Knowledge about and management of sexually transmitted infections by general practioners of Karachi
Date of Award
Master of Science in Epidemiology & Biostatistics (MSc Epidemiology & Biostats)
Community Health Sciences
HIV/AIDS has affected almost every nation on the world map. This upsurge has brought all the major modes of HIV/AIDS spread to the notice of public health professionals around the globe. Sexually Transmitted Infections (STIs), being a major mode of spread, increase the incidence of HIV/AIDS by 8-10 folds. The success in STI control is most likely to occur when the messages are launched from a fully trained health provider in managing the STIs. But as the STI management is not taught as a part of the coursework in the medical colleges of the country at the undergraduate level, it is highly unlikely that the GPs would manage STI patients coming to them. In order to cater for this approaching public health problem, it is imperative to assess the abilities of GPs for managing STIs. The objectives of the study were to estimate the proportion of GPs who managed STI patients, to determine the factors associated with whether or not the GP manages STI patients, to estimate the proportion of GPs who appropriately managed three most prevalent STI syndromes namely Urethral Discharge Syndrome (UDS), Genital Ulcer Syndrome (GUS) and Vaginal Discharge Syndrome (VDS), and to determine the factors associated with whether or not the GP appropriately manages these STI syndromes in their private practices in Karachi. A cross sectional survey was conducted utilizing structured questionnaires to interview 518 general practitioners of Karachi. The statistical analyses included descriptive analysis for computing means and proportions, as appropriate, and univariate and multivariable logistic regression analyses for determination of associations. In the present study, 74.7 percent of the GPs were found to be managing STI patients. The GPs who managed STI patients were more likely to be younger than 34 years of age (adj OR: i "8.9; 95% CI: 8.6 — 41.7), empioyed by die government (adj OR: 12.2; 95% CI: 4.5 — 33.1) and kept privacy while managing patients (adj OR: 2.4; 95% CI: 1.7 — 3.4). These GPs were more likely to manage STI patients as the number of their daily patients increased by 25 (adj. OR: 1.34; 95% CI: 1.13 — 1.56). This study estimates that 23 percent of the GPs appropriately managed UDS and 5 percent of them appropriately managed GUS among those who managed the respective syndromes. None of the GPs were, however; found to be managing VDS appropriately. The GPs who appropriately managed UDS were more likely to be trained for syndromic management (adj. OR: 8.0; 95%CI: 3.2 — 20.1). These GPs were more likely to manage UDS appropriately as the number of STI patients increased (adj. OR: 2.7; 95% CI: 2.0 — 3.6). The GPs who appropriately managed GUS were more likely to have done their internships in medicine and dermatology (adj. OR: 18.2; 95% CI: 5.5- 59.8) as compared to medicine and surgery. These GPs were more likely to manage GUS appropriately as the user fee increases by every Rs.50/- (adj. OR: 3.8; 95% CI: 1.9- 7.5). This study shows that there is a considerable proportion of GPs who manage STIs in Karachi. This offers a tremendous opportunity to treat and counsel STI patients and notify their partners. However, the GPs do not have proper skills to manage STI patients appropriately. Thus there is a need to train the GPs on STI management so that the impending disaster of HIV/AIDS could be averted.
Rafay, A. (2006). Knowledge about and management of sexually transmitted infections by general practioners of Karachi (Unpublished doctoral thesis). Aga Khan University, Karachi, Pakistan.