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Biomedical subjects

M Temmerman

Publications and source records attributed to M Temmerman.

At least 19 recordsLinked to original sources
PubMed2005

Comparison of pap smear, visual inspection with acetic acid, human papillomavirus DNA-PCR testing and cervicography.

OBJECTIVE: To assess the test qualities of four screening methods to detect cervical intra-epithelial neoplasia in an urban African setting. METHOD: Six hundred fifty-three women, attending a family planning clinic in Nairobi (Kenya), underwent four concurrent screening methods: pap smear, visual inspection with acetic acid (VIA), PCR for high risk human papillomavirus (HR HPV) and cervicography. The presence of cervical intra-epithelial neoplasia (CIN) was verified by colposcopy or biopsy. RESULT: Sensitivity (for CIN2 or higher) and specificity (to exclude any CIN or cancer) were 83.3% (95% CI [73.6, 93.0]) and 94.6% (95% CI [92.6, 96.5]), respectively, for pap smear; 73.3% (95% CI [61.8, 84.9]) and 80.0% (95% CI [76.6, 83.4]) for VIA; 94.4% (95% CI [84.6, 98.8]) and 73.9% (95% CI [69.7, 78.2]) for HR HPV; and 72.3% (95% CI [59.1, 85.6]) and 93.2% (95% CI [90.8, 95.7]) for cervicography. CONCLUSION: The pap smear had the highest specificity (94.6%) and HPV testing the highest sensitivity (94.4%). The visual methods, VIA and cervicography, were similar and showed an accuracy in between the former two tests.

Acetic Acid↗
PubMed2005

Human papillomavirus DNA detection in women with primary abnormal cytology of the cervix: prevalence and distribution of HPV genotypes.

OBJECTIVES: In this study, we focus on the prevalence and occurrence of different anogenital human papillomavirus (HPV) genotypes in a first abnormal cervical screening test, and correlate HPV genotyping with the cytological diagnosis on thin-layer liquid-based preparations in routine gynaecological screening. METHODS: Out of 780 abnormal smears, 513 tested positive for HPV. All 25 different HPV types were identified by Line Probe Assay. RESULTS: The prevalence of high-risk HPV types increased from 72% in atypical squamous cell of undetermined significance to 94.5% in high-grade intra-epithelial lesion (HSIL). Co-infection with multiple HPV types was predominantly found in HSIL (35.8%). In the HSIL group the most common HPV types were 16, 52, 51 and 31; type 18 was rarely present. CONCLUSION: The role of types 31, 51 and 52 should be considered in future studies on vaccine development.

Adolescent↗
PubMed2004

Delayed childbearing and maternal mortality.

OBJECTIVES: To assess the maternal age trend in pregnant women in Flanders, Belgium, and examine the impact of maternal age on maternal mortality. STUDY DESIGN: Retrospective analysis of a population based regional perinatal database during one decade. RESULTS: Between 1991 and 2000 a significant increase in maternal age was found, in primiparous as well as in multiparous women. The maternal mortality ratio was 5.8, and strongly related to maternal age, with a relative risk of 7.0 (95% CI: 3.0-16.2) from the age of 35 on, and of 30.0 (95% CI: 11.4-80.6) in women aged 40 years or beyond. CONCLUSIONS: These data call for further research and action to facilitate career and reproduction, and for special care for older pregnant women.

Adult↗
PubMed2004

Congenital syphilis in a Nairobi maternity hospital.

OBJECTIVE: To assess adverse pregnancy outcome associated with maternal syphilis and congenital syphilis rate based on FTA-ABS-19s-IgM. DESIGN: Descriptive cross-sectional study. SETTING: Pumwani Maternity Hospital (PMH), the largest maternity unit in Nairobi, Kenya. SUBJECTS: Rapid Plasma Reagin reactive women and their live born infants. MAIN OUTCOME MEASURES: Syphilis serology in pregnant women, FTA-ABS-19s-IgM in cord blood and pregnancy outcome. RESULTS: Three hundred and seventy seven out of 12,414 women (3%) were RPR+. 4.0% of RPR+ and 1.4% of RPR- women delivered a stillbirth (OR 3.0, p<0.001). 19% of RPR+ and 10% of RPR- had low birth weight deliveries (OR 2.1, p<0.001). Mothers untreated for syphilis during pregnancy had significantly more preterm births (18.5% vs 9.2%, OR 2.3, p=0.026), and more stillbirths (5.4% vs 1.0%, OR 6.3, p=0.044). Of the 200 randomly selected cord bloods of RPR+ women, 142 (72%) were TPHA+. Nine (6.3%) of the 142 TPHA+ cords were FTA-ABS-19s-IgM+. CONCLUSIONS: Stillbirth and low birth weight rates were high in RPR+ untreated pregnant women and treatment significantly improved pregnancy outcome. Based on very stringent laboratory criteria (FTA-ABS-19s-IgM), 6.3% of live born infants with TPHA+ cord blood were considered syphilis infected.

