Sexually transmitted diseases: a survey of case management in Malawi.
A national survey of sexually transmitted disease (STD) case management was carried out at 39 health care facilities in Malawi in 1994. Fifty-four health care providers were observed managing 150 patients presenting with selected STD syndromes and 103 providers were interviewed. STD case management was assessed by calculation of WHO/GPA prevention indicators (PIs) from observation data. The overall rate for PI-6, which measures correct assessment and treatment of STD patients was 11% (81% for history taking, 46% in physical examination, and 13% correct antibiotic treatment according to national guidelines). The score for PI-7, which measures overall patient counselling was 29% (65% for partner notification and 40% for condom advice). Although Haemophilus ducreyi is at least as common as Treponema pallidum as the causative agent for genital ulcers, only 16% of patients with genital ulcers were treated effectively for chancroid vs 56% for syphilis. Female patients received less comprehensive care than male STD patients. Only 20% of STD patients were offered condoms. Overall, the survey results support the policy decision to adopt syndromic management of STDs, and provide baseline information for planning and evaluation of a national control programme.
Chilongozi
D A
DA
National AIDS Control Programme, Ministry of Health, Malawi.
Daly
C C
CC
Franco
L
L
Liomba
N G
NG
Dallabetta
G
G
D000349:Africa / Q000453:epidemiology; D019090:Case Management; D002602:Chancroid / Q000628:therapy; D017280:Condoms; D003376:Counseling; D003695:Delivery of Health Care / Q000379:methods; D005260:Female; D019538:Health Care Surveys / Q000706:statistics & numerical data; D006282:Health Personnel; D006801:Humans; D008297:Male; D010353:Patient Education as Topic; D011287:Prejudice; D012749:Sexually Transmitted Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D011795:Surveys and Questionnaires; D013587:Syphilis / Q000628:therapy