by Roche Linear Array. Logistic regression was used to identify factors associated with HPV infection. Y chromosome was tested as a marker of recent condomless sex.Results163/385 girls (42.3%) reported previous penetrative sex. HPV was detected in 125/385 (32.5%) girls, including 84/163 (51.5%) girls reporting previous sex and 41/222 (18.5%) reporting no previous sex. High-risk (HR) genotypes were detected in 70/125 (56.0%) girls with HPV infection. The most common HR genotype was HPV-16 (15/385; 3.9%). The prevalence of other HR HPV vaccine genotypes was between 0.8% and 3.1%. Among 186 girls who reported no previous sex, were negative for Y chromosome, and had no STI, 32 (17%) had detectable HPV. Lactobacillus sp and bacterial vaginosis-associated bacteria were negatively and positively associated, respectively, with HPV.ConclusionsHPV prevalence among adolescent girls around the time of sexual debut was high. However, prevalence of most vaccine genotypes was low, indicating that extending the age range of HPV vaccination in this region may be cost-effective.

Background A high prevalence of epilepsy has been observed in several onchocerciasis-endemic villages in the Sanaga River basin, Cameroon. Recent studies suggest that ivermectin, a drug that is distributed annually with the aim of eliminating onchocerciasis, may have a protective effect against acquiring onchocerciasis-associated epilepsy (OAE). This study, therefore, provides an in-depth understanding of both the complex therapeutic landscape for epilepsy as well as the experiences related to the ‘community-directed treatment with ivermectin’ (CDTI) campaign in order to identify a more trenchant path forward in the fight against epilepsy. Methodology/Principal findings Based on a mixed methods study combining a qualitative strand with a quantitative survey, we found that epilepsy was perceived to have had an epidemic emergence in the past and was still considered an important health issue in the study area. Socio-economic status, availability and accessibility of drugs and practitioners, as well as perceived aetiology shaped therapeutic itineraries for epilepsy, which included frequenting (in)formal biomedical health care providers, indigenous and/or faith healing practitioners. Ivermectin uptake for onchocerciasis was generally well known and well regarded. The CDTI faced structural and logistical bottlenecks undermining equal access and optimal adherence to the drug. Conclusions/Significance Locally accessible, uninterrupted, sustainable and comprehensive health-service delivery is essential to help alleviate the epilepsy burden on afflicted households. Addressing structural challenges of CDTI and communicating the potential link with epilepsy to local populations at risk could optimize the uptake of this potentially significant tool in OAE prevention., Author summary Regions where onchocerciasis–a parasitical infection transmitted by blackflies–is endemic also tend to suffer from high levels of epilepsy. Recent studies suggest that ivermectin, an anti- onchocerciasis drug distributed annually to entire populations in onchocerciasis-endemic regions, may protect against developing onchocerciasis-associated epilepsy (OAE). As the link between onchocerciasis and epilepsy has been poorly understood and scientifically neglected in the past, our mixed methods research investigated how residents in an affected Cameroonian area perceive and cope with epilepsy; how they interpret the (causes of the) illness; where they seek care and why there. Armed with this knowledge, epilepsy control programs can optimize interventions geared at relieving the burden of epilepsy–and potentially OAE–which is essential given the fact that, despite 15–20 years of ivermectin distribution, onchocerciasis transmission persists and epilepsy prevalence in these regions remains high. Our findings illustrate how crucial it is to ensure locally accessible, uninterrupted, sustainable and comprehensive health service delivery for epilepsy. Furthermore, the structural challenges associated with the mass ivermectin distribution campaign must be addressed in order to relieve the burden of onchocerciasis, and potentially OAE. Without first addressing these structural bottlenecks, uptake and adherence to ivermectin treatment will remain insufficient.

