Browsing by Author "Chakhtoura, Nahida"
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Item Open Access Factors Associated with Birth Spacing and Contraceptive Use in Leogane, Haiti(2012) Chakhtoura, NahidaAbstractAbstractAbstractAbstract Abstract
Spacing the inter-pregnancy interval to more than two years reduces maternal and neonatal morbidity and mortality. Modern contraceptive use can reduce maternal morbidity and mortality by contributing to birth spacing and reducing the total fertility rate. This study is designed to understand the factors associated with appropriate birth spacing and the barriers to modern contraceptive use in Leogane, Haiti. A cross sectional survey of 552 reproductive age women in Leogane proper was performed from June to July of 2011. Univariate, multivariate, and logisitic regressions were used to analyze the data. The results demonstrate the importance of education, employment status, contraceptive use and stable relationships in influencing appropriate birth spacing. Women who spaced their births tended to have less complications compared to women who did not, however this difference was not statistically significant. Barriers to contraceptive use were cultural factors such as religion, and low socioeconomic status. However, contraceptive use was positively influenced by education and partner acceptance of contraceptives. These findings indicate that family programs focused on educating women and their partners on the benefits of contraception and birth spacing would be successful in Leogane, Haiti.
Item Open Access Vaginal Self-Sampling for Human Papillomavirus Infection as a Primary Cervical Cancer Screening Tool in a Haitian Population.(Sex Transm Dis, 2015-11) Boggan, Joel C; Walmer, David K; Henderson, Gregory; Chakhtoura, Nahida; McCarthy, Schatzi H; Beauvais, Harry J; Smith, Jennifer SBACKGROUND: Human papillomavirus (HPV) testing as primary cervical cancer screening has not been studied in Caribbean women. We tested vaginal self-collection versus physician cervical sampling in a population of Haitian women. METHODS: Participants were screened for high-risk HPV with self-performed vaginal and clinician-collected cervical samples using Hybrid Capture 2 assays (Qiagen, Gaithersburg, MD). Women positive by either method then underwent colposcopy with biopsy of all visible lesions. Sensitivity and positive predictive value were calculated for each sample method compared with biopsy results, with κ statistics performed for agreement. McNemar tests were performed for differences in sensitivity at ≥cervical intraepithelial neoplasia (CIN)-I and ≥CIN-II. RESULTS: Of 1845 women screened, 446 (24.3%) were HPV positive by either method, including 105 (5.7%) only by vaginal swab and 53 (2.9%) only by cervical swab. Vaginal and cervical samples were 91.4% concordant (κ = 0.73 [95% confidence interval, 0.69-0.77], P < 0.001). Overall, 133 HPV-positive women (29.9%) had CIN-I, whereas 32 (7.2%) had ≥CIN-II. The sensitivity of vaginal swabs was similar to cervical swabs for detecting ≥CIN-I (89.1% vs. 87.9%, respectively; P = 0.75) lesions and ≥CIN-II disease (87.5% vs. 96.9%, P = 0.18). Eighteen of 19 cases of CIN-III and invasive cancer were found by both methods. CONCLUSIONS: Human papillomavirus screening via self-collected vaginal swabs or physician-collected cervical swabs are feasible options in this Haitian population. The agreement between cervical and vaginal samples was high, suggesting that vaginal sample-only algorithms for screening could be effective for improving screening rates in this underscreened population.