title: Risk assessment at the primary health care level in Moshi, Tanzania: limits in predicting sexually transmitted infections among women.
abstract: OBJECTIVE
  To identify risk factors for sexually transmitted infections (STI) and to evaluate the accuracy of using risk assessment for identifying infected women in Moshi, Tanzania.
  
  
  METHODS
  A cross sectional study.
  
  
  METHODS
  Three primary health care clinics in Moshi.
  
  
  METHODS
  382 consenting women attending the clinics for routine reproductive health care were interviewed followed by a pelvic examination between September and December 1999. Blood and genital specimens were collected for STI diagnosis.
  
  
  METHODS
  Prevalent STIs, risk factors and accuracy of using risk factors to identify infected women.
  
  
  RESULTS
  Among 382 women, 118 (31%) had at least one STI diagnosed clinically or by a laboratory test; (T. vaginalis 21%, syphilis 4.2%, chlamydia and/or gonococcal cervicitis 3.2%, genital ulcer 4.5% and warts 2%). The risk of CT/GC cervicitis was greater among women aged < 20 years (p = 0.04), with cervical friability (p = 0.01) and with > 10 cervical leucocytes (p < 0.001), while having more than one partner in the past three months (p = 0.008) predicted syphilis infection. Trichomoniasis was associated with the presence of vaginal discharge (p = 0.001) and pH > 4.5 (p < 0.001). However, using these risk factors as a screening tool for various STIs achieved a low sensitivity and a low positive predictive value, hence a low utility for case detection.
  
  
  CONCLUSIONS
  STIs were prevalent in this setting. However, risk factors were not a good tool for identifying infected women. While there is an urgent need to develop low cost microbiological tests for case detection, efforts should be made to maximise the available control strategies, such as proper treatment of symptomatic patients and their partners.
authors.affiliation: Department of International Health, lnstitute of General Practice and Community Medicine, University of Oslo, Postboks 1130 Blindern, N-0318 Oslo, Norway. siamsuya@hotmail.com
authors.forename: S E
authors.initials: SE
authors.lastname: Msuya
authors.forename: E M
authors.initials: EM
authors.lastname: Mbizvo
authors.forename: B
authors.initials: B
authors.lastname: Stray-Pedersen
authors.forename: J
authors.initials: J
authors.lastname: Sundby
authors.forename: N E
authors.initials: NE
authors.lastname: Sam
authors.forename: A
authors.initials: A
authors.lastname: Hussain
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D003430:Cross-Sectional Studies; D005260:Female; D005544:Forecasting; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D017533:Marital Status; D008875:Middle Aged; D011237:Predictive Value of Tests; D015995:Prevalence; D011320:Primary Health Care; D018570:Risk Assessment; D012307:Risk Factors; D012747:Sexual Partners; D012749:Sexually Transmitted Diseases / Q000175:diagnosis* / Q000453:epidemiology; D013636:Tanzania / Q000453:epidemiology; D014505:Urban Population; D055815:Young Adult