actual situation of lower genital tract infections in married women aged 18-49 in the marine and island areas, hai phong city and effectiveness of some intervention solutions ttta

BACKGROUND The lower genital tract infection has been one of women’s diseases which causes a great influence on the physical as well as mental health of the sick women, especially for on

BACKGROUND

The lower genital tract infection has been one of women’s diseases which causes a great influence on the physical as well as mental health of the sick women, especially for ones in rural areas, including the marine and island area Therefore, studies on infections of the lower genital tract infections in women at the marine and island areas have had an important role in contribution of study data to make suitable solutions to improve people's health

However, studies that were valuable and satisfied the above requirements are still limited In particular, there have been no studies in Vietnam on the current situation and factors associated with the lower genital tract infections in women as well as of the effective measures to improve the prevention of these diseases in the marine and island areas The previous studies in this field were mainly implemented

in other geographical and ecological areas

In the above context, this study was done to help the health sector of Vietnam get research data on the lower genital tract infections in women in the marine and island areas in order to find appropriate solutions to improve the provision of high quality reproductive health care services for this target group With the study sites which are marine and island areas of Hai Phong City where there have been no formal studies on the lower genital tract infections in women, the study aims to give out new and valuable findings not reported before The results of the study will contribute to the scientific basis for managers and planners to make more effective and appropriate policies in order to improve the quality of reproductive health care services for women in general, for women in marine and island in particular

For the reasons mentioned above, this study was conducted with the following objectives:

STUDY OBJECTIVES

1) Describe the actual situation and some factors related to the lower genital tract infections in married women aged 18-49 in three districts of the marine and island area of Hai Phong City in 2012

2) Assess the effectiveness of some interventions in raising the awareness, attitude and practice of the above target subjects on prevention of the lower genital tract infections

STRUCTURE OF THE THESIS

The thesis has 126 pages (excluding the table of contents, references and annex), includes 4 chapters: Chapter 1: Literature review, 31 pages; Chapter 2: Study subjects and methodology, 21 pages; Chapter 3: Study results, 35 pages; Chapter 4: Discussion, 33 pages The thesis has 37 tables, 14 figures, 131 reference documents:

72 in Vietnamese and 59 in English

Chapter 1

LITERATURE REVIEW

The lower genital tract infection (LGTI) is one of the very common diseases in women and is the most common in women at the age of sexual activities Some studies found that the rate of women knowing about this disease accounted for less than 60%; the understanding of the consequences and treatment of STDs is still weak; the rate of subjects with correct knowledge on the majority of the disease-related contents was below 50% The research of Le Thi Oanh (2001) on women at reproductive age shows that the rate of LGTIs in women in the urban of Hanoi was 41.5%; suburban of Hanoi was 59.4%; Thai Binh was 56.9%

It was found that environmental pollution in agriculture and fishing, as well as environmental pollution from manufacturing factories are related to the health of the workers in general and women in particular

Research in 6 regions of the Northern Vietnam shows that the rate of LGTIs were very different by region, ranging from 41-64%, the highest in mountains of Nghe An (64.07%); and the pathogens also varies by region: ones in the urban of Hanoi were mainly bacteria, but ones in the suburbs of Hanoi were mainly fungi; the mountainous areas of Nghe An has the highest rate of fungus as pathogens

A trial intervention of Esere M (2008) in adolescents through communication activities in schools shows a clear reduction of the risk factors to sexually transmitted diseases (STDs) in this group, and they were evaluated as a successful intervention The author launched a sex education program in secondary schools

Kim Bao Giang (2011) did a research on improving the knowledge some kinds

of STDs at sewing factories in Binh Duong and Ho Chi Minh City; after one year of communication interventions, the results shows that the development of the network

of peer educators selected from the factories was a reasonable strategy in communication interventions to raise the awareness for workers of these factories

Research done by Nguyen Minh Quang (2013) on female prostitutes in Hanoi adopted health education as an intervention method It communicated on STDs prevention via many forms such as direct communication at class rooms, delivery of communication materials, films, television, direct counseling

- Intervention study was performed in 2 communes of Cat Hai district (1 for intervention and 1 for control) among ones selected in the pre-intervention survey

- Study period: from 1/2012 to 7/2013

2.2 Methodology

The design is 2 consecutive and logical survey and study, including an analytical descriptive cross-sectional survey and a community intervention study with control group

