Makandwe Nyirenda

Introduction: Bacterial vaginosis (BV) remains highly prevalent worldwide. Although vaginal pH has been suggested to be a good predictor of BV, findings are conflicting. This study investigated the prevalence and risk factors associated with BV and the association between BV and vaginal pH in women from Durban, South Africa. Methods: This was a cross-sectional study that included 150 pregnant and non-pregnant women. BV was diagnosed using Nugent scoring and vaginal pH was measured using Lovibond® pH strips. Vaginal pH results were compared with Nugent scores. Statistical analyses were performed in STATA 17.1 using 95% confidence intervals and a significance level of 0.05. Results: According to Nugent’s criteria, BV prevalence was 29.33%, while an additional 29.33% of the women had intermediate BV. Women aged 31–39 years were more likely to have BV than younger women (odds ratio [OR]: 7.27; 95% CI 1.40- 37.85; p = 0.018). Women with intermediate BV had a 2.4-fold higher likelihood of vaginal dysbiosis (OR: 2.42; 95% CI: 1.07-5.45; p = 0.033). Significant associations were observed between BV status and the presence of BVAB-1 (p = 0.016), BVAB-2 (p = 0.009), BVAB-3 (p = 0.048), Atopobium vaginae (p = 0.029), and Sneathia sanguinegens (p < 0.001). However, vaginal pH was not significantly associated with the prevalence of BV-associated microorganisms (p > 0.05). Conclusions: BV was common among women in Durban, South Africa; however, vaginal pH was not associated with BV or BV-associated bacteria, indicating that it was a poor predictor of BV in this population.

Background: The global burden of uterine fibroids (UFs) has increased from 4.5% to 68.6%, but insufficient data in sub-Saharan Africa limit the development of effective prevention and treatment strategies. The study aimed to determine the prevalence and associated risk factors of symptomatic UFs in Eswatini. Methods: An analytical cross-sectional study used purposive sampling to enrol 645 women aged 25–64 years old with UFs or symptoms. Data were collected via face-to-face interviews with a standardised questionnaire and analysed with descriptive statistics and logistic regression. Results: The overall prevalence of UFs was 67.8% (437/645). A higher prevalence was evident in the age group 50 years and older (81.4%) compared to prevalence (33.3%) in the age group 25–29 years. Notably, high prevalence was among people with diabetes (88.5%), widows (80%), those with a primary level of education (79.1%), the obese (76.3%), Depo-Provera (75.6%) and Hhohho (76.3%) participants. The univariate analysis significant association show that: for (1) ages 30–34 years (OR: 2.33; 95% CI: 1.26–4.35, p < 0.007), 35–39 years (OR: 5.08; 95% CI: 2.82–9.36, p < 0.001), 40–44 years (OR: 7.77, 95% CI: 4.19–14.9, p < 0.001), 45–49 years (OR: 5.50; 95% CI: 2.96–10.5, p < 0.001) and 50+ years (OR: 8.80, 95% CI: 4.58–17.6, p < 0.001); (2) primary education (OR: 2.43; 95% CI: 1.27–4.84, p = 0.009), and secondary education (OR: 1.88; 95% CI: 1.12–3.18, p = 0.017); (3) been pregnant (OR: 1.53; 95% CI: 1.04–2.23, p = 0.029); (4) obesity (OR: 3.39, 95% CI:2.02–5.70, p < 0.001); and (5) overweight (OR: 1.71; 95% CI: 1.02–2.89, p = 0.044). After adjustments, age remained significantly associated. Conclusion: Uterine fibroids are highly prevalent and significantly associated with age, underscoring the need for targeted awareness and future research. Contribution: The study provided insights to inform policy and enhance preventive strategies within the sexual reproductive health programs.

Introduction The co-occurrence of multiple long-term conditions, that is, multimorbidity, is increasing globally and is associated with lower quality of life and increased risk of death. The risk and prevalence of multimorbidity are higher among women compared with men, but currently, evidence focusing on women’s multiple long-term conditions during the perinatal period is limited. Existing evidence needs to be examined to determine the extent to which maternal multimorbidity or women’s multiple health needs related to pregnancy have been addressed, especially for women living in low-income and middle-income countries (LMICs) where this burden of disease is the highest. The objective of this scoping review is to map existing evidence in LMICs on (a) Study designs and data sources, (b) Context-relevant definitions and descriptions, (c) Associated risk and protective factors, (d) Relevant maternal and infant health outcomes and (e) Treatments and interventions used to manage multiple long-term conditions before, during and after pregnancy. Methods and analysis This scoping review will be conducted using Joanna Briggs Institute methodology and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement extension for scoping reviews. This review will include observational, experimental or quasi-experimental studies, as well as systematic or umbrella reviews, on multimorbidity in women of reproductive age (15–49 years) in prepregnancy, pregnancy or up to 6 weeks after childbirth in LMICs. The studies will focus on definitions, risk and protective factors and management strategies for multiple long-term conditions before, during and after pregnancy. Studies of morbidity in women with a single index condition or conditions that are not related to pregnancy or childbirth will be excluded. A search strategy will be developed using thesaurus (including MeSH) and free-text terms for ‘maternal morbidity’ or ‘multiple long-term conditions’ and associated keywords such as multimorbidity, co-morbidity and unmet health needs related to pregnancy and/or childbirth for women living in LMICs. Electronic (EBSCOhost (CINAHL Ultimate, STM Source, Medline Ultimate), Cochrane Library, Web of Science or Scopus and Google Scholar) and grey literature databases will be searched from database inception. Reference lists and bibliographies of key topic articles will also be searched, and any additional papers that meet the inclusion criteria will be obtained. There will be no limitations on dates or languages. Records will be independently screened, selected and extracted by two researchers. Data will be presented in tables and narrative summaries. Ethics and dissemination Ethics approval is not required as this scoping review will summarise previously published data. Findings from the review will be disseminated through various platforms, including peer-reviewed journals, conferences and community meetings. Study registration Open Science Framework (https://doi.org/10.17605/OSF.IO/FYCR8).

