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Manjate A, Sergon G, Kenga D, Golparian D, Tyulenev Y, Loquilha O, Mausse F, Guschin A, Langa JC, Passanduca A, Sacarlal J, Unemo M. Prevalence of sexually transmitted infections (STIs), associations with sociodemographic and behavioural factors, and assessment of the syndromic management of vaginal discharge in women with urogenital complaints in Mozambique. FRONTIERS IN REPRODUCTIVE HEALTH 2024; 6:1323926. [PMID: 38706519 PMCID: PMC11067503 DOI: 10.3389/frph.2024.1323926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 04/04/2024] [Indexed: 05/07/2024] Open
Abstract
In Mozambique, sexually transmitted infections (STIs) are estimated to be prevalent, but diagnosis and treatment of curable STIs rely only on syndromic management. We examined the prevalence of four non-viral STIs and HIV-1/2, based on etiological diagnosis, associations with sociodemographic and behavioural factors, and the STI diagnostic accuracy of the vaginal discharge syndromic management in women with urogenital complaints in Maputo, Mozambique. A cross-sectional study was performed in Maputo, Mozambique, February 2018-January 2019, enrolling 924 women of reproductive age with urogenital complaints. Endocervical/vaginal swabs were sampled and chlamydia, gonorrhoea, trichomoniasis and Mycoplasma genitalium infections were diagnosed using a multiplex real-time PCR (AmpliSens; InterLabServices). Serological testing was performed for HIV-1/2. A structured questionnaire collected metadata. All data were analyzed in STATA/IC 12.1 using descriptive statistics, chi-square tests and logistic regression model. About 40% of the women were less than 24 years old, 50.8% were single, 62.1% had their sexual debut between 12 and 17 years of age, and the main complaint was vaginal discharge syndrome (85%). The prevalence of chlamydia was 15.5%, trichomoniasis 12.1%, gonorrhoea 4.0%, M. genitalium 2.1%, and HIV-1/2 22.3%. The vaginal discharge syndrome flowchart had a sensitivity of 73.0%-82.5% and a specificity of 14%-15% for the detection of any individual non-viral STI in women with urogenital complaints. In total, 19.2% of the symptomatic women with chlamydia, trichomoniasis or gonorrhoea would not be detected and accordingly treated using the vaginal discharge syndromic management (missed treatment) and 70.0% of the women would be treated despite not being infected with any of these three STIs (overtreatment). In conclusion, a high prevalence of especially chlamydia, trichomoniasis, and HIV-1/2 was found in women of childbearing age with urogenital complaints in Maputo, Mozambique. Syndromic management of vaginal discharge revealed low accuracy in the detection of STIs in symptomatic women, especially low specificity, which resulted in under-treatment of STI-positive cases and incorrect or over-treatment of women with urogenital complaints, many of whom were negative for all the non-viral STIs. Etiological diagnosis is imperative for effective management of STIs in symptomatic and asymptomatic women.
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Affiliation(s)
- Alice Manjate
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Departament de Microbiologia, Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Gladys Sergon
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Darlenne Kenga
- Departament de Microbiologia, Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Daniel Golparian
- WHO Collaborating Centre for Gonorrhoea and Other Sexually Transmitted Infections, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Yuriy Tyulenev
- Department of Healthcare, Moscow Scientific and Practical Center of Dermatovenereology and Cosmetology, Moscow, Russia
| | - Osvaldo Loquilha
- Departamento de Matemática e Informática, Faculdade de Ciências, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Fabião Mausse
- Departament de Microbiologia, Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Alexander Guschin
- Department of Healthcare, Moscow Scientific and Practical Center of Dermatovenereology and Cosmetology, Moscow, Russia
| | - José Carlos Langa
- Departament de Microbiologia, Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Alfeu Passanduca
- Departament de Microbiologia, Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Jahit Sacarlal
- Departament de Microbiologia, Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Magnus Unemo
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- WHO Collaborating Centre for Gonorrhoea and Other Sexually Transmitted Infections, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Institute for Global Health, University College London (UCL), London, United Kingdom
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Hensen B, Phiri MM, Sigande L, Schaap A, Simuyaba M, Zulu-Phiri R, Mwape L, Floyd S, Fidler S, Hayes R, Simwinga M, Ayles H. Self-reported uptake of STI testing services among adolescents and young people aged 15-24 years: Findings from the Yathu Yathu cluster randomized trial in Lusaka, Zambia. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002491. [PMID: 38437238 PMCID: PMC10911628 DOI: 10.1371/journal.pgph.0002491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 12/18/2023] [Indexed: 03/06/2024]
Abstract
There is little evidence regarding community-based delivery of STI testing and treatment for youth aged 15-24 (AYP) in Zambia. In a cluster-randomised trial, we evaluated whether offering syndromic STI screening through community-based, peer-led sexual and reproductive health services (Yathu Yathu) with referral to a local health facility for testing, increased self-reported testing for STIs (other than HIV) among AYP. Two communities in Lusaka were divided into 10 zones each (20 zones in total); by community, zones were randomly allocated (1:1) to Yathu Yathu or control. Monitoring data were used to describe syndromic STI screening through Yathu Yathu and an endline cross-sectional survey used to evaluate the impact of Yathu Yathu on self-reported ever and recent (last 12 months) STI testing. 10,974 AYP accessed Yathu Yathu; 66.6% (females-67.7%; males-64.7%) were screened for STIs, 6.2% reported any STI symptoms. In the endline survey, 23.3% (n = 350/1501) of AYP who ever had sex ever STI tested; 13.5% (n = 174/1498) who had sex in the last 12 months recently STI tested. By trial arm, there was no difference in self-reported ever or recent STI testing among all AYP. Among men aged 20-24, there was evidence that ever STI testing was higher in the Yathu Yathu compared to control arm (24.1% vs 16.1%; adjPR = 1.67 95%CI = 1.02, 2.74; p = 0.04). Among AYP who ever STI tested, 6.6% (n = 23) reported ever being diagnosed with an STI. Syndromic STI management through community-based, peer-led services showed no impact on self-reported STI testing among AYP. Research on community-based delivery of (near) point-of-care diagnostics is needed. Trial registration number(s): NCT04060420 https://clinicaltrials.gov/ct2/show/NCT04060420; and ISRCTN75609016; https://doi.org/10.1186/ISRCTN75609016.
