Mirjana Štrbac

Relationship Between Population Density, Availability of Gynecological Services, and Cervical Cancer Incidence and Mortality Across Administrative Units in Serbia and Bosnia and Herzegovina During 2016–2020

Background and Objectives: Burden of cervical cancer in Central and Eastern Europe is higher than in other parts of Europe. We analyzed cervical cancer epidemiology in Serbia and Bosnia and Herzegovina (the Federation of Bosnia and Herzegovina and the Republic of Srpska) from January 2016 to December 2020, exploring the role of available sociodemographic factors and healthcare service parameters on incidence and mortality rates, using an ecological approach based on aggregated data. Materials and Methods: Incidence and mortality rates are standardized using the method of direct standardization with the World-ASR-W. Administrative units are grouped by tertiles of incidence and mortality to explore sociodemographic factors and healthcare parameters across these groups. Results: Average age-standardized incidence rates of cervical cancer per 100,000 females were 19.28 in Serbia, 12.48 in the Federation of Bosnia and Herzegovina, and 22.44 in the Republic of Srpska. Mortality rates per 100,000 females were 6.67, 5.22, and 4.56 in Serbia, the Federation of Bosnia and Herzegovina, and the Republic of Srpska, respectively. Several parameters of sociodemographics and health service usage differed significantly across units grouped by tertiles based on incidence level, i.e., female population ≥ 15 years old (p = 0.028), population density (p = 0.046), percent of gynecologists in the primary healthcare (p = 0.041), number of gynecologists per 10,000 females ≥ 15 years (p = 0.007), and the area-to-gynecologist ratio (p = 0.010). A moderate negative correlation was found between incidence and population density (rho = −0.465, p = 0.017), and a moderate positive correlation between incidence and area-to-gynecologist ratio (rho = 0.534, p = 0.005). Conclusions: Cervical cancer remains a leading cause of cancer among women in developing countries. Implementing tailored activities, such as educational programs, preventive services, and investments in healthcare infrastructure, particularly at the administrative units’ level, can help in reducing health disparities and improving health outcomes.

Motives and attitudes of parents toward HPV vaccination: Results from the initial period of HPV vaccine rollout in Serbia

Human papillomavirus (HPV) infection is one of the most common viral infections in sexually active population worldwide, and is the main cause of cervical cancer, which is the fourth most common cancer among women. Serbia ranks third in incidence and mortality rate of cervical cancer in Europe. We conducted a cross-sectional study considering parents’ motivation for the HPV vaccination of their children. Statistical analysis included descriptive statistics and a logistic regression model. We found that the strongest motive was “Recommendation from paediatrician” (20.2%), followed by the attitude that HPV vaccine protects against cancers in different localization (15.4%), the motive “It is better to vaccinate a child than expose them to potential risk of HPV infection” (13.3%) and “Feeling anxiety due to a possible infection and cancer in the child” (13.1%). For those parents that vaccinated their child for some other strongest motive, reasons like “Vaccine is free of charge”, “Recommendation from friends and family” and motive „My child received all obligatory vaccines, so I want to receive this one as well“, were significantly more frequently selected. In the group where paediatricians’ recommendation was not a motive for accepting the HPV vaccine, the largest percentage of parents (89.6%) selected motive “HPV vaccine protects against cancers in different localization” and the motive “It is better to vaccinate a child than expose them to potential risk of HPV infection” (78.1%). Paediatrician’s recommendation is very important for parents’ decision to vaccinate, however, other motives also influenced and had significance in making the parents’ decision to vaccinate their children against HPV. Encouraging trust in public health authorities in Serbia, highlighting the advantages of the HPV vaccine and further encouraging healthcare workers to give stronger recommendations can increase the HPV vaccine uptake. Finally, we provided the basis to create more targeted messages that will empower parents to vaccinate their children.