Management of Reproductive Tract Infections in Rural Bangladesh

Abstract

This study was undertaken to identify existing reproductive tract infection (RTI) treatment practices of the government family planning (FP) paramedics in rural Bangladesh. It also assessed the knowledge and perceptions of the clients about RTIs as well as the service-seeking behaviour of the clients and their husbands. Data on paramedic treatment practices were collected by observing paramedic-client interactions at the family welfare centres (FWCs) and satellite clinics (SCs). One hundred clients seeking RTI treatment were observed. The same clients were interviewed at departure from the health-care facility to assess their knowledge and perceptions about RTIs as well as service-seeking behaviour of the clients and their husbands. Twenty-four village practitioners were also interviewed to assess their knowledge on the subject. Results of the study showed that in the treatment of RTI, paramedics of government FP services commonly: (i) did not do a physical examination, (ii) used a substandard dosage of drugs, and (iii) made no attempt to notify or treat male partners. Thirty-one of the 97 clients reported that their husbands had some kind of genital problem. It was revealed from the study that as an alternative to the government FP services, the clients and their husbands often seek RTI treatment from the village practitioners though the village practitioners' knowledge concerning RTI is poor. Based on the findings of this study, it is recommended that the knowledge and skills of the paramedics and village practitioners for RTI treatment be strengthened. Prevention of RTI through awareness campaigns is essential for the control of RTIs, and especially of STDs.

Knowledge and Skills for Management of Sexually Transmitted Infections by Rural Medical Practitioners in Bangladesh

“…It is evident from the findings of this study and also through other studies [17] [22–23] that informal providers like RMPs are capable of learning and changing their practices, even after a brief educational intervention. We call for further operations research to study how best to mobilise interactive training and multi-faceted educational interventions for RMPs to better engage them in health care for prevention and control of STIs and other health conditions by taking care of the country specific regulatory framework.…”

“…There is still considerable room for improvement in RMPs knowledge and practices; perhaps a longer training program would have a greater impact on knowledge and STI treatment practices. A systematic review on role of informal health care providers in developing countries and another study report on the management of reproductive tract infections in rural Bangladesh recommended to undertake educational interventions and capacity building exercises for unqualified village doctors, given their role as major care providers in rural areas [13] [17]. Our study reinforces the importance of this mandate in Bangladesh context.…”

“…Most of the RMPs in this study had inadequate knowledge about STI/HIV/AIDS. A similar conclusion of low RTI/STI knowledge was reported among village doctors in a study of reproductive health in rural Bangladesh [17]. Most RMPs sell medicine (90.7%) to their clients alongside their practice as a principal income source, since most of them do not take a patient fee (82.2%).…”

“…RMPs are often not familiar with proper dosages of various medications and their potential side effects. One study indicated that RTIs were not well understood among village practitioners; they did not perform examination of their patients, used substandard dosage of drugs, and made no attempt to notify or treat sexual partners [17]. …”

Effect of single session counselling on partner referral for sexually transmitted infections management in Bangladesh

“…General doctors and secondary/tertiary level providers in public sector may follow STI management protocols in medical textbooks that may be supported by basic laboratory investigations 16 17. At the primary healthcare level, NGO clinics play a vital role in STI management, where syndromic management protocols are mostly used without the benefit of laboratory confirmations 18.…”