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PubMed1996

Reproductive and sexual health: a research and developmental challenge.

There is a growing awareness of the burden and implications of reproductive ill health as contributed by unsafe motherhood (during pregnancy, childbirth, abortion), reproductive tract infection (RTIs) and cancer, sexually transmitted infections (STIs) including the human immunodeficiency virus (HIV), poorly regulated fertility, infertility, unwanted pregnancy and adolescent/teenage sexuality and pregnancy. Sexual health further entails a state of well-being in expression of sexuality, prevention of unwanted pregnancies, prevention of STIs and AIDS and freedom from sexual abuse and violence. Reproductive health is increasingly being recognized as one of the corner stones of health and a major determinant and indicator of human social development. It is central to general health as it reflects health in childhood and adolescence and sets the stage for health and life expectancy beyond the reproductive years. It is affected by other health aspects such as nutrition and environment, low birth weight, neonatal and perinatal mortality and morbidity. According to the WHO, reproductive health problems account for more than one third of the total burden of disease in women and more than 10 pc of that in men. The challenges posed by the subordinate status of women, the exclusion of men in reproductive health programmes and the need for shaping adolescents' sexual knowledge and behaviour are viewed against today's poor reproductive and sexual health outcomes in the context of Africa. Education systems, employers and policy makers are challenged to provide adequate STI/HIV education and on-site (school, work, satellite, drop in) control services. Prevention interventions, disease and health trends and their outcome require systematic research in order to impact on policy. Reproductive health education should be universal, especially for adolescents, and its impact assessed against appropriate monitoring criteria such as reproductive morbidity, STI prevalence and abortion complications.

Adolescent↗
PubMed2001

Reproductive health-seeking by married adolescent girls in Maharashtra, India.

In India, most adolescent girls 15-19 years old are married. A study was conducted in 1995-97 in Ahmednagar district of Maharashtra, India to gain insight into whether and how their reproductive health needs are met, especially for gynaecological problems, family planning and perceived fertility problems. It included a survey among 302 married girls of this age, and in-depth interviews with 74 girls, 37 husbands and 53 mothers-in-law. Girls were treated quickly for illnesses interfering with domestic work and were expected to conceive in the first year of marriage. Menstrual disorders and symptoms of reproductive tract infection often went untreated. There was an emerging need for delaying and spacing pregnancies; limiting the number of children was well established. Household work, protection of fertility and silence arising from embarrassment related to sexual health problems were the strongest factors influencing care-seeking. Husbands made the decision whether their wives could seek care and mothers-in-law sometimes influenced these decisions; girls had neither decision-making power nor influence. This study provides valuable input for the new reproductive and child health programme in Maharashtra.

Adolescent↗
PubMed2006

Seroprevalence and correlates of herpes simplex virus type-2 infection in a general gynecology clinic.

BACKGROUND: Up to two-thirds of individuals acquire herpes asymptomatically and most infected persons shed the virus during latency periods. Genital infection is frequently associated with the presence of other sexually transmitted diseases. The objective of this paper was to assess the seroprevalence of HSV-2 in a low risk population and to validate the use of reported symptoms and clinical signs as a possible diagnostic tool to screen for HSV-2. METHODS: One hundred and fifty consecutive women presenting for the first time to the Gynecology outpatient clinic with complaints of vaginal discharge, lower abdominal pain, genital warts or ulcers were enrolled over a period of 4 months. Samples were taken and laboratory tests were performed to evaluate the presence of common reproductive tract infections including HSV-2. RESULTS: In this study, using a validated type specific assay, we found an unexpected high prevalence of HSV-2 (35 subjects, 23.3%). Of the 147 women who presented with the symptom of vaginal discharge, 34 (23.1%) tested positive for HSV-2. On examination cervical erosion and tenderness was noted in 50 women, in 23 (46%) of whom HSV-2 tested positive. On univariate analysis, no significant association was found between selected demographic factors, STIs and NSTIs and HSV-2. The association between previous abortion and HSV-2 was however, statistically significant. Also, none of the women who had HSV-2 positivity tested positive for HIV. CONCLUSION: The high HSV-2 seroprevalence in this low risk population may indicate a high risk for future acquisition of HIV in this population. Cervical erosion and hypertrophy as a possible clinical marker for HSV-2 has low positive predictive value and cannot be recommended as a possible diagnostic tool to screen for HSV-2 in resource poor settings.

