Evaluation of barriers to cervical cancer screening in Georgia

OBJECTIVES

The Cervical Cancer (CC) Screening Programme in Georgia provides insufficient coverage of the target population. The aim of the study is to identify the barriers to cervical cancer screening for women in Georgia in order to plan and implement adequate measures to increase the screening effectiveness.

METHODS

The study is based on the results of a survey of 582 women aged 25-60 years (mean age 42.11 + 12.17). Respondents were selected in out-patient clinics. The questionnaire included questions related to the place of residence, ethnicity, religion, marital status, education, employment, cervical cancer awareness and screening, screening participation practices, and barriers to participation.

RESULTS

The following factors reliably increase the chance of participating in the screening: residing in Tbilisi, OR = 1.84 (95% CI: 1.10-3.07); higher education, OR = 1.87 (95% CI: 1.09-3.19); being employed as a nurse, OR = 3.42 (95% CI: 1.49-7.85); receiving screening-related information from medical staff, OR = 2.43 (95% CI: 1.42-4.15); and from television, OR = 2.57 (95% CI: 1.47-4.50). The chance of participating in the screening is reduced due to incomplete secondary education, OR = 0.10 (95% CI: 0.01-0.77); single marital status, OR = 0.49 (95% CI: 0.28-0.87); employment in public service, OR = 0.39 (95% CI: 0.17-0.89); and receiving screening-related information from friends, OR = 0.26 (95% CI: 0.09-0.77). Women with higher education are undoubtedly more informed about screening, screening procedures and free programmes than those without higher education. The common barrier to participation in the screening was "fear of the manipulation-related pain" but the most frequent answer was "I'm afraid that the test will detect cancer (36.3%)." Women with a lower level of education are more likely to believe that "Pap testing is appropriate for the women who have active sexual life", and/or "have multiple sexual partners", and/or "have children," and "it is not necessary if a woman has no complaints".

CONCLUSION

Screening participation among women in Georgia depends on screening availability, formal education and awareness of CC, sources of information, and employment type.

The impact of antenatal care utilization on admissions to neonatal intensive care units and perinatal mortality in Georgia

Introduction

Appropriate antenatal care (ANC) utilization has direct, significant effects on perinatal mortality (PM). Georgia has one of the highest PM rates (11.7 per 1000 births) in Europe and launched a more intensive ANC programme in 2018.

Aim

To evaluate the associations between the Adequacy of Prenatal Care Utilization (APNCU) index and neonatal intensive care unit (NICU) admission and PM in Georgia.

Methods

The Georgian Birth Registry (GBR), with linkage to the Vital Registration System, was used as the main data source; 148,407 eligible mothers and singleton newborns were identified during the observation period (2017–2019). The main exposure was ANC utilization, measured by the APNCU index, and the hospitalization registry was used to validate NICU admissions. Logistic regression analysis was used to assess the associations between the exposure and outcomes while controlling for potential confounders.

Results

The overall PM rate was 11.6/1000 births, and the proportion of newborns with a NICU admission was 7.8%. 85% of women initiated ANC before gestational age week 12. According to the APNCU index, 16% of women received inadequate, 10% intermediate, 38% adequate, and 36% intensive care. Women who received intermediate care had the lowest odds of PM (adjusted odds ratio [AOR] = 0.56, 95% confidence interval [CI] 0.45–0.70), and newborns of women who received inadequate care had the highest odds of NICU admission (AOR = 1.16, 95% CI 1.09–1.23) and PM (AOR = 1.18, 95% CI 1.02–1.36).

Conclusion

ANC utilization is significantly associated with newborn asmissions to NICU and PM in Georgia. Women received inadequate care experienced the highest odds of newborn admissions to NICU and PM.