2.2.1 Sample size of the cross-sectional survey (Objective 1; Phase 1)

The sample size applies the following formula:

d

pq Z

n  21 α/2  2 

Where: n: sample size for study; Z 1-α / 2 = 1.96 (95% confidence level); p = 0.57 (the proportion of LGTIs according to the study of Le Thi Oanh conducted in Thai Binh province); d: desired deviation = 0.05; DE: design effect = 2)

With the above parameters, the required minimum number of the women to study was 754 ones In fact, the research team examined and interviewed 804 subjects

of 3 districts

2.2.2 Sample sizes for the intervention study (Objective 2; Phase 2)

The formula for calculating the sample size:

2 2 1

2 2 2 ) 1 ( 1 1 ) 2 / 1 (

) (

} ) 1 ( )

1 ( {

p p

p p Z p p Z

to 1.96; Z (1-  ): the probability distribution, equal to 1.28

The sample size was multiplied by the design effect of 2 Because the calculated sample size is nearly equal to the sample size of Cat Hai district in Phase 1 (267 subjects), this study remained that sample size for Phase 2 (267 subjects)

2.2.3 Sampling method

- Cluster sampling for the cross-sectional study (Objective 1; Phase 1)

- Sampling ratio of 1:1 for selection of the case and control in the intervention study (Objective 2; Phase 2)

2.2.4 Data collection and processing

* Interview with survey subjects: done at households to collect data on knowledge, attitudes and practices of women on LGTIs by questionnaires; sent the invitation letter to the subjects for doing gynecological examination

* Do gynecological examination tests to diagnose LGTIs:

- Gynecological examination: The study subjects were examined to assess the

actual condition of LGTIs

- Para-clinical testing: For the subjects suspected to have LGTIs through

clinical examination, physicians took swabs of the vagina and cervix for testing according to the instructions about doing tests of the Ministry of Health

2.2.5 Intervention solutions

- Solution 1: Combination of therapy with counseling at the survey site: treatment with procedures and drugs Consultation on contents related to the diseases (right after examination and treatment) at the commune health centers

- Solution 2: Continuous communication at community: periodic information was provided in the intervention: communication by the communal loudspeaker system; discussions integrated into women's meetings at villages; home visits

- Solution 3: Monitoring and providing technical support for commune health centers: monitoring combined with technical support for commune health center once every month Implementers were obstetricians of the District Health Center

- Time of intervention was 12 months

2.2.6 Some evaluation criteria

- Knowledge is considered as the "pass" level when the subjects correctly answered at least 50% of the items of each content in the questionnaires

- Attitude at the "pass" level if the subject shows the "necessary", "importance"

of related contents affecting health

- A poor household is determined according to the "Standard of poor and poor households in the period 2011-2015" of the Government Accordingly, a poor household in rural areas is one having an average income of not over than 400,000 VND / person / month

near-2.2.7 Data processing

The statistical parameters and calculations in the study include: The number, percentage; Comparison of 2 rates by Chi-square test; Identification of p-value for tests done; Calculation of Odds ratio with 95% confidence interval (CI95%); Calculation of intervention effect to evaluate the actual effectiveness of interventions

Chapter 3

STUDY RESULTS

3.1 Actual situation, factors related to the lower genital tract infections

Table 3.1 Prevalence rate of lower genital tract infections

Single vulvanosis Single vaginosis Single cervicitis Vulvanosis-vaginosis Vaginosis - cervicitis Vulvanosis - vaginosis - cervicitis

Figure 3.1 Rate of LGTIs in all the women examined, by location and combination

mode of infection (n = 804)

The number of women with single vaginosis accounted for the highest rate (23%), followed by women with single cervicitis (14.3%) and single vulvanosis (10.1%) Very low rates of women were found having the cervicitis-vaginosis, vulvanosis - vaginosis - cervicitis (2.6 and 3.1%, respectively)

Table 3.2 Distribution of diseases in all the women with LGTIs

Among 489 women diagnosed with LGTIs, the highest rate among 6 groups of LGTIs was the single vaginosis (37.9%), followed by single cervicitis (23.6%) In the remaining ones, the rate of women having the diseases ranged from 5.2% to 16.5%

Table 3.3 Distribution of causes of disease in all the women with LGTIs

3.1.3 Some factors related to the lower genital tract infections

Table 3.4 Relation between the age of women and LGTIs

Age group Surveyed

women

CI95%

p Case %

(0.85 to 1.85)

