Self-reported and observed female genital cutting in rural Tanzania: associated demographic factors, HIV and sexually transmitted infections.
OBJECTIVE
To determine (i) the prevalence and type of female genital cutting (FGC) in a rural multi-ethnic village in Tanzania, (ii) its associated demographic factors, (iii) its possible associations with HIV, sexually transmitted infections (STIs) and infertility and (iv) to assess the consistency between self-reported and clinically observed FGC.


METHODS
The study was part of a larger community-based, cross-sectional survey with an eligible female population of 1993. All were human immunodeficiency virus (HIV)-tested and asked whether they were circumcised (n = 1678; 84.2%). Participants aged 15-44 years were interviewed (n = 636; 79.7%), and 399 (50.0%) were gynaecologically examined to screen for STIs and determine the FGC status.


RESULTS
At a mean age of 9.6 years, 45.2% reported being circumcised. In the age-group 15-44 years, 65.5% reported being cut, while FGC was observed in 72.5% and categorized as clitoridectomy or excision. The strongest predictors of FGC were ethnicity and religion, i.e. being a Protestant or a Muslim. FGC was not associated with HIV infection, other STIs or infertility. A positive, non-significant association between FGC and bacterial vaginosis was found with a crude odds ratio of 4.6. There was a significant decline of FGC over the last generation. An inconsistency between self-reported and clinically determined FGC status was observed in more than one-fifth of the women.


CONCLUSIONS
The data indicate that both women and clinicians might incorrectly report women's circumcision status. This reveals methodological problems in determining women's circumcision status in populations practising the most common type of FGC. The positive association between FGC and bacterial vaginosis warrants further investigation.
Klouman
Elise
E
Department of General Practice and Community Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway. elise.klouman@medisin.uio.no
Manongi
Rachel
R
Klepp
Knut-Inge
KI
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D019093:Circumcision, Female / Q000009:adverse effects / Q000208:ethnology / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D003906:Developing Countries; D005260:Female; D015658:HIV Infections / Q000209:etiology; D006801:Humans; D007247:Infertility, Female / Q000209:etiology; D008875:Middle Aged; D015995:Prevalence; D012423:Rural Health / Q000706:statistics & numerical data; D012650:Self Disclosure; D012725:Sexual Behavior / Q000706:statistics & numerical data; D012749:Sexually Transmitted Diseases / Q000209:etiology*; D013636:Tanzania / Q000453:epidemiology