Adult↗
PubMedDate not supplied

Interface between drug use and sex work in Manipur.

BACKGROUND: In India, drug use is seen predominantly as a problem among men. This study attempts to address the interface between drug use and sex work among women drug users in Manipur and the prevalence of HIV, hepatitis B and other sexually transmitted infections in them. METHODS: This cross-sectional survey was conducted between April and October 1997 at the time of an ethnic clash in imphal, the capital of Manipur. Sixty-nine women drug users were interviewed through street-based outreach workers; 38 women (55%) were injecting drug users. Data were generated with the help of a semi-structured questionnaire on sociodemography, drug use practice and health issues after obtaining informed consent from the participants. Subsequently, consent was also obtained from 60 respondents for collecting blood for unlinked anonymous tests for HIV and hepatitis B surface antigen. Clinical examination for reproductive tract infections, offered to all the study participants, generated data on sexually transmitted diseases. RESULTS: The prevalence of HIV infection in injecting drug users was 57% (20/35) compared to 20% (5/25) among non-injecting drug users (p = 0.001), although the prevalence of hepatitis B surface antigen was similar in the two groups, 48% v. 56%, respectively. Eighty per cent of the respondents, many of whom migrated following the ethnic clash, reported having sex with non-regular partners, two-thirds reported sex in exchange for money or drugs. Eighty-one per cent (29/36) of women who agreed to have a clinical examination had abnormal vaginal discharge, of which 10 had endocervical discharge. The presence of infection was confirmed in only 24% of those with vaginal discharge--4 had bacterial vaginosis and 3 trichomoniasis. CONCLUSION: Environmental interventions to reduce civil unrest and forced migration have an important role to play in HIV containment. The high rate of HIV infection, and the probability of a high rate of sexually transmitted infections in women drug users suggests that a targeted intervention in this population group is a public health need. An innovative outreach strategy should be designed for effective implementation of interventions among women injecting drug users and non-injecting drug users who operate from the streets as sex workers to support their drug habit as well as livelihood.

Adolescent↗
PubMed2000

Screening of Tanzanian women of childbearing age for urinary schistosomiasis: validity of urine reagent strip readings and self-reported symptoms.

The screening of women of childbearing age for haematuria, leukocyturia and proteinuria to detect urinary schistosomiasis can be confounded by several factors such as menstruation, pregnancy and genitourinary infections. We therefore undertook a study in an area endemic for Schistosoma haematobium in the United Republic of Tanzania to carry out the following: assess the sensitivity, specificity and predictive values--in women of childbearing age--of indirect indicators of urinary schistosomiasis, as measured by urine reagent strip readings; assess the predictive values of self-reported symptoms; and finally to estimate the morbidity attributable to S. haematobium. A total of 303 women (128 and 175, respectively, living in high- and low-risk sites) participated in the study. Haematuria was more frequent among women excreting S. haematobium eggs than among those who did not (65% versus 32%). The predictive potential of all indirect disease markers was poor in the highly endemic site, while in the sites with low endemicity the negative predictive values were high. Among infected women, 54% of haematuria could be attributed to S. haematobium, but for patients with more than 10 eggs/10 ml the attributable fraction rose to 70%. Symptoms of "bloody urine" and "pain while urinating" were recalled significantly more often by women living in the highly endemic site. On a population level, one-third of the self-reported cases with bloody urine could be attributed to urinary schistosomiasis. Screening of women of childbearing age for urinary schistosomiasis using urine reagent strips can be biased in two directions. The prevalence of S. haematobium will be overestimated if other causes of haematuria, such as reproductive tract infections, are highly endemic. On the other hand, women with light or very light infections will be missed and will not be treated. This is of concern because genital schistosomiasis, a possible risk factor for the transmission of HIV, occurs among women even with light infections.

Adolescent↗
PubMed2006

Gender disadvantage and reproductive health risk factors for common mental disorders in women: a community survey in India.