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Affiliation(s)
- Bernadette Hensen
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | | | | | - Ab Schaap
- Zambart, Lusaka, Zambia
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | | | - Sian Floyd
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sarah Fidler
- Department of Infectious Disease, Imperial College, London, United Kingdom
| | - Richard Hayes
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Helen Ayles
- Zambart, Lusaka, Zambia
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Oluoch L, Tapia K, Kiptinness C, Casmir E, Maina SG, Makena L, Selke S, Wang M, Chohan B, Sycuro L, Wald A, Ngure K, Mugo N, Roxby A. Longitudinal assessment of bacterial vaginosis prior to and during incident pregnancy: an observational study in Kenyan adolescent girls and young women. BMJ Open 2023; 13:e071746. [PMID: 37813538 PMCID: PMC10565234 DOI: 10.1136/bmjopen-2023-071746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 09/11/2023] [Indexed: 10/13/2023] Open
Abstract
OBJECTIVE To determine bacterial vaginosis (BV) status at multiple time points among adolescent girls and young women (AGYW) and assess the impact of pregnancy on their BV status. DESIGN Longitudinal cohort study. SETTING Thika, Kenya. PARTICIPANTS AGYW aged 16-20 years enrolled prior to first sex or reporting only a single lifetime partner. MAIN OUTCOME MEASURES The primary outcome was relative risk (RR) of BV during pregnancy compared with before pregnancy by analysing longitudinal trends in BV over time. BV risk was estimated using Poisson regression models. RESULTS A total of 121 AGYW became pregnant in the parent cohort and had BV results before, during or after pregnancy. Point prevalence of BV was 11.0% at visits >12 months pre-pregnancy, 13.0% at 3-12 months pre-pregnancy, 22.1% at <3 months pre-pregnancy and 13.4% during pregnancy. Compared with visits during pregnancy, RR of BV was 1.65 (95% CI: 1.00 to 2.71; p=0.05) at visits <3 months pre-pregnancy, 0.97 (95% CI: 0.62 to 1.52; p=0.90) at visits 3-12 months pre-pregnancy and 0.82 (95% CI: 0.44 to 1.53; p=0.53) at visits 12 months pre-pregnancy. An adjusted analysis including age, income, residence, date of first sex, recent sexual activity and positive sexually transmitted infection test resulted in small changes in risk estimates, with adjusted RR of BV of 1.66 (95% CI: 1.04 to 2.67; p=0.04) at visits <3 months pre-pregnancy compared with visits during pregnancy. CONCLUSIONS BV risk during pregnancy was lower than during the immediate pre-pregnancy period. Hormonal changes in pregnancy may reduce BV.
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Affiliation(s)
- Lynda Oluoch
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Kenneth Tapia
- Global Health, University of Washington, Seattle, Washington, USA
| | | | - Edinah Casmir
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | | | - L Makena
- Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Stacy Selke
- Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Melody Wang
- Global Health, University of Washington, Seattle, Washington, USA
| | - Bhavna Chohan
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
- Global Health, University of Washington, Seattle, Washington, USA
| | - Laura Sycuro
- Department of Microbiology, Immunology and Infectious Diseases; Obstetrics and Gynecology; Snyder Institute for Chronic Diseases; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Anna Wald
- Medicine, Laboratory Medicine and Pathology, Epidemiology, University of Washington, Seattle, Washington, USA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Kenneth Ngure
- Community Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Nelly Mugo
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
- Global Health, University of Washington, Seattle, Washington, USA
| | - Alison Roxby
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Global Health, Medicine, Epidemiology, University of Washington, Seattle, Washington, USA
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Kalbarczyk A, Mir F, Ariff S, Ali Nathwani A, Kazi M, Kaur G, Yousuf F, Hirani F, Sultana S, Bartlett LA, Lefevre AE, Bhutta S, Soofi S, Zaidi AKM, Winch PJ. Exploring terminology for puerperal sepsis and its symptoms in urban Karachi, Pakistan to improve communication, care-seeking, and illness recognition. Glob Public Health 2022; 17:3825-3838. [PMID: 36038965 DOI: 10.1080/17441692.2022.2115527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Puerperal sepsis is an important cause of maternal morbidity and mortality in developing countries. Awareness of local terminology for its signs and symptoms may improve communication about this illness, what actions to take when symptoms appear, timely care seeking, and clinical outcomes. This formative research aimed to improve recognition and management of postpartum sepsis in Pakistan by eliciting local terms used for postpartum illnesses and symptoms. We conducted 32 in-depth interviews with recently delivered women, their relatives, traditional birth attendants, and health care providers to explore postpartum experiences. Terms for symptoms and illness are used interchangeably (i.e. bukhar, the Urdu word for fever), many variations exist for the same term, and gradations of severity for each term as not associated with different types of illnesses. The lack of a designated term for postpartum sepsis in Urdu delays care-seeking and proper diagnosis, particularly at the community level. Ideally, a common lexicon for symptoms and postpartum sepsis would be developed but this may not be feasible or appropriate given the nature of the Urdu language and local understandings of postpartum illness. These insights can inform how we approach educational campaigns, the development of clinical algorithms that focus on symptoms, and counselling protocols.
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Affiliation(s)
- Anna Kalbarczyk
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Fatima Mir
- Pediatrics and Child Health, The Aga Khan University Karachi, Karachi, Pakistan
| | - Shabina Ariff
- Pediatrics and Child Health, The Aga Khan University Karachi, Karachi, Pakistan
| | - Apsara Ali Nathwani
- Pediatrics and Child Health, The Aga Khan University Karachi, Karachi, Pakistan
| | - Momin Kazi
- Pediatrics and Child Health, The Aga Khan University Karachi, Karachi, Pakistan
| | - Gurpreet Kaur
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Farheen Yousuf
- Obstetrics and Gynaecology, The Aga Khan University Karachi, Karachi, Pakistan
| | - Farzeen Hirani
- Pediatrics and Child Health, The Aga Khan University Karachi, Karachi, Pakistan
| | - Shazia Sultana
- Pediatrics and Child Health, The Aga Khan University Karachi, Karachi, Pakistan
| | - Linda A Bartlett
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Amnesty E Lefevre
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Shereen Bhutta
- Obstetrics and Gynaecology, Jinnah Postgraduate Medical Center Karachi, Karachi, Pakistan
| | - Sajid Soofi
- Pediatrics and Child Health, The Aga Khan University Karachi, Karachi, Pakistan
| | - Anita K M Zaidi
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Peter J Winch
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Murewanhema G, Moyo E, Mhango M, Chitungo I, Moyo P, Musuka G, Dzobo M, Dzinamarira T. Abnormal vaginal discharge among women of reproductive age in sub-Saharan Africa: the need for a paradigm shift from a syndromic approach to specific pathogen identification and directed treatment. IJID REGIONS 2022; 5:165-168. [PMID: 36467508 PMCID: PMC9713322 DOI: 10.1016/j.ijregi.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/26/2022] [Accepted: 10/26/2022] [Indexed: 06/17/2023]
Abstract
Background An abnormal vaginal discharge is a frequent manifestation of reproductive tract infections, including sexually transmitted infections (STIs) and vulvovaginal candidiasis. It is also a manifestation of bacterial vaginosis, which has a prevalence of up to 50% among women of reproductive age. Reproductive tract infections are associated with a range of reproductive health challenges and increase the risk of HIV acquisition. Methods This study was performed to critically review and discuss the current diagnostic and treatment approaches to abnormal vaginal discharge among women of reproductive age in sub-Saharan Africa, and to call for a paradigm shift from the syndromic approach to specific pathogen identification and directed antimicrobial therapy. Discussion Young women have the highest incidence of HIV infection in sub-Saharan Africa. Countries in sub-Saharan Africa where the prevalence of both STIs and bacterial vaginosis is very high have been employing a syndromic approach for the treatment of abnormal vaginal discharge since around 1984. However, the syndromic approach has several limitations, with the potential to miss infections, over-diagnose and over-treat STIs, and propagate antimicrobial resistance, which is one of the greatest global health challenges of the 21st century. Conclusions The low to middle-income countries of sub-Saharan Africa must innovate and leverage improved diagnostics to capacitate primary health care and other levels for point-of-care diagnostic testing, in order to provide an immediate diagnosis and treatment for women with an abnormal vaginal discharge.