Cross-Sectional Studies↗
PubMed2003

Placental inflammation and perinatal outcome.

OBJECTIVE: To examine the role of placental inflammation in adverse obstetrical outcome (AOO). METHODS: Analysis of perinatal data of 701 randomly selected mothers of singleton infants, Mombasa, Kenya. RESULTS: There were 661 (94.3%) live infants and 40 (5.7%) stillbirths. Out of the live born infants, 78 (12.4%) had a low birth weight (LBW < 2500g); 33 of them were preterm and 41 small for gestational age (SGA). The incidence of neonatal sepsis and post partum endometritis was 3.6 and 19.8%, respectively. The perinatal death rate was estimated to be 7.3% (51/701). The prevalence of acute placental inflammation was 19.6%. Acute placental inflammation was independently associated with preterm low birth weight (ARR=3.8, 95% CI=1.7-8.9, P<0.01), stillbirth (ARR=2.3, 95% CI=1.1-5.0, P=0.03) and perinatal death (ARR=2.8, 95% CI=1.4-5.4, P<0.01). Women with acute placental inflammation had a two-fold higher risk for AOO (32.6 versus 15.2%, respectively, ARR=2.5, 95% CI=1.3-4.8, P<0.01). Other risk factors for AOO were bad obstetrical history, low haemoglobin level and leucocytosis. CONCLUSIONS: The incidence of adverse obstetrical outcome defined as low birth weight, low Apgar score, perinatal mortality and post partum endometritis, was high in this population. Acute placental inflammation was associated with preterm birth, stillbirth and perinatal death. More research is needed to study the role of infection in adverse obstetrical outcome, and to design interventions to decrease infectious morbidity and mortality in pregnancy.

Adult↗
PubMed2003

Integration of cervical screening in family planning clinics.

OBJECTIVES: To assess the suitability of cervical cancer screening in family planning (FP) clinics and the relevance for women's health. METHODS: A survey was done on clients visiting the clinics of the Family Planning Association of Kenya (FPAK). Client characteristics, age, screening status and PAP smear results were registered. In-depth interviews were held with a limited number of staff and clients. RESULTS: In 1999, 38052 clients visited FPAK clinics, 43.5% were younger than 30 years old. More than 10000 cervical smears were taken. A total of 4.5% of the smears were abnormal, including 1.5% high-grade squamous intraepithelial lesions (HSIL) and 0.2% invasive cancers. The clinics were well prepared to provide high quality screening services. Patients and staff had a positive view on screening. CONCLUSIONS: Providing cervical cancer screening in FP clinics is beneficial for the clients but is unlikely to have an impact on the epidemiology of cervical cancer morbidity as FP services reach only a small percentage of the women who are most at risk. Measures to reach more and older women could assure a larger impact.

Adult↗
PubMed2003

Performance of the acetic acid test when used in field conditions as a screening test for cervical cancer.

OBJECTIVE: To assess if visual inspection with acetic acid (VIA) is a useful alternative screening test for cervical cancer, when used in a resource-poor setting with an existing cytology-based screening programme. METHODS: Women living in Rivas district (Nicaragua), who attended the programme, were concurrently screened with VIA and Papanicolau (PAP) smear. Screening was performed by health providers who had received training in VIA and a refresher course in cytology. Women testing positive for either of the results were referred for colposcopy and biopsy when indicated. The performance of VIA was compared with PAP smear, calculating the relative true and false positive rate (RELTPR and RELFPR) and for a high threshold on biopsy (cervical intraepithelial neoplasia grade 2 or a higher grade). We determined the trade-off between both tests by calculating the ratio of extra false positives detected through extra true positives (EFP:ETP ratio). RESULTS: A total of 1076 patients were screened. Nearly 33% had a positive screening test. On biopsy, 7.6% had a low-grade intraepithelial lesion, 4.5% a high-grade intraepithelial lesion (HSIL) and 0.5% invasive cancer. The RELTPR (VIA to PAP) was 1.96, the RELFPR 5.02 and the EFP:ETP ratio 8.04. VIA detected twice as much HSIL and invasive cancers as the PAP smear. Yet, for every extra diagnosis, eight extra false positives had to be examined at the referral level. CONCLUSIONS: The VIA spectacularly increases the number of HSIL and invasive cancers detected. The high FPR is a concern for the organization of the referral level. There is a need to establish uniform criteria on test positivity and to further improve the performance in field conditions.

