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  • Title: Asymptomatic gonorrhoea in women attending family planning clinics in Dar es Salaam, Tanzania. Results of a pilot study.
    Author: Mandara NA, Takulia S, Kanyawana J, Mhalu F.
    Journal: Trop Geogr Med; 1980 Dec; 32(4):329-32. PubMed ID: 7210172.
    Abstract:
    In an attempt to determine the prevalence of asymptomatic gonorrhoea in women in Tanzania urban areas, 405 women attending family planning clinics in Dar es Salaam had cervical swabs cultured on a selective gonorrhoea medium for Neisseria gonorrhoea. Twenty-nine of them (7.1%) were found with the organism despite absence of symptoms of the disease at the time of screening. Twenty (69%) of those with N. gonorrhoea came back after two weeks for results and all were treated with a single dose of penicillin. Only four (13.8%) of their male contacts came forward for treatment. In view of this high prevalence rate, it is recommended that gonorrhoea and other sexually transmitted diseases be regarded as among the most prevalent communicable diseases in the country necessitating control measures. Consideration should be given to screening for gonorrhoea in antenatal and family planning clinics as is now the case for syphilis. The material cost of gonococcal screening per individual was estimated at 10 T shillings (US$ 1.25) which is well above the health ministry's capability. The authors assessed the prevalence of asymptomatic gonorrhea in Tanzanian urbran women attending family planning clinics. A random sample of 405 women attending these clinics between July and November 1978 had cervical swabs taken. Of this group, 341 were attending for family spacing and 64 were attending for treatment of infertility. 29 (7.1%) of the 405 women had Neisseria gonorrhea isolated from the cervical swabs; of the 341 there for family spacing, 26 (7.6%) had positive cultures while 3 (4.7%) of those attending for infertility were positive for gonorrhea. When screening took place, 41% of those with gonorrhea had vaginal discharge and/or cervical erosion. All of the women attending for family spacing were taking the pill and had been using some form of contraception for between 1 month and 9 years. 20 (69%) of the positive cases returned for results and were treated with penicillin. However, ohly 4 of the treated women who reurned for treatment were able to convince their male partners of the need to submit to treatment. Statistics show that gonorrhea is an increasing health problem; in Tanzania alone, over 150,000 cases were reported to the Ministry of Health in 1969. Furthermore, it has been estimated that 10-20% of women infected with N. gonorrhea develop salpingitis. The best place to screen women when they are most likely to harbor a positive culture is at the family planning clinic or maternal-child health clinic. If screening were conducted at such clinics and assuming that the prevalence rate of asymptomatic gonorrhea is 7%, about 50,000 cases of asymptomatic gonorrhea could be detected at a cost of 7.2 million Tanzanian shillings. Treatment of infected women and men would cost much more but the ultimate savings would be enormous. Several recommendations were made based on this pilot study. Sexually transmitted diseases should be among those diseases given improved facilities, new methods of contact tracing should be developed, health education campaigns should be organized and laboratory facilities should be developed.
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