Original Article
KAP Study on Sexually Transmitted Infections/ Reproductive Tract Infections (STIs/RTIs) among married women in rural Haryana Rizwan SA, Rama S. Rath1, Gupta Vivek2, Nitika1, Gupta Anant1, Ahamed Farhad1, Silan Vijay3 Department of Community Medicine, Velammal Medical College Hospital and Research Institute, Velammal Village, Madurai, Tamil Nadu, 1 All India Institute of Medical Sciences, New Delhi, 2National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, 3 Department of Community Medicine, BPS Government Medical College for Women, Khanpur Kalan, Sonepat, Haryana, India
ABSTRACT Context: About 490 million cases of curable Reproductive Tract Infections (RTI) occur throughout the world, of which 79 million cases occur in India annually. Sexually Transmitted Infections/Reproductive Tract Infections (STI/RTI) confers a huge economic burden on the individual and the health system. Complications of RTI/STI are many, ranging from chronic pain syndrome to infertility. Most of these complications can be prevented by early diagnosis and treatment. Aims: To assess knowledge, attitude and practices on STI/RTIs among married women aged 15‑45 years in rural Haryana. Setting and Design: Cross‑sectional study, conducted in selected villages under the primary health centre Mandi, Sonepat, Haryana. Subjects and Methods: Systematic sampling was used to cover 10 villages. In each village, every tenth house was sampled, taking first house from the center of the village. Face‑to‑face interview was conducted using pretested questionnaire. Statistical Analysis Used: Descriptive statistics and results were described in percentages. Results: A total of 344 women were interviewed. About 44% women had never heard of STI/RTI. The prevalence of self‑reported symptoms of STI/RTI was very high (60%). Only 40% of them opted for treatment and most common cause for not opting for treatment was that they considered it as a minor problem. Advice for use of condom during the treatment was received by only 20% of patients and only 26.5% of their husbands also received treatment. Conclusions: Overall knowledge, attitude and practices relating to STI/RTI among married women in rural Haryana was poor. The prevalence of self‑reported STI/RTI was found to be high and treatment seeking behavior was poor. Key words: Attitude, knowledge, married women, practices, rural Haryana, reproductive tract infections, sexually transmitted infection
Access this article online Website: www.idoj.in
INTRODUCTION
DOI: 10.4103/2229-5178.148919 Quick Response Code:
Address for correspondence: Dr. Vijay Silan, Department of Community Medicine, BPS Government Medical College for Women, Khanpur kalan, Sonepat, Haryana, India. E-mail: vijay.silan@ gmail.com
Sexually Transmitted Infections/Reproductive Tract Infections (STI/RTI) are a common public health problem in developing countries, contributing to a huge economic burden among individuals and health systems.[1] According to the World Health Organization (WHO), each year around 499 million cases of curable STIs occur throughout the world in the age group of 15-49 years, of which 80% cases occur in developing countries and about 79 million cases occur in India annually.[2] Another study suggests that about 40 million cases of RTIs occur in India each year.[3] National Family Health Survey (NFHS‑3) reported that 11% women and 5% men in the 15-49 years age group had STI/ RTIs related symptom in the past year.[4] STIs lead to several complications in women such as
Indian Dermatology Online Journal - January-February 2015 - Volume 6 - Issue 1
tubal blockade, pelvic inflammatory diseases, chronic pain syndromes, sexual dysfunction and many others. They cause significant morbidity among males as well including strictures, sexual dysfunction, genital ulcers, and kidney and bladder problems. They also lead to complications in the neonate like chlamydial conjunctivitis, sepsis and other morbidities. Most of these complications are preventable with early diagnosis and treatment, and prevention of infection. The main aim of this study was to assess knowledge, attitude and practices regarding STI/RTIs among married women of selected villages in rural Haryana.
