Skip to main content
PMC home page
Sexually Transmitted Infections logoLink to Sexually Transmitted Infections
. 2000 Dec;76(6):426–436. doi: 10.1136/sti.76.6.426

Operational performance of an STD control programme in Mwanza Region, Tanzania

H Grosskurth 1, E Mwijarubi 1, J Todd 1, M Rwakatare 1, K Orroth 1, P Mayaud 1, B Cleophas 1, A Buve 1, R Mkanje 1, L Ndeki 1, A Gavyole 1, R Hayes 1, D Mabey 1
PMCID: PMC1744245  PMID: 11221123

Abstract

Objectives: To describe important details of the design and operational features of the Mwanza sexually transmitted diseases (STD) control programme. To assess the feasibility of the intervention, the distribution of STD syndromes observed, the clinical effectiveness of syndromic STD case management, the utilisation of STD services by the population, and the quality of syndromic STD services delivered at rural health units.

Methods: The intervention was integrated into rural primary healthcare (PHC) units. It comprised improved STD case management using the syndromic approach, facilitated by a regional programme office which ensured the training of health workers, a reliable supply of effective drugs, and regular support supervision. Five studies were performed to evaluate operational performance: (i) a survey of register books to collect data on patients presenting with STDs and reproductive tract infections (RTIs) to rural health units with improved STD services, (ii) a survey of register books from health units in communities without improved services, (iii) a survey of register books from referral clinics, (iv) a home based cross sectional study of STD patients who did not return to the intervention health units for follow up, (v) a cross sectional survey of reported STD treatment seeking behaviour in a random cohort of 8845 adults served by rural health units.

Results: During the 2 years of the Mwanza trial, 12 895 STD syndromes were treated at the 25 intervention health units. The most common syndromes were urethral discharge (67%) and genital ulcers (26%) in men and vaginal discharge (50%), lower abdominal tenderness (33%), and genital ulcers (13%) in women. Clinical treatment effectiveness was high in patients from whom complete follow up data were available, reaching between 81% and 98% after first line treatment and 97%–99% after first, second, and third line treatment. Only 26% of patients referred to higher levels of health care had presented to their referral institutions. During the trial period, data from the cohort showed that 12.8% of men and 8.6% of women in the intervention communities experienced at least one STD syndrome. Based on various approaches, utilisation of the improved health units by symptomatic STD patients in these communities was estimated at between 50% and 75%. During the first 6 months of intervention attendance at intervention units increased by 53%. Thereafter, the average attendance rate was about 25% higher than in comparison communities. Home visits to 367 non-returners revealed that 89% had been free of symptoms after treatment, but 28% became symptomatic again within 3 months of treatment. 100% of these patients reported that they had received treatment, but only 74% had been examined, only 57% had been given health education, and only 30% were offered condoms. Patients did not fully recall which treatment they had been given, but possibly only 63% had been treated exactly according to guidelines.

Conclusions: This study demonstrated that it is feasible to integrate effective STD services into the existing PHC structure of a developing country. Improved services attract more patients, but additional educational efforts are needed to further improve treatment seeking behaviour. Furthermore, clear treatment guidelines, a reliable drug supply system, and regular supervision are critical. All efforts should be made to treat patients on the spot, without delay, as referral to higher levels of care led to a high number of dropouts. The syndromic approach to STD control should be supported by at least one reference clinic and laboratory per country to ensure monitoring of prevalent aetiologies, of the development of bacterial resistance, and of the effectiveness of the syndromic algorithms in use.

Key Words: sexually transmitted infections; syndromic treatment; programme performance; Tanzania