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Affiliation(s)
| | - Enos Moyo
- University of Zimbabwe, Harare, Zimbabwe
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Mugambi ML, Pintye J, Heffron R, Barnabas RV, John-Stewart G. HIV Prevention Tools Across the Pregnancy Continuum: What Works, What Does Not, and What Can We Do Differently? Curr HIV/AIDS Rep 2022; 19:293-300. [PMID: 35984551 PMCID: PMC9717592 DOI: 10.1007/s11904-022-00621-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW Multiple tools exist to support the primary prevention of HIV in pregnant and postpartum women; however, there are opportunities to enhance their use and impact. This review summarizes the current status of HIV prevention tools and existing gaps and opportunities to improve their use along the pregnancy care continuum. RECENT FINDINGS HIV screening efforts have steadily improved with close to universal screening of pregnant women in several East and Southern African countries. Strategies to implement partner testing through the distribution of HIV self-test kits are promising though linkage to care remains challenging. Syphilis screening rates are increasing though detection of other sexually transmitted infections could benefit from improved diagnostic capacity. Male and female condoms are rarely used and are often not the optimal tool of choice during pregnancy. Oral pre-exposure prophylaxis (PrEP) is a promising tool, although barriers such as the need for daily adherence, side effects, and stigma may limit its use. There is a growing pipeline of PrEP agents with alternative delivery platforms that might suit women's preferences better and supports the notion that choice is vital to improving HIV prevention coverage during the pregnancy-postpartum continuum. Clear guidance on which tools to use and how to use them, safety data supporting their use, and surveillance data documenting the scale and effectiveness of the tools will be imperative in establishing a path to more impactful prevention efforts among pregnant and postpartum women.
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Affiliation(s)
- Melissa Latigo Mugambi
- Department of Global Health, Hans Rosling Center, University of Washington, 3980 15th Ave NE, Box 351620, Seattle, WA, 98195, USA.
| | - Jillian Pintye
- Department of Global Health, Hans Rosling Center, University of Washington, 3980 15th Ave NE, Box 351620, Seattle, WA, 98195, USA
- School of Nursing, University of Washington, Seattle, WA, USA
| | - Renee Heffron
- Department of Global Health, Hans Rosling Center, University of Washington, 3980 15th Ave NE, Box 351620, Seattle, WA, 98195, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- University of Alabama Birmingham, Birmingham, AB, USA
| | - Ruanne Vanessa Barnabas
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Grace John-Stewart
- Department of Global Health, Hans Rosling Center, University of Washington, 3980 15th Ave NE, Box 351620, Seattle, WA, 98195, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
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Ayalew E, Fentaw S, Ebrahim S, Seyoum E, Woldesenbet Z, Wolde M. Comparison of syndromic versus laboratory-confirmed diagnosis of Neisseria gonorrhoeae and Treponema palladium, infections at the selected health centers in Addis Ababa, Ethiopia. Reprod Health 2022; 19:88. [PMID: 35366922 PMCID: PMC8976957 DOI: 10.1186/s12978-022-01395-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 03/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sexually transmitted infections (STIs) are major infectious diseases worldwide. Around one million people get STIs every day and among them a high burden of the diseases seen in Sub-Saharan African countries. In most developing countries, including Ethiopia, STIs are diagnosed only using syndromic methods, although there seems to be no consensus between syndromic and laboratory-based research. OBJECTIVE To compare the effectiveness of a syndromic versus laboratory-based approach in the diagnosis of sexually transmitted infections, especially Neisseria gonorrhoeae (NG) and Treponema palladium (TP), infections among those attending a public health center in Addis Ababa, Ethiopia. METHODS a cross-sectional study was conducted from April 2019 to March 2020, at selected health centers STIs clinics in Addis Ababa, Ethiopia. A total of 325 study participants were involved. From each participant after having socio-demographic data, additional blood, urethral and vaginal discharge was collected. Then serological, Gram stain, culture, and biochemical tests were performed. SPSS version 23 was used to enter and analyze data. All relevant bodies provided ethical approval, and each study participant gave written informed consent. RESULTS Among the total participants 167 (51.4%) were males; 177 (54.5%) between ages of 26 and 35; and 178(54.8%) single. Of the total 325 NG, and 125 TP syndromic managed suspected cases, only 163 (50%) and 38 (30.4%) were laboratory- confirmed positive cases respectively. However, there was no statistically significant difference between NG and TP syndromic versus laboratory diagnostic confirmed cases (P-value > 0.005). CONCLUSION The present study indicated that even if, there were no statistical differences between syndromic versus Laboratory diagnosis confirmed NG and TP cases, more than half of syndromic cases could not be confirmed by laboratory diagnosed tests. Thus, to strengthen the present findings, further large-scale studies are recommended.
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Affiliation(s)
- Enaniye Ayalew
- Department of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Surafel Fentaw
- Department of Microbiology, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Semira Ebrahim
- Department of Microbiology, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Elias Seyoum
- Department of Microbiology, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Zerihun Woldesenbet
- Department of Microbiology, Yekatit 12 Hospital and Medical College, Addis Ababa, Ethiopia
| | - Mistire Wolde
- Department of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
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Anywaine Z, Lule SA, Hansen C, Warimwe G, Elliott A. Clinical manifestations of Rift Valley fever in humans: Systematic review and meta-analysis. PLoS Negl Trop Dis 2022; 16:e0010233. [PMID: 35333856 PMCID: PMC8986116 DOI: 10.1371/journal.pntd.0010233] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 04/06/2022] [Accepted: 02/03/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Rift Valley fever (RVF) is an emerging, neglected, mosquito-borne viral zoonosis associated with significant morbidity, mortality and expanding geographical scope. The clinical signs and symptoms in humans are non-specific and case definitions vary. We reviewed and analysed the clinical manifestations of RVF in humans. METHODS In this systematic review and meta-analysis we searched on different dates, the Embase (from 1947 to 13th October 2019), Medline (1946 to 14th October 2019), Global Health (1910 to 15th October 2019), and Web of Science (1970 to 15th October 2019) databases. Studies published in English, reporting frequency of symptoms in humans, and laboratory confirmed RVF were included. Animal studies, studies among asymptomatic volunteers, and single case reports for which a proportion could not be estimated, were excluded. Quality assessment was done using a modified Hoy and Brooks et al tool, data was extracted, and pooled frequency estimates calculated using random effects meta-analysis. RESULTS Of the 3765 articles retrieved, less than 1% (32 articles) were included in the systematic review and meta-analysis. Nine RVF clinical syndromes were reported including the general febrile, renal, gastrointestinal, hepatic, haemorrhagic, visual, neurological, cardio-pulmonary, and obstetric syndromes. The most common clinical manifestations included fever (81%; 95% Confidence Interval (CI) 69-91; [26 studies, 1286 patients]), renal failure (41%; 23-59; [4, 327]), nausea (38%; 12-67; [6, 325]), jaundice (26%; 16-36; [15, 393]), haemorrhagic disease (26%; 17-36; [16, 277]), partial blindness (24%; 7-45; [11, 225]), encephalitis (21%; 11-33; [4, 327]), cough (4%; 0-17; [4, 11]), and miscarriage (54%) respectively. Death occurred in 21% (95% CI 14-29; [16 studies, 328 patients]) of cases, most of whom were hospitalised. DISCUSSION This study delineates the complex symptomatology of human RVF disease into syndromes. This approach is likely to improve case definitions and detection rates, impact outbreak control, increase public awareness about RVF, and subsequently inform 'one-health' policies. This study provides a pooled estimate of the proportion of RVF clinical manifestations alongside a narrative description of clinical syndromes. However, most studies reviewed were case series with small sample sizes and enrolled mostly in-patients and out-patients, and captured symptoms either sparsely or using broad category terms.