SUBJECTS AND METHODS This was a community based cross‑sectional survey. The study was conducted during September 2011 in 10 villages under Primary
9
Rizwan, et al.: RTI/STI knowledge among married women in rural Haryana
Health Centre (PHC) Mandi, Panipat District, Haryana. Married women aged 15 to 45 years living in study area for at least a year were eligible for inclusion. Sample size was calculated as 340 taking a prevalence of self-reported STI/ RTI among married women as 8%, absolute precision 3%, alfa error 5%, power 80% and non‑response rate of 5%. We employed a systematic random sampling technique. In each village, every tenth house was sampled, taking first house from the center of the village. If the selected house did not have eligible participants, the next house in the street with eligible persons was selected and the systematic sampling continued from that house onward. The sampling was continued till the entire village was covered. In the selected house, if more than one eligible participant was present, then one was selected randomly and face‑to‑face interview was conducted using pretested questionnaire. Informed verbal consent was obtained from all participants. The participants who had RTI/ STI symptoms were referred to PHC Mandi for syndromic management. Analyses were done using Statistical Package for the Social Sciences software (SPSS version 17.0). Data were described in terms of proportions.
RESULTS A total of 344 sexually active married women were interviewed. Most of the women were in the age group of more than 18 years and were educated up to middle school. Participants from nuclear and joint family constituted identical proportions [Table 1]. Almost 43.6% women had not heard about RTI. Those who had heard of RTI were asked about the symptoms that may indicate that a person was suffering from RTI. About 11% women said that they did not know the symptoms. Among those who knew about symptoms, most common (19%) response was white discharge per vaginum, followed by foul smell of vaginal discharge (14.5%). About 23% gave multiple answers (i.e. pain, vaginal discharge, foul smell). When asked about the cause of RTI, about 39% said that they did not know the cause, while 31% reported that it was due to bad blood in body and 19% said that it was a normal process in women. When asked about the effect of RTI on the health of women, 10.3% told that they did not know of any effect, but around 21% reported that it leads to cancer of uterus, followed by increased menstrual bleeding (15%) and damage to unborn child (12.3%). About 82% reported that RTIs were preventable. Most commonly stated preventive measures were condom use during sexual intercourse (42.1%) and maintaining hygiene of the genitalia (15%). A few women said that it can be prevented by avoiding hot foods, or by permanent contraceptive methods [Table 2]. Among women who had heard about STI/RTI, 75% said that it was treatable. When asked whether treatment of husbands was required if wife was suffering from RTI, 81.5% gave a positive response [Table 2].
10
All participants were asked whether they had suffered from RTI in the past 12 months by prompting the symptoms as options. About 60% said that they had suffered at least one of the symptoms of RTI in that period. White discharge per vaginum was reported by 53%, genital itching by 69%, lower abdominal pain by 68%, burning micturition by 48%, genital ulcers by 46%, dysmenorrhea by 73%, whereas mass in the inguinal region and pain during sexual intercourse was present in 29% each [Table 3]. Among these women treatment seeking was enquired for the most recent episode of RTI and only about 40% said they had taken any treatment. The reasons given by women for not taking any treatment were perceived lack of severity (71%) and financial problems (17%) and other reasons such as having no problem with routine activity and symptoms persisting just for a few days [Table 3]. Among those who received treatment, 82% said that they strictly followed the instructions given by the physicians. Among those who followed the instructions, 94% were cured of the symptoms completely, while 6% continued to have the symptoms. Among those who received treatment, only about 26% were advised treatment for husband and 20% were advised to use condoms during sexual intercourse [Table 3].
DISCUSSION In our study, we found that the knowledge about RTIs among the married women of Haryana was poor. Almost 47% had not heard about RTI. No one knew the actual cause of RTIs and many did not know the effects of RTIs on women’s health. Most of the participants knew that RTIs were preventable and
Table 1: Socio‑demographic characteristics of respondents (n=344) Nos.
