title: Syndromic management of sexually transmitted diseases at primary care level, Mozambique.
abstract: OBJECTIVE
  To assess STD management in primary healthcare facilities where STD clinics and syndromic management guidelines had been introduced.
  
  
  METHODS
  In 26 health facilities in selected sites, we observed management of all STD patients presenting in the adult general or STD clinic. We assessed the referral system by analysing patient registers.
  
  
  RESULTS
  408 STD patients (65% in STD and 35% in general clinics) were observed. 70% were women. Women were examined less (26% against 75%, p<0.0001), had laboratory tests ordered more (74% against 45%, p=0.0002), were more often diagnosed syndromically (57% against 38%, p=0.008), and received less advice on condom use (19% against 87%, p<0.001) and contact treatment (47% against 81%, p=0.04). Examination, laboratory requests, diagnosis, and treatment were not significantly different in the STD and general clinic. Health education was better in the STD clinic (condom advice 47% against 8%, p <0.001). Only 41% of referred patients presented to the STD clinic.
  
  
  CONCLUSIONS
  The better performance of STD clinics in health education was offset by high referral losses. A proposed integration of STD treatment into general outpatient clinics and better implementation of syndromic management and health education should improve STD case management at primary level in Mozambique.
authors.affiliation: Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique.
authors.forename: F S
authors.initials: FS
authors.lastname: Mbofana
authors.forename: F J
authors.initials: FJ
authors.lastname: Brito
authors.forename: A
authors.initials: A
authors.lastname: Saifodine
authors.forename: J L
authors.initials: JL
authors.lastname: Cliff
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000458:organization & administration; D017280:Condoms / Q000706:statistics & numerical data; D005260:Female; D006266:Health Education / Q000379:methods; D006293:Health Promotion / Q000379:methods; D006801:Humans; D008297:Male; D009073:Mozambique; D011320:Primary Health Care / Q000458:organization & administration; D012749:Sexually Transmitted Diseases / Q000628:therapy*