ObjectivesBacterial vaginosis (BV) increases women’s susceptibility to sexually transmitted infections (STIs) and HIV and may partly explain the high incidence of STI/HIV among girls and young women in East and southern Africa. The objectives of this study were to investigate the association between BV and sexual debut, to investigate other potential risk factors of BV and to estimate associations between BV and STIs.MethodsSecondary school girls in Mwanza, aged 17 and 18 years, were invited to join a cross-sectional study. Consenting participants were interviewed and samples were obtained for STI and BV testing. Factors associated with prevalent BV were analysed using multivariable logistic regression. Y-chromosome was tested as a biomarker for unprotected penile-vaginal sex.ResultsOf the 386 girls who were enrolled, 163 (42%) reported having ever had penile-vaginal sex. Ninety-five (25%) girls had BV. The prevalence of BV was 33% and 19% among girls who reported or did not report having ever had penile-vaginal sex, respectively. BV was weakly associated with having ever had one sex partner (adjusted odds ratio (aOR) 1.59;95% CI 0.93 to 2.71) and strongly associated with two or more partners (aOR = 3.67; 95% CI 1.75 to 7.72), receptive oral sex (aOR 6.38; 95% CI 1.22 to 33.4) and having prevalent human papillomavirus infection (aOR = 1.73; 95% CI 1.02 to 2.95). Of the 223 girls who reported no penile-vaginal sex, 12 (5%) tested positive for an STI and 7 (3%) tested positive for Y-chromosome. Reclassifying these positive participants as having ever had sex did not change the key results.ConclusionsTanzanian girls attending school had a high prevalence of BV. Increasing number of sex partner was associated with BV; however, 19% of girls who reported no penile-vaginal sex had BV. This suggests that penile-vaginal sexual exposure may not be a prerequisite for BV. There was evidence of under-reporting of sexual debut.

Background: In onchocerciasis-endemic areas, particularly in those with a sub-optimal onchocerciasis control programme, a high prevalence of epilepsy is observed. Both onchocerciasis and epilepsy are stigmatizing conditions. The first international workshop on onchocerciasis-associated epilepsy (OAE) was held in Antwerp, Belgium (12-14 October 2017) and during this meeting, an OAE alliance was established. In this paper, we review what is known about epilepsy-associated stigma in onchocerciasis-endemic regions, and present the recommendations of the OAE alliance working group on stigma. Main body: For this scoping review, literature searches were performed on the electronic databases PubMed, Scopus and Science Direct using the search terms "epilepsy AND onchocerciasis AND stigma". Hand searches were also undertaken using Google Scholar, and in total seven papers were identified that addressed epilepsy-related stigma in an onchocercisasis-endemic area. Due to the limited number of published research papers on epilepsy-associated stigma in onchocerciasis-endemic areas, other relevant literature that describes important aspects related to stigma is discussed. The thematic presentation of this scoping review follows key insights on the barriers to alleviating the social consequences of stigma in highly affected onchocerciasis-endemic areas, which were established by experts during the working group on stigma and discrimination at the first international workshop on OAE. These themes are: knowledge gaps, perceived disease aetiology, access to education, marriage restrictions, psycho-social well-being, burden on the care-giver and treatment seeking behaviour. Based on the literature and expert discussions during the OAE working group on stigma, this paper describes important issues regarding epilepsy-related stigma in onchocerciasis-endemic regions and recommends interventions that are needed to reduce stigma and discrimination for the improvement of the psycho-social well-being of persons with epilepsy. Conclusions: Educating healthcare workers and communities about OAE, strengthening onchocerciasis elimination programs, decreasing the anti-epileptic treatment gap, improving the care of epilepsy-related injuries, and prioritising epilepsy research is the way forward to decreasing the stigma associated with epilepsy in onchocerciasis-endemic regions., SCOPUS: re.j, info:eu-repo/semantics/published

