Prevalence of sexually transmitted infections, genital symptoms and health-care seeking behaviour among HIV-negative female sex workers in Kigali, Rwanda.

Timely diagnosis and treatment of sexually transmitted infections (STIs) is often hampered by the lack of symptoms, inadequate diagnostics and/or poor availability, accessibility and quality of treatment in resource-limited settings. Female sex workers (FSW) are highly vulnerable for HIV and key transmitters of STIs. Among FSW (n = 400) participating in a prospective HIV incidence study in Kigali, Rwanda, only 15% (17/116) of women with laboratory-diagnosed non-ulcerative STIs at baseline reported symptoms. Only 27% (20/74) of women self-reporting genital symptoms sought care at enrolment, and 39% (46/117) of women with self-reported genital symptoms during follow-up. During focus group discussions, FSW considered treatment-seeking and partner notification important. Shame and feeling disrespected by doctors or other health-care workers were identified as barriers to seeking health care. A comprehensive STI control programme targeting both symptomatic and asymptomatic FSW should be considered in this setting.

Aspects epidemiologiques et anatomopathologiques des cancers dans les centres hospitaliers universitaires (CHU) du Rwanda

Il s'agit d'une etude retrospective realisee dans le but de mesurer la frequence des cancers de toute origine dans les Centres Hospitaliers Universitaires (CHU) du Rwanda durant la periode de 2000 a 2004. Deux milles cinq cents dix sept (2517) patients ont ete retenus pour notre etude et 942 cas de cancers ont ete histologiquement confirmes dans le service d'anatomopathologie. Les tumeurs representent 38;5 des tissus examines dans le laboratoire d'anatomopathologie; dont 20;85 sont des tumeurs malignes. Seuls 30;1 des suspicions de cancers dans les CHU ont ete confirmees par l'histologie. Parmi les cancers diagnostiques; 54;4 surviennent chez des sujets de sexe feminin. L'age moyen est de 44;8 ans. Chez l'homme les cancers les plus frequents sont : les cancers de l'estomac (16;4); le sarcome de Kaposi (11;5); du foie (10;1) et les lymphomes malins non Hodgkiniens (9;1). Chez la femme; les cancers du col uterin constituent la localisation la plus frequente (27;3); precedant les cancers du sein (10;5) et de l'estomac (8;8). Les enfants de moins de 15 ans ont presente 7;7 des cancers diagnostiques et les cancers de l'enfance les plus frequents sont les lymphomes malins non hodgkiniens (33;15) et le nephroblastome (9;84). La frequence des tumeurs malignes observees au laboratoire d'anatomopathologie n'est certainement pas representative de toute la realite cancereuse et la mise en place d'un registre des cancers au Rwanda est necessaire pour la surveillance epidemiologique de cette affection

Sexual violence, HSV-2 and HIV are important predictors for infertility in Rwanda.

BACKGROUND: In order to formulate cost-effective health interventions aimed at preventing infertility it is necessary to identify modifiable risk factors for infertility in sub-Saharan Africa. This case-control study examined potential predictors and their population attributable fraction (PAF%) for various infertility types including lifestyle factors, sexual behaviour and reproductive tract infections (RTIs). METHODS: Sexually active women aged 21-45 year presenting with infertility problems at the infertility clinic of the Kigali University Teaching Hospital (n = 312), and fertile controls who recently delivered (n = 283) were surveyed together with their male partners. Participants were interviewed about socio-demographic characteristics, sexual behaviours and lifestyle factors, and were tested for HIV and RTIs. RESULTS: Variables significantly associated with tubal infertility were history of sexual violence [adjusted odds ratio (AOR) 2.41; 95% CI 1.36-4.25]; positive HIV (AOR 2.41; 95% CI 1.36-4.25), herpes simplex virus type 2 (HSV-2; AOR 1.67; 95% CI 1.03-2.71) and Chlamydia trachomatis serology (AOR 1.78; 95% CI 0.99-3.21), and current bacterial vaginosis by Amsel criteria (AOR 1.97; 95% CI 1.12-3.47). Among men, male factor infertility was associated with positive HIV (AOR 2.43; 95% CI 1.31-5.23) and HSV-2 serology (AOR 1.71; 95% CI 1.02-2.87) and current urologic abnormalities (AOR 2.38; 95% CI 1.01-5.31). Positive HSV-2 serostatus carried the greatest PAF% (26%) for tubal infertility, followed by positive HIV serostatus (20%) and history of sexual violence (17%). CONCLUSIONS: Although temporal relationships are difficult to ascertain, history of sexual violence, HSV-2 infection and HIV infection are important predictors of infertility in Rwanda.

