Understanding care seeking behavior for reproductive tract infections among Afghan women: A cross-sectional study

Abstract

Background In Afghanistan, a country with limited resources, providing care for Reproductive Tract Infections (RTIs) is challenging, also due to the extreme scarcity of reliable data. To address this gap, the present study investigates symptoms, potential risk factors, knowledge, and care-seeking behavior in the largest sample of women to date. Methods From September 16 to November 26 2022, a structured questionnaire was administered, by trained female medical students, to women presenting at multi-specialist clinics in the major cities of Afghanistan. Signs and symptoms of RTIs were investigated, together with reproductive history, hygiene practices, and socio-demographic characteristics. Logistic regression, adjusted for selected co-variates, was used to assess predictors of delays (over one month) from symptoms onset to care-seeking, and of a history of RTI. Results Out of 749 women who were asked to reply to the questionnaire, 601 responses were analyzed (80.2%). Mean age was 31.3 years (SD 11.5), with 69.1% being younger than 35 years, 26.8% unmarried, and 32.5% illiterate. Respectively 77.1% and 40.8% of the women had their first marriage and their first delivery between 14 and 20 years of age. Signs and symptoms related to RTIs were reported by 79.2%, knowledge of RTIs by only 23.0%, and care-seeking delays by up to 39.5%, of which 68.2% cited reasons other than mismanagement at the previous clinic. Care-seeking delays were positively associated with abnormal vaginal discharge (OR 4.12; 95%CI 2.01–8.45), lower abdominal pain (2.62; 1.44–4.77), and fever (1.93; 1.25–2.98) and negatively associated with being sedentary (0.38; 0.22–0.64), hand-washing (0.61; 0.40–0.95), and knowledge about RTI () although borderline significant. A history of RTI (reported by 44.1%) was predicted by abnormal vaginal discharge (2.29; 1.38–3.79), fever (1.56; 1.04–2.36), irregular menstruations (1.59; 1.07–2.35), and use of sanitary pads (vs. cloth: 0.63; 0.41–0.97), but not by the husbands’ history of RTI. Conclusions The majority of women presenting at clinics in Afghanistan reported signs and symptoms related to RTIs, delayed care-seeking, and lack knowledge about RTI. Healthcare providers should inform the population about RTIs and their standard care pathway, while adopting a multi-dimensional approach accounting for the cultural background of the women.