GHENT UNIVERSITY Karoline FONCK - International Centre for ...
GHENT UNIVERSITY Karoline FONCK - International Centre for ... GHENT UNIVERSITY Karoline FONCK - International Centre for ...
Of the patients interviewed, 68 (12%) refused to give a urine sample, with no statistical difference between the men and women (10% and 14% respectively, P=0.08). The dipstick results were positive in 109 (29%) of the patients, and no association with STI-related signs and symptoms was observed. Overall, 12 (3%) samples yielded positive PCR results for gonorrhea, 28 (6%) for chlamydia, and 2 for both. No difference in prevalence between the genders was observed. A positive PCR test result for gonorrhea, chlamydia or both was not associated with current reports of STI or with a history of STI or any other risk factor. Of the persons with positive PCR results for chlamydia, 9 (32%) had no reports of health problems on their medical cards. This was the case for 7 (58%) patients with positive PCR results for gonorrhea. None of the clinic cards of patients with positive PCR results mentioned any STI report, symptom, or diagnosis. The sensitivity, specificity, and positive predictive value of the dipstick for the detection of gonorrhea were 50%, 78%, and 6% respectively. For chlamydia those values were 26%, 88%, and 14% respectively. Discussion We found important gender differences in knowledge about health in general, and in healthseeking behavior among primary health care patients in a lower socio-economic population in Nairobi. This finding is similar to that described in other studies from both developing and developed countries, indicating that various socio-cultural and gender factors contribute to the delay in health-seeking (Johansson 2000, Oberlander 2000, Meyer-Weitz 2000). A study from Bangladesh reported that women with illness seek care significantly less often than men (Ahmed 2000). Patients may also neglect symptoms until the disease reaches a serious stage before seeking medical care. Furthermore, the kind of symptoms may influence the likelihood that patients will seek help (Goldman 2000). In western Kenya important differences in self-treatment practices and choice of medicines between boys and girls were found (Geissler 2000), which may reflect the higher income potential of boys. In Nairobi, the lack of economic means was found to be the most important factor influencing women with STI symptoms not to seek care (Fonck 2001). This may have serious consequences because it has been shown that the duration of sexually activity is one of the parameters determining the transmission dynamics of sexually transmitted infections in a given population (Anderson 1987). HEALTHCARE-SEEKING BEHAVIOR AND SEXUAL BEHAVIOR IN NAIROBI 53
Men reported more extramarital affairs and more histories of STI than women. Both genders reported low condom use. Rather high prevalences of STIs were found in this population, but with no difference between the genders. This may indicate that men are more likely to transmit STIs to their partners than women. This is consistent with the belief that African women are at increased risk of STI and HIV infections through their spouses (Hunter 1994, Quigley 1997, Ulin 1992). It is therefore urgent to educate men about taking their responsibilities and to either change their behavior or use safe sex methods. Hence, health education at various levels in Kenya must be improved, and messages should be directed more specifically to men. Both men and women were found to use the public health services less often than private sector health care when they have an STI. Another study in eastern Africa found that dissatisfaction with state medical provision is not manifested as rejection of the allopathic medicine with which it is associated, but as increased reliance on an emerging informal sector of private medical provision (Green 2000). In Kenya there has been a recent marked increase in the number of private clinics, with little control as to the quality of services they offer. There are no data on numbers of patients treated or the proportion of patients successfully treated. The consequences of patients receiving either inappropriate or insufficient drugs are dangerous (Moses 1992). The public health authorities in Kenya need to investigate the quality of treatment offered in these facilities, and if necessary, to provide appropriate training in the management of STIs for this cadre of health workers. Although STI management is provided in the public health sector, there exists a need to reexamine why there is a high proportion of treatment failures in these institutions. An important finding of our study was that the clinicians rarely recorded reports of health problems, signs, or symptoms of STI on clinic cards, although two of the three clinics offer integrated STI services. A possible explanation is that few patients, even if symptomatic, reported the STI directly. Even if they mentioned it, the clinicians were reluctant to indicate it on the cards. The training of health staff should put more emphasis on the importance of a good anamnesis and the correct recording of findings, treating an STI as any other health problem. We cannot conclude from this study whether individuals with positive laboratory testing showed signs or symptoms of STI because the cards did not indicate STI symptoms. Hence we can assume that a mixture of both symptomatic and non-symptomatic patients presented at the clinic. The performance of the dipstick procedure as a screening test for the detection of gonorrhea or chlamydia was unsatisfactory in this population. HEALTHCARE-SEEKING BEHAVIOR AND SEXUAL BEHAVIOR IN NAIROBI 54
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Of the patients interviewed, 68 (12%) refused to give a urine sample, with no statistical<br />
difference between the men and women (10% and 14% respectively, P=0.08). The dipstick<br />
results were positive in 109 (29%) of the patients, and no association with STI-related signs<br />
and symptoms was observed. Overall, 12 (3%) samples yielded positive PCR results <strong>for</strong><br />
gonorrhea, 28 (6%) <strong>for</strong> chlamydia, and 2 <strong>for</strong> both. No difference in prevalence between the<br />
genders was observed. A positive PCR test result <strong>for</strong> gonorrhea, chlamydia or both was not<br />
associated with current reports of STI or with a history of STI or any other risk factor. Of the<br />
persons with positive PCR results <strong>for</strong> chlamydia, 9 (32%) had no reports of health problems<br />
on their medical cards. This was the case <strong>for</strong> 7 (58%) patients with positive PCR results <strong>for</strong><br />
gonorrhea. None of the clinic cards of patients with positive PCR results mentioned any STI<br />
report, symptom, or diagnosis.<br />
The sensitivity, specificity, and positive predictive value of the dipstick <strong>for</strong> the detection of<br />
gonorrhea were 50%, 78%, and 6% respectively. For chlamydia those values were 26%,<br />
88%, and 14% respectively.<br />
Discussion<br />
We found important gender differences in knowledge about health in general, and in healthseeking<br />
behavior among primary health care patients in a lower socio-economic population<br />
in Nairobi. This finding is similar to that described in other studies from both developing and<br />
developed countries, indicating that various socio-cultural and gender factors contribute to<br />
the delay in health-seeking (Johansson 2000, Oberlander 2000, Meyer-Weitz 2000). A study<br />
from Bangladesh reported that women with illness seek care significantly less often than men<br />
(Ahmed 2000). Patients may also neglect symptoms until the disease reaches a serious<br />
stage be<strong>for</strong>e seeking medical care. Furthermore, the kind of symptoms may influence the<br />
likelihood that patients will seek help (Goldman 2000).<br />
In western Kenya important differences in self-treatment practices and choice of medicines<br />
between boys and girls were found (Geissler 2000), which may reflect the higher income<br />
potential of boys. In Nairobi, the lack of economic means was found to be the most important<br />
factor influencing women with STI symptoms not to seek care (Fonck 2001). This may have<br />
serious consequences because it has been shown that the duration of sexually activity is one<br />
of the parameters determining the transmission dynamics of sexually transmitted infections in<br />
a given population (Anderson 1987).<br />
HEALTHCARE-SEEKING BEHAVIOR AND SEXUAL BEHAVIOR IN NAIROBI 53
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