Publications

In many African countries where HIV infection is mainly heterosexually transmitted a substantial proportion of women of childbearing age are now infected with the virus. This paper will review the consequences of HIV-1 infection on the reproductive health of seropositive women. The adverse effect of HIV-1 infection on children will be outlined, and strategies for preventing HIV-1 transmission in women of childbearing age and their young children will be discussed.

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Infection with maternal syphilis during pregnancy is a serious condition with dramatic impact on pregnancy outcome, including perinatal wastage and congenital syphilis. Primary prevention of congenital syphilis by antenatal case-detection and treatment of infected mothers is feasible and cost-effective. Yet the implementation of syphilis prevention activities is not effective in many third world countries, due to logistic and managerial obstacles. This paper describes the achievements and the constraints of the antenatal syphilis prevention programme in Nairobi, Kenya.

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The role of the human immunodeficiency virus (HIV) and other sexually transmitted diseases (STDs) as risk factor for spontaneous abortion was investigated in a case-control study in Nairobi, Kenya. Cases (n = 195) were women admitted with clinical signs and symptoms of spontaneous abortion, before 20 weeks of gestation. Patients with induced or clinically septic abortion were excluded. Controls were unselected pregnant women in their second or third trimester (n = 195).

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OBJECTIVE: To determine the prevalence of HIV-1 and syphilis antibodies in a population of pregnant women in Nairobi, Kenya, between 1989 and 1991. METHODS: As part of an ongoing prospective study on the effect of HIV-1 infection and sexually transmitted diseases, 4883 pregnant women were screened for HIV-1 and syphilis antibodies in one health-centre in Nairobi. RESULTS: HIV-1 seroprevalence increased from 6.5 to 13.0% (P < 0.001) and syphilis seroreactivity from 2.9 to 5.3% (P = 0.002), while there was no change in gonococcal infection rates.

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A pilot study was conducted in Nairobi, Kenya, to evaluate the feasibility of a larger study on the prevalence of cervical cancer and precancerous lesions and on the role of Sexually Transmitted Diseases (STD) as risk factors for cervical cancer in Kenya. 692 women were screened for cervical cancer by cytology in 3 City Commission family planning clinics and in 1 City Commission STD referral clinic in Nairobi.

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Using a protected triple lumen device, Neisseria gonorrhoeae or Chlamydia trachomatis, or both, were isolated from the endometriums of five out of 35 women with clinical postpartum endometritis compared with none of a control group of 30 puerperal women without endometritis (p less than 0.05) in Nairobi, Kenya. These sexually transmitted agents were also found in 12 cervical specimens from women with and three without postpartum endometritis (p = 0.04). Mycoplasma hominis and Ureaplasma urealyticum were equally isolated from the endometrium in both groups.

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We carried out a case-control study to investigate the role of sexually transmitted diseases (STDs), including infection with HIV, as risk factors for adverse outcome of pregnancy. Overall, 1507 women were enrolled within 24 h of delivery. Cases (n = 796) were mothers of low-birthweight infants (less than 2500 g) or of stillborns. Low-birthweight infants were divided into preterms (n = 373) and neonates small for gestational age (n = 234). Stillborns were separated into intrauterine fetal deaths (n = 120), and intrapartum fetal deaths (n = 69).

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During an ongoing study investigating the impact of maternal HIV infection on pregnancy outcome at a large maternity hospital in Nairobi, Kenya, asymptomatic HIV positive women who had recently delivered were informed of their HIV sero-status and counselled by a trained nurse regarding contraception and reproductive behaviour in a single session. Both HIV infected women and a comparison group of uninfected women matched for pregnancy outcome were followed up after an interval of one year. Contraceptive use, condom use and pregnancy rates were similar in both groups.

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