STDS IN WOMEN ATTENDING FAMILY-PLANNING CLINICS - A CASE-STUDY IN ADDIS-ABABA

For cultural reasons modern contraception has been slow to gain accept ance in Ethiopia. Knowledge about contraception and abortion is still limited in many family and community settings in which it is socially disapproved. By 1990 only 4% of Ethiopian females aged 15-49 used cont raception. Little is known of sexually transmitted disease (STD) preva lence in family planning (FP) attenders in Africa in general and Ethio pia in particular, even though attenders of family planning clinics (F PCs) are appropriate target groups for epidemiological studies and con trol programmes. A study of 2111 women of whom 542 (25.7%) attended FP Cs in Addis Ababa showed utilisation rates to be highest in women who were: Tigre (33%) or Amhara (31%), aged 20-34 years (30%), age 16 or o lder at first marriage/coitus (28%:38% in those first married after 25 years); who had a monthly family income of 10 Ethiopian Birr (EB) or more (33%:36% for those with income 100-500 EB), three or more childre n (37%), more than five lifetime husbands/sexual partners (39%); or we re bargirls (73%) or prostitutes (43%). The seroprevalence rates for a ll STDs, higher in FPC attenders compared with other women, were syphi lis (TPHA) 39%, Neisseria gonorrhoeae 66%, genital chlamydia 64%, HSV- 2 41%, HBV 40% and Haemophilus ducreyi 20%. Only 4% of FPC attenders h ad no serological evidence of STD: 64% were seropositive for 3 or more different STD. Clinical evidence of pelvic inflammatory disease (PID) was also more common in the FPC attenders (54%), 37% having evidence of salpingitis. The FPC provides a favourable setting for screening wo men likely to have high seroprevalence of STD, who for lack of symptom s will not attend either an STD clinic nor a hospital for routine chec k up. We recommend that measures be taken to adequately screen, treat and educate FPC attenders, their partners, and as appropriate and when possible their clients, in an attempt to control STDs and ultimately HIV in the community. Social, economic and cultural factors in the occ urrence of STDs, prostitution, family planning and modern contraceptio n coverage in Ethiopia are identified and deficiencies of current prog rammes briefly discussed with the objective of targeting services more effectively. Copyright (C) 1997 Elsevier Science Ltd