MINISTRY OF EUDCATION AND TRAINING MINISTRY OF HEALTH NATIONAL INSTITUTE OF HYGIENE AND EPIDEMIOLOGY Nguyen Minh Quang PREVALENCE AND INFLUENCING FACTORS OF THE LOWER REPRODUCTIVE TR
Trang 1MINISTRY OF EUDCATION AND TRAINING MINISTRY OF HEALTH
NATIONAL INSTITUTE OF HYGIENE AND EPIDEMIOLOGY
Nguyen Minh Quang
PREVALENCE AND INFLUENCING FACTORS OF THE LOWER
REPRODUCTIVE TRACT INFECTIONS AMONG FEMALE SEX WORKERS IN THE
CENTRE FOR TREATMENT - REHABILATION - EDUCATION - SOCIAL LABOUR II
HANOI AND EVALUATION OF THE INTERVENTIONS
Speciality: Social Hygiene and Health Administration
Code: 62.72.01.64
SUPERVISORS:
1 Associate Prof Ngo Van Toan, MD., PhD
2 Do Hoa Binh, MD., PhD
Ha Noi - 2013
THE THESIS WAS COMPLETED
NATIONAL INSTITUTE OF HYGIENE AND EPIDEMIOLOGY
SUPERVISORS:
1 Associate Prof PhD NGO VAN TOAN
2 DO HOA BINH, MD PhD
Opponent 1:
Opponent 2:
Opponent 3:
The thesis will be defended at the Assessment Commetee at Institute Level
The defend at National Institute of Hygiene and Epidemiology
Time: date month 2013
The thesis stored at:
- National Library
- National Institute of Hygiene and Epidemiology Library
Trang 2PUBLICATIONS
1 Nguyen Minh Quang, Bui Van Nhon, Ngo Van Toan (2012),
“Prevalence of lower genital tract infections among female sex workers
in Hanoi Social Education Labor Centre in 2009-2011”, Journal of
Medical Research, Volume 80, N03
2 Nguyen Minh Quang, Bui Van Nhon, Ngo Van Toan, Do Hoa Binh,
Nguyen Thi Thuy Duong (2012), “Risk behaviors of the lower sexual
tract infections among female sex workers in Hanoi Social Education
Labor Centre in 2010”, Journal of Preventive Medicine, Volume XXII,
N0 6 (133)
3 Nguyen Minh Quang, Bui Van Nhon, Ngo Van Toan, Do Hoa Binh,
Nguyen Thi Thuy Duong (2012), “Effectiveness of intervention
measures to prevent the lower genital tract infections in female sex
workers at Centre 02 in Hanoi city, 2010-2012”, Journal of Preventive
Medicine, Volume XXII, N0 6 (133)
INTRODUCTION
1 Rationale of the thesis
WHO defined that infections of lower reproductive tract (LRTI) are genitials infections including STDs and others LRTIs are common, dificult
to determine exactly the the incident rates of the differente teritories, especial in sex workers (SW) The rate of LRTI is general high from 41-47% in the world In Vietnam, a study in 2005 reported 81.3% abnormal of reproductive tract, including 66.6% LRTI, closely related to HIV, sinificant hight in FSW Risks of LRTI in FSW are lack of knowledge and practising
to prevent STD, including unsafty exual, less of condom using, many kinds
of sex partners, unsatisfy contraception The stydy on efectiveness of LRTI preventive measures was carry out and it is pointed that the most effected solution is using condom for all sexual intercourses
In Vietnam, there are some stydies in effectiveness of prevention HIV, however the systematic studies on LRTI are very rare This sudy aims to indicate the risk factors and efectiveness of interventions, in order to improve the knowledge and practising to prevent LRTI in FSWs , who are concentrated for treatment, rehabilation, education and social labor in the Center II, Ba Vi, Hanoi The subjects of study are:
1 Describe the incidences and risk behaviors of LRTIs in female sex workers, who are concentrated in the Center for Treatment, Rehabilitation, Education and Social Labor II of Hanoi in 2011
2 Evaluate the effectiveness of interventions to prevent lower genital tract infection for female sex workers and improve the knowledge of sexually transmitted infections for medical staffs in the Center for Treatment, Rehabilitation, Education and Social Labor II of Hanoi, period 2011-2012
2 New contributions of the thesis
This is the first systemetic study on LRTI with evaluations on incidences and efectiveness of interventions, in order to improve the knowledge and pratising for FSW, who were being in the Center II
