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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