Observations of sexually transmitted disease consultations in India
Mertens, T.E.; Smith, G.D.; Kantharaj, K.; Mugrditchian, D.; Radhakrishnan, K.M.
Public Health 112(2): 123-128
1998
ISSN/ISBN: 0033-3506 PMID: 9581455 Document Number: 273902
To assess the quality of sexually transmitted disease (STD) case management in Madras, Tamil Nadu State, India, structured observations of 108 consultations with 48 doctors at 65 private and public health facilities were conducted. These observations were scored according to standards for history taking, examination, treatment, and provision of basic health promotion counseling. When scored against national guidelines (which outline an etiologic approach to diagnosis), history taking, examination, and treatment were judged adequate in 76 observations (70%). However, if STD treatment adequacy was rated according to a syndromic approach (recommended by the World Health Organization) to selected STDs (male urethritis and nonherpetic male and female genital ulcers), only 8 (10%) of 81 such patients were managed satisfactorily. Condom use to prevent further STDs was encouraged in 32 consultations (30%), but instructions on how to use condoms properly was offered to only 7 patients (6%) and condoms were provided to just 1 patient (1%). Use of the STD consultation for health promotion, defined as condom promotion and encouragement to refer sexual partners for treatment, was adequate in 13 consultations (12%). These findings suggest a need for improvements in the standards of STD care at health facilities in Madras. Recommended are measures such as simplification of existing national guidelines for the treatment and prevention of STDs, promotion of a syndromic approach to STD management, continuing education programs for providers, and repeat assessments and feedback on the quality of STD care.