Science journalism was little known in Cuba when Iramis Alonso wrote her thesis on the specialized field in 1990. That year, journalism degree from the University of Havana in hand, she set off to Cuba’s eastern countryside to complete two years of social service reporting for local, regional and national print media. Living in the […]
Dr Barry is incoming Board Chair of the Consortium of Universities for Global Health (CUGH) and past President of the American Society of Tropical Medicine and Hygiene. She is a member of the National Academies of Sciences, Engineering, and Medicine, and serves on the National Academy of Medicine’s Board of Global Health. She has […]
Excerpted and translated from the Spanish (Letras de Género, CUBADEBATE) and reprinted with the author’s permission. Original available at: http://www.cubadebate.cu/especiales/2020/01/23/roles-de-genero-y-si-no-basta-con-salir-de-la-cocina/#.XioBOSO23IU The scene: a family doctor-and-nurse office. After the usual well-baby visit for the eight-month-old, the physician poses a question to the young mother that sounds more like a statement: “I suppose you won’t be going […]
INTRODUCTION Human papillomaviruses and Chlamydia trachomatis are the most frequent causes of sexually transmitted infections. Although the association between some human papillomavirus genotypes and cervical cancer has been demonstrated and Chlamydia trachomatis infection is the most common cause of female infertility, Cuba has no national baseline studies on the circulation and co-circulation of these agents, the synergistic effect of which may be a risk factor for occurrence and development of precancerous cervical lesions. Additionally, few local studies have examined risk factors for infection.
OBJECTIVE Determine the frequency of infection by human papillomavirus and Chlamydia trachomatis and their association with sociodemographic, clinical and epidemiological variables in women seeking routine Pap smears or other medical services at the primary care level in Cuba.
METHODS A cross-sectional study was conducted among 500 women aged 16–67 years (100 from Havana, 200 from Villa Clara and 200 from Holguín Provinces, Cuba), from August through December 2015. Chlamydia trachomatis infection was detected by real-time polymerase chain reaction and 35 genotypes of human papillomavirus by low-density microarray. We then examined the association of infection with sociodemographic, clinical and epidemiological variables.
RESULTS Human papillomavirus was detected in 14.8% (74/500) of the women. Of the 29 genotypes identified, 79.7% (59/74) were oncogenic high-risk types. Type 16 was the most frequently identified (23%; 17/74), followed by type 31 (10.8%; 8/74) and then by types 33, 53, 61 and 66 in equal proportions (8.1%; 6/74). Infection frequency was greater in women aged ≤25 years (38.8%; 31/80), students (46.7% 7/15), single (23.0%; 40/174) and among those who reported having more than 3 sexual partners in the last 2 years (41.0%; 17/41). Differences were found among provinces for circulating genotypes and infection-related variables. Human papillomavirus infection from genotypes 16, 31, 33, 53, 61, 66, 68 and 89 was associated with the 7.9% (30/382) of women who had positive Pap tests. Infection from Chlamydia trachomatis was positive in 1% (5/500) of women, all aged ≤25 years. Coinfection by Chlamydia trachomatis and HPV was found in one woman infected with human papillomavirus genotype 61.
CONCLUSIONS Frequency of human papillomavirus is high in the three Cuban provinces studied, with greater frequency of genotype 16 and other oncogenic high-risk types. For both agents, infection is more frequent in young women and adolescents. Positive Pap tests are frequently associated with HPV infection. Prevalence findings from this study could be used as a baseline for future research or interventions.
KEYWORDS Human papillomavirus, microarrays, genotypes, Chlamydia trachomatis, real-time polymerase chain reaction, women, Cuba
After nearly 60 years of universal education and health, coupled with national policies supporting women’s rights and advancement, the results are in: according to recent data, more than half of Cuban scientists and almost 60% of all professionals in Cuba are women. Moreover, women’s representation in government is rising, including at the highest levels such as parliament, where they constitute 53.2% of members. Digging deeper, we find a story richer than national statistics or political representation. It’s the story of the collective achievements of female professionals on the island. For example, the clinical research team responsible for developing CIMAvax-EGF, Cuba’s novel biotech therapy for non-small cell lung cancer, was headed by a woman. Likewise, the lead scientist of the Cuban team that developed the world’s first effective meningitis B vaccine is a woman. And the cofounder of the country’s clinical trials coordinating center and registry is a woman, as is the founder of the National Center for Agricultural Animal Health. Yet, as in any country, there is more to be done to achieve true gender parity and release the full potential of women. To begin our series profiling outstanding Cuban women professionals, MEDICC Review spoke with sociologist Dr Marta Núñez, who has devoted decades to research on gender relations and the role of women in Cuba. She provides an overview and framework for contextualizing the advancement of Cuban women—including the challenges still to overcome.
