prevalence and influencing factors of the lower reproductive tract infections among sex workers in the centre for treatment - education- labour ii hanoi and evaluation of the intervention

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prevalence and influencing factors of the lower reproductive tract infections among sex workers in the centre for treatment - education- labour ii hanoi and evaluation of the intervention

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1 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 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 THESIS SUMMARY SUPERVISORS: 1. Associate Prof. Ngo Van Toan, MD., PhD. 2. Do Hoa Binh, MD., PhD Ha Noi - 2013 2 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 3 PUBLICATIONS 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, N 0 3. 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, N 0 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, N 0 6 (133). 4 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 5 mentioned 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 6 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 7 reported 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. 8 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 9 2.2.1. 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 21 2 22111)2/1( 21 )( ])1()1([)1(2[ pp ppppZppZ nn − −+−+− == −− βα Includings: n 1 : sample size before intervention n 2 : sample size after intervention p 1 : prevalence of FSW using condoms for all sexual intercourses, before intervention (estimated 52 %) p 2 : 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) z 1-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. 10 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 χ 2 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, 11 most 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 Vu lg a - vaginalis Exposed cervical Chart 3.9. The lession morphology of lower genital/reproductive tract infections 12 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 (n=134) OR 95%CI Quantity % Quantity % ≥ 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. 13 Table 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 14 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 (n=134) OR 95%CI Quantit y % Quantit y % 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 (n=134) OR 95%CI Quantit y % Quantit y % Infidelity sex Right Wron g 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 15 meaning. 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 (n=134) OR 95%CI 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% self-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 O R 95% CI A g e 1.2 0.78-1.79 Ethnic g rou p 0.8 0.53-1.34 Teritor y 0.6 0.60-1.51 Education 1.1 0.66-1.36 A g e of 1st sexcourse 1.2 0.72-2.08 Number of clients / month 1.1 0.81-1.36 New clients / da y 1.1 0.78-1.49 Re g ular clients / da y 1.0 0.78-1.33 New clients used condom for all sexcouses 2.5 1.07-4.09 Re g ular clients used condom for all sexcouses 2.3 1.12-4.10 Initiative medical exam 0.9 0.43-2.05 Iniative medical test 1.5 0.69-3.31 Self-assessment LRTI risks 1.0 0.95-1.09 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. 16 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 (%) Quantity % Quantity % 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 (%) Quantity % Quantity % 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%. 17 3.3.3. Reduce symptoms and LRTIs Table 3.29. Effective in reducing the clinical symptoms LRTI Clinical symptoms B e f ore i n t erven ti on ( n=407 ) Aft er i n t erven ti on ( n=407 ) p Eff. Fig. (%) Q uan tity % Q uan tity % L ower a b nona l pa i n Yes No 54 353 13.3 86.7 15 392 3.7 96.3 <0.01 72.2 Di sc h arge / pus Yes No 101 306 24.8 75.2 12 395 2.9 97.1 <0.001 88.7 U r i nary pa i n Yes No 38 369 9.3 90.7 6 401 1.5 98.5 <0.001 83.9 G en i ta l sore pa i n Yes No 43 364 10.6 89.4 17 390 4.4 95.6 <0.01 58.5 G en i ta l l ess i on Yes No 34 373 8.4 91.6 3 404 0.7 99.3 <0.01 88.1 G en i ta l prur i tus Yes No 60 347 14.7 85.3 25 372 6.3 93.7 <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 B e f ore i ntervent i on ( n=407 ) Af ter i ntervent i on ( n=407 ) p Eff. Fig. (%) Q uant i t y % Q uant i t y % V u l gar i s Yes N o 36 371 8.8 91.2 17 390 3.9 96.1 <0.01 55.7 V ag i na li s Yes N o 89 318 21.9 78.1 5 402 1.2 98.8 <0.001 94.5 V u l vo-vag i na li s Yes N o 203 204 49.9 50.1 87 320 21.2 78.8 <0.001 57.5 C erv i t i s Yes N o 49 358 12.0 88.0 18 389 8.3 91.7 <0.01 30.8 E xpose d cerv i t i s Yes N o 32 375 7.9 92.1 2 403 0.5 99.5 <0.01 93.7 18 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 B e f ore i n t erven ti on ( n=407 ) Aft er i n t erven ti on ( n=407 ) p Eff. Fig. (%) Q uan tity % Q uan tity % T r i c h omonas vag i na li s Yes N o 18 389 4.4 95.6 0 407 0 100.0 - 100.0 G onorr h ea Yes N o 2 405 0.5 99.5 0 407 0 100.0 - 100.0 S yp hili s Yes N o 10 397 2.5 97.5 0 407 0 100.0 - 100.0 C omp l ex b acter i a l Yes N o 179 228 44.7 55.3 71 336 17.7 82.3 <0.01 62.9 F ung i L eveus Yes N o 41 366 10.1 89.9 16 391 3.9 96.1 <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 C l i n i cal s y mtoms B e f ore i nvent i on Af ter i ntervent i on p Yatess Q uant i t y % Q uant i t y % S cretc h Y es 11 73 . 3 10 66 . 7 p>0.05 N o 4 26 . 7 5 33 . 3 Ul ce r Y es 13 86 . 7 14 93 . 3 p>0.05 N o 2 13 . 3 1 6 . 7 S arc h ome Y es 5 33 . 3 15 100 . 