Discussion
viral infection, miscarriages, FGS, HPV infection
HPV INFECTION, GENITAL WARTS, VIRAL INFECTION, SCHISTOSOMIASIS, MISCARRIAGES
This cross-sectional study reports a high prevalence of FGS, HPV, and the concomitant presence of the two conditions in women living in the Boeny region of north-western Madagascar. To the best of our knowledge, this is the first study describing the two conditions in the country together, bringing the attention to a relevant women’s health issue in Madagascar. An overall prevalence of 62.0% FGS and 43.0% HPV infection is reported in a primarily rural setting in a population that has never been vaccinated against HPV, mostly aligned with the prevalence estimated for the conditions in SSA [Firstly, this data shows the urgency of implementing strategies for FGS screening, detection, and management in endemic areas. The policies and guidelines for the control of schistosomiasis mostly based on MDA [Secondly, our results also show that HPV infection is highly prevalent in the population. Even if the majority of women (57.0%) is positive for the viral infection in the age range 18 to 24 years, still in higher age groups high positivity rates can be observed, suggesting a high risk for the subsequent development of CC or genital warts [Our study shows a high concomitant presence of the two conditions (26.5%) but no evidence of association. Additional studies would be beneficial to confirm or further explore the role of FGS in HPV infection clearance but also the role of HPV in FGS progression and cure. Interestingly, in our study population, none of the women interviewed were vaccinated against HPV (Table In our study, the majority of the population affected by FGS and HPV lives in rural areas. If for FGS this can be easily explained through the lack of access to clean water [Notably, there is a lower association of HPV infection with previous pregnancy (Additional file The diagnosis of FGS remains a challenge [Importantly, our study shows a very good acceptability of colposcopy at primary level of care (Fig. It is noteworthy that our data show a high rate of miscarriages in the area (TabThis study manages to highlight critical aspects of women’s health in Madagascar focusing on two conditions mostly neglected in the country but urgent on the global health agenda. Despite its strengths, this study does not come without limitations. A first limitation is given by the age of our study population (aged 18–49), which does not allow to sufficiently explore the effects of FGS and HPV on CC cancer onset and prevalence, since it normally occurs at older ages [