Knowledge, attitudes and practices of doctors at Jubilee Hospital, Tshwane District, regarding the syndromic management guidelines for sexually transmitted infections (original) (raw)
Related papers
2017
Background: Sexually transmitted infections (STIs) are a public health problem globally, but especially so in sub-Saharan Africa. They contribute significantly to the burden of disease in South Africa and are recognised as major contributors to the human immunodeficiency virus (HIV) epidemic, with other potential complications when not managed properly. First-line doctors play a critical role in the management of persons suffering from STIs, and need to comply with the national guidelines for STI management. Aim: To determine the knowledge, attitudes and practices of doctors working in Jubilee District Hospital, Metsweding region, Tshwane, regarding the STI syndromic management (SM) guidelines. Setting: Jubilee District Hospital in Tshwane North, Gauteng province, South Africa. Methods: A cross-sectional, descriptive study using a self-administered questionnaire was conducted. Results: Forty-three of the 50 doctors employed at the hospital participated in the study. Fourteen (32.6%) of the doctors were in the 36-40-year age group. Most of the doctors (36 or 83.7%) had only the basic bachelor's degree, and only 4 (9.3%) attended additional STI training. Only 2 respondents (4.6%) had correct knowledge concerning management of male urethritis syndrome and 10 (23.3%) regarding management of genital ulcer syndrome. In compliance with the national SM guidelines for STIs, 22 (52.4%) of the doctors said they made a diagnosis of STIs using history and physical examination. Only 7 (16.7%) said they asked their patients during every consultation about the number of sexual partners, 21 (51.7%) said they always counsel/ screen patients with STIs for HIV infection, and only 4 (9.5%) said they always filled in partner notification slips after attending to the index patient with STIs. This study demonstrated a relationship between doctors' knowledge of the SM guidelines for STIs and their age. Conclusion: Overall the knowledge and practices of doctors at Jubilee District Hospital were suboptimal, and training on the SM of STIs should be made available to address this. Management should introduce regular monitoring, evaluation and supportive services for the doctors regarding their management of STIs according to the guidelines.
Sexually transmitted diseases, 2016
The sexually transmitted infection (STI) clinical encounter is an opportunity to identify current and prevent new HIV and STI infections. We examined knowledge, attitudes, and practices regarding STIs and HIV among public and private providers in a large province in South Africa with a high disease burden. From November 2008 to March 2009, 611 doctors and nurses from 120 public and 52 private clinics serving patients with STIs in Gauteng Province completed an anonymous, self-administered survey. Responses were compared by clinic location, provider type, and level of training. Most respondents were nurses (91%) and female (89%), were from public clinics (91%), and had received formal STI training (67%). Most (88%) correctly identified all of the common STI syndromes (i.e., genital ulcer syndrome, urethral discharge syndrome, and vaginal discharge syndrome). However, almost none correctly identified the most common etiologies for all 3 of these syndromes (0.8%), or the recommended fir...
Sexually transmitted infections in primary care
InnovAiT, 2016
Provision of quality health care service is the product of cooperation between the patient and the healthcare provider (HCP) in a supportive environment. The efficiency of STIs health program requires proper management and efficient use of resources. In Sudan the STIs services are provided as part of PHC service package. The management and responsibility for PHC centers is decentralized to state and locality levels. This study investigated the managerial factors at health care system , and care provision levels that affect the provision of quality STIs service, and consequently the utilization of STIs health service, in El-Damazin locality at Blue Nile state (BNS), 2015-2016. The study design was descriptive cross-sectional facility-based applying qualitative research method. Purposive sampling technique was applied for health program managers at state ministry of health (SAP coordinator, RH coordinator and the manager of curative medicine department) and the care providers at all primary health centers in El-damazin locality (total of eight centers and ten care providers). Both content and framework analysis was performed. The following findings were identified by the program managers as barriers to the provision of STI services: the verticality state AIDS program (SAP) and reproductive health program (RH), ineffective coordination between both SAP, RH, and the curative medicine department, and inadequate financial & technical resources. The STIs were reflected in the annual plans, however not prioritized and budgeted. The care providers were not following the standard STI syndromic management protocols, they identified the lack of treatment protocol tools, and no recent trainings on STIs were the main barriers to provide quality services. In addition, the care providers indicated low health seeking of the surrounding communities for STI. It is recommended that proper advocacy on the importance of STI, in addition to effective coordination between the relevant programs at ministry of health should be activated, and are mandatory to ensure proper technical and financial resource mobilization which consequently will yield into provision of quality management of STI program. Moreover, care providers are required to be equipped with the necessary skills and tools in order to provide high quality syndromic management of STIs.
