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  • Title: Sterility in women in sub-Saharan Africa.
    Author: Frank O.
    Journal: IPPF Med Bull; 1987 Feb; 21(1):6-8. PubMed ID: 12340979.
    Abstract:
    This article examines the problem of sterility in women in sub-Saharan Africa. The term sterility indicates a physiological inability to bear children: conception and early pregnancy may occur, but successful pregnancy does not. Primary infertility is the total absence of live-born children, whereas 2ndary infertility is the absence of additional children after a reasonably long period. Some naturally occurring level of primary infertility is expected in all populations of women, and various research had shown this to be 3%, on the basis of the proportion of women who have reached the end of their childbearing years childless. Although measurement of 2ndary fertility is more difficult, studies show that almost 3 times as many women suffer from 2ndary infertility as from primary infertility. Using the 3% standard of childlessness in women past childbearing, studies show that infertility varies by region in Africa, with higher levels of childlessness in Central Africa and parts of East Africa. Given the predominant natural fertility pattern of the region, the variation levels of infertility alone accounts for 60% of the variation in fertility levels. These high levels of infertility are acquired through infection, most particularly from sexual transmission of Neisseria gonorrhea and Chlamydia trachomatis. Recent findings reveal that more than 85% of infertile women have diagnosed reproductive pathology indicative of such genital infections. Together, gonorrhea and chlamydia challenge the medical resources of Africa, posing serious problems on the count of diagnosis, treatment, and their non-genital as well as 2ndary pathologies. Although the role of gonorrhea in infertility in Africa has long been recognized, the importance of C. trachomatis was not recognized until the early 1980s. The earlier absence of chlamydial control may account for the meager improvement in infertility by 1980, despite large scale penicillin campaigns. The resulting need for new and multivalent drug regimens and for good patient compliance (for chlamydia treatment) to make case-management feasible in the light of still severe constraints on diagnosis may well mean that notable improvements in infertility will still be hard to achieve for some time to come.
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