Testing drops despite chlamydia crisis

As rates of the sexually transmitted disease chlamydia in Samoa remain widespread, testing for the disease, which causes infertility, dropped nearly 25 per cent last year, Health Ministry data shows. 

New research this year found that Samoa had the highest rates of chlamydia infection among four Pacific Island nations studied and that the disease could pose a serious risk to the nation's future population growth. Rates of infection were dropping in other nations such as Fiji and the Federated States of Micronesia but remained stubbornly high. 

The figures are contained in the Ministry of Health’s annual report for financial year 2018-2019 and show a drop in testing for most Sexually Transmitted Infections (S.T.I.s) across the board.

The measles epidemic and mass vaccination campaign has been blamed for the decrease in testing for Chlamydia and other sexually transmitted diseases in Samoa.

Samoa's reported rate of Chlamydia infections was 23.7 per cent in 2018 and marginally lower, or 23.2 per cent, the following year.

But the number of tests conducted for the disease fell drastically year-on-year" from 4428 to 3357 - a decrease of 24.8 per cent. The Ministry noted that there was a general decline in tests for S.T.I.s. 

“Testing for H.I.V. and S.T.I.’s decreased significantly compared to 2018. This is due to no reported data from Savai’i, and the 2019 measles epidemic and mass vaccination campaign were very costly to the health system and disrupted routine testing and patient attending," the report states.  

Chlamydia can lead to an increase of infertility in women and other health complications such as ectopic pregnancy amongst women of childbearing age in Samoa.

The annual report further says fertility rates for Samoa have dropped from 4.7 children per woman in 2011 to 3.9 children in 2016. Sexually transmitted diseases are one of the listed contributing factors to the decrease in fertility rate. 

Earlier this year the high rates of chlamydia amongst Samoan women were found to pose a serious risk to the nation's future population levels, a landmark study showed. 

These first, national-level prevalence estimations of a variety of sexually transmitted infections (S.T.I.s) was published by the World Health Organisation (W.H.O.) earlier this year.

The research covered rates of syphilis, gonorrhoea and chlamydia in women aged between 15-49 in Fiji, the Federated States of Micronesia, Papua New Guinea and Samoa between 1995–2017.

According to the report, Samoa holds the highest estimated prevalence of chlamydia amongst the four countries in the study.

The nation’s chlamydia rates are expected to be a lot higher than projected in the report as only cases among women are reported, the report found. 

Data tends to be dominated by women as most cases are detected when women are pregnant and undergo antenatal care.

The consequences of untreated S.T.I.s can be life-altering and life-threatening despite often being symptomless in the majority of men and women carrying infections.  

Untreated chlamydia can cause pelvic inflammatory disease, infertility and fatal pregnancy. 

University of New South Wales Professor Heather Wolf says such high figures present a real threat to the future population of Samoa.

"We don't really know what the rates are with men so we only make sense that nearly 1-in-3 women of childbearing age has chlamydia, it could be a little less or a bit more but basically what it means is that there is a likelihood of a decrease in fertility and more ectopic pregnancy in women who have chlamydia," she said.

Professor Wolf recalled an earlier study of chlamydia in Samoa which noted that women with chlamydia in Samoa tended to be young and single and tended to have multiple sexual partners.

The report notes that Samoa's chlamydia prevalence has not fallen since 2000, which may be due to the low awareness amongst providers and target populations and the lack of an operational strategy for partner tracing.

Although Professor Wolf noted that the difficulty in detecting cases and seeking treatment also stems from attitudes towards seeking sexual health in Samoa.

Representatives from the Ministry could not be reached for contact on Sunday. 


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