Journal of sexually transmitted diseases, 2015
Background. Sexually Transmitted Infections (STIs) are the leading causes of morbidity among young adults. This study assessed the knowledge and practice of clinicians regarding syndromic management of STIs in public health facilities of Gamo Gofa Zone, Southern Ethiopia. Methods. Facility based cross-sectional study with mixed methods of data collection was conducted in public health facilities of Gamo Gofa Zone. The study included 250 clinicians and 12 health facilities, 26 mystery clients were hired, and 120 STI patient cards were reviewed. Data was entered in EPI info version 7.0.1 and analyzed by SPSS version 20. Results. Of the participated clinicians, 32 (12.8%) were trained on syndromic management of STIs. Highest knowledge of clinicians was for urethral discharge (27.2%). Professional category of clinicians and type of health facility (AOR = 0.194; 95% CI = 0.092, 0.412) were determinants of urethral discharge knowledge. Of the cards reviewed, only in 8.3% of cards and 19.2...
Curationis, 2007
Curationis 30(4): 21-30 Sexually transmitted infections are a major public health problem in South Africa. The high incidence and prevalence of sexually transmitted infections in South Africa pose a serious threat to public health for tw o m ain reasons. Firstly, the long-term consequences o f these infections are a major cause o f loss o f health or life, and secondly, sexually transmitted infections are important co-factors in driving the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) epidemic. The control and prevention o f sexually transmitted infections has become an urgent priority. At a primary health care clinic, the nursing personnel experienced an increasing num ber of persons daily seeking treatment for sexually transmitted infections. The purpose o f the study was therefore to investigate the know ledge, attitudes and perceptions o f people seeking treatment at Stanza Bopape Clinic regarding sexually transmitted infections. The study was a contextual, quantitative survey. The population was all patients (15 years and older) who visited the clinic for a health-related problem during November 2004 to January 2005. The sampling method was convenient. The data gathering method was self-report using a structured questionnaire basic on current knowledge. The data analysis was done with descriptive statistics.
International Journal of Infectious Diseases, 2014
Background: Sexually transmitted infections (STIs), particularly genital ulcer diseases (GUD) are a neglected field in health care, partly due to the stigma associated with the diseases. Coinfection with HIV alters the clinical presentation, natural history and response to treatment. Moreover, STIs contribute significantly to increased risk of HIV transmission. Management of STIs at primary health care level is syndromic, driven by algorithms. In the absence of interest and expertise at secondary/tertiary care centres patients, who fail this management, suffer. Methods & Materials: We present a retrospective chart review of patients referred to our a specialist Infectious Diseases Unit with challenging or unusual STI/GUD, who did not respond to syndromic management. Results: We have closely documented 42 patients (23 male, 39 HIV positive) seen at King Edward VIII hospital for STI/GUD. The patients had an average of 2.6 different primary health care providers (range: 1-5) before coming to the tertiary site. Only 54.8% were formally referred. 15 patients had extensive chronic HSV ulcers (8 males, all HIV +). Of these, 7 responded to high doses of acyclovir (400 mg 8 hourly to 800 mg 5 times daily). Duration of treatment varied from 7 to 21 days. 6 chronic HSV ulcers (4 males) failed high dose acyclovir but responded to topical imiquimod treatment. Of 13 patients (9 males) with extensive condylomata acuminata (warts) 4 underwent curative circumcision and 9 required extensive ablation. 5 of the latter (3 males) had squamous cell carcinomas. All were managed syndromically as STIs for >18 months. 4 patients had chronic genital ulcers with no discernible cause and very low CD4 counts. These ulcers healed completely after commencement of anti-retroviral treatment. One male with penile abscesses and multiple urinary fistulas had trichomonas vaginalis repeatedly isolated and responded to a prolonged course of metronidazole. Other diagnoses included severe tinea cruris (4), lichen planus chronicus (2), papular pruritic eruptions (PPE) (1), penile pearly papules (PPP) (1), vitiligo (1). Conclusion: We need to develop expertise in the management of patients who do not respond to syndromic STI/GUS treatment and develop clear referral pathways to secondary and tertiary care centres with adequate facilities and investigative capacity for timeous diagnosis and intervention. This is particularly urgent in the context of HIV/AIDS.
