What contraception do women use after experiencing complications from abortion? an analysis of cohort records of 18,688 postabortion care clients in Tanzania.

BACKGROUND: The family planning component of postabortion care (PAC) is critical, as it helps women to prevent unintended pregnancies and reduce future incidence of life-threatening unsafe abortion. In Tanzania, PAC was recently decentralized from tertiary-level district hospitals to primary health care dispensaries in four regions of the country. This analysis describes interventions used to improve access to high quality PAC services during decentralization; examines results and factors that contribute to PAC clients' voluntary uptake of contraception; and develops recommendations for improving postabortion contraceptive services. METHODS: This analysis uses service delivery statistics of 18,688 PAC clients compiled from 120 facilities in Tanzania between 2005 and 2014. RESULTS: This study suggests that efforts to integrate postabortion family planning into treatment for incomplete abortion contributed to higher postabortion contraceptive uptake (86%). Results indicate that variables associated with significant differences in contraceptive uptake were facility level, age, gestational age at the time of treatment, and uterine evacuation technology used. CONCLUSION: The experience of expanding PAC services in Tanzania suggests that integrating contraceptive services with treatment for abortion complications can increase family planning use.

Human papillomavirus infection and squamous cell carcinoma of the conjunctiva.

BACKGROUND: Squamous cell carcinoma of the conjunctiva (SCCC) is associated with HIV-related immunosuppression, but human papillomavirus virus (HPV) is also suspected to have a role. We carried out a case-control study to assess the role of cutaneous and mucosal HPV types in SCCC, conjunctival dysplasia, and their combination (SCCC/dysplasia) in Uganda. METHODS: We compared HPV prevalence in frozen biopsies from 94 SCCC cases (79 of whom were found to be HIV-positive), 39 dysplasia cases (34 HIV-positive), and 285 hospital controls (128 HIV-positive) having other eye conditions that required surgery. Highly sensitive PCR assays that detect 75 HPV types were used. Odds ratios (ORs) and 95% confidence intervals (CIs) were computed, adjusting for, or stratifying by age, sex, and HIV status. RESULTS: Cutaneous HPV types were detected in 45% of SCCC cases, 41% of dysplasia cases and 11% of controls. Human papillomavirus virus 5 and 8 were the most common types in SCCC, and most often occurred in combination with other types. Associations were observed between SCCC/dysplasia and detection of both single (OR=2.3; 1.2-4.4) and multiple (OR=18.3; 6.2-54.4) cutaneous HPV types, and were chiefly based on findings in HIV-positive patients. Cutaneous HPV infections were rarely observed among HIV-negative patients and the association with SCCC/dysplasia was not significant (OR=2.4; 0.6-9.6) among them. Squamous cell carcinoma of the conjunctiva/dysplasia risk and mucosal HPV types were not associated in either HIV-positive or HIV-negative patients. CONCLUSIONS: We detected cutaneous HPV types in nearly half of SCCC/dysplasia cases and often multiple types (HPV5 and 8 being most common). The role of HIV (confounder or strong enhancer of cutaneous HPV carcinogenicity) is still uncertain.

Parasitological and clinical characterization of Simulium neavei-transmitted onchocerciasis in western Uganda.

In the forests of western Uganda onchocerciasis is transmitted by Simulium neavei s.s. Since little is known about the infection transmitted by this vector, a survey was made in 1991 with special regard to adult persons of 15 years and older in the 13 villages of the parish Kigoyera 40 km northeast of Fort Portal. 3268 (52%) of the 6271 registered inhabitants were examined clinically and parasitologically. The highest microfilaria (mf) densities were found on the buttocks, lower ones on the shoulders and the lowest on the ankles. In the parish the standardised prevalence of mf carriers was 62%. The crude prevalences of adult mf carriers ranged from 80% to 95% in the 13 villages. Densities of 100 mf/snip or more were found in 25% of male persons. The community microfilarial load (CMFL) in skin snips from the buttocks was 49 mf/snip, ranging from 22 to 93 in the 13 villages. The standardised prevalence of nodule carriers was 25% and the mean nodule load was 1.9 nodules per nodule carrier. Among 3420 nodules 90% were found on the pelvic girdle. The standardised prevalence of onchocercal dermatitis was 19%. The crude rates ranged within the age groups in males from 20% to 45% and in females from 16% to 41%. The standardised prevalence of persons presenting mf in the anterior chamber of the eye was 24% and the CMFL in the anterior chamber ranged between 1.2 and 3.3 mf/chamber in six villages. Standardised rates were 1.6% for sclerosing keratitis and 0.9% for reduced vision of 3/60 or less. These prevalences of eye lesions are comparable to those observed in West African forest areas. The CMFLs and the prevalences of mf and nodule carriers represent suitable criteria for community diagnosis of S. neavei-transmitted onchocerciasis in Uganda to guide ivermectin treatment, whereas the prevalence of "leopard skin" is not useful. Immigrants living less than five years in the endemic focus should be excluded from the assessment of mf carrier rates and those living there less than ten years from rapid assessment of nodule carrier rates.