Condom use and risk factors of inconsistent or low use of the condoms during heterosexual anal intercourse in sub-Saharan Africa: a scoping review

Anal intercourse (AI) has been reported to be the riskiest among other sexual intercourses in spreading human immunodeficiency virus (HIV) and the risk could be minimized by the use of condoms. Whilst AI is believed to be practiced mainly by men who have sex with men, AI has also been reported to occur in heterosexual relationships. However, data on condom use during heterosexual AI are inadequate in sub-Saharan Africa. Method: A scoping review of English language published articles on condom use during heterosexual anal sex, whose studies were conducted in Sub-Saharan Africa from January 2010 to May 2020 was conducted. Articles were searched systematically on PubMed and Google Scholar electronic databases. Heterosexual AI was defined as penile penetrative anal sex between a man and a woman regardless of the sexual orientation of the 2 parties involved in the act of heterosexual AI. Findings: A total of 21 studies were eligible for analysis. Most of the studies (17 out of 21) reported females to be involved in heterosexual AI whilst 9 out of 21 studies reported males to be involved in heterosexual AI. The lifetime prevalence estimates of condom use during heterosexual AI ranged from 29%-97.5%. Other prevalence estimates of condom use during heterosexual anal intercourse were reported over various recall periods which were: 12 months' recall period with prevalence estimates ranging from 2.9%-59%; prevalence estimates for the past 3 months which ranged from 50%-94.4%; 1 month's recall period with prevalence estimates ranging from 5%-96% and prevalence estimates for the last intercourse experienced ranging from 1%-55%. Condom use during heterosexual AI was generally low and/or inconsistent among female sex workers (FSWs), men who have sex with men and women (MSMW) and some women in the general population. There were no risk factors identified in the study for the inconsistent or low use of condoms during heterosexual AI. Conclusion: Evidence from this study suggests condom use during heterosexual AI could be fairly low especially among groups such as FSWs, MSMW and some women in the general population. Risk factors for using condoms inconsistently or using condoms less during heterosexual AI are not clear. Heterosexual anal intercourse and condom use during the AI practice is generally an under-studied subject in Sub-Saharan Africa. Future studies need to explore on heterosexual AI and condom use practices during AI comprehensively so that there can be concrete evidence on the subject which will inform targeted interventions aimed at reducing HIV among heterosexual populations in SSA

The effect of pregnancy and delivery on anal function in black Africans and Indians

Background: Occult anal sphincter disruption, following childbirth may contribute to the development of anal incontinence (AI). The type and mechanism of injury may differ between first and subsequent deliveries. Objectives: To describe the effect of pregnancy and delivery on the endosonographic morphology of the anal sphincter and on anal sphincter pressures, and to highlight any differences in these between nulliparous and multiparous Black African and Indian women. Methods: One hundred Black African and Indian women delivering at two hospitals in the Pietermaritzburg area underwent anal endosonography and manometry in the third trimester of pregnancy and 24 hours post-delivery. Those with occult injury were followed up at 6 weeks and six months. Participants were asked about bowel symptoms at each visit. Ante-natal and intra-partum obstetric data was also recorded. Results: The majority were Black African (82%), and 76% were multiparous. Symptoms of urgency increased from 9% antenatally to 14.6% post-delivery, decreasing to 8.3% at six months. Symptoms of AI increased from 10% antenatally to 12.5% post-delivery, falling to 3.1% at six months. Internal sphincter defects were more common among primiparous and multiparous women delivering vaginally. There was a significant drop in functional anal length post-delivery, irrespective of the mode of delivery. Anal pressures also fell post-delivery and at six weeks post-partum. However, by six months there appeared to be a return to pregnancy values.Conclusion: Occult anal sphincter injuries and reduced anal pressures occur after delivery, in the absence of clinically detected anal sphincter trauma, irrespective of the mode of delivery

Management of anorectal malformation: changing trend over two decades in Zaria, Nigeria

Background: Anorectal malformation is a common congenital defect and its management has evolved over the years. This is a review of the trend in the management of this condition in a major paediatric surgical centre in Nigeria over two decades. Materials and Methods: A retrospective analysis of 295 patients with anorectal malformations managed from January 1988 to December 2007 was carried out. Results: There were 188 boys and 107 girls aged 1 day-9 years (median 8 years) at presentation. There were 73 (54.5) and 106 (65.8) emergency operations in groups A and B; respectively. There were 61 (45.5) and 55 (34.2) elective operations in groups A and B; respectively. Regarding treatment; in group A; patients requiring colostomy had transverse loop colostomy; while in group B; sigmoid (usually divided) colostomy was preferred. The definitive surgery done during the two periods were: group A: cutback anoplasty 29 (47.5); anal transplant 5 (8.2); sacroabdominoperineal pullthrough (Stephen's operation) 6 (9.5) and others 21 (34.4). In group B; posterior sagittal anorectoplasty (PSARP) 46 (83.7); anal transplant 1 (1.8); posterior sagittal anorectovaginourethroplasty (PSARVUP) 2 (3.6) and anal dilatation 6 (10.9) were done. Early colostomy-related complication rates were similar in the two groups (P 0.05). The overall late complication rate was 65.5in group A and 16.4in group B (P 0.05). The mortality was 25 (18.6) in group A compared to 17 (10.6) in group B (P 0.05). Conclusion: There have been significant changes in the management of anorectal malformations in this centre in the last two decades; resulting in improved outcomes