Maher D, Hoffman I
Department of Medicine, University of Malawi College of Medicine, Central Africa.
J Infect. 1995 Jul;31(1):77-8. doi: 10.1016/s0163-4453(95)91674-1.
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.
马拉维关于性传播疾病（STD）患病率的有限信息表明这些疾病很常见。在1989年于利隆圭及1990年于布兰太尔开展的研究中，未经挑选的门诊患者中性传播疾病的患病率分别为4.4%，而产前门诊患者中的患病率为42%。马拉维是受艾滋病流行影响最严重的国家之一，据估计，15岁以上年龄组的全国艾滋病毒血清阳性率为10%，1993年在布兰太尔产前门诊就诊的孕妇中这一比例为32%。异性性交是撒哈拉以南非洲艾滋病毒传播的主要方式，占艾滋病毒感染病例的80%。同时存在的生殖器溃疡疾病会促进艾滋病毒的性传播。非溃疡性性传播疾病也可能在促进艾滋病毒的性传播方面起作用，但证据尚不明确。因此，识别和治疗性传播疾病患者为减少艾滋病毒传播提供了一个机会。伊丽莎白女王中央医院（QECH）是马拉维最大城市布兰太尔（约50万人口）的地区医院，也是马拉维南部地区的三级转诊医院。有两个普通内科病房，一个男性病房和一个女性病房，1993年约有11000名患者入院。床位使用率可达150%至200%，资源有限。入院的十大主要原因是疟疾、肠胃炎、贫血、肺炎、痢疾、结核病、艾滋病、脑膜炎、高血压和腹水。主要死因是艾滋病和结核病。