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Affiliation(s)
- Zacchaeus Anywaine
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
- * E-mail:
| | - Swaib Abubaker Lule
- Institute for Global Health, University College London, London, United Kingdom
| | - Christian Hansen
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
- MRC International Statistics & Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - George Warimwe
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
- KEMRI WellcomeTrust Research Programme, Kilifi, Kenya
| | - Alison Elliott
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
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Iyemosolo BM, Chivese T, Esterhuizen TM. A comparison of the prevalence of sexually transmitted infections among circumcised and uncircumcised adult males in Rustenburg, South Africa: a cross-sectional study. BMC Public Health 2021; 21:656. [PMID: 33823828 PMCID: PMC8022379 DOI: 10.1186/s12889-021-10509-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 02/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND South Africa has a persistent burden of sexually transmitted infections (STIs). Male circumcision has been shown to be effective in preventing HIV and STIs, but data are scarce on the protective effect of circumcision in high-risk populations such as migrant miners. The objective of this study was to assess the effect of medical and traditional circumcision on the prevalence of STIs after adjusting for other risk factors in Rustenburg, a mining town in North West Province, South Africa. METHODS This cross-sectional study used baseline data collected from a cohort study. Adult males in a mining town were assessed for STIs (gonorrhea, chlamydia, and trichomoniasis) using syndromic assessment. Data on circumcision status and other risk factors for STI syndromes were collected using an interviewer-administered questionnaire. The following symptoms were assessed; penile discharge, painful urination, dyspareunia or penile sores. These symptoms indicate sexually transmitted infection in general since laboratory tests were not performed. Multivariable log binomial regression was used to assess the independent effect of circumcision on STI presence after adjusting for confounders. RESULTS A total of 339 participants with a median age of 25 years (IQR 22-29) were included in the study, of whom 116 (34.2%) were circumcised. The overall STIs prevalence was 27.4% (95% CI 22.8 to 32.6%) and was lower in the circumcised participants compared with those who were uncircumcised (15.5% vs 33.6%, respectively, p < 0.001). Both medical (OR 0.57, 95% CI 0.34-0.95, p = 0.030) and traditional circumcision (OR 0.34, 95% CI 0.13-0.86, p = 0.022) were strongly associated with a lower risk of STIs after adjustment for employment and condom use. CONCLUSION In this high-risk population in a mining town in South Africa, with a relatively high prevalence of STIs, and where one third of males are circumcised, both medical and traditional circumcision appear to be protective against STIs.
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Affiliation(s)
- Blanchard Mbay Iyemosolo
- Department of Global Health, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, University of Stellenbosch, Cape Town, South Africa
| | - Tawanda Chivese
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Tonya M. Esterhuizen
- Department of Global Health, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, University of Stellenbosch, Cape Town, South Africa
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Cheng Y, Paintsil E, Ghebremichael M. Syndromic versus Laboratory Diagnosis of Sexually Transmitted Infections in Men in Moshi District of Tanzania. AIDS Res Treat 2020; 2020:7607834. [PMID: 32089879 PMCID: PMC7029278 DOI: 10.1155/2020/7607834] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 12/26/2019] [Indexed: 11/30/2022] Open
Abstract
The syndromic diagnosis of sexually transmitted infections (STIs) is widely recognized as the most practical, feasible, and cost-effective diagnostic tool in resource-limited settings. This study assessed the diagnostic accuracy of syndromic versus laboratory testing of STIs among 794 men randomly selected from the Moshi district of Tanzania. Participants were interviewed with a questionnaire that included questions on history of STIs symptoms. Blood and urine samples were taken from the participants for laboratory testing. Only 7.9% of the men reported any symptoms of STI; however, 46% of them tested positive for at least one STI. There was little agreement between syndromic and laboratory-confirmed diagnoses, with low sensitivity (0.4%-7.4%) and high specificity (96%-100%) observed for each individual symptom. The area under the receiver-operating curve was 0.528 (95% CI: 0.505-0.550), indicating that the syndromic approach has a 52.8% probability of correctly identifying STIs in study participants. In conclusion, whenever possible, laboratory diagnosis of STI should be favored over syndromic diagnosis.
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Affiliation(s)
- Yuwei Cheng
- Department of Mathematical and Computer Sciences, College of the Holy Cross, Worcester, MA, USA
| | - Elijah Paintsil
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - Musie Ghebremichael
- Harvard Medical School, Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, USA
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Dela H, Attram N, Behene E, Kumordjie S, Addo KK, Nyarko EO, Kyei NNA, Carroll JNA, Kwakye C, Duplessis CA, Adams N, Garges E, Letizia AG. Risk factors associated with gonorrhea and chlamydia transmission in selected health facilities in Ghana. BMC Infect Dis 2019; 19:425. [PMID: 31096920 PMCID: PMC6524331 DOI: 10.1186/s12879-019-4035-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 04/26/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Understanding the underlying epidemiology that shapes Neisseria gonorrhoeae (GC), and Chlamydia trachomatis (CT) infections can contribute to data driven policies directed towards curbing the proliferation of these pathogens in Ghana. Information on the symptoms and risk factors for STIs will help to identify high-risk individuals which will in turn inform STI syndromic management and tailor the use of public health resources. METHODS Participants were from 4 military clinics and 1 civilian STI clinic in Ghana and eligible if they had symptoms suggestive of STI. First void urine samples were collected and tested with Nucleic Acid Amplification Test (NAAT). A structured questionnaire was administered to all participants. Multivariate logistic regression identified factors associated with infection, separately for NG and for CT and for men and women. RESULTS A total of 950 patients, 58% of whom were females were enrolled, 28% had gonorrhea and 11% had chlamydia with more males testing positive than females. Reported symptoms that were more common among patients who tested positive for gonorrhea were painful urination and urethral discharge (all P values < 0.05). Additionally, multiple sexual partners and alcohol use were statistically associated with higher rates of gonorrhea in males while only the frequency of condom use was associated with gonorrhea for females. None of the symptoms or risk factors except marital status was associated with testing positive for chlamydia. CONCLUSION Identifying these symptoms and risk factors help inform health care delivery systems for STIs in Ghana. Furthermore, men and women presenting with these symptoms and risk factors are a prime target for public health education campaigns, aimed at curbing the spread of gonorrhea and chlamydia infections.