Acetic Acid↗
PubMed2003

Miniature, low-dose, intrauterine drug-delivery systems.

The safety of systemically administered sex steroids continues to be a major focus of researchers. The negative results of the Women's Health Initiative study (WHI), and follow-up reports published in JAMA, evaluating the safety of estro-progestogen in postmenopausal women, elicited an unprecedented reaction in the press by women and doctors alike. From these publications, it is clear that research should focus on new progestogens and on alternative administration routes to minimize adverse drug effects. One approach to the improvement of safety, efficacy, and acceptability of steroid hormones, including patient compliance, is to develop long-acting implantable methods that deliver the lowest possible dose to the key target tissues. This therapeutic concept of "minimal intervention" has been known for several decades, but the practical applications of the method were lacking. Intrauterine drug-delivery systems can be developed to achieve minimal intervention fertility control without influencing normal ovarian function and/or causing adverse hormonal effects. With hormone replacement therapy in postmenopausal women, research suggests that progestogens delivered directly to the uterine mucosa could reduce side effects and minimize reversal of the beneficial effect of estrogens. Various "frameless" and "framed" intrauterine systems are currently being clinically evaluated. They are less troublesome than the available intrauterine systems and could therefore be suitable for use in the majority of women for contraception and treatment purposes (e.g., menorrhagia, hormone replacement). These systems require a single short office procedure, and have a low morbidity, which is undeniably linked with more invasive methods and systemic hormonal contraceptives. Due to the technological progress miniature, low-dose, long-term intrauterine drug-delivery systems offer enhanced effectiveness, reduced side effects, and optimal user compliance. Although there is minimal absorption in the systemic circulation, they deserve the status of a locally acting method that should be regarded as fundamentally advantageous, if effective, to systemically applied medications that may have potentially inherent ill side effects.

Adult↗
PubMed2003

Cesarean scar dehiscence and irregular uterine bleeding.

BACKGROUND: Abnormal uterine bleeding is a frequent symptom in gynecology, caused by functional as well as by anatomic genital tract abnormalities. CASE: An endocervical diverticulum was diagnosed in a patient with secondary infertility, intermenstrual bleeding, and a prior cesarean delivery. Dehiscence of the cesarean scar was visualized by ultrasound, hysterosalpingogram, and hysteroscopy. The defect was repaired and the bleeding stopped. A spontaneous pregnancy occurred but ended in premature delivery at 17 weeks' gestation. Recurrence of chronic bleeding led to a hysterectomy 6 months later. CONCLUSION: Uterine scar defects may be associated with intermenstrual bleeding in women with a previous cesarean delivery.

Adult↗
PubMed2002

HIV and cervical cancer in Kenya.

OBJECTIVES: To determine the effect of the HIV epidemic on invasive cervical cancer in Kenya. METHODS: Of the 3902 women who were diagnosed with reproductive tract malignancies at Kenyatta National Hospital (KNH) from 1989 to 1998, 85% had invasive cervical cancer. Age at presentation and severity of cervical cancer were studied for a 9-year period when national HIV prevalence went from 5% to 5-10%, to 10-15%. RESULTS: There was no significant change in either age at presentation or severity of cervical cancer. Of the 118 (5%) women who were tested for HIV, 36 (31%) were seropositive. These women were 5 years younger at presentation than HIV-negative women. CONCLUSIONS: A two- to three-fold increase in HIV prevalence in Kenya did not seem to have a proportional effect on the incidence of cervical cancer. Yet, HIV-positive women who presented with cervical cancer were significantly younger than HIV-negative women.

Adenocarcinoma↗
PubMed2002

Determinants of cervical cancer screening in a poor area: results of a population-based survey in Rivas, Nicaragua.

