Academic journal article Bulletin of the World Health Organization

Reproductive Tract Infections, Gynaecological Morbidity and HIV Seroprevalence among Women in Mumbai, India

Academic journal article Bulletin of the World Health Organization

Reproductive Tract Infections, Gynaecological Morbidity and HIV Seroprevalence among Women in Mumbai, India

Article excerpt

Introduction

Gynaecological morbidity associated with sexually transmitted diseases (STDs) is thought to be high among women in developing countries. Pelvic inflammatory disease (PID) is one consequence of STD infection and itself may lead to infertility (1). Previous studies have indicated that in India PID was more likely to be obstetric in origin rather than to result from STDs (2). A study of reproductive tract infections among rural Maharashtrian women by Bang et al. in 1989 reported a high prevalence of signs and symptoms indicative of reproductive tract infections in older women (3). Those observations were made at a time when India was experiencing a rapid rise in reported human immunodeficiency virus (HIV) infections and acquired immunodeficiency syndrome (AIDS) cases among commercial sex workers, and there was growing international concern that HIV infection would spread heterosexually to lower-risk populations of women in India (4, 5). Under such circumstances a rise in STDs and PID among these women might also be expected. In order to determine the prevalence of reproductive tract infections and their contribution to pelvic infection, we carried out a cross-sectional study of Indian women suffering from infertility and pelvic inflammatory disease and of controls who were representative of fertile, healthy women. The control group selected consisted of women attending for tubal ligation; not only are such women demonstrably fertile, but tubal ligation in India is routinely performed by laparoscopy (6). This provided a unique opportunity to screen apparently healthy women for lower and upper genital tract infection as well as for tubal pathology. The first epidemiological results from this study are reported in this article: a detailed analysis of risk factors for pelvic infection has been reported elsewhere (7).

Methods

Study area and subjects

The study was undertaken in Mumbai (formerly Bombay), capital of Maharashtra State, between October 1993 and December 1995, in association with Brihan Mumbai Municipal Corporation (BMC). Mumbai is the industrial, commercial, and financial capital of India and over the last 20 years urbanization and industrialization have led to its rapid growth. The current population is over 10 million and inner city areas are densely populated. Almost half of the population lives in slums (huts and one-room tenements (chawls) (8). Since 1988 BMC has sought to extend family health services to all slum areas by creating health posts and postpartum centres offering health education, preventive services, simple curative care, family planning and legal abortion (medical termination of pregnancy), and laparoscopic sterilization (tubal ligation). Clinical care, including medical termination of pregnancy and tubal ligation, is available free at municipal establishments, although nonscheduled medicines must be paid for.

The study women were recruited at three centres located in three neighbouring administrative areas (wards). Most cases were recruited at Lokmanya Tilak Municipal General Hospital (LTMGH) (ward F/N) and most controls from Mahim Maternity Home (ward G/N) and F/S Postpartum Centre (ward F/S). Wards F and G are characterized by the presence of textile mills and tenements. All three wards have large slum areas, although vacant plots have attracted private builders and settlement of middle-class families. LTMGH is a 1304 bed tertiary hospital with a medical school and has six consultant units providing obstetric and gynaecological out-and inpatient care. Mahim Maternity Home is a 60-bed unit, performing 1200 deliveries a year and postpartum services, including tubal ligation. The Postpartum Centre in ward F/S is the city's busiest municipal clinic offering family planning, medical termination of pregnancy, and tubal ligation services. It is favoured by women because they are not retained for overnight observation after sterilization. Medical termination of pregnancy may be performed at the same time as tubal ligation, and at LTMGH and Mahim tubal ligation is often performed immediately after delivery. …

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