Prevalence of genital infections in medical inpatients in Blantyre, Malawi

The limited information on the prevalence of sexually transmitted diseases (STDs) in Malawi suggests that they are common. In studies in Lilongwe in 1989 and Blantyre in 1990, the prevalence of STDs was 4.4% in unselected outpatients and 42% in antenatal clinic patients respectively. Malawi is one of the countries worst affected by the HIV pandemic, with an estimated national HIV seroprevalence of 10% in the age group over 15 years and of 32% in pregnant women who attended antenatal clinics in Blantyre in 1993. Heterosexual intercourse is the main mode of HIV transmission in sub-Saharan Africa, accounting for up to 80% of cases of HIV infection. Concomitant genital ulcer disease facilitates sexual transmission of HIV. Non-ulcerative STDs may also play a role in facilitating sexual transmission of HIV but the evidence is less clear. The identification and treatment of people with STDs therefore presents an opportunity for decreasing HIV transmission. Queen Elizabeth Central Hospital (QECH) is the District Hospital for Blantyre, Malawi's largest city (about 500,000 population) and the tertiary referral hospital for Malawi's Southern Region. There are two general medical wards, one male and one female, to which about 11,000 patients were admitted in 1993. Bed occupancy can run at up to 150-200% and resources are limited. The top ten causes of admission are malaria, gastroenteritis, anaemia, pneumonia, dysentery, tuberculosis, AIDS, meningitis, hypertension and ascites. The leading causes of death are AIDS and tuberculosis.