The burden of reproductive disease in rural women in The Gambia, West Africa1

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The burden of reproductive disease in rural women
in The Gambia, West Africa1

• Gijs Walraven
• Medical Research Council Laboratories, The Gambia
• 1 See also Lancet 2001 357 1161-1167

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Woman of Africa,Sweeper, smearing floors and
walls with cow dung and black soil,cook, ayah,
the baby on your back,Washer of
dishes,Planting, weeding, harvesting,Storekeeper
, builder,Runner of errands, cart, lorry,
donkey.Woman of AfricaWhat are you not?Okot
PBitek, Uganda
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Background

• High maternal mortality
• High fertility
• Polygamy is common
• Poor education and largely informal employment

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Maternal mortality

• Estimations of the 1980s Maternal Mortality
  Ratio gt 1,000/100,000 live births
• Estimation 1993-1998 period MMR 424/100,000 live
  births2
• Most important direct cause haemorrhage
• Most important indirect cause anaemia
• 2 See also Bull WHO 2000 78 603-613

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Fertility

• Total fertility rate for women 6.83
• Total fertility rate for men 12.03
• 25 of births in women younger than 20, 11 to
  mothers over age 35
• 21 followed birth intervals of less than 24
  months
• Modern family planning use 6.0 in sexually
  active non-pregnant women
• 3 See also Bull WHO 2000 78 570-579

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• Formal education 3.1
• Occupation farmer/housewife 95
• Marital status married 86, single 11, widowed
  1.3, divorced 1.5,
• 54 of married women were in a polygynous unions
  

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Reproductive health has been defined as the
ability to live through the reproductive years
and beyond with reproductive choice, dignity, and
succesful childbearing, and free of
gynaecological disease and risk (Fathalla 1988)
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MethodsStudy population

• Women aged 15-54 from half of the 40 study
  villages and hamlets
• Cluster sampling technique
• 3 main ethnic groups Mandinka (45), Wollof
  (35) and Fula (20)

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MethodsEntry in the community

• Meetings with village leaders (both women and
  men)
• If feed-back from village leaders was positive
  village meetings
• If village meeting granted permission for the
  study individual consent

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Field methods (I)

• Reproductive health questionnaire demographic
  and socio-economic data, past gynaecologic and
  obstetric history, current reproductive health
  symptoms, health seeking behaviour

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Field methods (II)

• Repetition of part of the questionnaire by a
  female gynaecologist
• Anthropometry
• General medical examination
• Gynaecological evaluation inspection of
  genitalia, speculum examination, bimanual pelvic
  examination
• Blood taking

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Laboratory methods

• Sera TPHA and RPR, HIV and HSV-2
• Vaginal swabs wet prep for Trichomonas
  vaginalis, culture for Candida albicans, gram
  stain for bacterial vaginosis
• Cervical swabs culture for Gonorrhoea, PCR for
  Chlamydia
• Cervical smear for cytology, biopsy for histology