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Affiliation(s)
- Helena Dela
- Noguchi Memorial Institute for Medical Research (NMIMR), Legon, Ghana.
| | - Naiki Attram
- US Naval Medical Research Unit 3 Ghana Detachment, Accra, Ghana
| | - Eric Behene
- Noguchi Memorial Institute for Medical Research (NMIMR), Legon, Ghana
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Ghosh I, Paul B, Das N, Bandyopadhyay D, Chakrabarti MK. Etiology of Vaginal/Cervical Discharge Syndrome: Analysis of Data from a Referral Laboratory in Eastern India. Indian J Dermatol 2018; 63:484-489. [PMID: 30504977 PMCID: PMC6233047 DOI: 10.4103/ijd.ijd_296_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Context Sexually transmitted infections (STIs) and reproductive tract infections (RTIs) constitute important public health problem worldwide. Syndromic diagnosis of vaginal/cervical discharge (VCD) is often inaccurate leading to over- or under-treatment. Aims This study aimed to ascertain the laboratory-confirmed diagnosis of VCD and their relative frequency in a group of patients presenting to a STI clinic in eastern India and to determine the sensitivity and specificity of clinical diagnosis. Settings and Design This was a cross-sectional study. Materials and Methods Data of 5301 consecutive patients with VCD were analyzed for etiological diagnosis and the findings were compared with laboratory data of 3110 asymptomatic cases. Statistical Analysis Used Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of clinical diagnosis of vaginal discharge syndrome were obtained considering the results of the laboratory diagnosis as gold standard. The strength of agreement was computed using Kappa statistic. Results Of 5301 cases of VCD, 90.83% had STI/RTIs. The most prevalent infection was trichomoniasis (35.23%), followed by bacterial vaginosis (33.05%) and vulvovaginal candidiasis (19.67%). Sensitivity, specificity, PPV, and NPV of vaginal discharge as an indicator of STI/RTI were 85.5%, 99.0%, 99.3%, and 80%, respectively, with agreement of 90.49% and kappa value of 0.8, indicating "almost perfect" agreement. Many cases with VCD also suffered from other STIs such as herpes simplex virus-2, hepatitis B, human immunodeficiency syndrome, and syphilis and some asymptomatic cases suffered from one or more STIs. Conclusions All patients with VCD with high-risk behavior should preferably undergo laboratory evaluation of the VCD syndrome to avoid over- or under-treatment.
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Affiliation(s)
- Ishita Ghosh
- Department of VD Serology and Department of STD, Institute of Serology, Kolkata, West Bengal, India
| | - Bandhan Paul
- Department of VD Serology and Department of STD, Institute of Serology, Kolkata, West Bengal, India
| | - Nibedita Das
- Department of VD Serology and Department of STD, Institute of Serology, Kolkata, West Bengal, India
| | - Debabrata Bandyopadhyay
- Department of Dermatology, Venereology and Leprosy, Medical College, Kolkata, West Bengal, India
| | - Manas Kumar Chakrabarti
- Department of VD Serology and Department of STD, Institute of Serology, Kolkata, West Bengal, India
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Uchenna C, Govender I. Knowledge, attitudes and practices of doctors at Jubilee Hospital, Tshwane District, regarding the syndromic management guidelines for sexually transmitted infections. S Afr Fam Pract (2004) 2018. [DOI: 10.1080/20786190.2018.1487212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- Charles Uchenna
- Department of Family Medicine and Primary Health Care, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Indiran Govender
- Department of Family Medicine and Primary Health Care, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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Sevoyan A, Agadjanian V. Male Migration, Women Left Behind, and Sexually Transmitted Diseases in Armenia. INTERNATIONAL MIGRATION REVIEW 2018. [DOI: 10.1111/j.1747-7379.2010.00809.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The effect of male circular labor migration on risks of sexually transmitted diseases (STDs) among women left behind has not been well studied. Our study examines this effect using data from a survey of 1,240 married women in rural Armenia, where international male labor migration has traditionally been very common. A multivariate comparison of women married to migrants and women married to non-migrants finds that the former, ceteris paribus, reported more STD symptoms, on average, and were more likely to report diagnosed STDs than the latter. However, in the case of STD symptoms, this effect is moderated by household income, as the predicted number of STD symptoms reported by migrants’ wives increases as income rises. The findings illustrate the complex tradeoffs that migration entails for left-behind women and are interpreted in the context of the literature on gender, migration, and STDs.
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15
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Garrett NJ, Osman F, Maharaj B, Naicker N, Gibbs A, Norman E, Samsunder N, Ngobese H, Mitchev N, Singh R, Abdool Karim SS, Kharsany ABM, Mlisana K, Rompalo A, Mindel A. Beyond syndromic management: Opportunities for diagnosis-based treatment of sexually transmitted infections in low- and middle-income countries. PLoS One 2018; 13:e0196209. [PMID: 29689080 PMCID: PMC5918163 DOI: 10.1371/journal.pone.0196209] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 04/09/2018] [Indexed: 11/18/2022] Open
Abstract
Introduction In light of the limited impact the syndromic management approach has had on the global sexually transmitted infection (STI) epidemic, we assessed a care model comprising point-of-care (POC) STI testing, immediate treatment, and expedited partner therapy (EPT) among a cohort of young women at high HIV risk in South Africa. Methods and findings HIV negative women presenting for STI care underwent POC testing for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Trichomonas vaginalis (TV), and swabs were sent for NG culture and susceptibility testing. Results were available within 2 hours and women with STIs were immediately treated and offered EPT packs, including medication, condoms, and information for sexual partners. An EPT questionnaire was administered after one week, and women retested for STIs after 6 and 12 weeks. 267 women, median age 23 (IQR 21–26), were recruited and 88.4% (236/267) reported genital symptoms. STI prevalence was CT 18.4% (95%CI 13.7–23.0), NG 5.2% (95%CI 2.6–7.9) and TV 3.0% (95%CI 1.0–5.0). After 12 weeks, all but one NG and two CT infections were cleared. No cephalosporin-resistant NG was detected. Of 63/267 women (23.6%) diagnosed with STIs, 98.4% (62/63) were offered and 87.1% (54/62) accepted EPT. At one week 88.9% (48/54) stated that their partner had taken the medication. No allergic reactions or social harms were reported. Of 51 women completing 6-week follow up, detection rates were lower amongst women receiving EPT (2.2%, 1/46) compared to those who did not (40.0%, 2/5), p = 0.023. During focus group discussions women supported the care model, because they received a rapid, specific diagnosis, and could facilitate their partners’ treatment. Conclusions POC STI testing and EPT were acceptable to young South African women and their partners, and could play an important role in reducing STI reinfection rates and HIV risk. Larger studies should evaluate the feasibility and cost-effectiveness of implementing this strategy at population level.
