Comparative acceptability of combined and progestin-only injectable contraceptives in Kenya.

OBJECTIVE: We compared 12-month continuation rates, menstrual bleeding patterns and other aspects of acceptability between users of Cyclofem and users of Depo-Provera. METHODS: The life-table method was used to calculate quarterly continuation rates. In all, 360 Kenyan women were randomly assigned to one of the two contraceptives. User-satisfaction questionnaires were administered at 6 and 12 months or at discontinuation, whichever occurred first. RESULTS: The 1-year continuation rate was 75.4% for Depo-Provera users versus 56.5% for Cyclofem users (p<.001). Main reasons for discontinuation included difficulty making clinic visits (45.1% for Cyclofem vs. 40% for Depo-Provera), menstrual changes (14.1% vs. 12.5%) and nonmenstrual problems (15.5% vs. 12.5%). None of the Depo-Provera users and 8.5% of the Cyclofem users claimed frequency of visits as the main reason for discontinuation. In all, 70.6% of the Depo-Provera users were amenorrheic after 12 months, as were 20.8% of the Cyclofem users. CONCLUSIONS: The 1-year continuation rate was higher for Depo-Provera than for Cyclofem. There was no important difference in discontinuation rates because of menstrual problems; the difference mainly reflected the frequency of visits required.

Monitoring technologist reading skills in a sperm morphology quality control program.

OBJECTIVE: The value of sperm morphology as a predictor of a man's fertilizing potential has often been challenged because of different classification systems used to distinguish between normal and abnormal spermatozoa. The study aimed to monitor the reading skills of 53 laboratory technologists who are enrolled in a continuous quality control program for sperm morphology assessment. DESIGN: Prospective analytical study. SETTINGS: Academic hospital and academic institution setting. PATIENT(S): Sperm samples from the sperm donor program and andrology technicians from sub-Saharan Africa. INTERVENTION(S): Papanicolaou-stained sperm slides were prepared and shipped on a quarterly basis to participating laboratories. Papanicolaou-prestained sperm morphology slides were used as test material for 21 months. MAIN OUTCOME MEASURE(S): Percentage normal spermatozoa.A new statistical model was developed to record reading skills of the participating technicians. Reading skills were classified as marginal (5.7% of cases), good (11.3% of cases), and excellent (83% of cases). RESULT(S): Participants maintained their morphological reading skills and agreed with the reference laboratory by not exceeding a SD limit of 0.2 to set stringent standards for the program. CONCLUSION(S): Technician proficiency can be monitored using the results of a quality control program. A continuous quality control program can be initiated only after intensive training, because baseline values at the onset of the quality control program serves as an internal reference value.

Progesterone, estradiol and their receptors in leiomyomata and the adjacent normal myometria of black Kenyan women.

The contents of progesterone and oestrogen, and their respective receptors in uterine leiomyomata and adjacent normal myometrial tissue in indigenous black women in Kenya were studied. A random selection of twenty women undergoing hysterectomy for uterine fibroids at Kenyatta National Hospital was used for the studies. The myometria contained higher levels of E(2 ) (181% : P < 0.001); and P(4 ) (240.6 % : P < 0.001); as compared to the leiomyomata. On the other hand uterine leiomyomata contained significantly higher levels of ER (147.6% : P < 0.001); and PR (178.7% : P < 0.001 ); than normal myometria. These findings differ slightly from those reported in black women in developed countries, but support the proposal that manipulation of sex steroids may be useful in the treatment and management of uterine leiomyomata.