■肯尼亚,像许多国家一样,COVID-19期间关闭了学校,随之而来的是不良心理健康的增加,性活动,和怀孕。
我们试图了解COVID-19大流行如何介导生殖道感染的风险。
■我们分析了肯尼亚西部436名中学女生的数据。基线和6-,12-,2018年4月至2019年12月进行了18个月的研究访问(COVID-19之前),30-,36-,从2020年9月至2022年7月(COVID-19期间)进行了48个月的研究访问。参与者自行完成了一项社会人口统计学和性活动调查,并提供了自行收集的阴道拭子进行细菌性阴道病(BV)测试,每年访视时进行性传播感染(STI)检测。我们假设更大的COVID-19相关压力会通过心理健康介导风险,在家里感到安全,和性接触,考虑到学校停课对这些因素的大流行缓解相关影响。用标准化量表测量与COVID-19相关的压力,并在最高四分位数进行二分。混合效应建模量化了BV和STI随时间的变化。纵向中介分析量化了COVID-19应激与BV增加之间的关系。
■分析结果为BV和STI。
■BV和STI患病率分别从COVID-19前的12.1%和10.7%增加到COVID-19期间的24.5%和18.1%。这相当于COVID-19期比COVID-19期前的BV和性传播感染的相对患病率高26%(95%CI,1.00-1.59)和36%(95%CI,0.98-1.88),适应了许多社会人口统计学和行为因素。较高的COVID-19相关压力与抑郁症状升高和在家中感觉不安全有关,每个人都与有男朋友的可能性更大。在调解分析中,COVID-19相关应激对BV的直接影响小且不显著,这表明BV增加是由于在COVID-19大流行期间受到影响的一系列因素。
■这些结果突出了在未来危机中有助于维持青春期少女生殖健康的因素,比如预测和减轻心理健康影响,国内安全问题,维持性健康服务。
COVID-19大流行对未上学或生活在不同环境中的生殖道健康驱动因素的影响可能有所不同。
■在这个青春期女孩群体中,在与COVID-19相关的学校关闭后,BV和性传播感染有所增加,风险是由抑郁症状和在家里感觉不那么安全来调节的,导致性暴露的可能性更高。
UNASSIGNED: Kenya, like many countries, shuttered schools during COVID-19, with subsequent increases in poor mental health, sexual activity, and pregnancy.
UNASSIGNED: We sought to understand how the COVID-19 pandemic may mediate the risk of reproductive tract infections.
UNASSIGNED: We analyzed data from a cohort of 436 secondary schoolgirls in western Kenya. Baseline and 6-, 12-, and 18-month study visits occurred from April 2018 to December 2019 (pre-COVID-19), and 30-, 36-, and 48-month study visits occurred from September 2020 to July 2022 (COVID-19 period). Participants self-completed a survey for sociodemographics and sexual activity and provided self-collected vaginal swabs for bacterial vaginosis (BV) testing, with sexually transmitted infection (STI) testing at annual visits. We hypothesized that greater COVID-19-related stress would mediate risk via mental health, feeling safe inside the home, and sexual exposure, given the pandemic mitigation-related impacts of school closures on these factors. COVID-19-related stress was measured with a standardized scale and dichotomized at the highest quartile. Mixed effects modeling quantified how BV and STI changed over time. Longitudinal mediation analysis quantified how the relationship between COVID-19 stress and increased BV was mediated.
UNASSIGNED: Analysis outcomes were BV and STI.
UNASSIGNED: BV and STI prevalence increased from 12.1% and 10.7% pre-COVID-19 to 24.5% and 18.1% during COVID-19, respectively. This equated to 26% (95% CI, 1.00-1.59) and 36% (95% CI, 0.98-1.88) higher relative prevalence of BV and STIs in the COVID-19 vs pre-COVID-19 periods, adjusted for numerous sociodemographic and behavioral factors. Higher COVID-19-related stress was associated with elevated depressive symptoms and feeling less safe inside the home, which were each associated with a greater likelihood of having a boyfriend. In mediation analyses, the direct effect of COVID-19-related stress on BV was small and nonsignificant, indicating that the increased BV was due to the constellation of factors that were affected during the COVID-19 pandemic.
UNASSIGNED: These results highlight factors to help maintain reproductive health for adolescent girls in future crises, such as anticipating and mitigating mental health impacts, domestic safety concerns, and maintaining sexual health services.
UNASSIGNED: Impacts of the COVID-19 pandemic on drivers of reproductive tract health among those who did not attend school or who live in different settings may differ.
UNASSIGNED: In this cohort of adolescent girls, BV and STIs increased following COVID-19-related school closures, and risk was mediated by depressive symptoms and feeling less safe in the home, which led to a higher likelihood of sexual exposures.