Reproductive Tract Disorders among Afghan Refugee Women Attending Health Clinics in Haripur, Pakistan

Gl Darmstadt,C Robinson,I Wu,R Nazir,Zp Balsara,E Owaso,At Ihsan,Dr Marsh

doi:10.3329/jhpn.v28i5.6159

Abstract

Afghans comprise one of the largest groups of refugees in the world, with the majority living in Pakistan. The objective of this study was to identify commonly-occurring reproductive tract infections (RTIs), describe knowledge of women about RTIs, and assess physical and behavioural factors contributing to the development of RTIs. Afghan women presenting at Basic Health Units in refugee camps in Haripur, Pakistan, with reproductive health-related complaints, were included in the study (n=634). Data collection included implementation of an interviewer-administered questionnaire, along with a physical examination and laboratory tests. A descriptive analysis was conducted first. Qualitative data were coded and analyzed using predetermined themes. Chi-square test was used for determining the possible relationships between a binary outcome and categorical risk factors. Over three-fourths (76.7%) of those who reported to the health clinics with reproductive complaints had an RTI. Nearly half (49.5%) of these women were diagnosed with some form of vaginitis, and 14.7% were diagnosed with clinical suspicion of pelvic inflammatory disease (PID). Women with cervical prolapse (p = 0.033) or who cleansed after intercourse (p = 0.002) were more likely to have vaginitis. There was a significant difference (p = 0.017) in the prevalence of suspected PID among women who used mud only (11.1%), any water (18.8%), and an old cloth or toilet paper (9.8%) for cleansing after defaecation. Specific physical and behavioural contributors to the high prevalence of RTIs in this population were identified, and recommendations to ameliorate these factors are offered.

Highlights

Decades of strife have caused millions of Afghans to flee violence, political oppression, and economic instability [1] to become one of the largest groups of refugees in the world [2]
Each Basic Health Units (BHUs) was staffed by a primary healthcare (PHC) team, headed by an Afghan female physician and a rotating male doctor catering to the genderspecific needs of the male population
634 women who attended the seven BHUs during the study period with a reproductive health problem were eligible for participation and provided verbal informed consent

Summary

Introduction

Decades of strife have caused millions of Afghans to flee violence, political oppression, and economic instability [1] to become one of the largest groups of refugees in the world [2]. Within Pakistan, an estimated 62% of Afghan refugees live in the Northwest Frontier Province [3]. Since this study was conducted in 1998, there have been several political changes in the area with dramatic repercussions for Afghan refugees. A recent report by the United Nations High Commissioner for Refugees (UNHCR) estimated that, as of end-2008, there were more than 2.8 million Afghan refugees. This study was conducted in 1998, there have been no studies published in the intermediate period addressing morbidity due to RTIs among Afghan refugee women.

Objectives

Methods

Results

Discussion

Conclusion