> 0.05

There was no statistically significant difference of the rates of women having LGTIs between two age groups 18-29 and 30-49; p> 0.05

Table 3.5 Relation between the education of women and LGTIs

Education Level Surveyed

<0.05 Secondary school or higher 154 82 53.2

Table 3.7 Relation between the economic condition of women and LGTIs

Household economic

condition

Surveyed women

CI95%

p Case %

1.7 (1.01 - 2.98)

<0.05 Average and wealthier 730 437 59.9

Table 3.9 Relation between the abortion history and LGTIs

History of Abortion Surveyed

<0.05

Women who had abortion had the rate of LGTIs (70%) higher than women who have never experienced abortion (50.8%) (OR=2.3, CI: 1.68 to 3.05, p <0.05)

Table 3.10 Relation between the number of abortions and LGTIs

Number of abortions Surveyed

<0.05

Table 3.11 Relation between receiving mobile gynecological examination in the

previous year and LGTIs

Mobile gynecological

examination

Surveyed women

Table 3.12 Relation between using intrauterine devices and LGTIs

Using status Surveyed

> 0.05 Not currently using 552 333 60.3

There was no relation between the use of intrauterine devices for contraception

of the women with the rate of LGTIs (OR = 0.98)

3.2 Effectiveness of some intervention solutions

Table 3.13 Change in the rate of women knowing the causes of disease

Measurable unit

Intervention group (n = 267)

Control group (n = 267) Change

(%) Before

(1)

After (2)

Before (3)

After (4)

19.3

Comparison p (1&2) <0.05; p (3&4)> 0.05

The rate of women in the intervention group knowing the causes of LGTIs after intervention (88.8%) was higher than that before the intervention (75.5%) The difference is statistically significant, p<0.05

Table 3.14 Change in the rate of women knowing the symptoms of LGTIs

Measurable unit

Intervention group (n = 267)

Control group (n = 267) Change

(%) Before

(1)

After (2)

Before (3)

After (4)

35.8

Comparison p (1&2) <0.05; p (3&4)> 0.05

The rate of women in the intervention group knowing the symptoms of LGTIs after intervention (82.4%) increased when compared to the pre-intervention (59.6%),

p <0.05

Table 3.15 Change in the rate of women knowing transmission route

Measurable unit

Intervention group (n = 267)

Control group (n = 267) Change

(%) Before

(1)

After (2)

Before (3)

After (4)

48.0

Comparison p (1&2) <0.05; p (3&4)> 0.05

The rate of women in the intervention groups knowing routes of disease transmission after intervention (80.5%) increased when compared to the pre-intervention (56.5%), p <0.05; while that of the control tends to decrease (from 54.7%

to 51.7%)

Table 3.16 Change in the rate of women knowing the consequences of LGTIs

Measurable unit

Intervention group (n = 267)

Control group (n = 267) Change

(%) Before

(1)

After (2)

Before (3)

After (4)

15.7

Comparison p (1&2) <0.05; p (3&4)> 0.05

The rate of women in the intervention group knowing the consequences of the disease after intervention (83.9%) was higher than before intervention (67.8%), p<0.05, significantly increased when compared to the control (from 59.6% to 64.4%)

Table 3.17 Change in the rate of women knowing sources of information on LGTIs

prevention

Measurable unit

Intervention group (n = 267)

Control group (n = 267) Change

(%) Before

(1)

After (2)

Before (3)

After (4)

37.9

Comparison p (1&2) <0.05; p (3&4)> 0.05

The rate of the intervened women knowing sources of information on prevention

of LGTIs increased after intervention when compared to the pre-intervention (74.2%

vs 58.1%) while the rate in the control decreased (from 62.9% to 56.5%) The difference of before-after intervention was statistically significant, p <0.05

%

Intervention Control

Before intervention After intervention

Table 3.18 Change in the rate of women knowing how to ensure the intercourse

and menstrual hygiene

Knowing how to properly

toilet

Intervention group (n = 267)

Control group (n = 267) Change

(%) Before

(1)

After (2)

Before (3)

After (4)

Comparison p (1&2) <0.05; p (3&4)> 0.05

The rate of the intervened women knowing ways to ensure the intercourse hygiene increased after intervention when compared to the pre-intervention (93.6%