OBJECTIVE: To obtain baseline information for designing a community-based intervention programme aimed at increasing the cervical cancer screening coverage of women most at risk. METHODS: A population-based survey, using proportional stratified two-stage cluster sampling in Rivas, one of the 16 Departments of Nicaragua. The individuals selected were interviewed at home by one of 26 interviewers, using a structured questionnaire. The questionnaire was designed to elicit (1) knowledge, attitudes and practices concerning sexual and reproductive health and behaviour, (2) risk factors for cervical cancer and (3) the use of health and cervical cancer screening services. RESULTS: A total of 612 men and 634 women participated in the survey. Of the women who had been sexually active at least 3 years, only 41.1% had undergone screening within that period and were considered adequately screened. Correlates of inadequate screening status included low educational level, exclusive use of public health facilities and lack of knowledge about prevention and symptoms of cervical cancer. Negligence, absence of medical problems, fear, lack of knowledge and economic reasons were the main reasons given for not being screened. Reluctance to be screened in the future was related to lack of knowledge of the disease, inadequate screening status, older age and low educational level. CONCLUSIONS: The current screening programme is not effective in reaching the majority of the population. Complementary activities such as education and information, as well as a more pro-active approach to invite women for screening are necessary.

Adolescent↗
PubMed2002

Prevalence and risk factors of sexually transmitted infections and cervical neoplasia in women's health clinics in Nicaragua.

OBJECTIVES: To determine prevalence and risk factors of sexually transmitted infections (STIs), HIV, and cervical neoplasia in women attending women's health clinics in Nicaragua, and to assess the potential impact of screening for these diseases. METHODS: Consecutive women attending women's health clinics in different regions were interviewed and examined for STI, HIV, and cervical neoplasia. RESULTS: Whereas only 30.4% of the 1185 participating women attended the clinics because of STI related complaints, 77.0% reported symptoms after probing. Clinical cervicitis was diagnosed in 32.8%, Chlamydia trachomatis in 4.1%, gonorrhoea in 0.4%, trichomoniasis in 10.2%. Antibodies for syphilis were found in 0.7%, for hepatitis B in 3.7%, and none were HIV seropositive. The STI prevalence was 21.8% in women offending with complaints, 17.3% in symptomatic women after probing, and 14.8% in asymptomatic women. Abnormal Papanicolaou (Pap) smears were found in 7.7%, with high risk human papilloma virus (HPV) types in almost 60%. Male promiscuity was associated with high grade squamous intraepithelial lesions (HSIL) and reported former screening was not shown to be protective. Young age and being employed were risk factors for C. trachomatis. CONCLUSION: Nearly one out of five women attending women's health clinics in Nicaragua had an STI, and one out of 13 a precancerous lesion of the cervix. These clinics provide an opportunity to improve the reproductive health of women by probing for STI symptoms, especially in young women, and by offering cervical screening to casual attendees. Of concern is the high rate of cervical lesions in women with a screening history, underlining the need for proper quality control.

Adolescent↗
PubMed2002

Part time female sex workers in a suburban community in Kenya: a vulnerable hidden population.

BACKGROUND: In sub-Saharan Africa, female sex workers (FSWs) are a vulnerable high risk group for the acquisition and transmission of sexually transmitted infections (STI) and HIV. OBJECTIVES: To study parameters of sexual behaviour and knowledge of STI and HIV, to describe health seeking behaviour related to STI, and to measure the prevalence of gonorrhoea, chlamydia, syphilis, and HIV-1, to provide baseline data for targeted STI and HIV prevention interventions. METHODS: In a cross sectional survey with snowballing recruitment, between February and March 2000, 503 self identified FSWs in a suburb in Mombasa, Kenya, were interviewed with a structured questionnaire and screened for gonorrhoea, chlamydia, syphilis, and HIV-1. RESULTS: The mean number of sexual partners in the previous week was 2.8 (SD 1.6). The mean number of non-regular clients and regular clients in the previous week was 1.5 (1.0) and 1.0 (0.9) respectively. The median weekly income from sex work was $US15. A total of 337 (67%) women had an alternative income in the informal sector. 146 (29%) and 145 (45%) never used a condom with a client and non-paying partner respectively. The prevalence of gonorrhoea, chlamydia, and syphilis was 1.8%, 4.2%, and 2.0% respectively. The overall HIV-1 seroprevalence was 30.6%. CONCLUSIONS: There is a large need for intensive STI and HIV prevention interventions in part time FSW.

Acquired Immunodeficiency Syndrome↗
PubMed2001

Vaginal lavage with chlorhexidine during labour to reduce mother-to-child HIV transmission: clinical trial in Mombasa, Kenya.