The thesis has proved the evidence on effectiveness of interventions by training, LRTI screening for FSW and performance on training to improve knowledge on managing LRTI for medical staffs of the center The thesis has identified the high incidence of LRTI in FSW and the role of condom using to prevent LRTI for all sexual intercoureses with all clients, it is also
Trang 3mentioned the effect of media education, advantage of initiative health care
to reduce LRTI diseases in FSW
The study results are used ful for the policy and planning programs in order
to expand this intervention modul for the other centers over the nation
3 Scientific and practical meanings of the thesis
Scientific meaning: The study uses community intervention design, meets
to subjects of research , data collection and analysis are exactly , has proved
remarkable effectiveness on interventions by media education, initiative
health care for FSW, has improved knowledge of managing LRTI for
medical staffs of the center
Practical meaning: The results of the thesis has performed the effectiveness
of the intervention model to help planners and policy makers as well as
presventing LRT for FSW and improve knowledge and pratising STD
managing for health workers, base on that to expand this intervention model
for other centers over the nation
4 The layout of the thesis
The thesis is presented in 124 pages, excluding appendixes and is divided into:
Introduction: 2 pages
Chapter 1: Overview: 35 pages
Chapter 2: Subjects and Methods of study: 198 pages
Chapter 3: Research Results: 36 pages
Chapter 4: Discussion: 27 pages
Conclusions: 2 pages
Recommendations: 1 page
There are 41 tables, 11 charts
The appendix includes 151 references (57 Vietnamese, 94 English),
Questionnaires sheet, List of FSW , List of staffs involved in the training
Chapter 1 OVERVIEW 1.1 Basic conceptions of LRTI:
By WHO, infections of lower reproductive tract (LRTI) are infection
disease caused by or not by sexual transmition disease (STD) including
vulgaris, vaginalis and cervicitis
1.2 Prevalance of LRTI and risk behaviors
1.2.1 Prevalence of LRTI
Gonorrhea: caused by Streptococcus Gonorrhea Studies in 5 provinces
showed the incidence is 3.2 % Nguyen Trong Thuc reported on his
Sentinel surveillence
Research in 4 southest province, the Gonorrhea incidence in FSW was 4.64
% This ratio is higher in the North and Middle of Vietname, the research in
5 North border provinces described with 11.9% Gonorrhea in FSW The Gonorrhea ratio in the neiboring contries are 5.7 % in Cambodia and 9.5 %
in China
Syphilis: caused by Treponema pallidum Research in 5 border provinces
of Vietnam showed the incidence rate is 10.7 % in general, highest is Quang ninh (24.8 %) and Lai Chau (20.2 %) and 03 remains provinces of Dong Thap, An Giang, Kien Giang have rates ranging 5.7 - 9.4 %
Chlamydiasis: is one of STD cause by Chlamydia,a parasite stained Gram
(-) color A research in Provinces of Mekong Delata indicated 3.5 % FSW has positive with Chlamydia Foreign researches on FSW reported incidence rate ranging 12% -2 7.0 % in Asia and Europe countries
Trichomatis: caused by Trichomonas, a parasite of anaerobic protozoa,
round shape with diameter 10-20 μm The incidence rate ranging 2-2.5 % in general and 50-70 % in FSW over the world In Vietnam LRT Trichomatis incidence rate 8.13 % in FSW and 0.84 % in pregnants are reported
Fungal LRTI: cause by Candidas Albicans and some time by other strains
Candidas Albicans is also causing fungal diseases in many organs such as
the skin and mucosal infections, Septicaemia, endocarditis, meningitis The
incidence in Haiphong province is 10.7%, highest among 5 researched provinces Research in 2005 showed fungal LRTI incidence rate is 11.9 %
of FSW in 4 South provinces
Reproductive papiloma: caused by Human Papiloma Virus (HPV)
Typical sumptoms are red-brown soft warts, glomerate in vulva, vagina, cervix The lessions evoke itching, discomfort due to increasing secretion, easy to bleed by touch Dianosistic based on physical symptoms, cervix luminate, HPV determine by PCR technique HPV papiloma has high ratio