KNOWLEDGE, ATTITUDES AND PERCEPTION AMONG PATIENTS TOWARDS CROSS-INFECTION CONTROL MEASURES IN DENTAL CLINICS IN GEORGIA BEFORE THE COVID-19 PANDEMIC

Problem of cross-infection and infection in dental practice has become a matter of public concern. Changing public expectations for cross-infection control could improve safety precautions of dental care. Goal of the study was to determine the level of Knowledge, Attitude and Perception (KAP) of Georgian patients attending dental clinics regarding cross-infections and infection control measures in dentistry. A cross-sectional study was conducted among 570 participants from all 10 regions of Georgia and Tbilisi (the capital city) during 2019. A standardized, confidential, self-administered, close-ended questionnaire was used to assess respondents' knowledge, attitudes, self-reported practices, perception and behaviors toward cross-infection control measures in dental clinics. 71.4% (n 407) of participants were females and 28.6% (n 163) were males. 72.6%, 63.2%, and 62.5% of respondents agreed that they can catch during dental treatment HCV, HBV and AIDS/HIV respectively, while 50.5% and 55.8% mentioned about TB and respiratory infectious (RI) diseases respectively. 80% of participants are concerned about the risk to be infected during the dental treatment. 62.5% of participants responded that they would not receive treatment in dental clinic where HIV and HBV/HCV patients are being treated. Overall, the study suggests that participants' knowledge, attitude and perception regarding cross-infection control in dentistry need some improvements. This study will assist in planning more effective interventions to enhance public awareness about infection control in dentistry in Georgia.

Incidence and Causes of Perinatal Mortality in Georgia

Georgia has one of the highest perinatal mortality rates (i.e., stillbirths and early neonatal deaths combined) in Europe. The Georgian Birth Registry was started in 2016 to provide data for preventive measures of maternal and child health. In this study, we aim to determine the incidence of perinatal mortality, assess the distribution of stillbirths and early neonatal deaths, and to determine the major causes of perinatal mortality in Georgia. Data sources were the Georgian Birth Registry and the vital registration system for the year 2017. Causes of early neonatal deaths were assigned into five categories, using the Wigglesworth classification with the Neonatal and Intrauterine deaths Classification according to Etiology modification. The study used descriptive statistics only, specifically counts, means, proportions, and rates, using the statistical software STATA version 15.0. (StataCorp, College Station, TX, USA). In 2017, 489 stillbirths and 238 early neonatal deaths were recorded, resulting in a perinatal mortality rate of 13.6 per 1000 births. About 80% of stillbirths had an unknown cause of death. The majority of stillbirths occurred before the start of labor (85%), and almost one-third were delivered by caesarean section (28%). Prematurity (58%) and congenital malformations (23%) were the main causes of early neonatal deaths, and 70% of early neonatal deaths occurred after the first day of life. The perinatal mortality rate in Georgia remained high in 2017. The major causes of early neonatal deaths were comparable to those of many high-income countries. Contrary to global data, most early neonatal deaths occurred after the first day of life.

[; PROBLEMS OF MONITORING THE QUALITY OF HOSPITALS IN GEORGIA IN THE CONTEXT OF THE COVID 19 PANDEMIC (REVIEW)]

The purpose of the study - scientific justification, development and implementation of an automated information system for assessing the results of the examination of quality and technology of medical care in hospitals at the regional level.; Based on the developed unified expert map for assessing the quality and technology of medical care, a mathematical model is built and the quantification method is used to form a unified regional system for automated monitoring of the quality of medical care in hospitals. The use of this system of monitoring the quality of medical care allows using the statistical methods to manage the quality of care ; to form homogeneous groups of patients according to specific parameters (nozology, gender, age, severity of condition, etc.) and evaluate the quality of the Health Care provided to them; monitor and conduct a comparative analysis of the quality health care in the work of individual doctors, structural divisions, and for institution as a whole, create a database of results carried out according to a unified.; The quality of the diagnostic and treatment process is characterized by many quantitative indicators. The formation of seven groups of process indicators from the number of questions included in the developed formalized expert map concentrates the attention of experts on the main logical stages of medical activity, optimizes decision-making on eliminating identified defects and objectifies collegial management of the level of professional activity of a medical institution.; Using a mathematical model and a quantification method to create an automated information-analytical system for monitoring the quality of medical care allows us to evaluate the qualitative features in quantitative terms. The unified technology for conducting examinations allows you to coordinate expert work at the intra-departmental and extra-departmental levels, carry out cross-expertise and determine the reliability of the examination.; The introduction of formalization in the work on examination of hospital quality and the use of an automated system for monitoring the quality of medical care, allows using statistical methods to generate specific ones. parameters (nozology, gender, age, severity of condition, etc.) are homogeneous groups of patients and assess the quality of care provided to them to monitor and conduct a comparative analysis of the work of individual doctors, structural divisions, the institution as a whole create a database of the results of the examinations carried out by a single technology in all medical institutions at the regional level.; A dynamic analysis of the quality of medical care in hospitals revealed the presence of a significant reserve for its further improvement. The greatest number of defects in the organization and technology of medical care is noted in two blocks: the quality of medical records and diagnostic measures.

