GHENT UNIVERSITY Karoline FONCK - International Centre for ...

More documents

Recommendations

Info

state-of-the-art laboratory for the detection of STI and HIV is available. The clinical work is performed mainly at following sites (Figure 4): • The Nairobi Special Treatment Clinic (STC), a down-town City Council referral STI clinic receiving 150 to 200 patients per day; • Pumwani Maternity Hospital, a large City Council referral maternity hospital with an average of 75 deliveries per day; • The Pumwani prostitute clinic, a special out-patient clinic for commercial sex workers in a slum area where commercial sex workers live and work; • The Langata City Council health center in which premises an out-patient clinic for a cohort of commercial sex workers from the surrounding largest Nairobi slum area has been established; • The ten City Council clinics all around the city of Nairobi, with decentralized STI case management, where first line STI treatment is provided including RPR screening for syphilis in pregnancy; Figure 4: NCC health facilities in Nairobi Source: HassConsult real estate 1.7. Study populations 1 Ngong Road 2 Riruta 3 Langata 4 Westlands 5 STC 6 Pumwani Maternity 7 Eastleigh 8 Umoja 9 Kariobangi 10 Baba Dogo 11 Dandora The study populations consist of various target groups such as commercial sex workers (core group), male and female STI clinic attendees (possible “bridging” group), and male and INTRODUCTION 13
female primary health care or antenatal clinic attendees (general population) as summarized in Table 2. Table 2: Summary of different population groups studied. Place of recruitment Sex Number Some characteristics Study 1 STC Female STI clinic attendees 520 33 % pregnant Study 2 PHC Pregnant women 81,311 5.2% RPR positive Study 3 STC Male and female STI clinic attendees 471 50% male Study 4 PHC Male and female PHC attendees 555 44% male Study 5 PHC + STC Women with vaginal discharge 621 53 % pregnant Study 6 PHC Pregnant women 27,377 3.4% RPR positive Study 7 PMH Post-delivery syphilis sero-positive women 357 Study 8 PHC Commercial sex workers 318 5% pregnant Study 9 PHC Commercial sex workers 543 A total of 54 health centers, controlled by the Public Health Department of the Nairobi City Council, care for the largest part of the low-income population of Nairobi. Mission and nongovernmental organizations (NGO) health facilities also exist in Nairobi, especially in the slum areas. It is not known what proportion of the population is covered by their services. Recently, Kenya, and in particular Nairobi, has seen a boom in private health facilities, going from private hospitals to nurse-run medical cabinets. Very often, these facilities are staffed by personnel employed by the MoH or the NCC who try to increase their rather modest public service salary by accumulation of employment. Although no data is available on the utilization rate of these centers, it seems that they are quite popular. This might be one of the reasons why the STI clinic catered for about 150 - 200 patients per day at the time of the study, reduced from about 500 daily a couple of years earlier. 1.8. STI management in Nairobi STI case management has been decentralized in Nairobi to ten primary health care (PHC) clinics. Those ten clinics have trained staff and are provided with the necessary first line STI drugs. Diagnostic algorithms are used at this level for diagnosis and treatment of STIs. These algorithms provide also for one alternative treatment after a first treatment failure. If still unsuccessful, the patient is referred to the STI clinic in downtown Nairobi, the STC (Special Treatment Center). PHC clinics without possibilities of STI management may refer the patient either to a nearby PHC with STI management or directly to the STI clinic (STC), a decision mostly based on distance. INTRODUCTION 14