in FSW, accounting for 9.2 %
Reproductive Herpes: caused by Herpes Simplex Virus type I, II It 's
leading to obstetric accidences such as miscarriage, premature give birth, premature placental detachment Research in Hai Phong province showed the incidence rate in FSW is 3.9 % in FSW, 32.8 times higher than the lower risk groups
Complex microbial LRTI - vulgaris, vaginalis: the pathogens are
nonspecific, diversity Clinic symptoms are homogeneous liquid discharge with white or gray color, stinking smell Some local and overseas studies
Trang 4reported the incidence rate of complex microbial vulgaris, vaginalis
without symtoms are quite hight (50-70 %)
1.2.2 Factors and risk behaviors afects to LRTI in FSW
Age is an important factor of LRTI in teenagers Studied in Central Institute
of Dermatology of Vietnam 2003-2005 and other researches indicated the
incidence rate tend to be higher in women over 20 years old than the
women under 19 years old
The incidence rate of LRTI is usually higher in group has low education
and and unstable careers This is also a difficult matter on education to
improve practising of LRTI prevention In fact, the low education group has
shown the poor knowledge of LRTI and unsafty sexual activities, unsafety
injection that entrain to high incidence of HIV and LRTI
Career is important factor related to LRTI and HIV infection, the incidence
rate are 14.7 %; 13.1%; 13.1 % and 8.4 %, correlatively in the groups of
workers, freelances, market sellers and students
Having unsafty sex is risk to be infected HIV and LRTI, in countries with
high prevalences of HIV & LRTI, were recognised the main cause of very
low rate of condom using (condoms) In a study in the southern provinces
showed that 65% of female sex workers do not use condoms during
sexcourses, HIV prevalence in this group was 5.2% and the proportion
accounted for LRTI is high (above 80%) Average number of customers
/ month is one of the high-risk factor to be infected HIV and STD in
FSWs Research by Centre for Disease Prevention and Control showed
up to 80% of cases LRTI does not use condoms regularly, compared
with 2% of LRTI cases in FSWs often use of condoms in sexcourses
with clients and partners The initiative to get the tests of LRTI is
meaningful in preventing infection LRTI for their clients, husband /
partner and also help the women be able to access the treatment in cases
of LRTIs
1.3 The LRTI prevention models
1.3.1 Communication programs for behavior change
The main purpose of communication programs for behavior change is to
increase awareness, knowledge, understanding of transmission LRTI and
prevention measures for all the people, forthe high risk groups, eapecial
FSWs Communication programs for behavior change aims to access the
high-risk groups, differentiate to the other media is for community This
program also provide information of to prevent LRTIs and provide
services, which support to change behaviors and maintain safety sex by
using condoms, resist drug abuse and personal hygiene guide
1.3.2 The program of 100% condom using
The program encourages FSWs to use condom for 100% sexual intercourses (says as program 100% condom) is not simply to provide condom, but it includes many activities to improve the awareness, knowlege about distribution of condoms, peer education and screening of STD and reproductive tract infections The aims of program is to prevent and reduce HIV and LRTI with effectiveness and low cost
1.3.3 Program of Management LRTI
The person, sho is sufered from LRTI diseases likely to be HIV infected more than 2-9 time compare with the ordinary subject Therefore, early detection and treatment of STD are not only make sense to restrict the spread of HIV through sexual, also are meaningful in management,
monitoring LRTI among indicated population
1.3.4 Peer education program
Peer education program is reachable enough to understand that "the sharing
