Journal of Reproductive Health, Gender, and HIV in Africa | 21 December 2008
A Meta-Analysis of Pelvic Inflammatory Disease Prevalence and Risk Factors in Women Using Long-Acting Reversible Contraception within Nairobi's Informal Settlements, 2008
M, i, r, e, i, l, l, e, N, z, e, n, g
Abstract
Pelvic inflammatory disease (PID) is a major cause of morbidity and reproductive health complications in sub-Saharan Africa. Women in informal settlements experience heightened vulnerability due to constrained healthcare access. The relationship between long-acting reversible contraception (LARC) use and PID risk in such settings requires clear synthesis to guide practice. This meta-analysis sought to determine the pooled prevalence of PID and to identify associated risk factors specifically among women using LARC within Nairobi’s informal settlements. A systematic search was performed across relevant electronic databases for observational studies reporting PID prevalence or risk factors in LARC users. Studies were screened, and data were extracted independently by two reviewers. Pooled prevalence was calculated using a random-effects model. Heterogeneity was assessed with the I² statistic. Risk factors were synthesised narratively. The pooled prevalence of PID among LARC users was 14.2% (95% CI: 11.8–16.9%). Key risk factors identified were a history of sexually transmitted infections, multiple sexual partners, and previous PID episodes. No significant association was found between specific LARC type (e.g., intrauterine device versus implant) and increased PID prevalence. PID prevalence among LARC users in Nairobi’s informal settlements is substantial. The identified risk factors are predominantly behavioural and related to sexual health history, rather than being attributable to the LARC method. Integrated sexual health services within contraception provision are needed, with emphasis on screening, partner management, and education. Programmes should prioritise enhanced follow-up for women with identified risk factors. Further high-quality prospective research is required. pelvic inflammatory disease, long-acting reversible contraception, meta-analysis, prevalence, risk factors, informal settlements, Nairobi This analysis consolidates evidence on PID burden and associated risks for a vulnerable population, providing a basis for targeted clinical and public health interventions.