Page 1 and 2: GHENT UNIVERSITY STI PREVENTION AND
Page 3 and 4: AIDS Acquired Immune Deficiency Syn
Page 5 and 6: 1.1. Sexually Transmitted Infection
Page 7 and 8: countries, the rate of reporting co
Page 9 and 10: district of Uganda randomized villa
Page 11 and 12: By identifying where significant
Page 13: 4.5%, 3.9%, 67.7% and 30.1% while t
Page 17 and 18: The research data have been publish
Page 19 and 20: 2.1. OBJECTIVES 2.1.1. General obje
Page 21 and 22: 2.2.3. Laboratory procedures The mi
Page 23 and 24: C HAPTER 3 PREVALENCE AND RISK FACT
Page 25 and 26: After registration by the clinic cl
Page 27 and 28: The majority of the women were infe
Page 29 and 30: eing single, ever having been treat
Page 31 and 32: prevalence found in a family planni
Page 33 and 34: 3.2. Declining Syphilis Prevalence
Page 35 and 36: Training Nurses at the antenatal cl
Page 37 and 38: We believe that the observed declin
Page 39 and 40: Wasserheit 1992, Laga 1993). In Nai
Page 41 and 42: Table 1: Demographic data of 471 pa
Page 43 and 44: women. Overall, significantly fewer
Page 45 and 46: Stigmatization by health staff also
Page 47 and 48: 4.2. Health-Seeking Behavior and Se
Page 49 and 50: Between September and November 1998
Page 51 and 52: Table 2: Healthcare-seeking behavio
Page 53 and 54: Thirteen women had engaged in sex w
Page 55 and 56: Men reported more extramarital affa
Page 57 and 58: C HAPTER 5 DIAGNOSIS AND MANAGEMENT
Page 59 and 60: discharge and abdominal pain-two co
Page 61 and 62: Data were entered and analyzed in S
Page 63 and 64: One of the peripheral health center
Page 65 and 66:
Evaluation of Algorithms The result
Page 67 and 68:
In this study of symptomatic women,
Page 69 and 70:
C HAPTER 6 PREVENTION OF SEXUALLY T
Page 71 and 72:
Table 1: Syphilis Rapid Plasma Reag
Page 73 and 74:
One should keep these problems in m
Page 75 and 76:
The use of mailed reminders did not
Page 77 and 78:
Table 1: Characteristics of women w
Page 79 and 80:
studies, indicating that couples ar
Page 81 and 82:
6.3. A Randomized, Placebo-controll
Page 83 and 84:
esistance patterns in bystander flo
Page 85 and 86:
In univariate analysis, the odds ra
Page 87 and 88:
Widows, divorcees and separated wom
Page 89 and 90:
They did not report much condom use
Page 91 and 92:
The low prevalence of the other STD
Page 93 and 94:
There is some evidence that frequen
Page 95 and 96:
Table 1. Characteristics of HIV- po
Page 97 and 98:
A significantly higher prevalence o
Page 99 and 100:
There is now considerable evidence
Page 101 and 102:
patients. The analysis revealed hig
Page 103 and 104:
contributory factor may be that mal
Page 105 and 106:
use in Kenya. In a supplement of Se
Page 107 and 108:
with intensive behavioral change in
Page 109 and 110:
C HAPTER 8 FINAL REMARKS STIs illus
Page 111 and 112:
to protect themselves and be empowe
Page 113 and 114:
Bell G, Ward H, Day S et al. Partne
Page 115 and 116:
Fleming D and Wasserheit J. From ep
Page 117 and 118:
Jackson DJ, Rakwar JP, Chohan B et
Page 119 and 120:
Manning B, Moodley J, Ross SM. Syph
Page 121 and 122:
Oberlander L, Elverdam B. Malaria i
Page 123 and 124:
Serwadda D, Gray R, Wawer M et al.
Page 125 and 126:
Van Dam J, Anastasi MC. Male Circum
Page 127 and 128:
WHO Collaborating Center on HIV/AID
Page 129 and 130:
S UMMARY Sexually transmitted infec
Page 131 and 132:
notification. Innovative and locall
Page 133 and 134:
connaissance des femmes sur la sant
Page 135 and 136:
Nous avons démontré que le coût
Page 137 and 138:
vonden we een hoge prevalentie van
Page 139 and 140:
We hebben aangetoond dat de kost va
show all

GHENT UNIVERSITY Karoline FONCK - International Centre for ...

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?