of knowledge, skills and life experiences between those who have the same characters of social and ecomomy such as age, gender, occupation, religion, hobbies, in order to change their behaviors" Peer education program is also called "program of communication accessibilities" In many countries, people have implemented the programs to reduce harm in community such
as peer education
Chapter 2 SUBJECTS AND METHODS 2.1 Object, location and study duration
2.1.1 Subjects of study
- The women are training in the CenterII (for Treatment,Rehabilitation, Education, Social Labor), located in Yen Bai commune, Ba Vi District, Ha Noi City, from 2011 to 2012 The time of concentrated training should be t least 12 months to warranty the time of intervention by research and the participants have to voluntary invole to the study
- 15 medical staffs and managing persons, who are working in the Center II for Rehabilitation, Education, Social Labor, Hanoi
2.1.2 Study site
The study was conducted at the Center II for Rehabilitation, Education, Social Labor, belongs to Department of Labour, Indisable and Social Affairs of Hanoi, located in Yen Bai commune, Ba Vi district
2.1.3.Duration of research and data collection
From 1/2011 - 12/2012, at Ba Vi district, Hanoi
2.2 Research Methodology
Trang 52.2.1 Study Design
An intervention experimental design, without comparative
2.2.2 Research sample and sampling
2.2.2.1 Female Sex Workers:
Sample sizes:
2 2 1
2 2 2 1 1 1 )
2 / 1 ( 2
] 1 ( ) 1 ( [ )
1 ( 2 [
p p
p p p p Z p p Z
n
n
−
− +
− +
−
=
Includings:
n1: sample size before intervention
n2: sample size after intervention
p1: prevalence of FSW using condoms for all sexual intercourses, before
intervention (estimated 52 %)
p2: prevalence of FSW using condoms for all sexual intercourses, after
intervention (estimated 65 %)
p: (p1 + p2) / 2, Z1-α / 2: reability coefficient, determined at 95 % (=1.96)
z1-β: force sample (= 80%)
Total: 407 FSWs were studied
Sampling: The FSWs were selected by the single random sampling, based
on a list of all FSWs, who are training in Center II, Ba Vi, Hanoi
2.2.2.2 Medical staffs
All medical staffs included all 15 doctors, nurses who are working in Center
II, Ba vi, Hanoi to be selected in the study
2.2.3 Process and means of data collection
2.2.3.1 Process of data collection
2.2.3.1.1 Interview
Interviewed FSWs following questionnaire sheet to collect information of
individuals, families, and knowledge of risk behaviors of LRTI of FSWs
Interviewed medical staffs to collect personal information and LRTI
knowledge of the medical staff of the Centre
2.2.3.1.2 Clinical examination
Clinical exam to identify the symptoms of LRTsI Take exam to detect the
exsisting STDs: genital ulcer, urethral and vaginal discharge, stinking odor
of discharge, urticaria, abnomal pain, papilome
2.2.3.1.3 Tests
The dicharge of lower genital tract and blood are testing find the pathogens
of LRTIs The LRTIs to be studied are including: Gonorrhea, Syphilis,
Trichomoniasis, Chlamydia, fungi and complex bacterial
2.2.3.2 Means of data collection
The interview questions sheet contains: the administrative part, personal characteristics, risk behaviors of FSWs and knowledge, skills of medical staffs Clinical examination leaflet, blood tests, discharge test
2.2.4 Technical tests
The testing techniques to find pathogens were performed under the guidlines of WHO and the Central Hospital of Dermatology
2.2.5 Content and intervention process
Examination, treatment for FSWs and monitoring of clinical and laborator expressions Communication and education activities focused on prevention
of sexually transmitted diseases, which is currently conducted at the Center, included: organized the direct education, communication via leaflets, media
by film/television, consult directly Training for medical staffs to perform screening, exam and treatment of LRTI and STDs for FSWs
2.2.6 Analysis