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Affiliation(s)
- Nigel J. Garrett
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
- School of Nursing and Public Health, Discipline of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa
- * E-mail:
| | - Farzana Osman
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
| | - Bhavna Maharaj
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
| | - Nivashnee Naicker
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
| | - Andrew Gibbs
- South African Medical Research Council, Durban, South Africa
| | - Emily Norman
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
- Department of Epidemiology, Columbia University, New York City, United States of America
| | - Natasha Samsunder
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
| | - Hope Ngobese
- Prince Cyril Zulu Communicable Disease Centre, eThekwini Municipality, Durban, South Africa
| | - Nireshni Mitchev
- Department of Microbiology, University of KwaZulu-Natal, Durban, South Africa
| | - Ravesh Singh
- Department of Microbiology, University of KwaZulu-Natal, Durban, South Africa
- National Health Laboratory Service, Durban, South Africa
| | - Salim S. Abdool Karim
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
- Department of Epidemiology, Columbia University, New York City, United States of America
| | - Ayesha B. M. Kharsany
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
| | - Koleka Mlisana
- Department of Microbiology, University of KwaZulu-Natal, Durban, South Africa
- National Health Laboratory Service, Durban, South Africa
| | - Anne Rompalo
- Johns Hopkins University, Baltimore, United States of America
| | - Adrian Mindel
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
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Obiero J, Rulisa S, Ogongo P, Wiysonge CS. Nifuratel-Nystatin combination for the treatment of mixed infections of bacterial vaginosis, vulvovaginal candidiasis, and trichomonal vaginitis. Hippokratia 2018. [DOI: 10.1002/14651858.cd013012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Jael Obiero
- Institute of Primate Research; Department of Reproductive Health and Biology; Nairobi Kenya
| | - Stephen Rulisa
- University of Rwanda; Department of Obstetrics and gynecology, School of Medicine and Pharmacy; BP 655 Kigali Rwanda
| | - Paul Ogongo
- Institute of Primate Research; Tropical and Infectious Diseases; P.O Box 24481 -00502, Karen Nairobi Kenya
| | - Charles S Wiysonge
- South African Medical Research Council; Cochrane South Africa; Francie van Zijl Drive, Parow Valley Cape Town Western Cape South Africa 7505
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Sonkar SC, Wasnik K, Kumar A, Sharma V, Mittal P, Mishra PK, Bharadwaj M, Saluja D. Evaluating the utility of syndromic case management for three sexually transmitted infections in women visiting hospitals in Delhi, India. Sci Rep 2017; 7:1465. [PMID: 28469158 PMCID: PMC5431118 DOI: 10.1038/s41598-017-01422-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 03/28/2017] [Indexed: 12/25/2022] Open
Abstract
Utility of syndromic case management (SCM) in women visiting obstetrics & gynecology department needs to be evaluated as it is subjective and imperfect. Consequently, antibiotic resistance has accelerated along with increased risk of infection to the partners. To understand the effectiveness and/or inadequacies of SCM, 11000 women were recruited and examined by clinicians for infection by Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Trichomonas vaginalis (TV), Bacterial vaginosis (BV) and others. Amongst these patients, 1797 (16.3%) reported vaginal discharge (VD). Other symptoms included: vaginitis (97%), cervicitis (75%), genital ulcers (60%), abnormal vaginal discharge (55%) and lower abdominal pain (48%). The patients were treated for single or co-infections using pre-packed National Aids Control Program III STI/RTI Kits. However, based on PCR diagnostics, 1453/1797 (81%) subjects were uninfected for NG/TV/CT. Amongst 344 (19%) infected patients, 257 (75%) carried infection with single pathogen (TV/NG/CT) while 87/344 (25%) were co-infected with multiple pathogens. Prevalence of TV, NG & CT was 4%, 7% and 8% respectively. Co-infection with CT + NG was highest, 51% (44/87), whereas, co-infection with CT + TV was 21% and NG + TV was 18% while co-infection with all three pathogens was 1.3%. We conclude that SCM is imprecise and successful intervention requires accurate and confirmatory diagnostic approach.
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Affiliation(s)
- Subash Chandra Sonkar
- Medical Biotechnology Laboratory, Dr. B. R. Ambedkar Center for Biomedical Research, University of Delhi, Delhi, India
| | - Kirti Wasnik
- Medical Biotechnology Laboratory, Dr. B. R. Ambedkar Center for Biomedical Research, University of Delhi, Delhi, India
| | - Anita Kumar
- Department of Obstetrics & Gynecology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Vineeta Sharma
- National Institute of Cancer Prevention and Research, Formerly Institute of Cytology and Preventive Oncology (Indian Council of Medical Research), Noida, Uttar Pradesh, India
| | - Pratima Mittal
- Department of Obstetrics & Gynecology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Prashant Kumar Mishra
- Medical Biotechnology Laboratory, Dr. B. R. Ambedkar Center for Biomedical Research, University of Delhi, Delhi, India
| | - Mausumi Bharadwaj
- National Institute of Cancer Prevention and Research, Formerly Institute of Cytology and Preventive Oncology (Indian Council of Medical Research), Noida, Uttar Pradesh, India
| | - Daman Saluja
- Medical Biotechnology Laboratory, Dr. B. R. Ambedkar Center for Biomedical Research, University of Delhi, Delhi, India.
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19
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The Syndromic versus Laboratory Diagnosis of Sexually Transmitted Infections in Resource-Limited Settings. ISRN AIDS 2014; 2014:103452. [PMID: 24729919 PMCID: PMC3963213 DOI: 10.1155/2014/103452] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 01/20/2014] [Indexed: 11/17/2022]
Abstract
Sexually transmitted infections (STIs) are highly prevalent in sub-Saharan Africa, where there is a severe HIV epidemic. Thus, accurate recognition and diagnosis of STIs are essential for successful HIV prevention programs in the region. Due to lack of trained personnel and adequate laboratory infrastructure in the region, information regarding the profile of STIs relies essentially on self-reported or physician-diagnosed symptoms. The main objective of the study was to assess the effectiveness of the syndromic diagnosis of STIs, which is often used as a proxy for laboratory diagnosis of STIs in sub-Saharan Africa and other resource-limited settings. The study builds on previously collected data from a community-based survey in Northern Tanzania. We found no significant agreements between patient-reported STIs symptoms and laboratory-confirmed STIs tests. The reported STIs symptoms had high specificity (range = 85-99%) and poor sensitivity (range = 2-17%). Knowledge gained from our study will have significant public health implications, and can help improve the syndromic diagnosis of STIs.
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Souverein D, Euser SM, Ramaiah R, Narayana Gowda PR, Shekhar Gowda C, Grootendorst DC, Barot S, Jenniskens F, Kumar S, Kumar S, Den Boer JW. Reduction in STIs in an empowerment intervention programme for female sex workers in Bangalore, India: the Pragati programme. Glob Health Action 2013; 6:22943. [PMID: 24378194 PMCID: PMC3875344 DOI: 10.3402/gha.v6i0.22943] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 11/15/2013] [Accepted: 11/28/2013] [Indexed: 11/23/2022] Open
Abstract
Background/Objective The Pragati programme is an on-going empowerment programme for female sex workers (FSWs) working and living in Bangalore, India. Pragati aims to reduce transmission of HIV and sexually transmitted infections (STIs) among FSWs. This study describes the STI incidence rate, contact rate, and condom use during follow-up years. Design Between April 2005 and November 2010, 20,330 FSWs participated in the programme. Outcome measures were programme exposure (number of contacts per person-year), STI incidence rate, and condom use. All analyses were stratified by year of follow-up. STIs were diagnosed by syndromic case management in either programme or referral clinics. We restricted our analyses to the period between April 2005 and July 2008 (when the majority of STIs were diagnosed in programme clinics), in order to minimise the possible influence of differences in STI diagnosis between clinic types. Results Results showed a significant increase of programme exposure (p-value for trend < 0.001) and a significant decrease in the STI incidence rate (p-value for trend < 0.001) over the follow-up time (between April 2005 and July 2008). Reported condom use at last paid sex increased from 77.6% in year 1 to 100% in year 4 of follow-up (p-value for trend < 0.001). Conclusion Our data seem to suggest that the Pragati programme had a positive effect on the STI incidence rate and condom use, possibly as a result of increased programme exposure. We recommend for future studies to invest more in the study design, type of data collection, and recording mechanisms before starting with an intervention. Incorporation of empowerment strategies as an approach in HIV prevention programmes can have a beneficial effect on the lives and livelihoods of FSWs.
