Economic Impact of Reproductive Tract Infections and Resources for Their Control

  • Peter Piot
  • Jane Rowley
Part of the Reproductive Biology book series (RBIO)


There is little doubt that the various reproductive tract infections (RTIs) and their complications and sequelae are a significant public health problem in terms of morbidity and, common opinion among the medical profession notwithstanding, mortality.1–6 This paper reviews the economic burden of RTIs in the developing world, as well as resources available and needed for their prevention and control. Since data on these topics are scarce to nonexistent, we are by necessity quite vague in many sections of this paper, and we do not quantify resources needed to control RTIs.


Human Immunodeficiency Virus Human Immunodeficiency Virus Infection Chlamydia Trachomatis Pelvic Inflammatory Disease Family Planning Program 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Wasserheit JN. The significance and scope of reproductive tract infections among Third World women. Int J Gynecol Obstet 1989; Suppl 3: 145–68.Google Scholar
  2. 2.
    Wasserheit JN. Reproductive tract infections in Special challenges in Third World women’s health. 117th Annual Meeting, American Public Health Association, October 1989, International Women’s Health Coalition, New York, 1990.Google Scholar
  3. 3.
    Goeman J, Meheus A, Piot P. L’ épidémiologie des maladies sexuellement transmissibles dans les pays en développement a l’ère du SIDA. Ann Soc Belge Méd Trop 1991; 71: 81–113.Google Scholar
  4. 4.
    Brunham RC, Ronald AR. Comparative epidemiology of sexually transmitted diseases in industrialized and developing countries. In: Wasserheit JN, Aral SO, Holmes KK et al., eds. Research issues in human behavior and sexually transmitted diseases in the AIDS era, Washington, DC: American Society for Microbiology, 1991; 61–80.Google Scholar
  5. 5.
    Over M, Piot P. HIV infection and sexually transmitted diseases. In: Jamison DT, Mosley WH, eds. Disease control priorities in developing countries, New York: Oxford University Press for the World Bank, 1991.Google Scholar
  6. 6.
    Population Information Program. Complications of abortion in developing countries. Popul Rep 1980; 7: 105–55.Google Scholar
  7. 7.
    Feacham RG, Jamison DT, eds. Disease and mortality in Sub-Saharan Africa, Oxford: Oxford University Press for the World Bank, 1991.Google Scholar
  8. 8.
    Nabarro D, McConnell C. The impact of AIDS on socioeconomic development. AIDS 1989; 3 (Suppl 1): 5265–72.Google Scholar
  9. 9.
    World Bank. World development report 1990, New York: 1990.Google Scholar
  10. 10.
    Washington AE, Arno PS, Brooks MA. The economic cost of pelvic inflammatory disease. JAMA 1986; 255: 1732–5.CrossRefGoogle Scholar
  11. 11.
    Piot P, Laga M. Current approaches to STD control in developing countries. In: Wasserheit JN, Aral SO, Holmes KK et al., eds. Research issues in human behavior and sexually transmitted diseases in the AIDS era, Washington, DC: American Society for Microbiology, 1991.Google Scholar
  12. 12.
    Piot P, Hira SK. Control and prevention of sexually transmitted diseases. In: Lamptey P, Piot P, eds. The handbook of AIDS prevention in Africa, Durham, NC: Family Health International, 1990.Google Scholar
  13. 13.
    Meheus A, Schulz KF, Cates W Jr. Development of prevention and control programs for sexually transmitted diseases in developing countries. In: Holmes KK, Mdrdh P-A, Sparling PF et al., eds. Sexually transmitted diseases, second edition, New York: McGraw-Hill, 1990.Google Scholar
  14. 14.
    Fransen L, Van Dam CJ, Piot P. Health policies for controlling AIDS and STDs in developing countries. Health Policy Plann 1991; 6: 148–56.CrossRefGoogle Scholar
  15. 15.
    Rosenfield A. Maternal mortality in developing countries: an ongoing but neglected “epidemic” JAMA 1989; 262: 376–9.PubMedGoogle Scholar
