Use of syndromic management algorithm for sexually transmitted infections and reproductive tract infections management in community settings in Karachi.
OBJECTIVE
Syndromic management is promoted as a measure to manage and control STIs in resource poor settings. This research was conducted to assess the diagnosis and prescription patterns using syndromic management algorithms as part of a community-based reproductive health programme.


METHODS
The research was conducted in four squatter settlements of Karachi. Health care providers working for a reproductive health programme in these settlements received similar training on the use of algorithms. The people in these settlements had comparable socioeconomic and cultural backgrounds and access to health services. The medical records of 400 women who attended the centres for RTI/STIs were randomly selected. These records were reviewed for diagnosis and prescription patterns.


RESULTS
The diagnoses by and prescription practices of the health care providers differed greatly across the four clinics. As often there are more than one etiologic agents for most of the STI/RTI syndromes, algorithms allow multiple antibiotics use. However, this research pointed that despite diagnosing many patients as suffering from one particular infection, a large number of patients were prescribed more than one antibiotic.


CONCLUSIONS
It appeared that the health care providers had difficulties in using the algorithms, pointing to the need for ongoing support and training. The difficulty in correctly diagnosing STIs/RTIs could be the reason for over prescription. There is likelihood that the use of algorithms without sufficient support might contribute to the problems of drug resistance and prescription of drugs when they are contraindicated. Effective use of syndromic management algorithms requires training for effective communication, understanding about the locally prevalent STIs & RTIs, and periodic assessments of the quality of services.
Discipline of Public Health, School of Population Health & Clinical Practice, University of Adelaide, Australia.
Mohammad Afzal
MA
Mahmood
Arthur
A
Saniotis
D000293:Adolescent; D000328:Adult; D000465:Algorithms; D000553:Ambulatory Care / Q000379:methods; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D003153:Community Health Services; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D010154:Pakistan / Q000453:epidemiology; D010808:Physical Examination; D011203:Poverty; D010818:Practice Patterns, Physicians'; D015995:Prevalence; D060737:Reproductive Tract Infections / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D012749:Sexually Transmitted Diseases / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D019522:Vaginal Discharge / Q000188:drug therapy / Q000382:microbiology; D055815:Young Adult
D000890:Anti-Infective Agents