Unattended Pregnancies and Perinatal Mortality in Georgia

Introduction

The majority of pregnant women in Georgia attend the free-of-charge, national antenatal care (ANC) programme, but over 5% of pregnancies in the country are unattended. Moreover, Georgia has one of the highest perinatal mortality (PM) rates in Europe (11.7/1000 births).

Purpose

To assess the association between unattended pregnancies and the risk of PM.

Methods

Data were extracted from the Georgian Birth Registry (GBR) and the national vital registration system. All mothers who had singleton births and delivered in medical facilities in Georgia in 2017–2018 were included in the study and categorised into attended pregnancies (at least one ANC visit during pregnancy) and unattended pregnancies (no ANC visits during pregnancy). After exclusions, the study sample included 101,663 women and their newborns, of which 1186 were either stillborn or died within 7 days. Logistic regression analysis was used to assess the effect of unattended pregnancies on PM.

Results

During the study period, the PM rate was 12.9/1000 births. In total, 5.6% of women had unattended pregnancies. The odds of PM among women with unattended pregnancies were more than double those among women with attended pregnancies (odds ratio=2.21, [95% confidence interval: 1.81–2.70]). Multiparous women with higher education and who resided/delivered outside of Tbilisi were significantly less likely to experience PM.

Conclusion

The risk of PM doubled among women with unattended pregnancies. Six percent of PM cases were attributable to unattended pregnancies. Targeting women with previous unattended pregnancies will likely reduce the PM rate in Georgia.

NEURAL TUBE DEFECTS AND MICRONUTRIENTS DEFICIENCY PREVALENCE IN GEORGIA

Until 2015, systematic statistical data on micronutrient deficiency was not available in Georgia, to provide developing national strategy. In the same year, the National Centre for Disease Control and Public Health of Georgia (NCDC) in collaboration with the USA CDC launched the project "Strengthening surveillance of micronutrient deficiency in Georgia". In 2015 we did choose sentinel surveillance approach. For setting nutrition surveillance system 8 sentinel sites (2 sites in each region/children and pregnant health facilities) in four regions of Georgia (Tbilisi, Kakheti, Achara, and Samegrelo) were selected, using the criteria of geographical, social, ethnical, urban/rural, and religion. Also, existing information about malnutrition and dietary habits from the above mentioned regions. The project protocols was approved by the Institutional review board (IRB) at the NCDC and by the Research Review Committee and Ethical review committee of the US CDC. As a result of surveillance system functioning (2016-2019) we reviled that, about 36% out of 1021 studied children U2 (12-23 months) were anemic, 74% of them were identified as iron deficient. Hemoglobin was tested among 963 pregnant women and about 21% of them were found anemic, 57% were iron deficient, and 28% tested positive for folate deficiency. Neural tube defects (NTDs) prevalence per 1000 live births registered in sentinel sites was high 3.7. Our results show that anemia and iron deficiency are prevalent among both pregnant women and children of the specified age group in Georgia. Additionally, folate deficiency was quite common during the1st trimester of pregnancy. Our findings will inform public health policy decision makers to take relevant decisions on required interventions, such as health education, distribution of relevant supplements, and food fortification.

[PROBLEMS OF IMPROVING ANTENATAL MONITORING OF PREGNANT WOMEN IN THE PRIMARY HEALTH CARE SYSTEM IN GEORGIA]