As the global population's ageing accelerates, especially in low-middle-income countries (LMICs), an increase in age-related and sexual health challenges can be expected. However, a focus on reproductive ages, ageism, taboos, stigma and limited resources, has contributed to a neglect of older adults’ sexuality as broadly defined by the World Health Organization (WHO). We used qualitative methods to explore the attitudes and perceptions of sexuality and sexual behaviour among older adults aged 50 years and above. Focus group discussions with 37 South African men and women (aged 50–78) were thematically analysed using an ethnographic and phenomenological naturalistic paradigm. Four major themes emerged: 1) Importance of sexuality and sexual activity, 2) gendered perspectives on sexual activity, 3) health state as a barrier to sexual activity, and 4) cultural influences on sexuality and behaviour. Study highlights the significant role cultural norms and beliefs can play in old-age sexuality, with distinct gender differences in sexual practices. Health conditions, including chronic illnesses, disabilities, frailty and HIV status can act as barriers to sexual activities in old age. Understanding these barriers and facilitators is crucial to addressing the sexual health concerns of older adults. A holistic approach and further research for a nuanced understanding of older adults’ need for and enjoyment of sexual activity to inform policy and programmes is needed. The scarcity of data and evidence on this subject in LMICs hinders the development of policies and targeted interventions for successful healthy ageing.

As the global population aging accelerates, especially in low-middle-income countries, an increase in age-related and sexual health challenges can be expected. However, for various reasons including a focus on reproductive ages, ageist stereotypes, taboos and stigma and limited resources, sexuality as broadly defined by the World Health Organization (WHO) in older adults is often neglected. This study used qualitative methods to explore the attitudes and perceptions of sexuality and sexual behaviour among older adults aged 50 years and above. Focus group discussions with 37 South African men and women (aged 50-78) were thematically analysed using an ethnographic and phenomenological naturalistic paradigm. Four major themes emerged from the analysis: the importance of sexuality and frequency of sexual activity, gendered perspectives on sexual activity, health state as a barrier to sexual activity, and cultural influences on sexuality and behaviour. Study highlights the significant role cultural norms and beliefs can play in old-age sexuality, with distinct gender differences in sexual practices. Health conditions, including chronic illnesses, disabilities, frailty and HIV status can act as barriers to sexual activities among older adults. Understanding these barriers and facilitators of sexuality in older adults is crucial in addressing sexual health concerns and challenges faced by older adults. Overall, the study contributes valuable insight into the often-neglected topic of sexuality in older adults, and the complexity of factors influencing sexual behaviours in ageing populations. There is a need for a holistic approach and further research to bring this subject matter to the attention of policy and programme makers. The scarcity of data and evidence on sexuality and sexual health needs of older adults in low-and-middle-income countries hinders the development of policies and targeted interventions to address the specific sexual health needs of older adults.

Background: Uterine fibroids (UFs) are benign uterine growths that significantly impact women’s daily activities, quality of life, fertility and expenditure. Aim: This study aimed to provide in-depth insights into the lived experiences of women diagnosed with UFs. Setting: The study was conducted in Eswatini health facilities across the four geographic regions. Methods: An explorative qualitative design was used; participants with confirmed UFs diagnoses or surgery related to UFs were purposively recruited for focus group discussions. Data collection was guided by the revised Wilson and Cleary model of health-related quality of life (HRQOL), which was iteratively analysed using Braun and Clark’s thematic analysis framework. Results: Sixty participants with confirmed UFs diagnoses or surgery related to UFs were included in this study. Five themes emerged: awareness of the disease, symptoms experienced, treatment and care, perceptions and beliefs and health-seeking behaviour. Most participants experienced physical symptoms, abdominal pain and vaginal bleeding. Among the emotional and psychological consequences experienced by the majority of participants were fear, worry, tension and (perceived) disrupted body image. The majority of the participants lacked knowledge of UFs, and their perceptions and health-seeking behaviour differed. Conclusion: Findings showed that most participants experienced physical, psychological, emotional and social challenges. Contribution: These experiences were influenced by lack of knowledge, symptoms experienced, poor treatment and care and perceptions and beliefs about UFs. Health education, client involvement, early diagnosis and effective treatment are recommended to improve the experiences of UFs.

Objective: To examine how older adults perceive their own risk of acquiring HIV; and how this perception correlates with their sexual behaviour and HIV status.Methods: We used cross-sectional surve...

Disabilities are increasing globally, which is attributed to the overall ageing of populations in affluent countries. This trend may differ in low and middle-income countries. This paper assesses t...