International journal of gynaecology and obstetrics : the official organ of the International Federation of Gynaecology and Obstetrics
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Int J Gynaecol Obstet · Jul 2017
Progress in HPV vaccination in low- and lower-middle-income countries.
The past 10 years have seen remarkable progress in the global scale-up of human papillomavirus (HPV) vaccinations. Forty-three low- and lower-middle-income countries (LLMICs) have gained experience in delivering this vaccine to young adolescent girls through pilot programs, demonstration programs, and national introductions and most of these have occurred in the last 4 years. ⋯ Four areas require dedicated action to overcome remaining challenges to national scaling-up: maintaining momentum politically, planning successfully, securing financing, and fostering sustainability. Advances in policy, programming, and science may help accelerate reaching 30 million girls in LLMICs with HPV vaccine by 2020.
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The outlook for elimination of the scourge of cervical cancer is bright, because we now have the tools to achieve this goal. In recent years human papillomavirus (HPV) vaccination in high-income countries has resulted in dramatic decreases in HPV infection and associated cervical disease. If all countries with a substantial burden of disease introduce the vaccine nationally, we can protect the vast majority of women and girls most at risk. ⋯ Human and financial resources must be increased and directed to programs that follow best practices and reach all women, including the marginalized or disadvantaged. Seven key actions are recommended. Now is the time for action at national, regional, and global levels.
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Int J Gynaecol Obstet · Jul 2017
Matched cohort study of external cephalic version in women with previous cesarean delivery.
To evaluate the efficacy and safety of external cephalic version (ECV) among women with previous cesarean delivery. ⋯ To avoid a repeat cesarean delivery, ECV can be offered to women with breech presentation and previous cesarean delivery who are otherwise eligible for a trial of labor.
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Int J Gynaecol Obstet · Jul 2017
The health and economic impact of scaling cervical cancer prevention in 50 low- and lower-middle-income countries.
To estimate the health impact, financial costs, and cost-effectiveness of scaling-up coverage of human papillomavirus (HPV) vaccination (young girls) and cervical cancer screening (women of screening age) for women in countries that will likely need donor assistance. ⋯ Investment in HPV vaccination of young girls and cervical cancer screen-and-treat programs in low- and lower-middle-income countries could avert a substantial burden of disease while providing good value for public health dollars.
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Int J Gynaecol Obstet · Jul 2017
Advocacy, communication, and partnerships: Mobilizing for effective, widespread cervical cancer prevention.
Both human papillomavirus (HPV) vaccination and screening/treatment are relatively simple and inexpensive to implement at all resource levels, and cervical cancer screening has been acknowledged as a "best buy" by the WHO. However, coverage with these interventions is low where they are needed most. ⋯ Clear and sustained communication, robust advocacy, and strategic partnerships are needed to inspire national governments and international bodies to action, including identifying and allocating sustainable program resources. There is significant momentum for expanding coverage of HPV vaccination and screening/preventive treatment in low-resource settings as evidenced by new global partnerships espousing this goal, and the participation of groups that previously had not focused on this critical health issue.