i ADDIS ABABA UNIVERSITY GRADUATE PROGRAMMS CENTER FOR ENVIRONMENTAL ...

83 Pages·2015·1.78 MB·English

by  Vostro 2520

Tit 1 e
SEXUALLY TRANSMIT'T'SD DISE.\SES
IN GOND,II1 T.)WN
By
HAILEMICHAEL G/SELASSIE, M.D.
Thesis submitted as partial fulfillment of the r equire
ments for the degree of Master of Sciences
yebru;::.ry -'. JC ,
Jimma In6titute 06 Health Science6
P06t in Community Iledicine
G~aduate P~og~am
CERTIFICATE OF APPROVA L
rr
fh411j 11
I
V t e
I that the the6l6
ha~eby. ~ecommend p~epa~ed unde~
my by HAILEMICHAEL G/SELASS IE entitled SEXUA LLY
6upe~vi6ion
TRANSMITTEV VISEASES IN GONVAR TOWN
be accepted in 06 the
pa~tial . 6ul6alment ~equi~ement6
the 06 MASTERS OF SCIENCE IN COMMUN ITY MEVICINE
60~ deg~ee
M.Sc. (Comm . Med.1
In 06 The6e6
cha~ge
Recommendat;~n concu~~ed ~n
Head 06
Vepa~tment
c (' t.t e eon
'11I1Li
F i.Ilne Exnminnti 011
ACKNOWLEDGEMENTS
r am to the Swedi6h Intennational Veveeopment
g~ate6ul
Ageney (SIVA) 6undl.> to eonduet the 6tudy and to
6o~ g~aJlted
Kay Wotton my devoted time in
V~. advil.> e~ ~llo he~ p~eeiou6
me the 6ield and ekitieael y the
6upe~vi6ing ~n ~eviewing
manu6e~ipt.
r wi6h to aeRnowledge ,the A66oeiation
UkbaI1Vwelle~l.> ,(11
TWon they all vaellable
Gonda~ 6o~ p~ovided admini6t~ative
and the phnhnlaclj 01Ullek6 in t he t own e6pr
l.>Uppo~t, p~ivate
eially Ato Nega Getu and Ato A6e 5a Geme6a who coopekated in
the 06 eal.> e6 . r extend my tilallR6 to Ze kU G/
~e6 e~kal V~6.
Makia", and Seyum Ta6 e66 e OOk aeloIVil1g me to 6tudy patient/.)
attending elinicl.> and who ae/.)o nknang ed a eondueive
thei~
l.>ituation to 6aeilitate the intekviewl.> and tel.>tl.>
labokato~y
by minimizing queuel.> .
r am alao to Vk . Yv e/.) Bekg evin OOk keviewing
g~ate6ul
the and methodology.
int~oduetion
Finally , r wi6h t o thanR Weljzeko Tegene6 h Altaye and
Yedenel<u exeetlellt
Weyz~it A~age 6o~ thei~ 6ecketa~ial
6Uppokt .
i i
TABLE Of CONTENTS
CHAPTER Page
I • INTRODUCTION.............. . ...... • . . • 1
II. LITRATURE REVI EW .. ..•... •..•.•.•....•
III. MATERIALS AcJD METHODS . . . . . . . . . . . . .. . . J ~
A. Study design ...... . ....... .... . .. 12
B. The patients ........... . . .. ...... 1-1
C. Diagnostic criteria & procedure.. 15
D. The controls. .................... 17
E. Data coll('ct ion and anal ysi.s ..... 18
IV. RESULTS ... • . . . . . • • • • . . . . . . . . . . . . . . . . . 21
V. DISCUSSION . .... ... .. . ... . ............ 35
VI. CONCLUSIONS .. ... ........... .. ..... . .. 39
VII. APPENCICES
A......................