Gender differences and factors associated with treatment-seeking behaviour for infertility in Rwanda.

BACKGROUND: This study examines perceptions of infertility causes, treatment-seeking behaviour and factors associated with seeking medical care in an urban infertile population in Rwanda, as well as the response of health providers. METHODS: Between November 2007 and May 2009 a hospital based survey was conducted among 312 women and 254 male partners in an infertile relationship. RESULTS: Infertility causes based on a medical diagnosis were mentioned by 24% of women and 17% of men. Male infertility awareness was low in both sexes with 28% of men and 10% of women reporting male-related causes. Seventy-four per cent of women and 22% of men had sought care for their infertility in the past. Seeking treatment in the formal medical sector was associated with higher income, being married and infertility duration of more than 5 years in both sexes. In women, higher education and being nulliparous and in men blaming oneself for the infertility was also associated with seeking formal medical care. Participants reported a wide array of treatments they received in the past, often including ineffective or even harmful interventions. CONCLUSION: Health authorities should invest in improving information, education and counselling on issues pertaining to causes and treatments of infertility, and in drawing up guidelines for the management of infertility at all levels of health care.

Preparing for microbicide trials in Rwanda: focus group discussions with Rwandan women and men.

The acceptability and feasibility of microbicide studies and future microbicide use are influenced by existing norms and values regarding sexual and contraceptive behaviour. In preparation for microbicide research in Rwanda, focus group discussions were conducted to assess sexual and contraceptive behaviour, preferences for vaginal lubrication, and hypothetical acceptability of microbicides among Rwandan women and men. Seven focus group discussions were conducted among sexually active married women, unmarried women, sex workers, female students, older women and men living in Kigali, Rwanda, and an additional group of women living in a rural area. The results indicate that condom use is low among Rwandan men and women and that condoms are mainly used by men during commercial sex. Women have limited power to negotiate condom or family planning use. Vaginal hygiene practices are very common and consist primarily of washing with water. Lubrication during sex is highly preferred by both men and women. Hypothetical microbicide acceptability after an explanation of what microbicides are and a demonstration with lubricant jelly was high.

The brittle bone: how to save women from osteoporosis.

For a woman, the risk of suffering an osteoporotic fracture during her lifetime is higher than the combined risk of breast, endometrial, and ovarian cancer. It is important to reduce the number of osteoporosis-related fractures. Therefore, it is necessary to emphasize various interventions and attitudes which will decrease both the risk of falling and that of breaking bones. Strategies should be followed to reach adulthood with an optimal bone mass through improved diet and exercise during childhood. Programs that identify women with the lowest bone mass at the time of menopause may be useful, since prophylactic measures against osteoporosis such as hormone replacement therapy (HRT) can be offered to them. Identification of women at risk can be achieved through bone densitometry; a decrease of each standard deviation of bone mineral mass below mean values predicts a doubling of the fracture risk. Some data suggest that physicians are more willing to prescribe HRT specifically to women with the lowest bone mass, and that the latter are more likely to stay on therapy for longer periods of time. The decision to use HRT should be taken by the patient after proper information of all benefits (diminished climacteric symptoms, decrease of cardiovascular risk) and potential risks (possible enhanced breast cancer risk, appearance of side effect). In women who do not want to take HRT, or for whom contraindications exist, alternative medications, such as calcium, vitamin D and biphosphonates can be considered, depending on fracture risk. For older and institutionalized women, programs should be developed to decrease the risk of falling. Likewise, it may be possible to reduce the consequences of a fall, for instance by promoting the development of energy-absorbing hip pads, which reduce fracture risk.

[Compliance with hormone replacement therapy]. / Observance au traitement hormonal de substitution.

Hormone Replacement Therapy (HRT) after menopause reduces climacteric symptoms and increases the quality of life. If correct dosage is used, bone loss can be prevented and fracture frequency reduced. Epidemiological studies also suggest a decreased cardio-vascular mortality among HRT users. A high proportion of post-menopausal women should therefore be treated using long-term therapy, but currently only a small proportion of women use HRT in Belgium, (around 14%). Further their compliance is particularly low. Fear of cancer and drug-related side effects, such as unaccepted bleeding are often mentioned causes of low compliance. Education of both physicians and patients, regarding HRT seems to be a crucial issue. The physician's attitude towards HRT is often reported as negative. Osteoporosis prevention and related bone mass measurements may have a favorable effect on compliance, but this is not well established. Establishing a confidential relationship with patients and the involvement of nursing counseling are strategies which may improve compliance. The use of easy-to-take medications supported by calendar blisters or reminders, may facilitate chronic use of medication. Future research needs to investigate the physician's and the patient's decision-making process.