GHENT UNIVERSITY Karoline FONCK - International Centre for ...

More documents

Recommendations

Info

Table 2: Treatment sought elsewhere and referral status among women and men attending the STD clinic. Men Women Had Sought Treatment Had Been Referred Had Sought Treatment Had been Referred Before (n=150) (n=61) Before (n=187) (n=104) Type of facility n (%) n (%) n (%) n (%) Nairobi City Council 36 (24) 45 (74) 79 (42) 80 (77) Government 14 (9) 2 (3) 18 (10) 12 (12) Private 71 (47) 7 (1) 65 (35) 8 (8) Chemist 13 (9) 0 (0) 5 (3) 0 (0) Mission 11 (7) 3 (5) 19 (10) 3 (3) Traditional healer 5 (3) 0 (0) 1 (1) 0 (0) Other 0 (0) 4 (7) 0 (0) 1 (1) Of the men, 181 (77%) were found to have urethritis, 12 (8%) genital ulcer disease, 6 (3%) other infections, and 19 (8%) no STD. Of the women, 83 (35%) were found to have vaginitis, 95 (40%) cervicitis, 30 (13%) pelvic inflammatory disease, 12 (8%) genital ulcer disease, 5 (2%) other infections, and 15 (6%) no STD. Table 3 shows the delay between the appearance of symptoms and the seeking of medical care by gender and by medical problem. The participants were symptomatic for an average of 1 week before seeking treatment, but the range of delay was wider for the women. Moreover, the participants, particularly the women, postponed their visit to the STD clinic for approximately 1 month, except in case of genital ulcer disease. Referred patients had a significant shorter delay before attending a health facility than the non-referred patients (12.7 days versus 40.6 days, P = 0.01). Table 3: Delay in days (median and percentiles [25-75]) between appearance of symptoms and medical contact, by gender. Days Before Seeking Treatment Days Between First Treatment and Visit to STD clinic Syndromes Man Women Man Women Any complaint 7 (3-14) 7 (3-21) 23 (5-60) 29 (7-90) Urethritis/PID/cervicitis 7 (3-14) 7 (3-30) 28 (5-60) 27 (7-90) GUD 7 (3-14) 7 (3-14) 14 (7-30) 16 (7-30) Vaginitis 7 (3-21) 46 (7-90) Non-STD 7 (2-21) 14 (3-30) 16 (7-60) 29 (3-150) Table 4 shows the participants' sexual behavior characteristics. Approximately half of the patients, significantly more women than men engaged in sex while symptomatic. Most of the women had sex with only one partner, who in most cases was their spouse or a regular partner. About one third of the men who engaged in sex while symptomatic had sex with two or more partners, and 22% had casual sex partners or sex in exchange for money. Only 19% of those who engaged in sex during illness used condoms, the men more often than the HEALTHCARE-SEEKING BEHAVIOR AND SEXUAL BEHAVIOR IN NAIROBI 41
women. Overall, significantly fewer women reported ever having used condoms (48% versus 63%, P = 0.001). Significantly more men (45%) than women (30%) had a history of STD (P < 0.000). Participants with a history of STD reported significantly more extramarital sex (54% versus 22%, P < 0.000) and had been referred less often (29% versus 39%, P = 0.05). More men than women had attended the STD clinic before (34% versus 24%, P = 0.01). Patients who had attended the STD clinic earlier or more often reported multiple partners (24% versus 12%, P = 0.04), previous STDs (65% versus 26%, P < 0.000), and sex in exchange for money (8% versus 2%, P = 0.04). Table 4: Sexual behavior during illness of 471 patients attending the STD clinic in Nairobi, Kenya. Men n % Women n % Sex while symptomatic 79 (34) 146 (62) P < 0.001 Number sex partners while ill: 1 54 (68) 137 (94) < 0.001 2 or more Sex partner 25 (32) 9 (6) 0.006 Spouse 42 (53) 97 (66) < 0.001 Girlfriend/boyfriend 37 (47) 22 (15) 0.04 Casual partner 7 (9) 4 (3) NS Person who received/gave gifts or money for sex 10 (13) 2 (1) 0.04 Condom use while symptomatic Condoms used with partner 17 (22) 26 (18) NS Spouse 5/17 (29) 15/26 (58) 0.04 Girlfriend/boyfriend 8/17 (47) 8/26 (30) NS Casual partner 2/17 (12) 2/26 (7) NS Person who received/gave gifts or money for sex NS= not significant. 4/17 (24) 0 NS As to the source of the current STD, only 57 (24%) of the men and 8 (3%) of the women responded. Men blamed mainly their regular partner for having contracted an STD, despite more self-reported risky behavior (Table 5). Most of the married men did not suspect their spouse of extramarital affairs, whereas almost half of the women thought their husbands engaged in extramarital sex. This was supported by 68% of the men self-reporting extramarital affairs, as compared with only 6% of the women. The unmarried men with a regular partner more often had a devious suspicion that their girlfriend had other partners. One third of all the men in the study also reported that they had paid for sex, as compared with 7% of women who admittedly had received money in exchange for sex. HEALTHCARE-SEEKING BEHAVIOR AND SEXUAL BEHAVIOR IN NAIROBI 42
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 and 38: We believe that the observed declin
Page 39 and 40: Wasserheit 1992, Laga 1993). In Nai
Page 41: Table 1: Demographic data of 471 pa
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?