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Affiliation(s)
- Dennis Souverein
- Department of Epidemiology, Regional Public Health Laboratory Kennemerland, Haarlem, The Netherlands;
| | - Sjoerd M Euser
- Department of Epidemiology, Regional Public Health Laboratory Kennemerland, Haarlem, The Netherlands
| | | | | | | | - Diana C Grootendorst
- Department of Epidemiology, Regional Public Health Laboratory Kennemerland, Haarlem, The Netherlands
| | - Snehal Barot
- Swasti A Health Resource Center, Bangalore, India
| | | | - Sunil Kumar
- Karnataka Health Promotion Trust, Bangalore, India
| | - Shiv Kumar
- Swasti A Health Resource Center, Bangalore, India
| | - Jeroen W Den Boer
- Department of Epidemiology, Regional Public Health Laboratory Kennemerland, Haarlem, The Netherlands
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Partner notification for sexually transmitted infections in developing countries: a systematic review. BMC Public Health 2010; 10:19. [PMID: 20082718 PMCID: PMC2821362 DOI: 10.1186/1471-2458-10-19] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2009] [Accepted: 01/18/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The feasibility and acceptability of partner notification (PN) for sexually transmitted infections (STIs) in developing countries was assessed through a comprehensive literature review, to help identify future intervention needs. METHODS The Medline, Embase, and Google Scholar databases were searched to identify studies published between January 1995 and December 2007 on STI PN in developing countries. A systematic review of the research extracted information on: (1) willingness of index patients to notify partners; (2) the proportion of partners notified or referred; (3) client-reported barriers in notifying partners; (4) infrastructure barriers in notifying partners; and (5) PN approaches that were evaluated in developing countries. RESULTS Out of 609 screened articles, 39 met our criteria. PN outcome varied widely and was implemented more often for spousal partners than for casual or commercial partners. Reported barriers included sociocultural factors such as stigma, fear of abuse for having an STI, and infrastructural factors related to the limited number of STD clinics, and trained providers and reliable diagnostic methods. Client-oriented counselling was found to be effective in improving partner referral outcomes. CONCLUSIONS STD clinics can improve PN with client-oriented counselling, which should help clients to overcome perceived barriers. The authors speculate that well-designed PN interventions to evaluate the impact on STI prevalence and incidence along with cost-effectiveness components will motivate policy makers in developing countries to allocate more resources towards STI management.
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Hay P, Ugwumadu A. Detecting and treating common sexually transmitted diseases. Best Pract Res Clin Obstet Gynaecol 2009; 23:647-60. [PMID: 19646929 DOI: 10.1016/j.bpobgyn.2009.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2009] [Accepted: 06/16/2009] [Indexed: 10/20/2022]
Abstract
In the UK, many sexually transmitted infections (STIs) are best managed in conjunction with an appropriate specialist, for example, a genitourinary medicine practitioner or a Microbiologist. In most of the world, however, gynaecologists routinely manage STIs in women. This article focuses on the most important infections in women, and those in which management is changing. It also addresses the current status, and new developments around the syndrome of pelvic inflammatory disease (PID), which essentially is an STI.
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Affiliation(s)
- Phillip Hay
- Department of Genitourinary Medicine, St George's University of London, London, UK
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Yin YP, Wu Z, Lin C, Guan J, Wen Y, Li L, Detels R, Rotheram-Borus MJ. Syndromic and laboratory diagnosis of sexually transmitted infection: a comparative study in China. Int J STD AIDS 2008; 19:381-4. [PMID: 18595875 DOI: 10.1258/ijsa.2007.007273] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The rate of sexually transmitted infections (STIs) has soared in China. Yet, there is no universal consensus about the accuracy of the syndromic approach to STI management. This study aims to compare the syndromic approach with laboratory tests. A randomly selected sample of market vendors in eastern China (n = 4510) was recruited and assessed for the five most common STIs (Chlamydia trachomatis infection, gonorrhoea, genital herpes [herpes simplex type 2, HSV-2] syphilis and trichomoniasis [female only]). Symptom-based assessments made by physicians were compared with laboratory tests. Laboratory test results were used as the gold standard for the comparisons. The overall sensitivity of physician symptom-based assessment was about 10%; sensitivity was lower for males (1.6%) than for females (17.2%). The sensitivity of physician assessments for those who reported STI symptoms was relatively higher (36.7%) than for those who reported no symptoms (5.1%). More than half (54.37%) of the participants were diagnosed with STI of trichomoniasis. For the other four types of STIs, physicians correctly identified only <10% of the positive cases. The study detected a low sensitivity of STI diagnosis made by physicians in an Eastern city of China. The failure in the detection of asymptomatic patients remains one of the limitations of the syndromic approach.
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Affiliation(s)
- Yue-ping Yin
- National Center for STD Control, China CDC, Nanjing, China.
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Khandoker A, . MK, . NA, . MFEC, . MK, . MM. Association Between Decision Making Autonomy and Knowledge of HIV/AIDS Prevention among ever Married Women in Bangladesh. JOURNAL OF MEDICAL SCIENCES 2006. [DOI: 10.3923/jms.2006.155.163] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Khan MMH, Wolter S, Mori M. Post-training quality of syndromic management of sexually transmitted infections by chemists and druggists in Pokhara, Nepal: is it satisfactory? Int J Qual Health Care 2005; 18:66-72. [PMID: 16254006 DOI: 10.1093/intqhc/mzi086] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Using simulated client and provider interview methods, this study assessed chemists and druggists' post-training management quality of syndromic sexually transmitted infections focusing on the areas of privacy maintaining, encouraging, history taking, counseling, referral practice, partner notification, and drug prescribing and then compared the findings of two methods. DESIGN Forty-five pharmacies from a list of 75 in Pokhara, who collected sexually transmitted infections data during 1999, were selected randomly. First simulated client successfully presented either urethral or vaginal discharge syndrome at 37 pharmacies and recorded the events of whole encounter into an observation form within 20 minutes. Later 39 chemists and druggists were interviewed by a pre-tested semi-structured questionnaire. MAIN MEASURE Results were reported mainly by numbers and corresponding percentages. For comparative purpose, P values were also shown. RESULTS Overall, interview method revealed satisfactory knowledge of chemists and druggists for management of sexually transmitted infections except drug prescribing but their actual behaviors, revealed by simulated client method, indicated lower quality and differed significantly in the areas of encouraging, history taking, counseling, referral practice, and partner notification. Both methods indicated very poor qualities of drug prescribing. CONCLUSION Retained knowledge of chemists and druggists for syndromic management of sexually transmitted infections were not applied to simulated client in actual practice. They should not prescribe drugs for patients of sexually transmitted infections, except referring to the doctors/hospitals. Continuous monitoring and further motivations for them may improve syndromic management quality of sexually transmitted infections. Moreover, depending on the purpose of study, various methods should be applied simultaneously to reach a better conclusion.
