1. Reproductive health care Croatian perspective Mario Kopljar, Joško Zekan

2. 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)

3. Incidence of STD in Croatia per 100000 Chlamydia19.9 -12.9 Gonococcal infections 0.6 - 0.4 Hepatitis B 4.4 - 3.0 HIV 0.7 - 1.5 HPV22.3 - 38.4

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

5. 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

6. Latin America55 -72 / 100 000 women Croatia 16.8 / 100 000 women Israel, Finland3 -4 / 100 000 women Cervical cancer – incidence

7. SMOKING – LUNG CANCER: ODD RATIO =17 HPV INFECTION – CERVICAL CANCER: ODD RATIO =150-250

8. 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

9. 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)

10. 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%

11. 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

12. Cervical cancer prevention modalities Education –Insitutional (schools) –Extra-institutional Public schools Courses Media Screening Vaccination

14. 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.

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

16. Reproductive health care Results of campagne: Pelvic Inflammatory Disease Ectopic pregnancy Sterility Impact on state budget for health

17. Womens Health Initiative continues to promote reproductive health through organizing european conferencesWomens Health Initiative continues to promote reproductive health through organizing european conferences Croatia accepted modern guidelines for protection of reproductive health and significantly improved reproductive healthCroatia accepted modern guidelines for protection of reproductive health and significantly improved reproductive health