ABSTRACT
A baseline evaluation of the quality of STD case management was conducted in five areas of Madras city in 1992, using HIV prevention indicators recommended by the World Health Organization. Eighty-four interviews and 108 observations of private and public clinic practitioners were conducted. Sixty-one percent of interviewed doctors reported making only specific "clinical" diagnoses and 17% reported making only the WHO recommended syndrome-based diagnoses while 22% reported making both types of diagnosis. The adequacy of treatment was compared against various standards, including the Indian National Guidelines for STD management. Almost half of the health care providers (HCP) reported using a treatment effective against the two main pathogens that may cause male urethritis, while 20% reported using a treatment that was not effective against either. For male ulcers only 12% of HCPs reported using treatment effective against both syphilis and chancroid. Seventy-nine percent of the HCP reported that they advised their patients to use condoms, but in 30% only of observed consultations, condoms were promoted for STD or HIV/AIDS prevention. As information concerning the relative prevalence of pathogens in different areas is unlikely to be available, there is an urgent need for the syndromic approach to STD treatment be adopted by health care providers.
Subject(s)
Acquired Immunodeficiency Syndrome/epidemiology , Adult , Developing Countries , Female , Health Knowledge, Attitudes, Practice , Humans , India/epidemiology , Male , Patient Care Team/statistics & numerical data , Population Surveillance , Quality Assurance, Health Care , Risk Factors , Sexually Transmitted Diseases/epidemiology , Urban Population/statistics & numerical dataABSTRACT
Les auteurs rapportent les resultats de quatre enquetes menees en 1991 et 1992 dans la population generale masculine; les lieux de travail et ceux de detente nocturne des villes de Yaounde et de Douala. Cette population masculine; sexuellement tres active; est caracterisee par un partenariat sexuel multiple et un recours frequent aux prostituees. En moyenne 10 pour cent d'entre eux relatent un episode de maladies sexuellement transmissibles dans le semestre ecoule. La pratique des rapports proteges entre dans les moeurs car 62 a 79 pour cent des personnes interrogees ont deja utilise un preservatif mais moins de 10 pour cent en font un usage systematique