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Reproductive Disease Burden in Rural Gambian Women

This study examines the burden of reproductive diseases in rural women in The Gambia, West Africa, focusing on maternal mortality, high fertility rates, poor education, and informal employment.

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Reproductive Disease Burden in Rural Gambian Women

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  1. 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

  2. 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 P’Bitek, Uganda

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

  4. Maternal mortality • Estimations of the 1980s: Maternal Mortality Ratio > 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

  5. 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

  6. 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

  7. 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)

  8. 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%)

  9. 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

  10. Field methods (I) • Reproductive health questionnaire: demographic and socio-economic data, past gynaecologic and obstetric history, current reproductive health symptoms, health seeking behaviour

  11. 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

  12. 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

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