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C HAPTER 4 HEALTHCARE-SEEKING BEHAVIOR AND SEXUAL BEHAVIOR IN NAIROBI 4.1. Healthcare-Seeking Behavior and Sexual Behavior of Patients with Sexually Transmitted Diseases in Nairobi, Kenya Summary Published in Sexually Transmitted Diseases, 2001; 367-371 by Fonck K, Mwai C, Rakwar J, Kirui P, Ndinya-Achola J, and Temmerman M. Sexual and health-seeking behaviors are important components of sexually transmitted disease (STD) control. We undertook this study to generate data for improved STD prevention and care, and to assess sexual behavior and relevant health-seeking behavior. A questionnaire to elicit social, demographic, healthcare-seeking, and sexual behavior information was administered to 471 patients attending the referral clinic for STDs in Nairobi, Kenya. A large proportion of the patients had sought treatment in public and private sectors before attending the clinic for STDs. Women waited longer than men to seek medical care. In addition, women more than men engaged in sex while symptomatic, mostly with their regular partner. Condoms were used rarely during illness. In their self-reports, 68% of the men admitted to having extramarital affairs, and 30% to paying for sex, yet they blamed their wives for their STDs. Health education messages in Kenya need adaptation to improve health-seeking behavior and safe sex practices. Introduction In Kenya, sexually transmitted diseases have long been recognized as a major public health problem because of their high prevalence and significant contribution to morbidity and mortality (Piot 1990, Hunter 1994, Temmerman 1990 & 1998). Furthermore, it is known that STDs, both ulcerative and non-ulcerative, facilitate HIV-1 transmission (Plummer 1991, Chapter 4 37
Wasserheit 1992, Laga 1993). In Nairobi, STDs represent 5% to 10% of the caseloads at many outpatient clinics (Reach 1988). Although the overall prevalence of STDs in the general population is not known, studies among specific population groups have illustrated high STD prevalence in both low- and high-risk groups. Work performed in 1989 among pregnant women in Nairobi showed prevalence rates of 6% for HIV, 3% for Neisseria gonorrhoeae, and 2% for syphilis (Temmerman 1992). Among women attending a family planning clinic in Nairobi, the prevalence rate was 10% for HIV-1, 4% for Chlamydia trachomatis, 2% for N. gonorrhoeae, 2% for syphilis, and 1% for genital ulcer disease (GUD) (Temmerman 1998 and 1995). A 1991 study of men attending an STD clinic in Nairobi showed an HIV seroprevalence of 24% (Tyndall 1994) among men with nonspecific symptoms as well as prevalence rates of 37% for N. gonorrhoeae and 33% for C. trachomatis (Tyndall 1999). The effectiveness of STD prevention and treatment programs depends, among other factors, on adequate knowledge about the health behavior and health-seeking behavior of the population, and on the sexual behavior characteristics of the target group. It is important to understand the dynamics and interactions that make a person decide why, when and where to seek care, and which health care facility to attend. To provide adequate health care, it is imperative to know whether the choice of the health facility for an STD differs from the choice for other common health problems. Issues such as accessibility and acceptability of services are key to the provision of successful STD services. This study examined the reasons for and patterns of health-seeking and related sexual behaviors of patients with STD-related signs and symptoms who present at STD referral clinics. The objective was to identify health-seeking behavioral factors and health servicerelated issues that can be used to improve STD services, and to develop education campaigns for the general public about seeking timely and correct STD treatment. Methods This study was conducted at the main public health STD referral clinic in Nairobi, also known as the Special Treatment Center. The clinic is located downtown and draws its patients from public and private institutions both within and outside Nairobi. The clinic, operated by the Nairobi City Council, serves as a referral clinic for approximately 50 primary health care clinics in Nairobi. Most of the peripheral public health clinics in Nairobi do not provide STD care, but reroute the patients with STD-related symptoms to the STD clinic. HEALTHCARE-SEEKING BEHAVIOR AND SEXUAL BEHAVIOR IN NAIROBI 38
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 and 16: female primary health care or anten
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: We believe that the observed declin
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
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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
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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
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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
Page 135 and 136:
Nous avons démontré que le coût
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vonden we een hoge prevalentie van
Page 139 and 140:
We hebben aangetoond dat de kost va
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