  16. 16.
    Foster SD. Improving the supply and use of essential drugs in Sub-Saharan Africa. Policy, Research, and External Affairs Working Paper 456, Washington, DC: World Bank, 1990.Google Scholar
  17. 17.
    Meheus A, Piot P. Provision of services for sexually transmitted disease in developing countries. In: Oriel JD, Harris JRW, eds. Recent advances in sexually transmitted diseases. Edinburgh: Churchill Livingstone, 1986.Google Scholar
  18. 18.
    Oronsaye AU, Odiase GI. Incidence of ectopic pregnancy in Benin City, Nigeria. Trop Doct 1981; 11: 160–3.PubMedGoogle Scholar
  19. 19.
    Figà-Talamanca I, Sinnathuray TA, Yusof K et al. Illegal abortion: an attempt to assess its cost to the health services and its incidence in the community. Int J Health Sery 1986; 16: 375–89.CrossRefGoogle Scholar
  20. 20.
    Bongwele O, Nichols D, Miatudila M, Whatley A, Burton N, Janowitz B. Determinants and consequences of pregnancy wastage in Zaire, Research Triangle Park, NC: Family Health International, 1986.Google Scholar
  21. 21.
    Fortney JA. The use of hospital resources to treat incomplete abortions: examples from Latin America. Public Health Rep 1981; 96: 574–9.PubMedGoogle Scholar
  22. 22.
    World Health Organization. Abortion. A tabulation of available data on the frequency and mortality of unsafe abortion, Geneva: World Health Organization, 1990.Google Scholar
  23. 23.
    Germain A. The Christopher Tietze International Symposium: an overview. Int J Gynecol Obstet 1989; Suppl 3: 1–8.Google Scholar
  24. 24.
    Germain A, Ordway J. Women’s health in the third world: balancing the scales. New York: International Women’s Health Coalition, 1989.Google Scholar
  25. 25.
    Schulz KF, Cates W Jr, O’Mara PR. Pregnancy loss, infant death, and suffering: legacy of syphilis and gonorrhoea in Africa. Genitourin Med 1987; 63: 320–5.PubMedGoogle Scholar
  26. 26.
    Evans T. The impact of permanent disability on rural households: river blindness in Guinea. IDS Bull 1989; 20: 41–8.CrossRefGoogle Scholar
  27. 27.
    Barnett T, Blaikie P. Community coping mechanisms in the face of exceptional demographic change. Report to the Overseas Development Administration.Google Scholar
  28. 28.
    Pryer J. When breadwinners fall ill: preliminary findings from a case study in Bangladesh. IDS Bull 1989; 20: 49–57.CrossRefGoogle Scholar
  29. 29.
    UNICEF. The state of the world’s children 1989. Oxford: Oxford University Press, 1989.Google Scholar
  30. 30.
    Bertozzi SM. Economic research: its role in the fight against AIDS in Africa. AIDS 1991; 5 (Suppl 1): 845–54.Google Scholar
  31. 31.
    World Health Organization. Management of patients with sexually transmitted diseases, WHO Technical Reports, Series 810, Geneva: World Health Organization, 1991.Google Scholar
  32. 32.
    Jamison DT, Mosley WH. Selecting disease control priorities in developing countries. In: Jamison DT, Mosley WH, eds. Disease control priorities in developing countries, Washington, DC: World Bank, 1991 (in press).Google Scholar
  33. 33.
    Nettleman MD, Jones RB, Roberts SD et al. Cost-effectiveness of culturing for Chlamydia trachomatis. A study in a clinic for sexually transmitted diseases. Ann Intern Med 1986; 105: 189–96.PubMedCrossRefGoogle Scholar
  34. 34.
    Trachtenberg AI, Washington AE, Halldorson S. A cost-based decision analysis for chlamydia screening in California family planning clinics. Obstet Gynecol 1988; 71: 101–8.PubMedGoogle Scholar
  35. 35.
    Phillips RS, Aronson MD, Taylor WC, Safran C. Should tests for Chlamydia trachomatis cervical infection be done during routine gynecologic visits? Ann Intern Med 1987; 107: 188–94.PubMedCrossRefGoogle Scholar
  36. 36.
    Handsfield HH, Jasman LL, Roberts PL, Hanson VW, Kothenbeutel RL, Stamm WE. Criteria for selective screening for Chlamydia trachomatis infection in women attending family plannning clinics. JAMA 1986; 255: 1730–4.PubMedCrossRefGoogle Scholar