Append ix 42
Append ix B..... . . ... ..... ....... 46
VIII. BIBLIOGRAPHY .. ...•.•. .•..•.•.. .• ..... 48
i i i
LIST OF T!\GLES
Page
I. Distribution of cases by age and sex ...... 2~
II. Distribution of cases by marital status ... 2~
III. The number and percentage distribution of
r
cases by occupational status ..... . .... .... 2
IV. The proport ion 0 [ STDc, d i:' ·c:nnsc:>d. . . . . . . . .. 27
V. Distribution of mixC'd i nfE'cti.on wi th STDs
in 285 patients by sex . . ... .... ..... ..... 28
VI. The frequency of past history of STDs ... . 29
VII. Distribution of cases and their matched
controls according to the age at first
sexual intercourses of less than 20 years
and above .. . . ... .. .. .. .......... . .... . . . 29(a)
VIII. The distribution of cases and their
matched controls according to marital
status................................. 30
IX. Distribution of female cases and their
matched controls by the practice of pre-
marital sex ........ . .. . .. .. ............ . 31
X. Distribution of cases and their matched
controls in r elation to l iving with their
marital partner and/or family.......... 32
XI. Distribution of cases and their matched
control s according Lo the number of
sexual partners encollntered in one week
period . . ........... . . ... .. ... .. ... ... .. 33
XII. Distribution of cases and their matched
controls encountered in Olle yC'11"
period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Lv
A B B REV I A T ION S
1. AIDS - Acquired ill'mtlnne defi.ci ency syndrome
2. LGV - LymplJogranuloma vener eum
3 . MOH - Ministry of Health
4 . PID - Pelvic inflammatory diseases
5. STD - Sexually transmitted di seases
6 . UDA - Urban dwellers association
7. UNICEF - United Nations Children Fund
8 . UTI - Urinary tract infection
9. VD - Venereal diseases
10 . WHO - World Health Organization
I
SUM MAR Y
A case-control study of sexunlly t r:lnsmitted was
di ~eases
carried out in two heal th uni.ts in Gondar Town north-west ern
Ethiopia between September 1987 and November 1987. A total
of 285 cases and 570 controls participated in the study.
The peak age range was 15- 19 year s (43.9%) and 20-24 years
(34.6%) for female and male cases r espectively. In con
trast to reports from other parts of the male-to
Afrj~R,
female ratio was 1.2:1 i n t his stud~· . Over 40[: of the
cases were found in Keft pgnn four in which there are pre
dominantly soldiers and prostitutes. Of 153 male cases,
only 26.2% were married. Married women constituted 33.1%
of t he cases. While a further 33 . 3% wprA di.vorced womAn.
Soldiers, prostitutes and students (28.8%, 19.7% and 13.3%
of the total cases respectively) were identified as high
risk groups. The commonest diagonsis was gonorrhoea (56.5 X),
with further 21.8% of the mixed infections including gonor
rhoea. Over 40% of the cases admitted to a previous history
of STD. A past history of four or more STD infections oc
curred in 10.9% of the total cases. Casual contact or
unknown contact as a source of infection accounted for 50%
of the infections rivalling prostitutes who accounted for
52.3% of the contacts. Of the total cases, 54.4% sought
a cure from druggists without seeing a healt h worker .
The practice of self-medication was high and did not appear
to differ greatly between educated and illiterate groups
(P>.lO) .
Age at first sexual intercourse of l ess than 20 years was
associated with a statistic:llly s igni f icant inCr0:lSed ris k
I
of STD (ORmh = 3. 6, P<.'OOl ) . H:l\'in:~ '10 spOLlse or living
away from marital partner nnel/or were
~:lnI11 y :l~socj ntcel
with STD infection (1R f = 2.3, pC. OO I '~;f d CR I ". 3,
/)1, t !ii I
P<. OO l) r espc('.li v(·l y) . Jil r""1:'! "" 'i," 1·,,,,1 I,i" " ":: "r
2
premarital sex was found to jn~rrR~e t.hp ri s k of acquir
ing STD 4.8 t imes . Hoth the of mUltiple partner
practic~
within on week and one year ]leriod were also associated
with an increased risk or STD (OR f : 13, P<.OOI
~~'1uir i nf':
tnt
CHId OR .. = 9.7 P<. 001, !tc.~I_',,-c.tl\'c.eyl . This study has impli
tnh
cations for the control of sexually t ransmitted diseases
in general and AIDS in particular .
