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OBJECTIVES: To study the burden of disease of reproductive tract infections (RTIs) and cervical dysplasia in women attending a family planning clinic in Nairobi, Kenya, and to assess the acceptability of integrating reproductive healthcare services into existing family planning facilities. METHODS: In a family planning clinic in Nairobi, Kenya, 520 women were enrolled in a study on RTI and cervical dysplasia. RESULTS: RTI pathogens were detected in over 20% of women, the majority being asymptomatic. HIV-1 testing was positive in 10.2%. The diagnosis of cervical dysplasia was made on 12% of the cytology smears (mild in 5.8%, moderate in 3.5%, severe in 1.2%), and 1.5% had invasive cervical cancer. The intervention of case detection of RTI and Papanicolaou smear taking was well received by clients and considered feasible by the staff. CONCLUSIONS: Early detection and treatment of potentially curable cervical lesions and RTI provide a unique opportunity to improve women's health. In Kenya, where the current contraceptive prevalence rate is 33%, family planning clinics are excellent sites to introduce health interventions.
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Approximately 1 in 4 Americans lives within 4 miles of a hazardous waste site according to the Environmental Protection Agency. In light of this large proportion and the public's high level of concern that hazardous waste causes health problems, it is important for primary care physicians and other health care providers to know that residential proximity to some kinds of hazardous waste sites is associated with adverse reproductive effects. Findings from both state-based surveillance programs and studies of individual hazardous waste sites have shown increased risk of congenital malformations and reductions in birth weight among infants born to parents living near hazardous waste sites. This article summarizes salient literature on human health effects of hazardous waste and suggests actions for primary care providers to consider.
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In 1988 a survey was carried out in order to obtain information on knowledge about reproduction, sexual activity, attitudes, and use of contraceptive methods among residents between 15 and 24 years of age in Greater Santiago. For this purpose, a multistage, self-weighted, non-replacement probability sample was chosen from the entire Santiago urban area. After 2,898 households were visited, 865 women and 800 men were selected and interviewed. For the interview, a questionnaire with 156 questions was developed; many questions were similar to those included in similar surveys in Brazil and Guatemala. The interviewers were professionals who had received prior training. Although 75% of the interviewees had attended sex education classes, they had erroneous ideas on various basic subjects. Sixty-nine percent of the women interviewed had undergone menarche before attending these classes. In addition, 35.4% of the women and 65.0% of the men had had sexual relations prior to marriage, and less than 20% had used any contraceptive method. More than 60% of the interviewees who had children had conceived them before marrying. These findings point up the necessity of offering sex education classes for children and young people, as well as facilitating their access to family planning services, in order to decrease the number of illegitimate and unwanted children that are born in Chile.
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The present communication concerns the potential of current surveillance programs for understanding the epidemiology of sexually transmitted infections. The often limited knowledge or the negligence of such infections both among health providers and in the general population, and the non-existence of laboratory services or poor utilization thereof, for example the lack of sampling material, lack of transport services for samples, lack of laboratory reagents and the use of unsensitive and unspecific detection methods, challenge the value of almost any surveillance system of these infections. Other factors are poor health-seeking behavior in the population, including hard-core groups for sexually transmitted infections, poor health economy, limited possibilities for attendees themselves to pay for etiological tests and lack of educated health providers for this type of infectious disease. Still other factors adding to the difficulty of interpreting sexually transmitted infection epidemics on the basis of monitored data are, for example, anonymous testing, double or multiple registration of detected sexually transmitted infection cases, and the chronicity of many sexually transmitted infections with relapses, which makes it difficult to differentiate between incidence and prevalence. Furthermore, partner notification legislations and bureaucracy in reporting cases can influence surveillance programs for sexually transmitted infections.
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The line of research focusing on the human, especially male, reproductive system in relation to occupational exposure has diversified since the infiltration of the concept of endocrine disrupting chemicals (EDC), early in the 1990s. The main stream, until then, was the study of reproductive toxicity caused by single albeit relatively heavy exposures to chemicals of limited range (conventional scheme). The new and increasingly important stem is the search for a wider range of chemicals with endocrine disrupting potential, and health effects due to multiple low-dose exposures of potent chemicals (new scheme). There are also studies having aspects of both the conventional and new schemes. For studies with the new scheme, progress has been made in areas such as adherence to standardized techniques in evaluating male reproductive function and more sensitive study designs. Indeed, some studies have suggested the presence of EDCs in the occupational setting. However, epidemiological findings are still constrained by difficulties in the identification of occupationally-exposed populations and evaluation of exposure. There is thus a need for convergence of knowledge and a widening of the scope of epidemiological research targeting occupationally exposed populations under a carefully-designed protocol.
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