OBJECTIVES: To evaluate the effect of vaginal lavage with diluted chlorhexidine on mother-to child transmission of HIV (MTCT) in a breastfeeding population. METHODS: This prospective clinical trial was conducted in a governmental hospital in Mombasa, Kenya. On alternating weeks, women were allocated to non-intervention or to intervention consisting of vaginal lavage with 120 ml 0.2% chlorhexidine, later increased to 0.4%, repeated every 3 h from admission to delivery. Infants were tested for HIV by DNA polymerase chain reaction within 48 h and at 6 and 14 weeks of life. RESULTS: Enrolment and follow-up data were available for 297 and 309 HIV-positive women, respectively, in the non-lavage and the lavage groups. There was no evidence of a difference in intrapartum MTCT (17.2 versus 15.9%, OR 0.9, 95% CI 0.6-1.4) between the groups. Lavage solely before rupture of the membranes tended towards lower MTCT with chlorhexidine 0.2% (OR 0.6, 95% CI 0.3-1.1), and even more with chlorhexidine 0.4% (OR 0.1, 95% CI 0.0-0.9). CONCLUSION: The need remains for interventions reducing MTCT without HIV testing, often unavailable in countries with a high prevalence of HIV. Vaginal lavage with diluted chlorhexidine during delivery did not show a global effect on MTCT in our study. However, the data suggest that lavage before the membranes are ruptured might be associated with a reduction of MTCT, especially with higher concentrations of chlorhexidine.

Adult↗
PubMed2001

Delayed interval delivery in multiple pregnancies.

Preterm delivery remains the most important complication of multiple pregnancies. We describe six cases of successful delay of the subsequent child(ren) after very preterm birth of the first-born, with intervals ranging between 14 and 117 days. Based on our findings and on the available literature, we propose a set of guidelines for the management of early preterm multiple birth deliveries, including tocolysis, antimicrobial therapy and corticosteroids.

Adult↗
PubMed2001

Modified Granada Agar Medium for the detection of group B Streptococcus carriage in pregnant women.

OBJECTIVES: To improve the detection rate of group B streptococci (GBS) in pregnant women, aiming at the prevention of early-onset septicemia in the newborn. METHODS: The yield from culturing two sites, vaginal and anorectal, on a Modified Granada Medium (MGM) was compared with our standard approach of culturing a vaginal swab on blood agar (BA). RESULTS: Samples were processed from 430 consecutive pregnant women. GBS was isolated from the vagina in 11.6% with BA, and in 13.7% with MGM. In 17.0% of anorectal samples, GBS was identified with MGM. The combination of both sites and media had a yield of 20.0%. MGM identified all but six (2%) of 310 GBS strains after aerobic incubation, with use of a cover slide, and missed only three strains (1%) after anaerobic incubation. CONCLUSIONS: Separate culture of vaginal and anorectal samples using the same MGM agar plate resulted in an increase in detection rate for GBS of 76% as compared to BA alone. The technique is simple and results are available after overnight incubation. MGM was confirmed as a specific medium for the identification of GBS, with a sensitivity of 98-99%.

Anal Canal↗
PubMed2001

Correlation between maternal and infant HIV infection and low birth weight: a study in Mombasa, Kenya.

This article aimed to examine the association between maternal and infant HIV infection and low birth weight (LBW <2500 grams). Data from 8563 singleton liveborns in Mombasa, Kenya, were analysed. Maternal HIV infection was found in 14.1% of the women and 9.6% of neonates had a birth weight of <2500 grams. In multivariate analysis, maternal HIV infection was independently associated with LBW (RR=1.46, 95% CI=1.20-1.79, P =0.0002). Maternal age, primiparity, sex of the baby, religion, syphilis infection, anaemia and previous history of stillbirth were also independently associated with LBW (RR: 1.32, 2.19, 1.44, 1.56, 1.61, 1.31 and 1.69, respectively). The rate of intra-uterine HIV transmission was 5.1% and 20.1% of the exposed infants were infected during the intrapartum period. Intrapartum infected infants had a relative risk of LBW of 1.95 (95% CI=1.18-2.87, P <0.01) compared to uninfected children, whereas the birth weight of infants infected in utero was not different from uninfected infants (RR=1.18, 95% CI=0.56-2.60, P=0.630). HIV infected mothers are more likely to have small babies, even after controlling for possible confounding factors. Low birth weight babies were more at risk for peripartum HIV transmission, but further research is needed to study mechanisms of transmission in relation to birth weight.

Journal Article↗