Global Journal of Health Science, 2012
Introduction: The main objective for this study was to investigate the quality of Sexually Transmitted Infections (STI) treatment and control by the private sector in Namibia. Method: This was a cross-sectional study employing quantitative methodology using different methods of data collection. A self-administered questionnaire exploring General Practitioners (GPs) perceptions of factors that influence the way they manage Sexually Transmitted Infections (STI) which was then concluded with the face to face interviews and the checklist that was used while doing observations in the consulting rooms Results: A total of 50 private general practitioners in the area of Windhoek were interviewed, 48 self-administered questionnaires plus all checklists were received back from the private general practitioners. None of the private general practitioners interviewed had specific training in the syndromic management of the STIs. The 86% of all patients were seen by these private general practitioners on a medical aid, while 14 % pay cash for service provided. With regard to Urethral Discharge, an average of 56.5% of GPs could treat urethral discharge correctly as per the Namibian syndromic approach guidelines. None of the GPs could demonstrate the correct treatment of genital ulcer (whether they received medical aid or not) as recommended in the syndromic approach guidelines in Namibia (GRN, 1999; 2000). Only 28% of the GPs could demonstrate the correct treatment of Pelvic Inflammatory Disease (PID) as per the syndromic management of the STIs. For patients without medical aid the drugs prescribed and their dosages for PID are correct but the frequencies are not in line with the guidelines as for patients with medical aid. Discussion: In general, patients presenting with STIs to the GPs in private practices are not given quality of care because not all private general practitioners have time to do investigations, counseling, give condoms and to notify the partners of those with urethral discharge, genital ulcers and PID looking for treatment.
There's ample evidence that other sexually transmitted infections, whether ulcerative or non-ulcerative, promote HIV transmission by increasing HIV infectivity and susceptibility through several mechanisms, mostly via direct biological pathway. Observational studies have revealed risk estimates of not less than 2, but more importantly, community level intervention studies have proven that timely provision of high quality STI services can significantly reduce HIVincidence. Health seeking behaviour of STI patients among the populace showed a preference for private health facilities, hence the conception of this study which aimed at assessing the pattern of management of STIs by Clinicians in Private Clinics in Uyo, Akwa Ibom State, Nigeria. It was a cross-sectional descriptive survey of clinicians in private clinics located in Uyo metropolis, using a structured self-administered questionnaire to collect the data. Twenty-three clinicians participated in the study, 20 males and 3 females. Majority (82.6%) diagnosed STIs using history, clinical and laboratory findings, 73.9% were aware of the existence of the algorithm for managing STIs, but only 47.8% used the algorithm consistently. Although 81.8% of the respondents admitted to offering their patients HIV Counselling and Testing; and 78.3% gave patient education and counselling, only 21.7% gave the correct and complete counselling details. It was concluded that most clinicians in Uyo do not manage STIs effectively, as complete patient education and counselling, a very important component of STI management is not offered by most them. This calls for skills reinforcement in STI management for clinicians in Uyo and Akwa Ibom State.
The learning curve: Health education in STI clinics in South Africa
Social Science & Medicine, 1998
AbstractÐThis qualitative study aims to assess health education practice in sexually transmitted infection (STI) clinics in South Africa with a view to develop improved health education programs in such clinics. Health workers' knowledge of and attitudes towards health education practice, their perceived health education skills, the content of health education in STI clinics and the organizational structure as context for health education were investigated. In-depth interviews were conducted with 18 health care workers practicing in the area of STI control. A lack in knowledge and skills required for eective health education practice was reported. The constraints posed by health workers' current knowledge and skills around health education and the organizational structure in terms of the absence of policy and protocols to govern health education, limited time, space and resources, impede on the actual practice of health education. It seems that these obstacles to health education facilitate a biomedical approach to STI management. This approach is further portrayed in the power dynamics between the health workers as well as between health workers and patients. The data suggest that a health education intervention needs to be directed at an individual level namely at health workers and at the organizational level, i.e. the clinic that provides the context for health education. The newly adopted district health system which equally embraces medical care and health promotion augers well for a holistic management of STIs in South Africa. This would ensure the recognition of all categories of health workers' contributions to health education within their own functions, strengths and time limitations. #
STD care in the South African private health sector
South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde, 2001
To establish the accessibility and quality of sexually transmitted disease (STD) care provided by private general practitioners (GPs) and workplace health services in South Africa. Structured telephone interviews were conducted with a random national sample of 120 GPs and 244 occupational health nurses (OHNs) between May and July 1997. The interview schedules covered indicators of access (including utilisation) and processes (drug treatment, partner management, counselling and condom promotion) of STD care. An estimated 5 million STD-related visits were made to private general practices in 1997. Reported treatment of STDs was assessed for effectiveness using well-established syndromic case management guidelines. Only 28% of GPs reported effective treatment for urethral discharge. This dropped to 14% for genital ulcer and 4% for pelvic inflammatory disease. Fifty-five per cent of the OHNs interviewed indicated that their workplace clinics provided STD care. Nurses provided this care,...