Quality of Sexually Transmitted Disease Treatments in the Formal and Informal Sectors of Bangui, Central African Republic

Summaryobjectives To assess the quality of sexually transmitted infections (STI) care in health care facilities in Abidjan attended by female sex workers.methods A cross-sectional study was conducted in June 2000 in the 29 health care facilities and 10 pharmacies, which were reported as points of first encounter for STI care by female sex workers in a previous study on health seeking behaviour. Evaluation components included: (1) checklists of equipment and STI drugs in the facilities; (2) interviews with health care providers and pharmacists; (3) direct observation of the provider/client interaction; (4) exit interviews with women attending with STI or genital problems.results Private health care facilities were more expensive, had fewer clients, and had less equipment and medical staff than public facilities, with the exception of the special female sex worker clinic. A total of 60 health care providers and 29 pharmacists were interviewed. There was no difference in their scoring on syndromic approach case studies, with the exception of the nurse assistants, who scored less.Overall scores for correct treatment were lowest for the pharmacists. We observed 513 provider-client interactions, of which 161 related to STIs or genital problems in women. Questions about recent sexual contacts were asked in only 20% and preventive messages were given in only 9% of the cases with STI/genital problems. Of 161 clients interviewed, 44% complained about a long waiting time, and 39% thought the health care provider had adequately explained the problem to them.conclusions The opportunity for improvement of STI case management in health care facilities in Abidjan where female sex workers go for STI care is enormous. Public and private health care facilities should be made more accessible for sex workers, and their services should be upgraded to better respond to the sexual health needs of high risk women.keywords sexually transmitted infections, female sex workers, quality of care, Africa

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“…1998). A clinical examination is not possible in most cases, because of the lack of privacy and equipment for an examination (Somsé et al. 2000).…”

Section: Discussionmentioning

confidence: 99%

“…Syndromic case management of STIs in women or female sex workers may be difficult in pharmacies, because of the poor predictive value of symptoms and signs (Garcia et al 1998). A clinical examination is not possible in most cases, because of the lack of privacy and equipment for an examination (Somsé et al 2000).…”

Section: Discussionmentioning

confidence: 99%

Quality of sexually transmitted infections services for female sex workers in Abidjan, Côte d'Ivoire

Vuylsteke

Traoré

Mah-Bi

et al. 2004

Tropical Med Int Health

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“…This merely reflects the dismal quality of STD care in this city, especially in the informal sector where treatment with ineVective drugs are the rule rather than the exception. 24 Unless the syndromic approach is used not only in government health centres but in the informal sector where most STD patients seek care, the potential impact of STD control on the spread of HIV will remain a missed opportunity.…”

Section: Discussionmentioning

confidence: 99%

Aetiology of urethral discharge in Bangui, Central African Republic

Martineau

Dubois²,

Grésenguet³

et al. 2001

Sexually Transmitted Infections

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Objectives:To determine the aetiology of urethritis in Bangui, Central African Republic. Methods: 410 men presenting with urethral discharge and 100 asymptomatic controls were enrolled. Urethral swabs were obtained and processed by gonococcal culture and polymerase chain reaction for the detection of Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium, Trichomonas vaginalis, and Ureaplasma urealyticum. Results: In multivariate analyses, M genitalium and C trachomatis were significantly associated with urethral discharge when comparing cases of non-gonococcal urethritis (NGU) with controls. T vaginalis was also more common in cases than in controls, but this reached statistical significance only among cases in whom N gonorrhoeae was also detected. U urealyticum was not associated with urethritis. The gonococcus was found in 69% of cases of urethral discharge. M genitalium was the predominant pathogen in patients with NGU, being found in 42% (53/127) of such patients while C trachomatis was found in only 17% (22/127). T vaginalis was found in 18% (23/127) of patients with NGU, but also in 15% (43/283) of patients with gonococcal urethritis, and two thirds of patients with T vaginalis also had the gonococcus. Multiple infections were common. M genitalium caused a syndrome similar to chlamydial urethritis, with a less severe inflammation than in gonococcal infection. No behavioural or clinical characteristic could discriminate between the various aetiological agents. Conclusions: M genitalium is more prevalent than C trachomatis and is the most common cause of NGU in Bangui. It causes a syndrome similar to chlamydial urethritis. T vaginalis is weakly associated with urethritis, and is often found along with other pathogens. (Sex Transm Inf 2001;77:125-129)

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“…Considering the unobtainable or prohibitively expensive treatment of gonorrhoea in most developing countries [7] and the increase in international travel, gonococcal infections are a signi¢cant threat in Africa. Medicinal plants, including Terminalia macroptera Guill.…”

Section: Introductionmentioning

confidence: 99%

In vitro anti-Neisseria gonorrhoeae activity of Terminalia macroptera leaves

Silva

2002

FEMS Microbiology Letters

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We used the agar dilution method to evaluate the antibacterial effect of Terminalia macroptera leaf (Tml) extract against nine reference and clinical Neisseria gonorrhoeae strains, including penicillin‐ and tetracycline‐resistant and ‐susceptible strains. Tml possesses anti‐N. gonorrhoeae activity against all of the strains and the minimum inhibitory concentrations (MIC) were between 100 and 200 μg ml−1. We then used a liquid–liquid partition method to divide the Tml extract into five fractions and determined the anti‐N. gonorrhoeae activity of each of the fractions. All of the fractions showed antibacterial activity. The most active one was identified as the diethyl ether fraction and had MIC values of between 25 and 50 μg ml−1 against all of the strains.

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Quality of Sexually Transmitted Disease Treatments in the Formal and Informal Sectors of Bangui, Central African Republic

Abstract: National STD and HIV control programs will have to improve STD management in pharmacies and in the informal sector if they are to have any impact on the dynamics of HIV infection in urban centers.

Cited by 18 publications

References 5 publications

Quality of sexually transmitted infections services for female sex workers in Abidjan, Côte d'Ivoire

Quality of sexually transmitted infections services for female sex workers in Abidjan, Côte d'Ivoire

Aetiology of urethral discharge in Bangui, Central African Republic

In vitro anti-Neisseria gonorrhoeae activity of Terminalia macroptera leaves

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