Sexually transmitted diseases at Queen Elizabeth Central Hospital, Blantyre, Malawi

Objectives: To re-assess attendance at the sexually transmitted diseases (STDs) clinic in relation to age, sex and seasonal variation over a three-year period, and to determine the pattern of STD syndromes presenting at the STDs clinic, Queen Elizabeth Central Hospital, Blantyre, Malawi.Design: A retrospective study.Setting: STDs clinic, Queen Elizabeth Central Hospital (QECH), Blantyre, Malawi.Results: The study findings indicate that of the 50,524 attendees, 52.72% and 47.28% were males and females respectively. Over the period there was a significant (30.7%) increase in the number of attendees from 14,622 (28.94%) in 1996 and 16,794 (33.24%) in 1997 to 19,008 (37.82%) in 1998, a trend that was also observed among the sexes. The age range was between 11 and 72 years. More than half(53.55%) of the patients were within 21 to 30 years age rangewhile a total of 48,054 (95.11%) were below 50 years. The most frequently presented STDs syndromes among the 21- 30 year age group were genital ulcer disease (GUD) (40.86%), genitourinary symptoms high risk (GUS - HR) (20.46%), urethral discharge (UD) (15.65%) and pelvic inflammatory diseases (PID) (13.37%). The four constituted 90.34% of all case presentations. Balanitis (BA) was the least common at 0.32% or 86 cases in three years. Whilethe incidence of genitourinary symptoms low risk (GUS - LR) decreased over the years and no clear pattern could be established with (GUS - HR), acute scrotal swelling/pain (SS), and BA, numerical increase in the presentation of UD, PID and enlarged inguinal lymph nodes(BU) was observed. However, the phenomenal increase in the prevalence of STDs particularly GUD rising from 2,988 (37.70%) in 1996 and 3,674 (40.27%) in 1997 to 4,392 (43.88%) in 1998 respectively was noted with concern. There seemed to be a link between seasonal variation and attendance at the STD clinic as more cases presented between March and May peaking in April of each year while December period recorded the least attendance.Conclusion: Attendance rate at the STDs clinic, Queen Elizabeth Central Hospital, Blantyre, is still on the increase in spite of the various STDs/HIV/AIDS awareness campaign programmes

Effect of HIV status on fertility desire and knowledge of long-acting reversible contraception of postpartum Malawian women

The objectives of this study were to describe the most recent pregnancy intentions and family planning preferences of HIV-infected and HIV-uninfected postpartum Malawian women, and to assess whether HIV status is associated with fertility desire and knowledge of intrauterine contraception (IUC) and the subdermal contraceptive implant. We conducted a cross-sectional analysis of the baseline characteristics of Malawian women enrolled in a prospective cohort study assessing postpartum contraceptive uptake and continuation. Women at a government hospital completed a baseline survey assessing reproductive history, family planning preferences, and knowledge of IUC and the implant. We used Pearson's chi-square tests to compare these parameters between HIV-infected and HIV-uninfected women. Modified Poisson regression was performed to assess the association between HIV status and fertility desire and knowledge about IUC and the implant. Of 634 postpartum women surveyed, HIV-infected women were more likely to report their most recent pregnancy was unintended (49% versus 37%, p=0.004). Nearly all women (97%) did not want a child in the next two years but HIV-infected women were more likely to desire no more children (adjusted PR: 1.59; 95% CI: 1.33, 1.89). HIV-infected women were also less likely to know that IUC (adjusted PR 0.72; 95% CI: 0.61, 0.84) and the implant (adjusted PR 0.83; 95% CI: 0.75, 0.92) are safe during breastfeeding. Postpartum women strongly desire family spacing and many HIV-infected postpartum women desire no more children, suggesting an important role for these long-acting methods. Education about the efficacy and safety of IUC and the implant particularly during breastfeeding may facilitate postpartum use

Effect of HIV status on fertility desire and knowledge of long-acting reversible contraception of postpartum Malawian women

The objectives of this study were to describe the most recent pregnancy intentions and family planning preferences of HIV-infected and HIV-uninfected postpartum Malawian women, and to assess whether HIV status is associated with fertility desire and knowledge of intrauterine contraception (IUC) and the subdermal contraceptive implant. We conducted a cross-sectional analysis of the baseline characteristics of Malawian women enrolled in a prospective cohort study assessing postpartum contraceptive uptake and continuation. Women at a government hospital completed a baseline survey assessing reproductive history, family planning preferences, and knowledge of IUC and the implant. We used Pearson's chi-square tests to compare these parameters between HIV-infected and HIV-uninfected women. Modified Poisson regression was performed to assess the association between HIV status and fertility desire and knowledge about IUC and the implant. Of 634 postpartum women surveyed, HIV-infected women were more likely to report their most recent pregnancy was unintended (49% versus 37%, p=0.004). Nearly all women (97%) did not want a child in the next two years but HIV-infected women were more likely to desire no more children (adjusted PR: 1.59; 95% CI: 1.33, 1.89). HIV-infected women were also less likely to know that IUC (adjusted PR 0.72; 95% CI: 0.61, 0.84) and the implant (adjusted PR 0.83; 95% CI: 0.75, 0.92) are safe during breastfeeding. Postpartum women strongly desire family spacing and many HIV-infected postpartum women desire no more children, suggesting an important role for these long-acting methods. Education about the efficacy and safety of IUC and the implant particularly during breastfeeding may facilitate postpartum use