Traditional healers in Zambia and their care for patients with urethral/vaginal discharge.

OBJECTIVE: The aim of this study was to describe the knowledge and practices of traditional healers in relation to the management of patients with urethral/vaginal discharge. SUBJECTS AND METHOD: Eighty (80) traditional healers, 54 from an urban and 26 from a rural setting in Zambia, who attend to patients with urethral/vaginal discharge, were interviewed using a semistructured questionnaire. RESULT: All of the traditional healers had knowledge of urethral/vaginal discharge being a symptom of a sexually transmitted disease (STD) and that individuals get the infection through sexual relations with infected persons. The healers were all able to cite other symptoms associated with urethral/vaginal discharge. The treatment the healers used was mostly herbal preparations in the form of roots or powders administered orally to induce diarrhea, vomiting, and diuresis. Patients were not allowed to combine traditional and biomedical therapies. Almost half of the healers did apply some biomedical practices in the management of patients with urethral/vaginal discharge, such as history taking and examination of patients before diagnosis and prescription. The healers also advised patients to avoid sex while on treatment and to avoid reinfection by remaining with one partner and using condoms. Some healers advised their patients to bring their sexual partners for consultation. CONCLUSION: Because traditional healers attend to patients with STDs, both in rural and urban areas, efforts should be made to promote cooperation between traditional and biomedical health care providers, so that treatment of patients and their partners could be improved. Traditional management that concurs with biomedical practices could thus be a starting point for discussion and cooperation.

"Shopping" for sexually transmitted disease treatment: focus group discussions among lay persons in rural and urban Zambia.

BACKGROUND: In Zambia, persons use different types of services when seeking treatment for sexually transmitted diseases (STDs). GOAL: To gain insight into the rationale behind the selection of treatment sources by investigating perceptions of STDs and by identifying STD treatment sources used. STUDY DESIGN: Focus group discussions were held with 57 men and 44 women in one urban and one rural area in Zambia between May 1997 and June 1997. The focus group discussions were audiotaped and analyzed qualitatively. RESULTS: Participants combined traditional and modern treatment. The main reason given was that even when biomedical medicine was effective, STDs could only be totally cured if the patient was cleansed by traditional herbs. Factors influencing health-seeking behavior were the person's perception, how the diagnosis was determined, type and cost of treatment, demand for sexual partners, and attitudes of health workers, parents, and the church. CONCLUSION: Barriers and enabling factors for the use of treatment sources were identified. Interventions to improve services and cooperation between the health sectors need to consider these factors.

Health-seeking behaviour of patients with sexually transmitted diseases in Zambia.

The aim of this paper is to describe health-seeking behaviour, time with symptoms and sexual activity during symptom period among patients attending the public health sector in urban and rural Zambia for treatment of an STD. The study was conducted at two urban health centres and at one rural mission hospital during four months in 1994 and 1995. Four hundred and seventy nine patients seeking health care for STD symptoms were interviewed. The patients had experienced STD symptoms for one to two weeks before they came to the clinic. During this period two thirds in the urban and one third in the rural setting had had sex. Sixty per cent of the patients in the urban and 50% in the rural setting had taken some kind of medicine before they came to the clinic. More people had used modern compared to traditional medicine, especially in the urban area. Market places, other clinics and doctors, friends, and relatives were common treatment sources. Ten per cent had received medicine from a traditional healer. Thus, a majority of the patients had received medication from other sources before they came to the clinic. Sex during periods with STD symptoms was common. This has serious implications for STD as well as HIV transmission.