Percentage
12
3.5
21-25
135
39.2
26-30
104
30.2
31-35
56
16.3
36-40
32
9.3
41 and above
5
1.5
Illiterate
58
16.9
Knows only reading
14
4.1
Age group Up to 20
Educational status
Primary
67
19.5
Middle school
78
22.7
Secondary
68
19.8
Higher secondary
42
12.2
Graduate
17
4.9
Nuclear family
179
52.0
Joint family
165
48.0
Family type
Indian Dermatology Online Journal - January-February 2015 - Volume 6 - Issue 1
Rizwan, et al.: RTI/STI knowledge among married women in rural Haryana
Table 2: Knowledge regarding STI/RTI among those who had heard about RTIs/STIs Nos. Percentage Knowledge about symptoms of RTI (n=194)
Table 3: Prevalence of self‑reported symptoms of STI/RTI (multiple responses possible) Symptoms
Nos.
Percentage
White discharge
53
15.4
Curdy white discharge
6
3.0
Curdy white discharge
25
7.3
White discharge per vaginum
37
19.0
Genital itching
69
20.1
Itching in the genitals
12
6.1
Pain in lower abdomen
68
19.8
Abdominal pain
18
9.2
Burning micturition
48
14.0
Burning micturition
5
2.5
Genital erosion
46
13.4
Ulcers in the genitals
10
5.1
Dysmenorrhea
73
21.2
Foul smelling menstrual bleeds
28
14.4
Mass in inguinal region
29
8.4
Swollen genitals
7
3.6
Painful intercourse
29
8.4
Treatment received (n=205)
Pain during sexual intercourse
5
2.5
Multiple options (discharge, foul smell, pain etc.,)
45
23.1
Yes
83
40.4
Don’t know
21
10.8
No
122
59.5
Knowledge about causes of RTI (n=194)
Reasons for not opting for treatment (n=122)
Bad blood in body
62
31.9
Only minor problem
87
71.3
Warm food
7
3.6
Financial problem
21
17.3
Curse of god
1
0.5
No problem during daily work
9
7.4
Normal process in women
37
19.0
Problem was for a short time
5
4.0
Multiple options (bad blood, warm blood etc.,)
11
5.6
Don’t know
76
39.2
Knowledge about effects of RTI (n=194)
Treatment taken as per advice (n=83) Yes
68
81.9
No
15
18.0
Treatment for husband advised (n=83)
Cancer of uterus
41
21.1
Increased menstrual bleeding
29
14.9
Advised
22
26.5
Damage to the child
24
12.3
Not advised
61
73.5
Chronic abdominal pain
10
5.1
Problems during pregnancy
11
5.6
Yes
17
20.4
No
66
79.5
Still birth
6
3.1
Congenital anomalies
24
12.3
Multiple options (cancer, increased bleeding etc.,)
29
14.9
Don’t know
20
10.3
Knowledge about preventive measures of RTI (n=194) Maintaining hygiene of genitalia
24
15.0
Using condom during intercourse
67
42.1
Avoiding sex with infected persons
19
11.9
Not taking hot foods
2
1.2
Permanent contraceptive methods
4
2.5
Others
2
1.2
Multiple options (hygiene, condom use etc.,)
38
22.8
Don’t know
38
19.3
Treatable
146
75.2
Not treatable
19
9.7
Don’t know
29
14.9
Required
158
81.5
Not required
36
18.5
Treatability (n=194)
Whether treatment of husband required or not if wife is suffering (n=194)
STI/RTI: Sexually transmitted infections/reproductive tract infections
Indian Dermatology Online Journal - January-February 2015 - Volume 6 - Issue 1
Use of condom advised (n=83)
STI/RTI: Sexually transmitted infections/reproductive tract infections
were aware about the correct methods of prevention. Most of them were aware of the fact that RTIs were treatable and that treatment of husbands was also essential. We found that the prevalence of self‑reported RTIs (at least one symptom) was higher than that reported in some similar studies. A community‑based study conducted in urban Shimla showed that the prevalence of any RTI symptom was 36.3%, vaginal discharge was 16.2%, genital ulcer was 1.5%, pelvic inflammatory diseases was 18%, and inguinal bubo was 0.7%.[5] Another study in rural Hoogli showed that the prevalence of RTI was 13.5%, the most common symptom being foul smelling discharge per vaginum.[6] Another population based study conducted in Hubli, Karnataka also showed that the prevalence of RTI was around 40%.[7] This difference might be due to better hygiene practices among women in urban settings as compared to rural settings. However, our estimated prevalence was similar to that reported (50%) by Nandan et al., in rural Agra.[8] NFHS 3 conducted in the year 2005-06 showed that the prevalence of RTIs in rural Haryana was around 8.4%, which was less than all of the above mentioned studies.[4] The observed difference may