INTRODUCTION Iron deficiency is the main cause of anemia, but infections, inflammation and other factors also play a role. Anemia in women of childbearing age is a risk for pregnancy, childbirth and childhood development during the first two years of life. In Cuba, per WHO definition, anemia is a moderate public health problem in the third trimester of pregnancy and in preschoolers, with a prevalence of 21.6%, in both cases.
OBJECTIVE Estimate prevalence of anemia and iron deficiency in women of childbearing age and assess its relation to inflammation, overweight, central adiposity, H. pylori infection and ingestion of iron-rich foods and enhancers of iron absorption.
METHODS A cross-sectional, analytical study was performed in 391 women aged 18–40 years in four municipalities of Havana, Cuba, from February through June 2014. Variables (indicators in parentheses) were anemia (hemoglobin), iron deficiency (ferritin), nutritional status (body mass index and waist circumference), inflammation (C-reactive protein, acid alpha 1-glycoprotein and interleukin 6), H. pylori infection and ingestion of iron-rich foods. SPSS 20.0 and Epi Info 7.1.2.0 were used for statistical analysis.
RESULTS Anemia prevalence was 24.6% (96/391); iron deficiency, 68% (266/391); H. pylori infection, 47.1% (184/391); inflammation detected by C-reactive protein, 8.4 % (33/391) and by alpha-1-glycoprotein, 19.9% (78/391). Limited results are included for interleukin 6, which was determined in fewer cases (96). Excess body weight was found in 38.7% (150/388) and increased central adiposity in 26.7% (101/378). Iron deficiency was the main cause of anemia (OR 2.68). Central adiposity, excess body weight, and iron deficiency were positively associated with inflammation (OR of 1.77, 1.23 and 1.72, respectively), whereas H. pylori infection was negatively associated with iron deficiency and anemia (OR 0.75 and 0.94, respectively). Low consumption of meat (OR 1.17) and vegetables (OR 1.36) showed discrete limited positive associations with iron deficiency, as well as low consumption of eggs (OR 1.69) and vegetables (OR 1.56) with anemia.
CONCLUSIONS Anemia is a moderate public health problem in the studied group, but with iron deficiency present in two thirds of the population and associated with anemia. Risk factors for anemia and iron deficiency, such as menorrhagia and bacterial or viral infections, should be assessed in women of childbearing age, to support interventions needed to reduce risks in pregnancy and childbirth.
KEYWORDS Anemia, iron deficiency, women, women of childbearing age, inflammation, Helicobacter pylori, obesity, adiposity, Cuba
INTRODUCTION Women are being diagnosed with HIV infection in increasing numbers, and now account for 50% of cases worldwide. In Cuba, HIV is more frequent in men, but in recent years, a growing number of women have been diagnosed.
OBJECTIVE Describe patterns of HIV among women in Havana, Cuba, 1986–2011.
METHODS Descriptive study of women with HIV aged >14 years, residents of Havana, Cuba, who were diagnosed with HIV from 1 January 1986 through 31 December 2011. Information was obtained from the limited-access HIV/AIDS database of Cuba’s Ministry of Public Health. Data were studied from all reported cases, a total of 1274 women. Variables selected were age at diagnosis, education, municipality of residence, screening group, year of HIV diagnosis, late presentation, AIDS-defining condition, year of diagnosis as AIDS case, vital status at the end of 2011, and year of death (if applicable). Incidence of HIV and AIDS, cumulative incidence by municipality of residence, and case fatality rates were calculated.
RESULTS Those aged 20–29 years were most affected by HIV. Almost half (46.7%) the women had completed middle school, and a further 35.4% had completed high school or middle-level technical studies. HIV incidence began to increase more steeply starting in 1998, as did AIDS incidence by year of diagnosis, though to a lesser extent. Central Havana and Old Havana municipalities had the highest cumulative incidence. Late presentation was seen in 7.4% of cases; mean age of those diagnosed late was 38.9 years. Wasting syndrome and Pneumocystis jirovecii pneumonia were the most frequent AIDS-defining conditions. Case fatality rates started to decline in 1998.
CONCLUSIONS HIV infection in women is occurring in a predominantly young, relatively well-educated population. Increasing rates of HIV and AIDS in the past decade are a warning sign of the possible expansion of HIV infection in women, even though mortality is declining.
KEYWORDS Human immunodeficiency virus, acquired immunodeficiency syndrome, AIDS, HIV infections, women, delayed diagnosis, Cuba