BACKGROUND: Gender disadvantage and reproductive health are major determinants of women's health in developing countries. OBJECTIVE: To determine the association of factors indicative of gender disadvantage and reproductive health with the risk of common mental disorders (CMDs) in women. DESIGN: Cross-sectional survey from November 1, 2001, to June 15, 2003. PARTICIPANTS: A total of 3000 women randomly selected from a sampling frame of women aged 18 to 45 years in Goa; 2494 women participated. MAIN OUTCOME MEASURES: The primary outcome was the presence of a CMD, as defined by the Revised Clinical Interview Schedule. An interview and blood and vaginal/urine specimens were collected to ascertain risk factors. RESULTS: The prevalence of CMD was 6.6% (95% confidence interval [CI], 5.7%-7.6%). Mixed anxiety-depressive disorder was the most common diagnosis (64.8%). Factors independently associated with the risk for CMD were factors indicative of gender disadvantage, particularly sexual violence by the husband (odds ratio [OR], 2.3; 95% CI, 1.1-4.6), being widowed or separated (OR, 5.4; 95% CI, 1.0-30.0), having low autonomy in decision making (OR, 1.98; 95% CI, 1.2-3.2), and having low levels of support from one's family (OR, 2.2; 95% CI, 1.4-3.3); reproductive health factors, particularly gynecological complaints such as vaginal discharge (OR, 3.2; 95% CI, 2.2-4.8) and dyspareunia (OR, 2.5; 95% CI, 1.4-4.6); and factors indicative of severe economic difficulties, such as hunger (OR, 2.7; 95% CI, 1.6-4.6). There was no association between biological indicators (anemia and reproductive tract infections) and CMD. CONCLUSIONS: The clinical assessment of CMD in women must include exploration of violence and gender disadvantage. Gynecological symptoms may be somatic equivalents of CMD in women in Asian cultures.

Adolescent↗
PubMedDate not supplied

Family planning, sexually transmitted diseases and contraceptive choice: a literature update--Part I.

Couples who use contraceptives not only protect themselves against unwanted pregnancies, but also may reduce their risk of becoming infected with a sexually transmitted disease (STD). No currently available method, however, is highly effective in protecting simultaneously against pregnancy and infection. Thus, couples who place high priority on minimizing both risks may have to use two methods. The need for contraceptive methods that provide effective protection against both pregnancy and STDs has been intensified by the HIV epidemic, but progress has been slowed by the lack of integration between the STD and family planning fields. The first part of this two-part article discusses the similarities and differences between the two fields, examines the impact of STDs on contraceptive use and services, and reviews the scientific literature dealing with the effects of condoms, spermicides and barrier-and-spermicide methods on the risk of STD transmission. Part II (which will appear in the next issue) examines what is known about the effects of oral contraceptives, the IUD, tubal sterilization and abortion on reproductive tract infections. The second part also includes a discussion of the trade-offs involved in choosing a contraceptive and presents estimates of the first-year rates of unplanned pregnancy and gonorrhea infection (given an infected partner) that would occur among women using various contraceptive methods.

Contraceptive Devices, Female↗
PubMed1980

Actinomycins and intrauterine contraceptive devices: the clinicopathologic study.

Since their widespread introduction in the early 1960s, IUD have been considered effective and safe. Early studies revealed the ability of the cavum uteri to regain bacteriologic sterility within 4 weeks of insertion. However, experience with long-term use indicates an enhanced risk of pelvic inflammatory disease, often of proven bacterial origin. Of these pelvic infections the most pernicious are those caused by Actinomyces. We present nine cases of actinomycotic female genital tract infection encountered in the past 3 years. The features of a distinct clinicopathology entity of IUD-associated actinomycotic pelvic disease are described. This disease is one of subtle protean manifestations and is not often diagnosed preoperatively. The most significantly pathogenic factors appear to be the duration of IUD use and the demonstrated relationship between IUD usage and infestation of the vagina with Actinomyces organisms.

Actinomycosis↗
PubMed2006

The burden and determinants of dysmenorrhoea: a population-based survey of 2262 women in Goa, India.

