Prevalence and significance of sexually transmitted diseases among Ethiopian women attending antenatal clinics in Addis Ababa

Abstract: To determine the prevalence of sexually transmitted diseases (STDs) and the risk for (i) the mother regarding pregnancy wastage and puerperal sepsis and (ii) the child with regard to congenital and neonatal infection, 342 routine antenatal clinic (ANC) at tenders were investigated. The prevalence of antibodies showing exposure to specific STD pathogens in pregnant women attending ANC was: syphilis (TPHA) 27%, (VDR:) 28%, gonorrhoea 43%, genital chlamydiae 54%, HBV 37%, HSV-2 35 %, H ducreyi 10%. High titre seropositivity suggestive of active infection was: gonorrhoea 10%, genital chlamydiae 31 %, HSV2 19%; with HBV SAg 5% -all of which are likely to be transmitted to the foetus in utero or during delivery. Only 10% of ANC at tenders had no serological evidence of any STD: 72% had serological evidence for two or more STDs. Among conditions requiring treatment vaginitis was the most important, 20% having a severe trichomonal infection. Despite the frequency of this condition it was noted that few women (4%) complained of vaginal discharge. Thus women attending the ANC revealed a high prevalence of STD. Consequently the foetus and neonate are put at risk because of intrauterine or intrapartum transmission of infection. The high prevalence among ANC at tenders also reflects the relative prevalence of STDs in the community. Measures such as screening at ANC and information and education regarding prevention are required to reduce STDs in pregnant women and their sexual partners. Prophylaxis for the neonate can be considered until this goal is achieved. [Ethiop. J. Health Dev. 1995;9(1):31-40

A sociological and serological study of at tenders of family planning clinics in Addis Ababa

Abstract: A study of 542 women attending family planning clinics (FPC) and 1568 women attending obstetric and gynaecologic clinics in Addis Ababa showed utilisation of FPC was highest in those with a family income of 100-500 EB per month (36%), in women who were: Tigrawi (33%) or Amara (31 %), aged 20-34 years (30%), age 16 or older at first marriage/coitus (28%), parity of 2... 2 children (35%), > 5 lifetime husbands/sexual partners (39%), or were bargirls (73%) or prostitutes (43%). FPC attendance was lowest among the nulliparous (2.3%), women from rural areas (10%), the Guragie (10%) and Oromo women (19%), Moslem women 14(%), those of subsistence income ( < 10EB per month) (14%). The seroprevalence rates indicative of exposure to STD pathogens were high as was the prevalence of essentially asymptomatic pelvic inflammatory disease (PID). Only 4% of FPC at tenders had no serological evidence of STD: 64% had 3 or more different STD. Specific present or active STD infection prevalence for syphilis (VDRL) 28%, Neisseria gonorrhoea 31 %, genital chlamydia 46% and HSV-2 21% was higher in FPC at tenders than among women attending other clinics. Clinical evidence of PID was also more common in the FPC at tenders (54%), 37% having evidence of salpingitis. Thus FPCs provide a useful setting for screening women particularly at risk. Because of lack of symptoms, these women are unlikely to attend either an STDs clinic or a hospital for routine check up, and as such are not treated and represent a population from which STDs can spread into the population. Measures to screen, treat and educate FPC at tenders, their partners and their clients, are recommended in an attempt to Control STDs and ultimately HIV in the community. [Ethiop. J. Hea/th Dev. 1995;9(1):19-30

STDs in women attending family planning clinics: A case study in Addis Ababa

For cultural reasons modern contraception has been slow to gain acceptance in Ethiopia. Knowledge about contraception and abortion is still limited in many family and community settings in which it is socially disapproved. By 1990 only 4% of Ethiopian females aged 15-49 used contraception. Little is known of sexually transmitted disease (STD) prevalence in family planning (FP) attenders in Africa in general and Ethiopia in particular, even though attenders of family planning clinics (FPCs) are appropriate target groups for epidemiological studies and control programmes. A study of 2111 women of whom 542 (25.7%) attended FPCs in Addis Ababa showed utilisation rates to be highest in women who were: Tigre (33%) or Amhara (31%), aged 20-34 years (30%), age 16 or older at first marriage/coitus (28%:38% in those first married after 25 years); who had a monthly family income of 10 Ethiopian Birr (EB) or more (33%:36% for those with income 100-500 EB), three or more children (37%), more than five lifetime husbands/sexual partners (39%); or were bargirls (73%) or prostitutes (43%). The seroprevalence rates for all STDs, higher in FPC attenders compared with other women, were syphilis (TPHA) 39%, Neisseria gonorrhoeae 66%, genital chlamydia 64%, HSV-2 41%, HBV 40% and Haemophilus ducreyi 20%. Only 4% of FPC attenders had no serological evidence of STD: 64% were seropositive for 3 or more different STD. Clinical evidence of pelvic inflammatory disease (PID) was also more common in the FPC attenders (54%), 37% having evidence of salpingitis. The FPC provides a favourable setting for screening women likely to have high seroprevalence of STD, who for lack of symptoms will not attend either an STD clinic nor a hospital for routine check up. We recommend that measures be taken to adequately screen, treat and educate FPC attenders, their partners, and as appropriate and when possible their clients, in an attempt to control STDs and ultimately HIV in the community. Social, economic and cultural factors in the occurrence of STDs, prostitution, family planning and modern contraception coverage in Ethiopia are identified and deficiencies of current programmes briefly discussed with the objective of targeting services more effectively.family planning contraception sexually transmitted disease (STD) pelvic inflammatory disease (PID) Africa (Ethiopia)