The data has been analysis and presented by frequency and % ratio Test χ2
and p value expressed the difference between independent variable and dependent variable Estimation Test (OR) and 95% CI was used to identify the relation between LRTI ratio and individual characteristics, risk behaviours of FSWs Multivariable regress analysis to be used for error exclussion of indipendent and depend variables relationship Effectiveness indicator to be count for determining of intervention effects
2.2.8 Ethics in Research
The objects have informed the aims of study and to be volunteered All information is secured by encription and used for this dtudy only The research author have not to utilitize any inlegal supplemtation or service during study process
Chapter 3 RESULTS OF STUDY 3.1 Some personal characteristics of FSWs
Among 407 FSWs, the youngest is 15 years old and the oldest is 40 years old Mean age was 26.8 ± 6.29 years, minimum 15 and maximum is 40 years old Most FSWs were currently concentrated on training in the Center are Kinh ethnic group, accounting for 59%, the proportion of FSWs used to live in rural areas is very high, accounting for 93.4% Before to be FSWs,
Trang 6most of them were worked in agriculture (63.6%), continuous by groups of
jobless and freelance (14.3% and 14%) The education level of FSWs was
low, averaging 6 ± 3.8 years FSW illiteracy rate was 14%, primary school
was 28%, secondary school was 45.5% and high school was 12.5% only
Medical staffs group ≤ 30 years has highest for proportion (60.0%) Mean
age was 29.8 ± 6.6 years old There are 60 % of medical staffs are women,
highest proportion is nurse (46.7 %) Working experience of medical staffs
devided 02 groups: under 5 years, accountd for 46.6 % including 3 staffs just got
01 working year; 5-10 years and 11-20 years, accounted for 26.7 % One of them
has trained of LRTI treatment (6.6 %)
3.2 Incidence prevalence, influent factors and risk behaviors of female
sex workers
3.2.1 The clinical symptoms of LRTIs
In FSWs, the rate of at least one symptom associated with LRTI when
entering the Center was 34.2% The most common symptoms reported in
FSWs is abnormal vaginal discharge (24.8%), followed by itching in the
genital area (14.7%), abdominal pain (13.3%) Other symptoms were
genital sores (10.6%), sharp pain urine (9.3%) and lowest was genital ulcers
(8.4%)
3.2.2 Incidence prevalence in FSWs
Incidence prevalence of LRTI in FSWs when entering the center is high in
clinical, accounted for 67.1%
7.9%
49.9%
12%
21.9%
8.8%
0
10
20
30
40
50
60
Single
vulgaris
Single vaginalis
Single cervicitis
Vulga-vaginalis
Exposed cervical
Chart 3.9 The lession morphology of lower genital/reproductive tract
infections
The most common infection was vulvo-vaginalis (49.9%), single vaginalis (21.9%), single cervicitis (8.8%) Especially with 7.9% of FSWs had cervical cervicitis
10.1%
44.7%
2.5%
0.5%
4.4%
0 10 20 30 40 50
T.Vaginalis Gonorrhea Syphilis Complex
microbial
Fungal
Chart 3:10 Ratio of pathogens of lower genital tract infection (n = 273)
When entering the center, rate of complex microbial infection in FSWs was highet, accounted 44.7%, following by fungal infection 10.1%, Trichomonas, 4.4%, syphilis 2.5% and gonorrhea is lowest, accounted for 0.5%
3.2.3 Analysis the affected factors and pathogens of lower genital tract infections in FSWs
Table 3.17 The relation between pratising/whored time and LRTIs
Whored time
Infection
(n=273)
Non-infection
≥ 1 months
< 1 month
174
99
72.8 58.9
65
69
27.2 41.1
1 0.6 0.38-0.81 FSW group < 18 years old had a higher rate than the FSW group > 18 years old (70% compared with 66.2%) There was 58.7% FSWs had whored time
≥ 1 month The rate of LRTI in FSW group of whored time ≥ 1 months is higher than FSW group of whored time < 1 month (72.8% compared with 58.9%) This difference was statistic meaning
Trang 7Table 3.18 The relationship between the average sex client and LRTI
Number of the
clients
Infection
(n=273)