11
Rizwan, et al.: RTI/STI knowledge among married women in rural Haryana
be due to differences in study period, sampling methodology and differences in the study population, case definitions, and access to healthcare facilities. In spite of a large burden of RTIs, only 40% of affected women sought treatment. This was comparable to that reported by Samant A et al. in Hoogli city, which showed that 50% of women opted for treatment.[6] This low rate of seeking treatment may be due to lack of awareness. Healthcare providers also seemed to have deficiencies in the management of RTIs because only 26% of spouses of affected women were offered treatment, and only 20% received advice for use of condom during sexual intercourse. Overall, this study showed a high prevalence of RTI, poor knowledge and poor treatment seeking behavior among the study participants. This high burden could be mainly due to two reasons i.e. failure to prevent the occurrence of new cases and failure to effectively treat the prevalent cases. Two possible ways of reducing the failure of the health system in terms of preventive measures are awareness generation and curative measures such as effective and holistic treatment. Thus the large burden of RTI can be decreased by preventing the occurrence of new cases and effective treatment of the prevalent cases. Most of the RTIs are preventable. Preventing new cases requires educating people about the common symptoms, common methods of transmission, complications and preventive measures. There is also a need to alleviate the stigma associated with RTIs and favorably modify the treatment‑seeking behavior of the patients. Promoting condoms and their availability to the general people are also important steps in prevention of the disease. Effective treatment can be increased by integrating the RTI treatment services with the primary healthcare services. Reinforcement of the syndromic management of the RTIs and regular training of the healthcare personnel are also required. A number of initiatives have been taken by the health ministry such as setting up specialized STI/RTI clinics called ‘Surakha Clinics’
12
for providing better facilities for treatment. However, availability of these services exists mostly at the district level and are not readily accessible to the people in remote rural areas. The involvement of private practitioners for control of STI/RTIs is also an important link as equal number of people also visit the private practitioners for treatment.
REFERENCES 1.
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Over M, Piot P. HIV infection and sexually transmitted disease. In: Jameson DT, Mosley WH, Measham AR, Bobadilla JL, eds. Disease control 10 priorities in developing countries. New York: Oxford University Press;1993. p. 455. WHO. Sexually transmitted infections (STIs) [Internet]. Available from: http://www.who.int/mediacentre/factsheets/fs110/en/index.html [Last cited on 2013 Sep 15]. Aggarwal D. Reproductive tract infections – challenges and responses. Health Millions 2001;3:21‑3. International Institute for Population Sciences (IIPS) and Macro International. 2007. National Family Health Survey (NFHS‑3), 2005-06. Vol. 1. Mumbai; International Institute of Population Sciences. Parashar A, Gupta BP, Bhardwaj AK, Sarin R. Prevalence of RTIs among women of reproductive age group in Shimla city. Indian J Community Med 2006;31:15‑7. Samanta A, Ghosh S. Mukharjee S. Prevalence and health seeking behavior of reproductive tract infections/sexual transmitted infections symptomatic: A cross‑sectional study in rural Community in the Hooghly district west Bengal. Indian J Public Health 2011;55:38‑41. Sangeetha SB, Bendigeri ND. Community‑based study of reproductive tract infections among women of the reproductive age group in the urban health training centre area in Hubli, Karnataka. Indian J Community Med 2012;37:34‑8. Nandan D, Misra SK, Sharma A, Jain M. Estimation of prevalence of RTIs/STDs among women of reproductive age group in district Agra. Indian J Community Med 2002;27:7‑9.