  37. 37.
    Stray-Pedersen B. Economic evaluation of maternal screening to prevent congenital syphilis. Sex Transm Dis 183; 4: 167–72.Google Scholar
  38. 38.
    Hira SK, Bhat GJ, Chikamata DM et al. Syphilis intervention in pregnancy: Zambian demonstration project. Genitourin Med 1990; 66: 159–64.PubMedGoogle Scholar
  39. 39.
    National STD Control Programme. Two year plan for 1990–1991, Nairobi: MinistryGoogle Scholar
  40. of Health, 1990.Google Scholar
  41. 40.
    Sehgal A, Singh V, Bhamblani S, Luthra UK. Screening for cervical cancer by direct inspection. Lancet 1991; Vol. 1: 282.CrossRefGoogle Scholar
  42. 41.
    Laga M, Plummer FA, Piot P et al. Prophylaxis of gonococcal and chlamydial ophthalmia neonatorum: silver nitrate versus tetracycline. N Engl J Med 1988; 318: 653–7.PubMedCrossRefGoogle Scholar
  43. 42.
    Laga M, Meheus A, Piot P. Epidemiology and control of gonococcal ophthalmia neonatorum. Bull WHO 1989; 67: 471–8.PubMedGoogle Scholar
  44. 43.
    Fransen L, Nsanze H, Klaus V et al. Ophthalmia neonatorum in Nairobi, Kenya: the roles of Neisseria gonorrhoeae and Chlamydia trachomatis. J Infect Dis 1986; 153: 862–9.PubMedCrossRefGoogle Scholar
  45. 44.
    Brewer C. Prevention of infection after abortion with a supervised single dose of oral doxycycline. Br Med J 1980; 281: 780–1.PubMedCrossRefGoogle Scholar
  46. 45.
    Grimes DA, Schulz KF, Cates W. Prophylactic antibiotics for curettage abortion. Am J Obstet Gynecol 1984; 150: 689–99.PubMedGoogle Scholar
  47. 46.
    Sinei SKA, Schulz KF, Lamptey PR et al. Preventing IUD-related pelvic infection: the efficacy of prophylactic doxycycline at insertion. Br J Obstet Gynecol 1990; 97: 412–9.CrossRefGoogle Scholar
  48. 47.
    Lamptey P, Goodridge GAW. Condom issues in AIDS prevention in Africa. AIDS 1991; 5(Suppl 1) (in press).Google Scholar
  49. 48.
    Ngugi EN, Plummer F. Health outreach and control of HIV infection in Kenya. J AIDS 1988; 1: 566–70.Google Scholar
  50. 49.
    Lamptey P, Potts M. Targeting of prevention programs in Africa. In: Lamptey P, Piot P, eds. The handbook of AIDS prevention in Africa, Durham, NC: Family Health International, 1990.Google Scholar
  51. 50.
    Merritt G, W Lyerly, J Thomas. The HIV/AIDS pandemic in Africa: issues of donor strategy. In: Miller N, Rockwell RC, eds. AIDS in Africa: the social and policy impact, Lewistown, NY: Edwin Mellen Press, 1988; 115–29.Google Scholar
  52. 51.
    Romania: on the road to success. Safe Motherhood 1990; no. 3:1–2.Google Scholar
  53. 52.
    Hethcote HW, Yorke JA. Gonorrhea transmission dynamics and control, Berlin: Springer Verlag, 1984.Google Scholar
  54. 53.
    Moses S, Plummer FA, Waiyaki P et al. Cost-effectiveness of an STD/AIDS control programme for high frequency transmitters in Nairobi, Kenya. Fifth International Conference on AIDS in Africa, Abstract T.RT.F.5, Kinshasa, 1990.Google Scholar
  55. 54.
    World Health Organization. Consensus statement from the consultation on global strategies for coordination of AIDS and STD control programmes. Geneva, 11–13 July 1990.Google Scholar
  56. 55.
    Vernon R, Ojeda G, Murad R. Incorporating AIDS prevention activities into a family planning organization in Colombia. Stud Fam Plann 1990; 21: 335–43.PubMedCrossRefGoogle Scholar
  57. 56.
    World Health Organization. Sexually transmitted diseases research needs, Geneva: World Health Organization, 1989.Google Scholar

Copyright information

© Springer Science+Business Media New York 1992

Authors and Affiliations

  • Peter Piot
    • 1
  • Jane Rowley
    • 2
  1. 1.Department of Microbiology Institute of Tropical MedicineWHO Collaborating Centre on AIDSAntwerpBelgium
  2. 2.Department of Pure and Applied Biology Imperial CollegeUniversity of LondonLondonUK

Personalised recommendations