CHAPTER I . 1 ;;TRODUCTI ON
Sexuall y t ransmitted diseases (STU<; \ , affecting all age
groups but with particular cmong the product i ve
Inngll jtu~'
age groups, ar e on a tide dr::rilC Lhe avail abili ty
ri.sin'~
of antibiotics and chemotl'ernpeutics . This is vividly
reflected by t heir disturbing in many countries .
]evel~
Unt il recently, only the fi ve classical venereable venereal
diseases (gonorrhoea , syphi l.is , cl'on('r() id, l ymphogran1lloma
venereum, granuloma inguin:ll l wer o of great concern to t he
cl inicians as well as the 0;Jidemiol'lp;ist s . But t oday, t he
number of diseases whose importance as sexually transmitted
disease i s recognized has expanded greatly [11 . c hl amydia
trachomatis, gential herpes, ectoparasitic diseases and
acquired immune deficiency syndrome (AIDS) have become
incr easingly common in nearly all countries of the world .
Not only has the total number of these STDs increased but
also variety of agents responsibl e has expanded to include,
such as, hepatitis virus E, cytomegal ovirus , group B strep
tococcus and some enteric pathogens .
The r ecent wide spread and rapid dissaminaLi~il of t he fatal
disease AIDS spread mainly by s exunl acti vit y i s one of
the worst epidemics or pandemi cs tIle human race has encoun
tered. It constitutes one of the for emost challenges
of the medical f i eld today .
Inorder to cont rol STDS such as gonnr rlloca and syphilis,
national and l ocal control progrn~s have been set up in
many count r ies . Unfortunat(Jly , c\u(' to numerous fartor s ,
such as al tered virul ence of the npti o10~ic or ganisms , al-
t ered antibiotic and chemot hc'r:1!)·"'I1' 1 : ( ";0'1<:"; i ~ i .. " i;~:, ('h:1n~8S
in the environment , chang'.'s " r S<,.'··""l ;" 1" I\-i0I1I" [:'1 r1l1cl
2.
t he emergence of n('w orp;an i " "", rr's !")f'I1S ihl (' f0r STD, the
success of such programs h:.I,'-; not r (':'ched expected l evels
and decrease clinical cas('s has fajlpd to materalize .
Even though data on STDs i 3 scarce in devel oping countries ,
there are indications t hat the situation may be even worse
than in industri alized countri es [3] . On top of the high
incidence rates of the tradit i onal vener eal which
~isease
are far beyond control, t h(' occurrf'lH'," of ,'IDS in t hp.
African context makes the ~l Luation and control of STDs
complex and urgent .
Control programs int roduced in the devel oping countries
have been particularly unsuccessful. This can he attribut
ed to lack of adequate heall h service cover age , poor con
tact t racing, shortage and high cost of potent drugs ,
poor diagnostic facili t i es and appl ication of st rategies
without appropriate alterat ion from more affluent
countries. In addition, f ailure t o do r outine
v~ginal
swabs and routine vaginal exams during pregenancy and
failure to t rain all clinical health workers to do vaginal
swabs are factors which have limited the amount of asymp
tomatic carriers brought forward f or treatment.
Thus the loss of life and human suffering from the l ong
t erm consequences of STDs produce a more pronounced burden
in the devel oping world wi th inaccnss ihl e and ponrl y r,rp;a
nized and equipped heal th services .
In Ethiopia, some thirty f ive years ago , a Mini stry of
Health, WHO and UNICEF v('nture of control
coll~bnrativn
program for STD was inili::cl prj .I n t" , c~!' i till Adelis ,Ababa
with t he ult imate obj0cti,\',.' DL cou:~, !"'-'::i.cle co\'( 1''';'0 . In