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Affiliation(s)
- M M H Khan
- Department of Public Health, Sapporo Medical University, Japan.
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Hoyo C, Hoffman I, Moser BK, Hobbs MM, Kazembe P, Krysiak RG, Cohen MS. Improving the accuracy of syndromic diagnosis of genital ulcer disease in Malawi. Sex Transm Dis 2005; 32:231-7. [PMID: 15788921 DOI: 10.1097/01.olq.0000149669.98128.ce] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES/GOAL Most resource-poor settings rely on syndromic criteria to diagnose genital ulcer disease (GUD). However, the etiologic pathogens of GUD vary temporally and geographically, and current criteria may not reflect changes in the prevalence of specific pathogens. STUDY In 1999, we estimated the prevalence of Treponema pallidum (Tp), herpes simplex virus (HSV), and Haemophilus ducreyi (Hd) in Malawi. We then used regression coefficients of independent correlates of HSV and Hd to develop weighted diagnostic algorithms, in which weights were beta-coefficients corresponding to each factor. RESULTS Overall, a decrease in the proportion of sexually transmitted disease attributable to GUD was noted in 7 years. Thirty-five percent were attributable to HSV, 30% to H. ducreyi, and 4% to T. pallidum. Areas under the receiver operating characteristic curves for weighted and unweighted HSV diagnostic algorithms were 67.6% and 66.5%, respectively. There was no significant difference in the explanatory performance of the weighted and unweighted algorithms. CONCLUSIONS Unweighted algorithms can therefore be used to improve diagnostic accuracy of GUD.
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Affiliation(s)
- Cathrine Hoyo
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
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Liu H, Jamison D, Li X, Ma E, Yin Y, Detels R. Is syndromic management better than the current approach for treatment of STDs in China? Evaluation of the cost-effectiveness of syndromic management for male STD patients. Sex Transm Dis 2003; 30:327-30. [PMID: 12671553 DOI: 10.1097/00007435-200304000-00010] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The syndromic treatment approach has not been evaluated in sexually transmitted disease (STD) clinics in China. GOAL The goal was to evaluate and compare the validity and cost-effectiveness of syndromic management with current STD management for men in clinics in Hefei, China. STUDY DESIGN Diagnostic accuracy, treatment appropriateness, costs, and effectiveness of current clinical procedures and syndromic management were compared for 406 men attending four STD clinics. RESULTS A modified World Health Organization (WHO) syndromic algorithm for urethral discharge yielded 100% sensitivity and a 69% positive predictive value (PPV). A syndromic algorithm for genital ulcers correctly treated all syphilis patients, with a 25% PPV. The average cost (in US dollars) per correct treatment by the current approach was 323.48 dollars for urethritis and 85.65 dollars for syphilis. For the syndromic approach, the average cost per correct treatment was 3.15 dollars for urethritis and 13.54 dollars for syphilis. CONCLUSION Syndromic management can provide better treatment for men with STDs at significantly lower cost in resource-poor settings such as China.
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Affiliation(s)
- Hongjie Liu
- School of Public Health, University of California, Los Angeles, 90095-1772, USA
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Redwood-Campbell L, Plumb J. The syndromic approach to treatment of sexually transmitted diseases in low-income countries: issues, challenges, and future directions. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2002; 24:417-24. [PMID: 12196862 DOI: 10.1016/s1701-2163(16)30405-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Sexually transmitted diseases (STDs) are a major cause of adult morbidity worldwide. In 1991, the World Health Organization (WHO) introduced the concept of the "syndromic approach" to managing sexually transmitted diseases in low-income countries, however, there has been some controversy regarding the ongoing use of this approach. OBJECTIVES (1) To understand the use of the syndromic approach to managing sexually transmitted diseases in low-income countries, and to determine if evidence supports its continued use. (2) To help Canadian doctors understand the past STD management of immigrant patients from low-income countries, and evaluate the direct effect (if any) of such medical practices to the patient's health and perception of health in Canada. METHODS Medline was searched under the key words "sexually transmitted diseases," "developing nations," and "syndrome," as well as "algorithms," "prevention and control," and "WHO." Research articles and data were also accessed from the Web sites of WHO, UNAIDS, Reproductive Health Online (JHSPH), and the Centers for Disease Control and Prevention (USA). Data were selected based on the relevance to the topic, and research articles assessed from a methodological perspective. Most research articles were of Level II-2 evidence or lower as described using the Evaluation of Evidence criteria outlined in the Report of the Canadian Task Force on the Periodic Health Exam. RESULTS In resource-poor countries, the use of the syndromic approach is appropriate for high-risk groups and for symptomatic individuals. However, it is still a poor screening approach when applied to asymptomatic cases, particularly in women. Risk scoring and simple laboratory tests help to increase the algorithmic sensitivity of the syndromic approach. CONCLUSION Syndromic management involves making clinical decisions based on a patient's symptoms and signs. Until inexpensive, simple, and accurate STD diagnostics are developed and made available for use in low-income countries, a modified syndromic approach is the most feasible method of STD management in these countries. It is useful for Canadian physicians to be aware of this approach especially when caring for women from these countries.
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Voeten HA, Otido JM, O'Hara HB, Kuperus AG, Borsboom GJ, Ndinya-Achola JO, Bwayo JJ, Habbema JD. Quality of sexually transmitted disease case management in Nairobi, Kenya: a comparison among different types of healthcare facilities. Sex Transm Dis 2001; 28:633-42. [PMID: 11677385 DOI: 10.1097/00007435-200111000-00005] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In Nairobi, the prevalence for sexually transmitted diseases (STDs) among attenders at antenatal and family planning clinics is substantial, but knowledge about the quality of STD case management is scarce. GOAL To assess quality of STD case management in Nairobi healthcare facilities. STUDY DESIGN All the facilities in five sublocations were enumerated. In 142 facilities, 165 providers were interviewed, observed during 441 interactions with patients who had STDs, and visited by a simulated patient. RESULTS For observations of patients with STDs, correct history-taking ranged from 60% to 92% among the various types of facilities, correct examination from 31% to 66%, and correct treatment from 30% to 75%. The percentage of correctness for all three aspects (World Health Organization prevention indicator 6) varied between 14% and 48%. Public clinics equipped for STD care performed best in all aspects, whereas treatment was poorest in pharmacies and private clinics. The providers trained in STD management performed better than those without training. CONCLUSIONS Quality of STD case management was unsatisfactory except in public STD-equipped clinics. This indicates the need for improvement by interventions such as further training in syndromic management, improved supervision, and the introduction of prepackaged syndromic management kits.
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Affiliation(s)
- H A Voeten
- Department of Public Health, Erasmus University, Rotterdam, The Netherlands.
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Lawoyin TO, Larsen U, Osinowo H, Walker ME. Sexual behavioural risks of married men in Oyo State, Nigeria. Int J STD AIDS 2001; 12:63-4. [PMID: 11214817 DOI: 10.1177/095646240101200114] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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