Cite this article as: Rizwan SA, Rath RS, Vivek G, Nitika, Anant G, Farhad A, Vijay S. KAP Study on Sexually Transmitted Infections/ Reproductive Tract Infections (STIs/RTIs) among married women in rural Haryana. Indian Dermatol Online J 2015;6:9-12. Source of Support: Nil, Conflict of Interest: None declared.
Indian Dermatology Online Journal - January-February 2015 - Volume 6 - Issue 1
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KAP Study on Sexually Transmitted Infections/ Reproductive Tract Infections (STIs/RTIs) among married women in rural Haryana Rizwan SA, Rama S. Rath1, Gupta Vivek2, Nitika1, Gupta Anant1, Ahamed Farhad1, Silan Vijay3 Department of Community Medicine, Velammal Medical College Hospital and Research Institute, Velammal Village, Madurai, Tamil Nadu, 1 All India Institute of Medical Sciences, New Delhi, 2National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, 3 Department of Community Medicine, BPS Government Medical College for Women, Khanpur Kalan, Sonepat, Haryana, India
ABSTRACT Context: About 490 million cases of curable Reproductive Tract Infections (RTI) occur throughout the world, of which 79 million cases occur in India annually. Sexually Transmitted Infections/Reproductive Tract Infections (STI/RTI) confers a huge economic burden on the individual and the health system. Complications of RTI/STI are many, ranging from chronic pain syndrome to infertility. Most of these complications can be prevented by early diagnosis and treatment. Aims: To assess knowledge, attitude and practices on STI/RTIs among married women aged 15‑45 years in rural Haryana. Setting and Design: Cross‑sectional study, conducted in selected villages under the primary health centre Mandi, Sonepat, Haryana. Subjects and Methods: Systematic sampling was used to cover 10 villages. In each village, every tenth house was sampled, taking first house from the center of the village. Face‑to‑face interview was conducted using pretested questionnaire. Statistical Analysis Used: Descriptive statistics and results were described in percentages. Results: A total of 344 women were interviewed. About 44% women had never heard of STI/RTI. The prevalence of self‑reported symptoms of STI/RTI was very high (60%). Only 40% of them opted for treatment and most common cause for not opting for treatment was that they considered it as a minor problem. Advice for use of condom during the treatment was received by only 20% of patients and only 26.5% of their husbands also received treatment. Conclusions: Overall knowledge, attitude and practices relating to STI/RTI among married women in rural Haryana was poor. The prevalence of self‑reported STI/RTI was found to be high and treatment seeking behavior was poor. Key words: Attitude, knowledge, married women, practices, rural Haryana, reproductive tract infections, sexually transmitted infection
Access this article online Website: www.idoj.in
INTRODUCTION
DOI: 10.4103/2229-5178.148919 Quick Response Code:
Address for correspondence: Dr. Vijay Silan, Department of Community Medicine, BPS Government Medical College for Women, Khanpur kalan, Sonepat, Haryana, India. E-mail: vijay.silan@ gmail.com
Sexually Transmitted Infections/Reproductive Tract Infections (STI/RTI) are a common public health problem in developing countries, contributing to a huge economic burden among individuals and health systems.[1] According to the World Health Organization (WHO), each year around 499 million cases of curable STIs occur throughout the world in the age group of 15-49 years, of which 80% cases occur in developing countries and about 79 million cases occur in India annually.[2] Another study suggests that about 40 million cases of RTIs occur in India each year.[3] National Family Health Survey (NFHS‑3) reported that 11% women and 5% men in the 15-49 years age group had STI/ RTIs related symptom in the past year.[4] STIs lead to several complications in women such as
Indian Dermatology Online Journal - January-February 2015 - Volume 6 - Issue 1
tubal blockade, pelvic inflammatory diseases, chronic pain syndromes, sexual dysfunction and many others. They cause significant morbidity among males as well including strictures, sexual dysfunction, genital ulcers, and kidney and bladder problems. They also lead to complications in the neonate like chlamydial conjunctivitis, sepsis and other morbidities. Most of these complications are preventable with early diagnosis and treatment, and prevention of infection. The main aim of this study was to assess knowledge, attitude and practices regarding STI/RTIs among married women of selected villages in rural Haryana.