PIP: A number of factors influence which treatment sources people seek when symptoms of morbidity occur and a person alone, or with the advice of others, decides that the condition warrants additional attention. Some such factors are related to social structures such as kinship, social networks, gender, and economic status, while others are related to belief systems which define how people conceptualize the etiology of disease. Service quality, the introduction of user fees, and the cost of treatment can also affect health-seeking behavior (HSB). One highly important factor affecting HSB for sexually transmitted diseases (STD) is social stigma. For example, in Zambia, where STDs are a major public health problem, it is considered highly shameful to have an STD, especially for women. This paper describes the HSB, time with symptoms, and sexual activity during symptom period among patients attending 2 urban public health centers and 1 rural mission hospital in Zambia during 4 months in 1994 and 1995 to receive treatment for their STDs. 479 patients seeking health care for STD symptoms were interviewed. The patients had experienced STD symptoms for 1-2 weeks before coming to the clinic. During that period, two-thirds in the urban and one-third in the rural areas had had sexual intercourse. 60% of the patients in the urban and 50% in the rural settings had taken some kind of medicine before coming to the clinic. However, more people had used modern rather than traditional medicine, especially in the urban area. Marketplaces, other clinics, physicians, friends, and relatives were common treatment sources, although 10% had received medicine from a traditional healer.

Quality of STD care in Zambia. Impact of training in STD management.

STUDY OBJECTIVE: To assess quality of care of sexually transmitted diseases (STDs) and evaluate interactive training methods aimed at improving providers' performance. DESIGN AND SETTING: This comparative study, with a baseline, intervention, and evaluation phases was conducted at two urban health centers in Zambia. The personnel at one health center were trained in STD management using interactive training methods. The other health center acted as a control. SUBJECTS AND METHODS: Two-hundred patients with STD were interviewed and their interaction with health care providers observed before and after the training. Another 200 interviews and observations were conducted at the control health center. RESULTS: The proportion of patients being examined, given health education and informed about partner notification increased significantly after the intervention. The proportion of patients who had complaints about the health care did not decrease. Long waiting time and lack of time to discuss the disease were the main complaints. CONCLUSION: The training solved some, but not all, problems of poor case management. This indicates the need for a more process-oriented approach for improving quality of care.

Individual counseling of patients with sexually transmitted diseases. A way to improve partner notification in a Zambian setting?

BACKGROUND: Sexually transmitted diseases (STD) are a major health problem in Zambia. Partner notification, which is a recommended strategy to decrease STD, must be improved. GOAL: To assess whether individual counseling of patients with STD, combined with contact slip(s), had any impact on the proportion of sex partners traced in an urban setting in Zambia. STUDY DESIGN: A randomized trial comprised of 94 women and 302 men with STD. RESULTS: Women and men in the intervention group informed more partners than did those in the control group. In the intervention group, 1.8 partners per man was treated compared to 1.2 in the control group (P < 0.001). There was no difference between the two groups of women. There was a gradual decline from numbers of partners informed to numbers of partners treated according to the patient to number of contact slips filed. CONCLUSIONS: Individual counseling of men with STD improved partner notification.

PIP: In Lusaka, Zambia at an urban health center, researchers randomly allocated 302 male sexually transmitted disease (STD) patients and 94 female STD patients to receive or not receive individual counseling combined with written information to sex partners (i.e., contact slips). They aimed to determine whether or not this intervention improved partner notification. This study was conducted during October 1992-March 1993. The most common STD for men was chancroid, followed by gonorrhea and syphilis. For women, it was syphilis, followed by gonorrhea. Men and women in the intervention group were more likely to bring at least one sex partner to the clinic than those in the control group (100% vs. 93% and 72% vs. 56%, respectively). Men in the intervention group brought more partners from the last three months to the clinic than those in the control group (1.8 vs. 1.2; p 0.001), while women in both groups brought the same number of partners (0.7). In the intervention group, more partners of the men received treatment based on contact slips than partners of the women (1.6 vs. 0.4). For both sexes, based on the number of contact slips filed, the numbers of partners informed fell gradually with the numbers of partners treated. Men in the intervention group were less likely than those in the control group not to tell all partners from the last three months to come for treatment (19% vs. 48%). Among controls, the reasons were health staff failed to tell them to bring more than one partner and the men could not afford the medicines for their partners. Among cases, the leading reason was that the partners were unknown or out of town. Quarrels that prevented partners from seeking treatment occurred equally in both groups of women. They occurred more often among male cases than male controls, however (p = 0.0008). Yet partners of male controls who had experienced quarrels were less likely to seek treatment than those of male cases (p = 0.0015). The quarrels-related findings suggest the need for counseling to emphasize partners' emotional reactions and how to deal with these reactions. Overall findings show that individual counseling of men improved STD partner notification.