OBJECTIVE: To describe the prevalence and determinants of dysmenorrhoea, the most common menstrual complaint, in a community in India. DESIGN: Cross-sectional survey. SETTING: Catchment area of primary health centre in Goa, India. POPULATION: Three thousand women aged 18-45 years randomly selected. A total of 2494 women consented to participate (83.1%). METHODS: Eligible participants were asked standardised questions regarding menstrual complaints over the past 12 months, and socio-demographic, psychosocial and reproductive risk factors. Vaginal or urine specimens were collected for the diagnosis of reproductive tract infections. MAIN OUTCOME MEASURES: Dysmenorrhoea of moderate to severe intensity. RESULTS: A total of 2262 women were eligible. More than half reported dysmenorrhoea; moderate to severe dysmenorrhoea was reported by 755 participants (33.4%, 95% CI 31.4-35.4). There was a linear association between severity of pain and impact (medication and taking rest) and the onset of pain (premenstrual onset associated with more severe pain). On multivariate analyses, the risk of moderate-severe dysmenorrhoea was associated with the experience of violence (OR 2.23, 95% CI 1.5-34); other somatic complaints (OR 3.67, 95% CI 2.7-4.9 for highest somatoform symptom score category compared with the lowest); gynaecological complaints (non-menstrual lower abdominal pain: OR 1.78, 95% CI 1.3-2.3; dysuria: OR 1.98, 1.4-2.7); menorrhagia (OR 1.92, 95% CI 1.4-2.6); and illiteracy (OR 1.32, 95% CI 1.0-1.7). Having had a pregnancy (OR 0.53, 95% CI 0.4-0.7), older age of menarche (OR 0.70, 95% CI 0.5-0.9, for age >14 compared with <13 years) and older age (OR 0.43, 0.3-0.6 for age 40-50, compared with 18-24 years) were protective. CONCLUSIONS: The burden of dysmenorrhoea is greater than any other gynaecological complaint, and is associated with significant impact. Social disadvantage, co-morbidity with other somatic syndromes and reproductive factors are determinants of this complaint.

Adolescent↗
PubMed2006

Missed opportunities for reproductive and child health services of clients in urban NGO clinics of Bangladesh.

OBJECTIVES: The study was undertaken to identify the extent of missed opportunities of clients for selected reproductive and child health services, including the reasons and factors contributing to missed opportunities, in NGO clinics in Bangladesh. METHODS: A cross-sectional survey of 6 NGO clinics from 6 randomly-selected municipality areas was conducted for one month during July-August 2000. In total, 1,478 clients were consecutively selected both from fixed and satellite clinics. A structured questionnaire was used for conducting exit-interviews. RESULTS: Missed opportunities among female clients of reproductive age included tetanus toxoid (54%), family planning (26%), postnatal care (16%), reproductive tract infection (15%), and antenatal care (11%). The missed opportunities among children aged less than 5 years were the highest (42%) for acute respiratory infections, followed by diarrhoea (38%) and immunization (22%). Although the clients of clinics had specific health needs, over 50% did not perceive their importance, resulting in missed opportunities. Significantly higher missed opportunities for tetanus toxoid were observed among women aged 26 years and over and also among housewives. Missed opportunity for family-planning method was significantly lower (p < 0.01) among women aged 26 years and over compared to women aged 20-25 years. Missed opportunities for child immunization were significantly higher (p < 0.05) among the children living nearer ( <1 km) to the clinic compared to children who lived >1 km away from the clinic. CONCLUSIONS: The findings suggest that providing a broader range of services alone is not enough to ensure their use. A systematic screening mechanism should be in place for regular appraisal of clients for their missed opportunities. Behavioral change communication needs to be introduced to increase awareness among clients about the availability of additional services.

Adult↗
PubMed2001

Socio-cultural aspects of menstruation in an urban slum in Delhi, India.

This paper attempts to understand the experience of menstruation in the socio-cultural context of an urban Indian slum. Observations were gathered as part of a larger study of reproductive tract infections in women in Delhi, using both qualitative and quantitative methods. The qualitative phase consisted of 52 in-depth interviews, three focus groups discussions and five key informant interviews. In the quantitative phase inferences were drawn from 380 respondents. Mean age at menarche was 13.5. Onset of menarche is associated with physical maturity and the ability to marry and reproduce. However, a culture of silence surrounds menarche, an event which took the women interviewed almost by surprise. Most were previously unaware that it would happen and the information they were given was sparse. Menstruation is associated with taboos and restrictions on work, sex, food and bathing, but the taboos observed by most of the women were avoidance of sex and not participating in religious practices; the taboo on not going into the kitchen, which had been observed in rural joint households, was not being observed after migration from rural areas due to lack of social support mechanisms. There is a clear need to provide information to young women on these subjects in ways that are acceptable to their parents, schools and the larger community, and that allow them to raise their own concerns. Education on these subjects should be envisaged as a long-term, continuous process, beginning well before menarche and continuing long after it.

