Community-based survey on female genital excision in Faranah District, Guinea.

This paper reports on a community-based study in 1999 of the beliefs and practices of people in Faranah District, Guinea regarding female genital excision (FGE). Semi-structured individual interviews and focus group discussions were carried out with women of reproductive age, older women, married men, community and religious leaders, traditional practitioners and health workers. The study found that FGE was being carried out on girls aged 6-14, mostly using a traditional knife and involving total excision of the clitoris and partial removal of the external genitals, in conjunction with instruction on how young women should behave when they are married. The practice is illegal under national laws but few people were aware of this. There was a tendency towards taking girls for medical care to avoid complications, and some people suggested that FGE should be done by medical professionals, but this was a minority. More than 60 per cent of respondents thought FGE was harmful to health and supported its abolition. Many more men than women took this view; women felt under pressure to maintain the tradition. To stop FGE, local organisations need to support a process of change within the community, including awareness-raising about the law and the negative health effects of FGE, promoting alternative ceremonies, educating practitioners and supporting education and improvements in the status of women.

Sexually transmitted infections in young pregnant women in Bangui, Central African Republic.

In early 1996, 481 women visiting the antenatal services of the 3 major governmental health centres in the capital city of the Central African Republic (CAR) were included in the study. All study participants underwent the health centre's routine gynaecological examination, including laboratory diagnosis of trichomoniasis, candidiasis, gonorrhoea, syphilis and bacterial vaginosis. Cervical secretions and blood samples from study participants were sent to the National STD Reference Centre for diagnosis of Chlamydia trachomatis, Neisseria gonorrhoeae, Candida albicans, Treponema pallidum, and HIV. Overall, 34% of the study women were diagnosed with at least one sexually transmitted infection (STI) (3.1% N. gonorrhoeae, 6.2% C. trachomatis, 9.9% T. vaginalis, 6.7% T. pallidum, 12.2% HIV-1). In addition, 29.1% of women were diagnosed with bacterial vaginosis and 46.6% with candidiasis. Only a small proportion of these women had sought treatment during the weeks before, despite the recognition of genital symptoms. Self-reported and health worker-recognized symptoms, signs and laboratory results exhibited only low sensitivities, specificities, and positive predictive values in the diagnosis of STIs. These findings confirm the high vulnerability of young African women to STIs and emphasize the need for specific control interventions which should include affordable and user-friendly services. Moreover, these results call for more effective quality control in case of laboratory-based STI control strategies and question the validity of syndromic STI management strategies in women attending antenatal care services in Africa.

PIP: This study reports on the prevalence of sexually transmitted infections (STIs) among pregnant women in Bangui, Central African Republic. A total of 481 pregnant women visiting the antenatal services of the 3 major governmental health centers were included in the study. All these women were interviewed and underwent gynecological examination, including laboratory diagnosis of trichomoniasis, candidiasis, gonorrhea, syphilis and bacterial vaginosis. The results revealed that 34% of the women were diagnosed with at least one STI. Gonorrhea accounted for 3.1%, chlamydiasis for 6.2%, trichomoniasis for 9.9%, syphilis for 6.7%, and HIV-1 for 12.2%. In addition, 29.1% of women were diagnosed with bacterial vaginosis and 46.6% with candidiasis. The majority of the women diagnosed with an STI reported specific clinical symptoms during the week before they entered into the study, but only a minority of them actively sought treatment, and only half of those consulted the formal health sector. Self-reported and health worker-recognized symptoms, signs and laboratory results manifested only low sensitivities, specificities, and positive predictive values in STI diagnosis. These results confirmed the high susceptibility of young African women to STIs. Therefore, specific control interventions should be carried out which incorporate affordable and user-friendly services.

Reaching youth in the Central African Republic. Programme feature.

PIP: The Central African Republic's National Program for Sex Education of Youths of School Age has developed programs for students and out-of-school youth aimed at reducing the high incidence of adolescent pregnancy and human immunodeficiency virus (HIV)/sexually transmitted diseases (STDs). One such program, Support to Youth for Responsible Sexuality, has targeted out-of-school youth 10-22 years of age from Bangui. The program operates from the Information Center for Sexual Health, established in 1994. Educational videos are shown at the center, followed by discussion groups. Peer counselors are available for young people who wish to discuss sexual concerns privately. The center also has a small health post staffed by a nurse who performs pregnancy tests and simple STD diagnoses. A troupe of children perform puppet shows (written by program participants) about reproductive health issues throughout the city. Videos on condom use produced by local youth are being shown at movie theaters before the main feature, and condoms are sold at these locations. A newsletter and radio programming are also used to reach out to adolescents with sexual health messages. Plans are underway to establish a mobile information center. Key to the success of this program has been collaboration with the local family planning association, a condom social marketing program, youth clubs, a woman's nongovernmental organization, private video parlors, United Nations agencies, and governmental ministries.^ieng