Integration of STI Prevention and Management with Family Planning and Antenatal Care in Sub-Saharan Africa: What More Do We Need to Know?

Abstract

The way in which reproductive health services are offered, or at least how policies recommend they should be offered, has been undergoing considerable revision over the past few years. In most cases, these revisions focus on reorganizing the way in which services are configured, and the configurations receiving the most attention are those that integrate STI and HIV prevention, detection and management with family planning and antenatal care. There are several reasons for this in the Sub-Saharan region. 1 Reproductive tract infections (RTIs), particularly those that are sexually transmitted (STIs), continue to be a serious public health problem in Sub-Saharan Africa, with the World Health Organization (WHO) estimating that 12% of 15-49-year-olds have a curable STI. 2 Not only are the prevention and management of STIs important public health concerns in themselves, but the presence of some STIs enhances the sexual transmission of HIV, and STI management has been shown to be effective in reducing HIV transmission. Moreover, the Programme of Action of the 1994 International Conference on Population and Development (ICPD) emphasized reorienting health care systems to enable women to obtain comprehensive and quality reproductive health services. Finally, configuring services jointly rather than separately has perceived financial benefits for health systems.The clients of public-sector programs providing maternal and child health care and family planning services are almost exclusively women using family planning, pregnant women and women with newborn babies-women who usually are married and are considered at low risk for STIs. Data from a variety of sources 3 indicate that in some populations, 2-7% of pregnant women and of women using family planning have a cervical gonorrheal, chlamydial or syphilis infection. Moreover, trichomoniasis-a sexually transmitted vaginal infection-has been diagnosed in 4-34% of such women. (Non-sexually transmitted vaginal infections such as candidiasis and bacterial vaginosis are also common among these women-8-38%-but present less serious consequences to the woman and her fetus or newborn.) Finally, 25-30% of pregnant women in several parts of the region are infected with HIV. 4 These data indicate that many women served by maternal and child health and family planning programs should no longer be considered at low risk, and that efforts to reach them through these programs are justifiable on a public health basis. This article will focus on public programs, which are the primary source of family planning and antenatal services in Sub-Saharan Africa. A study in Uganda has shown that men are twice as likely as women to bring an HIV infection into a marriage, 5 emphasizing that the risk of HIV and other STIs among married women, who make up the majority of maternal and child health and family planning program clients in this

Opportunities for treating sexually transmitted infections and reducing HIV risk in rural South Africa

“…2005). Priority needs to be given to intervention trials for strategies that seek to re‐orient PHC nurses to major changes in the implementation of ANC and FP (Askew & Maggwa 2002).…”

“…In Sub‐Saharan Africa public sector primary health care (PHC) programmes are almost exclusively accessed by women seeking antenatal (AN), family planning (FP) and child health services (Askew & Maggwa 2002). Women are primarily affected by societal factors that include poverty, unemployment, illiteracy, lack of information and accessible health services as well as cultural practices that continue to impact on the transmission of human immunodeficiency virus (HIV) and sexually transmitted infections (STIs) (Lamptey 2002).…”

“…2002, McClelland et al. 2005) are a major public concern in Sub‐Saharan Africa (Askew & Maggwa 2002,Mayaud & Mabey 2004). Almost 35% of the 340 million curable STIs occur amongst women in Sub‐Saharan Africa (WHO 2001).…”

Integrating Sexual Health Services Into Primary Care: An Overview of Health Systems Issues and Challenges in Developing Countries

“…Current structures often lack privacy for consultations, which is particularly important for the provision of sexuality counseling, STI prevention and care, adolescent health care, and services for the victims of violence (Colombini, Mayhew, & Watts, 2008;Dick, Ferguson, Brabin, Chatterjee, & Ross, 2006). The integration of STI prevention and care services can be undermined by a lack of resources, including examination equipment, drugs and supplies, and laboratory equipment (Askew & Maggwa, 2002;Mayhew, 1996). Integrated commodity supply chains can be effective, for example, through joint contraceptive and condom procurement (United States Agency for International Development, 2003).…”

Reproductive Health and Behavior, HIV/AIDS, and Poverty in Africa

“…Askew et al (2002) notes that even for this more limited objective there may be difficulties, citing unfavorable experiences in Africa with the detection and treatment of (non-HIV) STIs in family planning clinics. On the other hand, integration may be more feasible for certain activities, such as prevention of mother to child transmission and VCT.…”