Reproductive health care Croatian perspective

Mario Kopljar, Joško Zekan

Public health impact of STD

• Sexually transmitted diseases have a sigificant influence on the pupulation reproductive health

• Infertility 12%• Healthcare burden• Reductio of working abillities (hepatitis B,

sick leave)

Incidence of STD in Croatiaper 100000

• Chlamydia 19.9 -12.9

• Gonococcal infections 0.6 - 0.4

• Hepatitis B 4.4 - 3.0

• HIV 0.7 - 1.5

• HPV 22.3 - 38.4

• Reduction of STD incidence

• HIV incidence under control – education, – promotion of anonymous testing, – legal purchase of sterile needles in pharmacies

• Growing problem is HPV

• HPV infection represents a major health problem because of its relation to cervical cancer

• HPV Summit 1999: there is no cervical cancer without HPV infection

• Cervical cancer is a preventable disease

• Latin America 55-72 / 100 000 women

• Croatia 16.8 / 100 000 women

• Israel, Finland 3-4 / 100 000 women

Cervical cancer – incidence

• SMOKING – LUNG CANCER:

ODD RATIO =17

• HPV INFECTION – CERVICAL CANCER:

ODD RATIO =150-250

High risk population• Sexarche before the age of 17• Promisquity• Early pregnancy• High-risk HPV infection• Low socioeconomical status• Immunodeficient conditions• Smoking• Nutritional deficit• Oral contraception• High-risk partners• Non-existance of national screening programme

Situation in Croatia

597 gyneacologists 142 pathologists 115 cytologists 112 cytoscreeners Opportunistic screening (OR

0.57): ~ 400 000 PAP-smears/year Organized screening (OR 0.25): 1 198 299 women (25-65 years)

• Croatia has enough resources for opportunistic screening (patients seeking medical attention, 400 000 PAP-smear/year)

• The goal of Womens Health Initiative: doctors activelly addressing people (organized screening) with anticipated reduction in STD incidence by 50%

• Target group for prevention – adolescents• Adolescent behavior and knowledge

- More than 50% of adolescents is under influence of alcohol or drugs before intercourse

- Only 6% tested for STD- Insufficient knowledge regarding contraception

and prevention of STD- However … over 60% seek relevant education

Cervical cancer prevention modalities

• Education– Insitutional (schools)– Extra-institutional

• Public schools• Courses• Media

• Screening• Vaccination

Figure reproduced from: Quinn M, Babb P, Jones J, Allen E. Effect of screening on incidence of and mortality from cancer of cervix in England: evaluation based on routinely collected statistics. BMJ 1999; 318: 904. Reproduced with permission from the BMJ Publishing Group.

Impact of vaccination strategies diagnosed HPV 16/18-related cervical cancer incidence, females (12+y), lifelong duration

0

1

2

3

4

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0 10 20 30 40 50 60 70 80 90 100

Time in Years

Inci

denc

e pe

r 100

,000

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No Vaccination12-yo females12-yo females+females catch up12-yo females&males12-yo females&males+females catch up12-yo females&males+females and males catch up

Reproductive health care

Results of campagne:

•⇓ Pelvic Inflammatory Disease

•⇓Ectopic pregnancy

•⇓ Sterility

•⇓ Impact on state budget for health

• Womens Health Initiative continues to Womens Health Initiative continues to promote reproductive health through promote reproductive health through organizing european conferences organizing european conferences

• Croatia accepted modern guidelines for Croatia accepted modern guidelines for protection of reproductive health and protection of reproductive health and significantly improved reproductive health significantly improved reproductive health