Abstract
Sexually transmitted infection (STI) management is considered rudimentary among rural medical practitioners (RMPs) in Bangladesh. We sought to understand the level of knowledge and skills in STI management and to assess the impact of a two-day training orientation among RMPs in Tangail district. Data were collected through a baseline survey of 225 practicing RMPs in the study area and a three-month follow-up survey of 99 RMPs who participated in a two-day STI/HIV orientation training. The level of formal training among RMPs ranged from none (22.7%), to paramedical training (14.7%) and local medical assistant training (62.6%). The baseline survey revealed a low level of STI/HIV knowledge and misconceptions about the transmission of STI/HIV among RMPs. RMPs mostly prescribed first line antibiotics for treatment of common reproductive tract infections (RTIs) including STIs, but they rarely prescribed the correct dosages according to the national RTI/STI management guidelines. Only 3% of RMPs were able to correctly answer all four HIV transmission (unprotected sexual intercourse, blood transfusion, needle sharing and mother to child transmission) questions at baseline, while 94.9% of RMPs answered all four correctly at three months following the training (p=0.001). Only 10% of RMPs reported suggesting the recommended drug (azithromycin) and only 2% mentioned about the recommended dosage (2gm single dose) for the treatment of urethritis/cervicitis; compared to 49.5% suggested azithromycin at follow-up with 39.4% mentioned the recommended 2gm single dose (p=0.001). Our study found low level of knowledge and poor practices related RTI/STI management among RMPs. Short orientation training and education intervention shown promise to increase knowledge and management skills for RTIs/STIs.
Highlights
Bangladesh is considered a low HIV prevalence country, it is vulnerable to epidemic because of its close proximity to Asian HIV epicentres and the presence of several high risk subgroups in the country [1]-[6]
A total of 225 rural medical practitioners (RMPs) participated in the baseline survey, 91.8% of the 245 of those originally identified in the census, rest 20 RMPs either refused to participate or could not be reached for baseline survey with several attempts
The level of training prior practicing allopathic medicine ranged from no training reported by 22.7% of the RMPs, paramedical training reported by 14.7%, and local medical assistant (LMA) training reported by 62.6% of the RMPs
Summary
Bangladesh is considered a low HIV prevalence country, it is vulnerable to epidemic because of its close proximity to Asian HIV epicentres and the presence of several high risk subgroups in the country [1]-[6]. The prevalence rates of curable sexually transmitted infections (STIs) among sex workers and other high risk groups in Bangladesh are high and consistent condom use in commercial sex is low [7] [8]. Effective STI management approaches along with other HIV/AIDS prevention efforts could play an important role in averting HIV/AIDS epidemic in Bangladesh. Though RMPs are often the only medical care providers for most of Bangladesh’s rural poor, there are no formal efforts to train them in disease management, including STIs, nor are there government regulations to monitor the quality of their practices [2]. One study indicated that RTIs were not well understood among village practitioners; they did not perform examination of their patients, used substandard dosage of drugs, and made no attempt to notify or treat sexual partners [17]
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