Quality of sexually transmitted disease case management in Nairobi, Kenya: a comparison among different types of healthcare facilities.
BACKGROUND
In Nairobi, the prevalence for sexually transmitted diseases (STDs) among attenders at antenatal and family planning clinics is substantial, but knowledge about the quality of STD case management is scarce.


OBJECTIVE
To assess quality of STD case management in Nairobi healthcare facilities.


METHODS
All the facilities in five sublocations were enumerated. In 142 facilities, 165 providers were interviewed, observed during 441 interactions with patients who had STDs, and visited by a simulated patient.


RESULTS
For observations of patients with STDs, correct history-taking ranged from 60% to 92% among the various types of facilities, correct examination from 31% to 66%, and correct treatment from 30% to 75%. The percentage of correctness for all three aspects (World Health Organization prevention indicator 6) varied between 14% and 48%. Public clinics equipped for STD care performed best in all aspects, whereas treatment was poorest in pharmacies and private clinics. The providers trained in STD management performed better than those without training.


CONCLUSIONS
Quality of STD case management was unsatisfactory except in public STD-equipped clinics. This indicates the need for improvement by interventions such as further training in syndromic management, improved supervision, and the introduction of prepackaged syndromic management kits.
Voeten
H A
HA
Department of Public Health, Erasmus University, Rotterdam, The Netherlands. voeten@mgz.fgg.eur.nl
Otido
J M
JM
O'Hara
H B
HB
Kuperus
A G
AG
Borsboom
G J
GJ
Ndinya-Achola
J O
JO
Bwayo
J J
JJ
Habbema
J D
JD
D000554:Ambulatory Care Facilities / Q000592:standards*; D019090:Case Management / Q000592:standards*; D005193:Family Planning Services / Q000592:standards; D006801:Humans; D007407:Interviews as Topic; D007630:Kenya; D008487:Medical History Taking; D011785:Quality Assurance, Health Care; D012749:Sexually Transmitted Diseases / Q000517:prevention & control*; D011795:Surveys and Questionnaires