Non-infection (n=134) OR 95%CI Quantity % Quantity %
Clients / month
1-9 clients
10-19 clients
≥ 20 clients
96
38
139
66.2 70.4 66.8
49
16
69
33.8 29.6 33.2
1 1.2 1.0
0.58-2.53 0.64-1.65 New clients / month
0 client
1-2 clients
3-5 clients
≥ 6 clients
18
131
19
25
52.9 71.3 64.5 67.6
16
56
50
12
47.1 38.7 35.5 32.4
1 2.1 1.5 1.9
0.93-4.65 0.85-3.24 0.64-5.44
In general, LRTI rate of FSW group had 10-19 clients/month is higher than
the other FSW groups (70.4% compared with 66.2% and 66.8%)
However, this difference is not statistic meaning Rate of LRTI of FSW
group had 1-2 new clients / day was higher than the other groups (71.3%
compared with 67.6%, 64.5% and 52.9%) This difference is also not
statistic meaning LRTI rate of FSW group had ≥ 6 regular client was
higher than the other FSW groups (71.1% compared with 64.2%, and
58.7% ) This difference was statistic meaningl
Table 3.19 The relation between behavior of condom use and LRTI
Behavior of condom
use
Infection
(n=273)
Non-infection (n=134) OR 95%CI Quantity % Quantity %
With new clients
No
All times
240
33
69.2 55.0
107
27
30.8 45.0
1 0.6 0.32-0.95 With regular clients
All time
No
140
133
60.9 75.1
90
44
39.1 24.9
1 1.9 1.21-3.34 With husband and lover
Yes
No
108
165
65.5 68.2
57
77
34.5 31.8
1 1.1 0.58-1.34
The LRTI rate of FSW with new clients groups had used condoms for all sexualcourses was lower than the FSW of correlative group had'nt used condom for all sexualcourses (55 % compared with 69.2%) The LRTI rate
of FSW with regular clients groups had used condoms for all sexualcourses was lower than the FSW in correlative group had'nt used condom for all sexualcourses (60 , 9% compared with 75.1%)
Table 3.20 Initiative health screening behavior and LRTIs
Initiative medical care behavior
Infection
(n=273)
Non-infection
Initiative examine
No Yes
181 92
69.6 62.2
79 55
30.4 37.4
1 0.7 0.51-1.20 Initiative test
No Yes
179
94
69.9 62.3
77
57
30.1 37.7
1 0.7 0.92-2.15 Only 36.5% FSWs got initiative medical exam and 37.1% FSWs got initiative test The LRTI rate of FSWs without initative exam and test was higher than correlativeness However, this difference is not statistic meaning
Table 3.21 Understanding of infedelity sex, condom use and LRTIs
Understanding
Infection
(n=273)
Non infection
Infidelity sex
Right Wrong
203 22
66.6 71.0
102 9
33.4 39.0
1 1.2 0.81-1.82 Condom use
Right Wrong
226
15
67.7 68.2
108
7
32.3 31.8
1 1.1 0.36-3.84 Right understanding FSW group had LRTI rate lower than the wrong group (66% compared with 71%) However, this difference was not statistic
Trang 8meaning Percentage of LRTI in FSW who wellknowed of condom use for
all sexcourses was lower than the misunderstading group (67.7% compared
with 68.2%) However, this difference is not statistically meaningful
Table 3.22 The relation between self-assessment of risks and LRTIs
Self-assessment
Infection
(n=273)
Non-infection
Quantity % Quantity %
High risk
Low rist
No risk
Did'nt know
29
39
98
107
75.2 57.4 72.6 66.2
11
29
37
57
27.5 42.6 27.4 34.8
1 0.5 1.0 0.7
0.20-1.28 0.42-2.36 0.71-1.62 Only 9.8% FSWs had self assessment for LRTI risks (for both FSWs with
or without the disease), 16.7% assessment for low risk, 33.2%
self-assessment in no risk and 40.3% did not know whether they were at risk of
LRTI or not No relation was statistic significant between self-assessment
and risk of LRTIs
Table 3:25 Relation between personal characteristics, risk behaviors and
LTRIs by multivariative regression model
Personal characteristics and behavior risks OR 95% CI
New clients used condom for all sexcouses 2.5 1.07-4.09
Regular clients used condom for all sexcouses 2.3 1.12-4.10
Study with multivariative regression model of the relation between personal
characteristics and risk behaviors with LRTI showed that no condom use
for all sexcourses lead to incease risks of LRTIs The other factors was not
significantly influenceto the incidence statistics of LRTIs