Full Text

The Full Text of this article is available as a PDF (156.6 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Cameron D. W., Simonsen J. N., D'Costa L. J., Ronald A. R., Maitha G. M., Gakinya M. N., Cheang M., Ndinya-Achola J. O., Piot P., Brunham R. C. Female to male transmission of human immunodeficiency virus type 1: risk factors for seroconversion in men. Lancet. 1989 Aug 19;2(8660):403–407. doi: 10.1016/s0140-6736(89)90589-8. [DOI] [PubMed] [Google Scholar]
  2. Cohen M. S., Hoffman I. F., Royce R. A., Kazembe P., Dyer J. R., Daly C. C., Zimba D., Vernazza P. L., Maida M., Fiscus S. A. Reduction of concentration of HIV-1 in semen after treatment of urethritis: implications for prevention of sexual transmission of HIV-1. AIDSCAP Malawi Research Group. Lancet. 1997 Jun 28;349(9069):1868–1873. doi: 10.1016/s0140-6736(97)02190-9. [DOI] [PubMed] [Google Scholar]
  3. Cowan F. M., French R., Johnson A. M. The role and effectiveness of partner notification in STD control: a review. Genitourin Med. 1996 Aug;72(4):247–252. doi: 10.1136/sti.72.4.247. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Fleming D. T., Wasserheit J. N. From epidemiological synergy to public health policy and practice: the contribution of other sexually transmitted diseases to sexual transmission of HIV infection. Sex Transm Infect. 1999 Feb;75(1):3–17. doi: 10.1136/sti.75.1.3. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Gilson L., Mkanje R., Grosskurth H., Mosha F., Picard J., Gavyole A., Todd J., Mayaud P., Swai R., Fransen L. Cost-effectiveness of improved treatment services for sexually transmitted diseases in preventing HIV-1 infection in Mwanza Region, Tanzania. Lancet. 1997 Dec 20;350(9094):1805–1809. doi: 10.1016/S0140-6736(97)08222-6. [DOI] [PubMed] [Google Scholar]
  6. Grosskurth H., Mosha F., Todd J., Mwijarubi E., Klokke A., Senkoro K., Mayaud P., Changalucha J., Nicoll A., ka-Gina G. Impact of improved treatment of sexually transmitted diseases on HIV infection in rural Tanzania: randomised controlled trial. Lancet. 1995 Aug 26;346(8974):530–536. doi: 10.1016/s0140-6736(95)91380-7. [DOI] [PubMed] [Google Scholar]
  7. Harrison A., Wilkinson D., Lurie M., Connolly A. M., Karim S. A. Improving quality of sexually transmitted disease case management in rural South Africa. AIDS. 1998 Dec 3;12(17):2329–2335. doi: 10.1097/00002030-199817000-00015. [DOI] [PubMed] [Google Scholar]
  8. Laga M., Manoka A., Kivuvu M., Malele B., Tuliza M., Nzila N., Goeman J., Behets F., Batter V., Alary M. Non-ulcerative sexually transmitted diseases as risk factors for HIV-1 transmission in women: results from a cohort study. AIDS. 1993 Jan;7(1):95–102. doi: 10.1097/00002030-199301000-00015. [DOI] [PubMed] [Google Scholar]
  9. Mayaud P., Grosskurth H., Changalucha J., Todd J., West B., Gabone R., Senkoro K., Rusizoka M., Laga M., Hayes R. Risk assessment and other screening options for gonorrhoea and chlamydial infections in women attending rural Tanzanian antenatal clinics. Bull World Health Organ. 1995;73(5):621–630. [PMC free article] [PubMed] [Google Scholar]
  10. Mayaud P., Mosha F., Todd J., Balira R., Mgara J., West B., Rusizoka M., Mwijarubi E., Gabone R., Gavyole A. Improved treatment services significantly reduce the prevalence of sexually transmitted diseases in rural Tanzania: results of a randomized controlled trial. AIDS. 1997 Dec;11(15):1873–1880. doi: 10.1097/00002030-199715000-00013. [DOI] [PubMed] [Google Scholar]
  11. Mosha F., Nicoll A., Barongo L., Borgdorff M., Newell J., Senkoro K., Grosskurth H., Changalucha J., Klokke A., Killewo J. A population-based study of syphilis and sexually transmitted disease syndromes in north-western Tanzania. 1. Prevalence and incidence. Genitourin Med. 1993 Dec;69(6):415–420. doi: 10.1136/sti.69.6.415. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Newell J., Senkoro K., Mosha F., Grosskurth H., Nicoll A., Barongo L., Borgdorff M., Klokke A., Changalucha J., Killewo J. A population-based study of syphilis and sexually transmitted disease syndromes in north-western Tanzania. 2. Risk factors and health seeking behaviour. Genitourin Med. 1993 Dec;69(6):421–426. doi: 10.1136/sti.69.6.421. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Pepin J., Plummer F. A., Brunham R. C., Piot P., Cameron D. W., Ronald A. R. The interaction of HIV infection and other sexually transmitted diseases: an opportunity for intervention. AIDS. 1989 Jan;3(1):3–9. [PubMed] [Google Scholar]
  14. West B., Changalucha J., Grosskurth H., Mayaud P., Gabone R. M., Ka-Gina G., Mabey D. Antimicrobial susceptibility, auxotype and plasmid content of Neisseria gonorrhoeae in northern Tanzania: emergence of high level plasmid mediated tetracycline resistance. Genitourin Med. 1995 Feb;71(1):9–12. doi: 10.1136/sti.71.1.9. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Sexually Transmitted Infections are provided here courtesy of BMJ Publishing Group

RESOURCES