Introduction Prevalence and incidence of HIV infection and other sexually transmitted infections (STIs) are particularly high among adolescent girls in sub-Saharan Africa. The role played by the vaginal microbiota in susceptibility to HIV and other STIs in adolescent girls is unclear. The aim of this study was to characterise the vaginal microbiota of adolescent girls in Tanzania around the time of their sexual debut. Methods Girls aged 17–18 years old attending secondary schools in Mwanza City were invited to join a cross-sectional study. After informed consent/assent, girls were interviewed and vaginal swabs were obtained and tested for the following species by in-house quantitative PCR: Lactobacillus crispatus, L. iners , L. gasseri, L. jensenii, L. vaginalis, Atopobium vaginae, and Gardnerella vaginalis . Differences in the prevalence of bacterial species were analysed using logistic regression. Results Of the 403 girls enrolled, 385 provided samples for this analysis. Of these, 163 reported having had sexual intercourse. Prevalences of bacterial species were as follows (overall; sexually active/sexually naive): L. crispatus (69%; 60%/75%), L. iners (83%; 85%/80%), L. gasseri (22%; 21%/23%), L. jensenii (49%; 40%/55%), L. vaginalis (66%; 55%/74%), A. vaginae (44%; 56%/34%), and G. vaginalis (62%; 75%/52%). Prevalences of A. vaginae and G. vaginalis were higher among girls who reported sexual intercourse (OR: 2.5; 95% CI: 1.7–3.8 and OR: 2.8; 95% CI: 1.8–4.4, respectively), while prevalences of L. crispatus, L. jensenii, and L. vaginalis were lower in sexually active girls (OR: 0.5; 95% CI: 0.3–0.8, OR: 0.5; 95% CI: 0.4–0.8, and OR: 0.4; 95% CI: 0.3–0.6, respectively). Conclusion Among girls attending secondary school in Tanzania, sexual debut was associated with quantifiable changes in vaginal microbiota. BV-associated bacteria were present in many girls before reported sexual debut. Additionally, the prevalence of L. crispatus was higher than expected; a recent study showed the prevalence among African women to be relatively low (17–38%). This challenges the view that women in sub-Saharan Africa have less L. crispatus colonisation. Disclosure of interest statement The authors do not have a conflict of interest. No pharmaceutical grants were received in the development of this study.

Introduction Prevalence and incidence of HIV infection and other sexually transmitted infections (STI) are particularly high among adolescent girls in sub-Saharan Africa. One area in need of further research is the role played by the vaginal microbiota in the susceptibility to HIV and other STI in adolescent girls. The aim of this study was to characterise the vaginal microbiota of adolescent girls in Tanzania around the time of their sexual debut. Methods Girls attending secondary schools in Mwanza City, ages 17 and 18 years old, were invited to join a cross-sectional study. After informed consent/assent, girls were interviewed and nurse-assisted, self-collected swabs were obtained for STI and BV testing. BV was considered as a binary outcome: Nugent scores 7–10 were considered BV positive. Factors associated with prevalent BV were analysed using multivariable logistic regression. Results Of the 403 girls who enrolled in the study, 176 (44%) reported having had sexual intercourse and 8 (2%) reported receiving cunnilungus. Ninety-five (25%) girls had BV, 9 (2%) were infected with Chlamydia trachomatis , 8 (2%) had Neisseria gonorrhoea, 18 (5%) had Trichomonas vaginalis , 85 (21%) had Human papilloma virus and 6 (2%) Mycoplasma genitalium . Six (2%) girls were infected with HSV-2. Among girls who were sexually naive, 19% had BV compared to 32% in sexually active girls. BV was independently associated with sexual debut (aOR = 2.11; 95% CI: 1.32,3.39); oral sex (aOR = 7.94; 95% 1.53,40.3); >1 sex partner (aOR = 2.55; 95% CI: 1.21,5.39); and HPV (aOR = 1.73; 95% CI: 1.02,2.94). Conclusion In this study among girls attending secondary school in Mwanza, Tanzania, sexual debut was associated with BV; however, 19% of girls who were sexually naive had BV. This suggests that sexual intercourse may not be a prerequisite for BV. Oral sex was also associated with BV although the reported prevalence of this sexual behaviour was low. Disclosure of interest statement The authors do not have a conflict of interest. No pharmaceutical grants were received in the development of this study.