0 p<0.001 N o 10 66 . 7 0 0 . 0 V as i cu l a r Y es 8 53 . 3 12 80 . 0 p>0.05 N o 7 46 . 7 3 20 . 0 P ustu l es Y es 10 66 . 7 11 73 . 3 p>0.05 N o 5 33 . 3 4 26 . 7 P a p u l a r Y es 5 33 . 3 6 40 . 0 p>0.05 N o 10 66 . 7 9 60 . 0 Bl ee di n g / p us Y es 10 66 . 7 8 53 . 3 p>0.05 N o 5 33 . 3 7 46 . 7 19 Knowledge 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 Quantit y % Quantit y % Pap Yes 11 73.3 14 93.3 p>0.05 No 4 26.7 1 6.7 Cell culture Yes 7 46.7 6 40.0 p>0.05 No 8 53.3 9 60.0 Serum test Yes 3 20.0 10 66.7 p<0.05 No 12 80.0 5 33.3 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 Mana g emen t direction Before intervention After intervention P Yatess Quantit y % Quantit y % S p ecific treatment Yes 14 93.3 14 93.3 p>0.05 No 1 6.7 1 6.7 Combination treatment Yes 12 80.0 12 80.0 p>0.05 No 3 20.0 3 20.0 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%. 20 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 [...]... adequated for So that still need to continue to update the knowledge and skills for them to improve the quality and efficiency of detection and the treatment of genital infections 4 Have to continue monitoring of interventions for female sex workers and the medical staffs of the Center II for Treatment - Rehabilation - Education - Social Labor of Hanoi to assess the long-term efficiency and the durability of. .. The other factors were not statistic significant influence to the incidence of LRTI in FSW The results of this study have confirmed effectiveness of using condoms for all sexcourses are very good for preventing LRTI in female sex workers The researches in Vietnam and around the world have also confirmed the role of condoms in preventing HIV and sexually transmitted infections 4.3 Effectiveness of intervention. .. genital tract infections and HIV A number of domestic and international research showed that the young FSWs had sexcourse early, before the age to be able to fully understand the risk of lower genital tract infections were very susceptible to the disease The findings of Nguyen Manh Cuong 2008 on FSW in 3 provinces of An Giang, Kien Giang and Dong Thap in the Mekong Delta showed the age of first sexual intercourse... quality of clinical management of lower genital tract infection in center Through the process of training the medical staffs at the Center, I realize that the training activities, provide documentation to guide medical care and monitoring support was very helpful for them, because the Centre under the Department of Labor War Invalids and Social Affairs in Hanoi, so they are less of updated well-trained and. .. Vietnam in Ha Noi and neighboring provinces, high rates of lower genital tract infection in high-risk populations One of the characteristics of FSW is the nature mobility, due to the inferiority of their career, they do not want to live in a place fixed for a long time On the other hand they also have to move from one province to another, one district to another depending on the number of clients and income... staffs at the Center II for Treatment - Rehabilation - Education - Social Labor of Hanoi is very effective It is nessesary to be multiple this intervention for the Centers for Treatment - Rehabilation - Education - Social Labor over country 2 Have to continue education and communications for FSW after training in focus for their pratising of using condoms for all sexual encounters (both new and regular... and attitudes of preventing transmission of lower genital tract disease 4.3.1 Knowledge and attitudes In education and communication interventions, the health knowledge indicators was the fastest growing, then to the attitude indicator and the practising indicator were slowly increased The results of this study on the improvement of knowledge on preventing sexually transmitted infections is quite in. .. in FSW in Vietnam we found there was a few studies on this issue and even less for FSW Currently, there are some researchs on the lower genital tract infection of women in the community and women in the military However, the study of infections of lower genital tract for FSW in Vietnam still rare and used to research with sentinel surveillance in the provinces / cities, in groups at high risk of LRTI,... re-trained for theit practising daily After intervention the rate of medical staffs who have knowledge of syphilis rised higher than before intervention, including syphilis diseas, syphilis classification, clinical signs, its complications (narrow foreskin, swelling foreskin) and treatment regimen Proportion of health workers have knowledge of genital herpes increased after intervention than before the. .. after the intervention (93.3% compared with 73.3%), knowledge of health workers about serum tests was higher after intervention (66.7% compared with 20.0%) CONCLUSIONS 1 The prevalence and risk behaviors of LRTI 1.1 LRTI prevalence in FSW The prevalence of at least one of the lower genital tract infection in FSW when entering the Center was high in clinical, accounted for 67.1% The most common infections . 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:. monitoring of interventions for female sex workers and the medical staffs of the Center II for Treatment - Rehabilation - Education - Social Labor of Hanoi to assess the long-term efficiency and the. 1 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

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