SUBJECTS AND METHODS This was a community based cross‑sectional survey. The study was conducted during September 2011 in 10 villages under Primary
9
Rizwan, et al.: RTI/STI knowledge among married women in rural Haryana
Health Centre (PHC) Mandi, Panipat District, Haryana. Married women aged 15 to 45 years living in study area for at least a year were eligible for inclusion. Sample size was calculated as 340 taking a prevalence of self-reported STI/ RTI among married women as 8%, absolute precision 3%, alfa error 5%, power 80% and non‑response rate of 5%. We employed a systematic random sampling technique. In each village, every tenth house was sampled, taking first house from the center of the village. If the selected house did not have eligible participants, the next house in the street with eligible persons was selected and the systematic sampling continued from that house onward. The sampling was continued till the entire village was covered. In the selected house, if more than one eligible participant was present, then one was selected randomly and face‑to‑face interview was conducted using pretested questionnaire. Informed verbal consent was obtained from all participants. The participants who had RTI/ STI symptoms were referred to PHC Mandi for syndromic management. Analyses were done using Statistical Package for the Social Sciences software (SPSS version 17.0). Data were described in terms of proportions.
RESULTS A total of 344 sexually active married women were interviewed. Most of the women were in the age group of more than 18 years and were educated up to middle school. Participants from nuclear and joint family constituted identical proportions [Table 1]. Almost 43.6% women had not heard about RTI. Those who had heard of RTI were asked about the symptoms that may indicate that a person was suffering from RTI. About 11% women said that they did not know the symptoms. Among those who knew about symptoms, most common (19%) response was white discharge per vaginum, followed by foul smell of vaginal discharge (14.5%). About 23% gave multiple answers (i.e. pain, vaginal discharge, foul smell). When asked about the cause of RTI, about 39% said that they did not know the cause, while 31% reported that it was due to bad blood in body and 19% said that it was a normal process in women. When asked about the effect of RTI on the health of women, 10.3% told that they did not know of any effect, but around 21% reported that it leads to cancer of uterus, followed by increased menstrual bleeding (15%) and damage to unborn child (12.3%). About 82% reported that RTIs were preventable. Most commonly stated preventive measures were condom use during sexual intercourse (42.1%) and maintaining hygiene of the genitalia (15%). A few women said that it can be prevented by avoiding hot foods, or by permanent contraceptive methods [Table 2]. Among women who had heard about STI/RTI, 75% said that it was treatable. When asked whether treatment of husbands was required if wife was suffering from RTI, 81.5% gave a positive response [Table 2].
10
All participants were asked whether they had suffered from RTI in the past 12 months by prompting the symptoms as options. About 60% said that they had suffered at least one of the symptoms of RTI in that period. White discharge per vaginum was reported by 53%, genital itching by 69%, lower abdominal pain by 68%, burning micturition by 48%, genital ulcers by 46%, dysmenorrhea by 73%, whereas mass in the inguinal region and pain during sexual intercourse was present in 29% each [Table 3]. Among these women treatment seeking was enquired for the most recent episode of RTI and only about 40% said they had taken any treatment. The reasons given by women for not taking any treatment were perceived lack of severity (71%) and financial problems (17%) and other reasons such as having no problem with routine activity and symptoms persisting just for a few days [Table 3]. Among those who received treatment, 82% said that they strictly followed the instructions given by the physicians. Among those who followed the instructions, 94% were cured of the symptoms completely, while 6% continued to have the symptoms. Among those who received treatment, only about 26% were advised treatment for husband and 20% were advised to use condoms during sexual intercourse [Table 3].