3.3 The effectiveness of the intervention measures to prevent LRTIs 3.3.1 Knowledge:
FSW understanding rate of the clinical symptoms of LRTI was much higher compared with the it's figure when FSW entered the center (51.4% to 98%) This difference was significantly meaningful for statistic with p
<0.001 and efficiency indicators (EI) was 86.1%
3.3.2 Attitude:
Table 3.27 Effectiveness of improvement to prevent LRTI
Preventive attitude
Before intervetion
(n=407)
After prevention (n=407) p Effectievness
figure (%)
Infidelity sex Right Wrong Does'nt know
305
31
71
74.9 7.6 17.4
403
0
4
99.3
0 0.7
<0.001 32.6
All sex uses condom Right
Wrong Does'nt know
334
22
51
82.1 5.4 12.5
403
0
4
99.3
0 0.7
<0.01 30.0
FSW attitude to prevent LRTI also highly increased and had significant statistic with high effectivness figure Increased level of attitude on the prevention / control LRTI was not as fast as the growth of knowledge
Table 3.28 Effective of improvement attitude on self-evaluation LRTI risk
Self-assessement of LRTI risk
Before intervention
(n=407)
After intervention (n=407) p Effectiveness
figure (%)
High risk Low rist
No risk Does'nt know
40
68
135 164
9.8 16.7 33.2 40.3
130
31
74 172
31.9 7.5 18.2 42.4
<0.01 225.5
After the intervention, the rate of self-assessment of LRTI risk by FSW was increased from 9.8% to 31.9% This difference had significant statistic with
p <0.01 and EF is 69.3%
Trang 93.3.3 Reduce symptoms and LRTIs
Table 3.29 Effective in reducing the clinical symptoms LRTI
Clinical
symptoms
Before intervention
(n=407) After intervention(n=407) p Eff Fig
(%)
Lower abnonal pain
Yes
No 353 54 13.3 86.7 392 15 96.33.7 <0.01 72.2
Discharge / pus
Yes
No 101 306 24.8 75.2 395 12 97.12.9 <0.001 88.7
Urinary pain
Yes
No 369 38 90.7 9.3 401 6 98.51.5 <0.001 83.9
Genital sore pain
Yes
No 364 43 10.6 89.4 390 17 95.64.4 <0.01 58.5
Genital lession
Yes
No 373 34 91.6 8.4 404 3 99.30.7 <0.01 88.1
Genital pruritus
Yes
No 347 60 14.7 85.3 372 25 93.76.3 <0.01 57.1
Some typical symptoms of LRTI as discharge / pus, urinary pain, genital
pain pain, genital ulcer / sarchome, genital pruritus were much reduced
These differences were significanct statistic with p ranging from less than
0.01 to 0.001 and EF ranged from 58.5% to 88.7%
Table 3.30 The effectiveness of reduced LRTI clinical symptoms
Reduce LRTI
Before intervention
(n=407) After intervention(n=407) p Eff Fig
(%)
Vulgaris
Yes
No 371 36 91.2 8.8 390 17 96.13.9 <0.01 55.7
Vaginalis
Yes
No 318 89 21.9 78.1 402 5 98.81.2 <0.001 94.5
Vulvo-vaginalis
Yes
No 203 204 49.9 50.1 320 87 21.2 78.8 <0.001 57.5
Cervitis
Yes
No 358 49 12.0 88.0 389 18 91.78.3 <0.01 30.8
Exposed cervitis
Yes
No 375 32 92.1 7.9 403 2 99.50.5 <0.01 93.7
Vulgaris declined from 8.8% to 3.9% Vaginalis dropped from 21.9% to 1.2% Vulvo-vaginalis decreased from 49.9% to 21.2% Cervitis reduced from 12% to 8.3% Exposed cervicitis decreased from 7.9% to 0.5% These differences were significant statistics with p ranged from less than 0.01 to 0.001 and EF ranged from 30.8% to 94.5%
Table 3.31 Effective in reducing LTRI by testevidence
Reduced LRTI Before intervention(n=407) After intervention(n=407) p Eff Fig
(%)
Trichomonas vaginalis
Yes
Gonorrhea
Yes
Syphilis
Yes
Complex bacterial
Yes
No 179 228 44.7 55.3 33671 17.7 82.3 <0.01 62.9 Fungi Leveus
Yes
No 36641 10.1 89.9 39116 96.13.9 <0.01 61.4 The pathogens of LRTIs on FSWs decreased very significantly compared to this figure when FSWs entering the center These differences were significant statistics with p less than 0.01 and EF ranged from 61.4% to 100%
3.4 Change knowledge of LRTI of medical workers 3.4.1 Change general knowledge of LRTI by interventions
Table 3.32 Changing knowledge of the clinical symptoms of LRTI before
and after intervention
Clinical symtoms Before invention Quantity % After intervention Quantity % p Yatess
Scretch
Ulcer
Sarchome
Vasicular
Pustules
Papular
Bleeding/ pus
Trang 10Knowledge of health workers in the majority of clinical symptoms of LRTI had
