Trial Lecture – time and place
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Adjudication committee
- First opponent: Professor Charles King, Case Western Reserve University, US
- Second opponent: Professor Kyllike Christensson, Karolinska Institutet, Sweden
- Third member and chair of the evaluation committee: Professor Anne Cathrine Staff, University of Oslo
Chair of the Defence
Professor Emeritus Borghild Barth-Heyerdahl Roald, Faculty of Medicine, University of Oslo
Principal Supervisor
Group Leader MD Eyrun Flörecke Kjetland, Oslo University Hospital
Summary
In Sub-Saharan Africa many young women are growing up in extreme poverty with limited access to health services, limited educational opportunities and with high prevalence of reproductive health problems, such as teenage pregnancy, HIV and sexually transmitted infections (STIs). Female genital schistosomiasis (FGS) is one of the neglected infections of the reproductive tract. It is caused by a waterborne parasite known as Schistosoma (S). haematobium. Affected females may suffer from symptoms mimicking STIs. Currently there is not a single reliable and affordable diagnostic method to diagnose S. haematobium.
In sexually active young women, living in rural, schistosomiasis endemic areas in South Africa, we sought to: Explore self-reported water contact as a predictor for urogenital symptoms, and explore the accuracy of four diagnostic indicators of S. haematobium infection. Lastly, we sought to explore possible socio-economic and behavioural associations with adverse reproductive health outcomes: pregnancy, HIV, STIs and FGS.
The study investigated school-attending young women (16-22 years). Date was collected from consenting participants by using a questionnaire and gynaecological examination with collection of samples.
In an area with a S. haematobium infection prevalence of 30.5%, there was an association between self-reported water contact and urogenital symptoms. In such areas, a simple patient history on water contact behaviour may therefore serve as a diagnostic indicator. Further, we found that each of four different diagnostic indicators were not satisfactory on their own: (1) urine microscopy for ova, (2) Schistosoma PCR of cervico-vaginal lavage, (3) combined clinical and image analysis to detect FGS, and (4) a questionnaire on symptoms. Finally, we found that factors such as early sexual debut, not living with biological parents, having multiple partners and older partners are significant risk factors for adverse reproductive health outcomes in young women.
Further studies are needed to explore a sensible approach to the diagnosis S. haematobium. Educational programs should be implemented to inform about safer sexual practices. Youth friendly health care facilities should be made more easily accessible for young women to obtain diagnosis, treatment and care.
Additional information
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