DISCUSSION In our study, we found that the knowledge about RTIs among the married women of Haryana was poor. Almost 47% had not heard about RTI. No one knew the actual cause of RTIs and many did not know the effects of RTIs on women’s health. Most of the participants knew that RTIs were preventable and
Table 1: Socio‑demographic characteristics of respondents (n=344) Nos.
Percentage
12
3.5
21-25
135
39.2
26-30
104
30.2
31-35
56
16.3
36-40
32
9.3
41 and above
5
1.5
Illiterate
58
16.9
Knows only reading
14
4.1
Age group Up to 20
Educational status
Primary
67
19.5
Middle school
78
22.7
Secondary
68
19.8
Higher secondary
42
12.2
Graduate
17
4.9
Nuclear family
179
52.0
Joint family
165
48.0
Family type
Indian Dermatology Online Journal - January-February 2015 - Volume 6 - Issue 1
Rizwan, et al.: RTI/STI knowledge among married women in rural Haryana
Table 2: Knowledge regarding STI/RTI among those who had heard about RTIs/STIs Nos. Percentage Knowledge about symptoms of RTI (n=194)
Table 3: Prevalence of self‑reported symptoms of STI/RTI (multiple responses possible) Symptoms
Nos.
Percentage
White discharge
53
15.4
Curdy white discharge
6
3.0
Curdy white discharge
25
7.3
White discharge per vaginum
37
19.0
Genital itching
69
20.1
Itching in the genitals
12
6.1
Pain in lower abdomen
68
19.8
Abdominal pain
18
9.2
Burning micturition
48
14.0
Burning micturition
5
2.5
Genital erosion
46
13.4
Ulcers in the genitals
10
5.1
Dysmenorrhea
73
21.2
Foul smelling menstrual bleeds
28
14.4
Mass in inguinal region
29
8.4
Swollen genitals
7
3.6
Painful intercourse
29
8.4
Treatment received (n=205)
Pain during sexual intercourse
5
2.5
Multiple options (discharge, foul smell, pain etc.,)
45
23.1
Yes
83
40.4
Don’t know
21
10.8
No
122
59.5
Knowledge about causes of RTI (n=194)
Reasons for not opting for treatment (n=122)
Bad blood in body
62
31.9
Only minor problem
87
71.3
Warm food
7
3.6
Financial problem
21
17.3
Curse of god
1
0.5
No problem during daily work
9
7.4
Normal process in women
37
19.0
Problem was for a short time
5
4.0
Multiple options (bad blood, warm blood etc.,)
11
5.6
Don’t know
76
39.2
Knowledge about effects of RTI (n=194)
Treatment taken as per advice (n=83) Yes
68
81.9
No
15
18.0
Treatment for husband advised (n=83)
Cancer of uterus
41
21.1
Increased menstrual bleeding
29
14.9
Advised
22
26.5
Damage to the child
24
12.3
Not advised
61
73.5
Chronic abdominal pain
10
5.1
Problems during pregnancy
11
5.6
Yes
17
20.4
No
66
79.5
Still birth
6
3.1
Congenital anomalies
24
12.3
Multiple options (cancer, increased bleeding etc.,)
29
14.9
Don’t know
20
10.3
Knowledge about preventive measures of RTI (n=194) Maintaining hygiene of genitalia
24
15.0
Using condom during intercourse
67
42.1
Avoiding sex with infected persons
19
11.9
Not taking hot foods
2
1.2
Permanent contraceptive methods
4
2.5
Others
2
1.2
Multiple options (hygiene, condom use etc.,)
38
22.8
Don’t know
38
19.3
Treatable
146
75.2
Not treatable
19
9.7
Don’t know
29
14.9
Required
158
81.5
Not required
36
18.5
Treatability (n=194)
Whether treatment of husband required or not if wife is suffering (n=194)
STI/RTI: Sexually transmitted infections/reproductive tract infections
Indian Dermatology Online Journal - January-February 2015 - Volume 6 - Issue 1
Use of condom advised (n=83)
STI/RTI: Sexually transmitted infections/reproductive tract infections