improved after intervention, including ulcers, sachome/chancre, vasicular, pustules
Table 3.33 Changes in knowledge of LRTI diagnosis tests before and after
intervention
Diagnosis tests Before intervention After intervention P Yatess
Pap
Cell culture
Serum test
p<0.05
Proportion of health workers with knowledge of direct examination tests to
diagnosis LRTI after intervention (93.3%) was higher than before the
intervention (73.3%) Besides, knowledge of the medical staff of serum
tests in the diagnosis of LRTI after intervention (66.7%) had increased
significantly compared to before intervention (20.0%) (with p <0,05)
While the knowledge of the medical staff of cells culture decreased after the
intervention than before the intervention, but this difference was not
significant statistic (p> 0.05)
Table 3:34 Change knowledge of management LRTI before and after
intervention
Managemen
t direction
Before intervention After intervention
Specific treatment
Combination treatment
LRTI treatment knowledge of medical staffs after intervention NTDSDD
had no changed compared with before intervention Before and after
intervention the rates of specific treatment was 93.3%, LRTI specific
treatment and combination treatment were 80.0%
Chapter 4 DISCUSSION 4.1 Some personal characteristics of FSW
Our results was complied with findings in Vinh Long province [18] and 3 provinces of the Mekong Delta Results of this study showed that the rate of FSWs in age group from 20-29 years old (respectively 74%, 65%), followed by the under 20 years old (17%, 25%) Group aged 30 and older accounted for the low rate (9%, 10%) Most FSWs inthe center II-Hanoi had low education levels, average 6 ± 3.8 years, lower than FSW edcation
in the Mekong Delta and Vinh Long (secondary school up to 53.5%, followed by the primary 36%, secondary or higher education accounted for 8.3% and illiterate 2.2%)
Although unmarried FSW rate was relatively low, but this group was at high risk of transmission of sexually transmitted infections for both husband and lover by having sex with clients and with her husband / lover concomittently This also confirmed by a number of studies around the world In particular, the results of this study showed that almost FSWs had sexual intercouses with clients and her husband or lover
4.2 The prevalence and risk behaviors of the lower genital tract infection in female sex workers
4.2.1 LRTI prevalence in FSW
Our study indicated that the rate of FSW with lower genital tract infection quite high, accounted up 67.1% It was clear that while the high of icidence but the symptoms were manifested low (about ½), to prove the undetectable LRTIs in FSWs The results of some other domestic and foreign studies were comformed with the results of this study to point out the high rate of LRTIs
Reported by WHO, the incidence of sexually transmitted infections, including infections of the lower genital tract and upper genital tract infection is approximately 333 million people every year Lower genital tract infection is not too severe or leading to death, but greatly affects the quality of life for the welfare of the family, causing discomfort, infertility affects and reduce labor productivity This study's results showed that the LRTI prevalence in FSW when entering the center was high, accounting for 67.1% The most common kinds were vulvo-vaginalis (49.9%), vaginitis (21.9%), cervicitis (8.8%), especial with exposed cervicitis 7.9% The other study results showed that LRTIs were spread in the world, concentrated in the developing countries such as Africa, Latin America and South Easth Asia By WHO, estimated 2003 there were 390 million case of STDs, including: Gonorrhea, Syphilus, Trichomonas, Chlamydia chromatis with highest risk group of FSWs, female workers in the restaurants, hotels WHO announced that the rate of uper genital and lower genital tract infections were highest in South Asia and South East Asia (151 millions case, accounting