Adolescent↗
PubMed1980

Trends for gonorrhea and pelvic inflammatory disease in England and Wales and for gonorrhea in a defined population.

Recent trends for gonorrhea and pelvic inflammatory disease in England and Wales are presented using routinely available data. The drawbacks of these data are examined, and a study is described which has attempted to rectify some of these inadequacies. The study attempted to identify patients with and without symptoms of gonorrhea, trichomoniasis, and candidiasis, living in a defined population. In addition, a calculation has been made of the number of cases of PID treated on an ambulatory basis in clinics for sexually transmitted disease in England and Wales.

Adolescent↗
PubMed1995

Ultrasonographically guided transvaginal aspiration of tuboovarian abscesses and pyosalpinges: an optional treatment for acute pelvic inflammatory disease.

OBJECTIVE: Our purpose was to assess the value of ultrasonographically guided transvaginal aspiration of tuboovarian abscesses and pyosalpinges presenting with the clinical picture of acute pelvic inflammatory disease. STUDY DESIGN: Fifteen patients seen for acute pelvic inflammatory disease were treated by ultrasonographically guided transvaginal aspiration of pus from tuboovarian abscesses and pyosalpinges, followed by local and systemic administration of antimicrobal therapy. RESULTS: Improvement of symptoms followed aspiration in all patients. Temperature dropped to normal within 24 to 72 hours, and pain completely disappeared within 3 days. All patients were symptom free during a follow-up period of 6 months after aspiration. CONCLUSION: Ultrasonographically guided transvaginal aspiration of pyosalpinges and tuboovarian abscesses is an effective, simple, and safe treatment. It avoided the need for laparoscopy or laparotomy.

Abscess↗
PubMed1989

Pelvic inflammatory disease and the intrauterine contraceptive device.

The relationship between the use of intrauterine contraceptive device (IUD) and pelvic inflammatory disease (PID) was examined in 1054 patients who were seen at the Family Planning Clinic of Jos University Teaching Hospital and were followed up. The overall risk of PID developing in women wearing the IUD was minimal: 62 out of 1054 (5.9%). The rates, however, varied for the 6-month periods studied. The incidence of PID decreased as the period of usage increased. The greater number of patients developed PID less than 3 months from the date of IUD insertion. When PID occurred it was usually of mild or moderate intensity and the response to antibiotic therapy was very encouraging. There was no relationship between the parity of the patients and the development of PID. Even though there is a definite link between the use of IUD and the development of PID it does not obliterate the benefits which the use of IUD provide for the majority of its patrons; and so the use of IUD should continue.

Female↗
PubMed1996

Patterns and predictors of infertility among African women: a cross-national survey of twenty-seven nations.

The purpose of this study is to provide a comparative framework within which the infertility rates across sub-Saharan Africa may be assessed. A measure of infertility is used that provides for reliable estimates of national prevalence rates in 27 African nations. The results indicate considerable variation in infertility rates between nations across the continent. Whatever the national rate, within each nation infertility is strongly associated with social, behavioral and cultural factors that are known to put women at risk for sexually transmitted diseases and other reproductive tract infections most closely associated with clinical infertility.

Adult↗
PubMed2006

Collection of tissue and culture samples from the canine reproductive tract.

Definitive diagnosis of reproductive tract infection or other disease often requires sampling of tissue, either for culture or histopathology. Indications, sample collection technique, possible side-effects and interpretation of results are reviewed. Pertinent facts include: (1) collection of uterine biopsy specimens via laparotomy was associated with higher yield of diagnostic samples and fewer side-effects than other less invasive techniques; (2) vaginal culture samples should be collected from the anterior vagina to minimize number of contaminants in the sample; (3) collection of culture samples from the anterior vagina during proestrus or estrus, in the presence of discharge originating in the uterus, was a non-invasive technique for assessment for uterine infection; (4) samples for bacterial culture from mucosal surfaces, including the vagina and penis, must be quantitated to allow interpretation, with moderate to heavy growth of any single aerobic bacterial organism relevant; (5) mycoplasma and ureaplasma are part of the normal flora of the genitourinary tract in dogs and bitches and, because most laboratories cannot give reliable quantitative results, interpretation of positive results often is difficult; (6) collection of prostatic tissue samples for cytology or culture was more likely to yield a correct diagnosis than submission of ejaculated prostatic fluid.

Animals↗