were aware about the correct methods of prevention. Most of them were aware of the fact that RTIs were treatable and that treatment of husbands was also essential. We found that the prevalence of self‑reported RTIs (at least one symptom) was higher than that reported in some similar studies. A community‑based study conducted in urban Shimla showed that the prevalence of any RTI symptom was 36.3%, vaginal discharge was 16.2%, genital ulcer was 1.5%, pelvic inflammatory diseases was 18%, and inguinal bubo was 0.7%.[5] Another study in rural Hoogli showed that the prevalence of RTI was 13.5%, the most common symptom being foul smelling discharge per vaginum.[6] Another population based study conducted in Hubli, Karnataka also showed that the prevalence of RTI was around 40%.[7] This difference might be due to better hygiene practices among women in urban settings as compared to rural settings. However, our estimated prevalence was similar to that reported (50%) by Nandan et al., in rural Agra.[8] NFHS 3 conducted in the year 2005-06 showed that the prevalence of RTIs in rural Haryana was around 8.4%, which was less than all of the above mentioned studies.[4] The observed difference may
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Rizwan, et al.: RTI/STI knowledge among married women in rural Haryana
be due to differences in study period, sampling methodology and differences in the study population, case definitions, and access to healthcare facilities. In spite of a large burden of RTIs, only 40% of affected women sought treatment. This was comparable to that reported by Samant A et al. in Hoogli city, which showed that 50% of women opted for treatment.[6] This low rate of seeking treatment may be due to lack of awareness. Healthcare providers also seemed to have deficiencies in the management of RTIs because only 26% of spouses of affected women were offered treatment, and only 20% received advice for use of condom during sexual intercourse. Overall, this study showed a high prevalence of RTI, poor knowledge and poor treatment seeking behavior among the study participants. This high burden could be mainly due to two reasons i.e. failure to prevent the occurrence of new cases and failure to effectively treat the prevalent cases. Two possible ways of reducing the failure of the health system in terms of preventive measures are awareness generation and curative measures such as effective and holistic treatment. Thus the large burden of RTI can be decreased by preventing the occurrence of new cases and effective treatment of the prevalent cases. Most of the RTIs are preventable. Preventing new cases requires educating people about the common symptoms, common methods of transmission, complications and preventive measures. There is also a need to alleviate the stigma associated with RTIs and favorably modify the treatment‑seeking behavior of the patients. Promoting condoms and their availability to the general people are also important steps in prevention of the disease. Effective treatment can be increased by integrating the RTI treatment services with the primary healthcare services. Reinforcement of the syndromic management of the RTIs and regular training of the healthcare personnel are also required. A number of initiatives have been taken by the health ministry such as setting up specialized STI/RTI clinics called ‘Surakha Clinics’
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for providing better facilities for treatment. However, availability of these services exists mostly at the district level and are not readily accessible to the people in remote rural areas. The involvement of private practitioners for control of STI/RTIs is also an important link as equal number of people also visit the private practitioners for treatment.
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Cite this article as: Rizwan SA, Rath RS, Vivek G, Nitika, Anant G, Farhad A, Vijay S. KAP Study on Sexually Transmitted Infections/ Reproductive Tract Infections (STIs/RTIs) among married women in rural Haryana. Indian Dermatol Online J 2015;6:9-12. Source of Support: Nil, Conflict of Interest: None declared.
Indian Dermatology Online Journal - January-February 2015 - Volume 6 - Issue 1
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