Infertility in Rwanda
Mukantabana, S.
Imbonezamuryango 2: 21-27
1985
PMID: 12267098 Document Number: 3624
Data are presented from the Obstetrics and Gynecology Service of the University Hospital of Butare, Rwanda, concerning the types, causes, diagnoses, and treatment of infertility. No studies have been done on the frequency of primary and secondary infertility and repeated abortion and premature delivery in the overall population. Between 1979-82, there were 270 new cases of primary infertility, 344 new cases of secondary infertility, and 181 new cases of habitual abortion or premature birth among the total of 12,485 new cases. The percentage of women seen for the 1st time because of fertility problems was thus 6.3%, of which primary infertility affected 34%, secondary infertility 43%, and habitual abortion or premature birth 23%. No data are available on the male role in infertility since most men in Rwanda regard sexual potency as a proof of fertility and refuse to be examined. 92 endometrial biopsies were performed for primary infertility and 128 for secondary infertility between January 1981-December 1983. Among cases of primary infertility, 6.5% were caused by endometrial tuberculosis, 5.4% by endometritis, and 13% by hormonal imbalance, while among secondary infertility cases, 14% were caused by endometritis and 13% by hormonal imbalance. Among 498 curettages after incomplete abortions, 47 showed signs of endometritis. Among patients undergoing surgery for fertility problems, there were 34 cases of ovarian cysts, 30 of uterine fibromas, 10 of hydrosalpinx, and 30 of cervico-isthmic misalignment. Very few tests have been done to diagnose tubal obstruction. On the basis of available evidence, the major causes of female infertility appear to be infections and hormonal problems, endometrial tuberculosis, and cervico-isthmic misalignment and uterine fibromas, which are frequent causes of abortion and premature labor. Most current forms of fertility testing are available at the University Hospital of Butare, but there is no laboratory equipped to evaluate hormonal levels, no technician specializing in sperm analysis, and no satisfactory program of laparoscopic investigation. Prevention of fertility problems is a very high priority. The public health activities that should be emphasized include prompt diagnosis and treatment of sexually transmitted diseases, improved vaccination against tuberculosis, and education of the female population concerning the risks of postpartum and postabortal infections. Greater efforts must also be made to make the population aware of the male role in infertility.
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