The purpose of the above work is to study the trends of mothers' health condition according to the implementation of antenatal monitoring of primary healthcare programs in 1996 - 2016 in Georgia. The methodology basis of the research is the qualitative investigation, so called Desk Research: collecting statistical data, description, systematization, comparison, analyses and interpretation. Data about mothers' health indicators were derived from National Center for Disease Control and Social Health and National Service of Georgian Statistics. Dynamic of the following indicators were studied: Number of births at home and the share of births at medical institution received by the qualified medical personnel, percentage of pregnant women's timely application, covering 4 antenatal visits, full time pregnancy, timely births, physiologic and pathologic births, Caesarean sections (planned, urgent); Number and indicator of mother's deaths. In order to study the law basis, the Statements of Georgian Government, normative acts of Labour, Health and Social Security of Georgia have been used for studying. In 1996 - 2016, as the result of Healthcare reforms, implemented in Georgia up to now, several parameters of antenatal monitoring were improved. The share of timely application and covering full, 4 antenatal visits increased; Share of births, received by qualified medical personnel increased; Number of mothers' mortality significantly decreased, but it is much higher when compared with the developed countries. Following the improvement in monitoring parameters and financial and geographical availability of antenatal care services, the unfavorable outcome of the pregnancy was revealed: the percentage of pathologic births increased, share of physiologic births decreased. The share of Caesarean sections is increasing and critically high. The share of early deliveries and incomplete period pregnancies increased. The above mentioned conditions indicate that there are systemic problems in the primary healthcare: In the preconception and then antenatal period, the quality of medical service does not meet the international standard. Assessment of pregnancy and fetal risks, prevention and management are inadequate.

HEALTH OF CHILDREN UNDER 12 MONTHS OF AGE IN GEORGIA

The main goal of this study is to determine trends in the field of health of children under the age of 1 in Georgia. Methodological basis of this research is the qualitative research, method of cabinet research ("Desk Research"), it was used gathering, descriptive, systematization, comparison, analysis, interpretation of statistical dates. The date on child health indicators were taken from the National Center for Disease Control and Public Health, National Statistics Office of Georgia. The following indicators have been studied: the dynamics of birth, Mortality and Morbidity of children under the age of 0-1, neonatal mortality, early neonatal mortality, late neonatal mortality, perinatal mortality, stillbirth. For studying the legal basis, we used Regulations of the Government of Georgia and normative acts of the Ministry of Labor, Health and Social Protection. 0-1 years old Child mortality, perinatal, neonatal, early neonatal mortality rates was decreased. The rate of late neonatal mortality, stillbirth, perinatal mortality and ratio of stillbirth with early neonatal mortality was increased. Incidence of "Infections specific to the perinatal period "and "Bacterial sepsis of newborn" was increased. Among the reasons of 0-1 year's old child mortality was increased "Certain conditions originating in the perinatal period" and "Congenital malformations, deformations and chromosomal abnormalitis". Among the reasons of 0-1 year's child morbidity was increased "Diseases of the respiratory system", "Diseases of the ear and mastoid process", "Certain infectious and parasitic diseases". High rates of late neonatal mortality, perinatal mortality and stillbirth, increasing incidence of "Infections specific to the perinatal period "and "Bacterial sepsis of newborn", indicates that the quality of antenatal care does not fit to the international standard, The risks of fetus and pregnant woman are not identified and prevented timely, Infections are not diagnosed timely. Because of the delayed identification, prevention and treatment is not adequate.

MAIN TRENDS IN ACCESS TO PRIMARY HEALTH CARE FOR ADOLESCENTS IN GEORGIA

This study identifies barriers to accessing primary health care among youth in Georgia to inform strategies for improving the appropriateness, quality and usage of primary health care services. The quantitative survey was conducted throughout Georgia among 1000 adolescents 11-19 years of age via interview. Multi stage probability sampling was used to administer questionnaires in the schools, universities and in the streets between March-May 2014 and September-October 2014. Young people in Georgia identified a range of problems in accessing primary health services. By far the most important issues were preventive checkups, geographical access, cost of care, and perceptions about the quality of care. The majority of respondents (78.4%) declared that they do not visit family doctor when well, and 81.9% said that no information was provided about reproductive health issues. Most (77.3%) stated that their family doctor had never talked about health promotion or life style risk factors. Access to health care is still problematic in the villages; and in some areas young people must travel more than 30 minutes by public transport. Limited access in rural areas compared to urban areas was statistically significant (p<0.05). As our survey data shows, most adolescents do not visit a health provider annually, obviating opportunities to integrate prevention into clinical encounters. Because repeated contacts with a primary care provider may occur over several years, clinicians should ideally have multiple opportunities to screen and counsel an adolescent patient for risky health behaviors. However, young people report that there is little screening or discussion about healthy lifestyles. The biggest health challenge for young people in Georgia is overcoming barriers (socioeconomic, geographic, trust, and perceived competence) to visit a doctor for regular preventive checkups and to get health behavior advice from health professional. Addressing the health and development needs of adolescents requires a comprehensive and timely response, and interventions can be incorporated in many programs supported young population of Georgia.