Quality of care in sexually transmitted diseases in Zambia: patients' perspective.

The aims of this study were to describe Zambian STD patients response to treatment, compliance with partner notification, and further to measure patients' satisfaction with the health care received. The majority of 179 STD patients (92 men, 87 women) interviewed twice at an urban health centre were not satisfied with the care received. Their response to treatment and compliance with partner notification were not satisfactory. Thirteen patients had not been able to buy medicines, since they had no money. One hundred and twenty-five patients had asked 134 sexual partners to come for treatment but only 60 percent of them had received treatment. To get free medicines, to have privacy, to get injections instead of tablets, to be examined before treatment, and to be informed about the diagnosis were judged most important for good quality STD care. Health workers must improve their communication and counselling skills to understand the needs of their patients, who are the ultimate evaluators of the quality of care.

PIP: Sexually transmitted diseases (STD) are the most common infectious diseases in Zambia, affecting mainly adolescents and young adults across society. Zambia, with a total population of about 8 million people, experiences approximately 125,000 cases of STD annually. Findings are reported from a study conducted to describe Zambian STD patients' response to treatment and compliance with partner notification, as well as their satisfaction with health care received. 92 male and 87 female patients were interviewed twice at an urban health center 5 km outside of Lusaka. The men and women were aged 17-55 and 15-37 years, respectively, of mean ages 26 and 23. 48% of the men and 78% of women were married. Most of the patients were unsatisfied with the care received. Their response to treatment and compliance with partner notification were unsatisfactory. For example, lack of funds prevented 13 patients from buying medicines, and 125 patients had asked 134 sex partners to come for treatment, but only 60% of them had actually done so and been treated. The most important factors defining good quality STD care noted by study participants were the provision of free medicines, privacy, injections rather than tablets, pre-treatment examinations, and information about their diagnoses. Health care providers must improve their communication and counseling skills to better understand patients' needs.

Behaviour, knowledge and reactions concerning sexually transmitted diseases: implications for partner notification in Lusaka.

Available data show that STDs and their consequences are a major health problem in Zambia. This study focuses on factors which could have implications for partner notification, as a tool for prevention. Fifty women and fifty men with STD were interviewed at two outpatient clinics in Lusaka, where partner notification is not functioning optimally. A majority of the sexual partners during the last three months were known by the patients who also stated a willingness to bring more partners than they were asked to do. Women had symptoms for a longer period than men before they came for treatment. They were less aware of symptoms connected with STD and a majority of them did not know that they were receiving treatment for STD. The communication between the health care provider and the patients about disease, treatment and partner notification needs to be improved especially for women.

PIP: Sexually/transmitted diseases (STD) and their consequences are a major health problem in Zambia. Partner notification is a strategy to find, counsel, and treat the sex partners of STD patients in the attempt to control the spread of STDs. The authors describe existing health care for STD patients in two urban health centers in Lusaka where partner notification is not functioning optimally with focus upon issues with implications for partner notification such as the number of sex partners identifiable and patients knowledge of and reactions to having an STD. 50 men of mean age 28.9 years and 50 women of mean age 23.7 years with STDs were interviewed at the clinics. 52% were married and 32% were unmarried. The men and women had had symptoms for medians of 5 and 14 days, respectively. STD patients are usually asked to bring their sex partners to the clinic for evaluation and treatment. This study found, however, that some patients were not asked to bring their partners. A majority of the sexual partners during the last three months were known by the patients who were also willing to bring more partners than they were asked to by health personnel. Partners of STD patients in Zambia could therefore be found and treated more extensively than is now the case. The research also found women to be less aware of symptoms connected with STDs and a majority did not know that they were receiving treatment for STD. It is concluded that communication between the health care provider and patients about disease, treatment, and partner notification needs to be improved, especially for women.