GHENT UNIVERSITY Karoline FONCK - International Centre for ...

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The STI referral clinic, STC, is located in downtown Nairobi and offers STI syndromic management, laboratory services, health education and HIV counseling and testing. An average of 200 STI patients per day was cared for, the majority being male. In November 1996, a flat fee of 100 KSh was introduced, resulting in a drop in the number of patients (about 150 per day), which picked up slowly by 1998, at which stage the number of women bypassed the male patients attending STC. The majority of patients are self-referred (65% in 1998). Of all new cases seen, 10% to 12% are contacts of index patients at the same clinic. One of the priorities of the Kenyan authorities was to control syphilis during pregnancy and a centralized program was set up to that effect. After an evaluation of that program revealed some problems, syphilis screening has equally been decentralized in Nairobi. The same ten primary health care clinics have been equipped to perform a rapid plasma reagin (RPR) test on site. Pregnant women attending other PHC are referred to these 10 clinics for syphilis testing. INTRODUCTION 15
The research data have been published in the following papers in international peerreviewed journals: 1. Fonck K, Kidula N, Kirui P, Ndinya-Achola J, Bwayo J, Claeys P, Temmerman M. Pattern of sexually transmitted infections among women attending a major STI referral clinic in Nairobi, Kenya. Sex Transm Dis 2000; 27:417-23. (Chapter 3) The study was undertaken to 1) determine the etiology of STI among women attending the STD referral clinic, 2) determine the prevalence of CIN in this population, and 3) study risk markers for STIs and CIN. 2. Temmerman M, Fonck K, Bashir F, Inion I, Ndinya-Achola J, Bwayo J, Kirui P, Claeys P, Fransen L, Declining syphilis prevalence in pregnant women in Nairobi since 1995: another success story in the STD field? Int J STD AIDS 1999; 10:405-8. (Chapter 3) This paper describes the trend in syphilis seroprevalence in pregnant women between 1994 and 1997. 3. Fonck K, Mwai C, Rakwar J, Kirui P, Ndinya-Achola J, Bwayo J, Temmerman M. Healthcare-seeking behavior and sexual behavior of patients with sexually transmitted diseases in Nairobi, Kenya. Sex Transm Dis 2001; 28:367-371. (Chapter 4) The objective of this study was to identify health-seeking behavioral factors and health service related issues that can be used to improve STI services, and to develop education campaigns for the general public about seeking timely and correct STI treatment. 4. Fonck K, Mwai C, Bwayo J, Achola J, Temmerman M. Health-seeking and sexual behaviors among health care patients in Nairobi, Kenya. Sex Transm Dis 2002; 29:106- 111. (Chapter 4) The objective of the study was similar to the previous study, but different results were expected as a different population was targeted. 5. Fonck K, Kidula N, Jaoko W, Estambale B, Claeys P, Kirui P, Bwayo J, Temmerman M. Validity of the vaginal discharge algorithm among pregnant and non-pregnant women in Nairobi, Kenya. Sex Transm Inf 2000; 76:33-38. (Chapter 5) This study was undertaken to validate the current Kenyan clinical algorithm for vaginal discharge. We validated additional risk scores as well as inclusion of signs and symptoms among pregnant and non-pregnant women. INTRODUCTION 16
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 and 14: 4.5%, 3.9%, 67.7% and 30.1% while t
Page 15: female primary health care or anten
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
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In this study of symptomatic women,
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C HAPTER 6 PREVENTION OF SEXUALLY T
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Table 1: Syphilis Rapid Plasma Reag
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One should keep these problems in m
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The use of mailed reminders did not
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Table 1: Characteristics of women w
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studies, indicating that couples ar
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6.3. A Randomized, Placebo-controll
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esistance patterns in bystander flo
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In univariate analysis, the odds ra
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Widows, divorcees and separated wom
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They did not report much condom use
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The low prevalence of the other STD
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There is some evidence that frequen
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Table 1. Characteristics of HIV- po
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A significantly higher prevalence o
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There is now considerable evidence
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patients. The analysis revealed hig
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contributory factor may be that mal
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use in Kenya. In a supplement of Se
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with intensive behavioral change in
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C HAPTER 8 FINAL REMARKS STIs illus
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to protect themselves and be empowe
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Bell G, Ward H, Day S et al. Partne
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Fleming D and Wasserheit J. From ep
Page 117 and 118:
Jackson DJ, Rakwar JP, Chohan B et
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Manning B, Moodley J, Ross SM. Syph
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Oberlander L, Elverdam B. Malaria i
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Serwadda D, Gray R, Wawer M et al.
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Van Dam J, Anastasi MC. Male Circum
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WHO Collaborating Center on HIV/AID
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S UMMARY Sexually transmitted infec
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notification. Innovative and locall
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connaissance des femmes sur la sant
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Nous avons démontré que le coût
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vonden we een hoge prevalentie van
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We hebben aangetoond dat de kost va
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