Knowledge about sexually transmitted diseases among primary health care providers

Objective: The objective of this study was to assess the knowledge about sexually transmitted diseases among various health care providers who attended the in-service training. Material & Methods: The study is of cross sectional design. The participants included in the study were the various level health care providers, viz. Medical Officers, Health Supervisors (Male & Female) and Multipurpose Health Workers (Male &Female). Results: Six hundred and sixty six health care providers had participated in the study. 74.7 % of the respondents mentioned AIDS as Sexually transmitted Disease, 49.5% syphilis and 45% gonorrhea. The most important symptoms mentioned were genital ulcer (39.3%), vaginal/urethral discharge (44.3%), fever (19.5%) and loss of weight (16.9%). Conclusion: In general, this study shows low level of awareness regarding Sexually Transmitted Diseases. Health care providers play important role in dissemination of knowledge, hence their awareness regarding Sexually Transmitted Diseases should be of optimal level.


Introduction
Sexually transmitted diseases (STDs) can have serious consequences beyond the immediate impact of the infection. Sexually transmitted diseases produce considerable waste-age of manpower besides unfolding misery both directly and indirectly through complications they produce. Globally 333 million suffer from STDs per year. In India, this comes to 30 million. Thus STDs occupy second position among communicable diseases in India [1]. STDs have nexus with HIV transmission. Some STDs can increase the risk of Human Immunodeficiency Virus (HIV) infection three -or more fold. Acquired Immunodeficiency Syndrome (AIDS) is a leading cause of adult deaths in the world. Case fatality is 100%. HIV/AIDS has emerged as pandemic.
Adolescent health and health of young people should focus on access to information on HIV/AIDS, modes of transmission and do away some of the wrong beliefs and misconceptions [2,3]. Health care providers are expected to provide care and accurate information on this subject matter to the patients and their relatives, as well as to the general public. It is clearly important that they have credible and accurate knowledge of the disease. This is important for optimal health care delivery because several studies have shown that knowledge and beliefs of health care providers about HIV and AIDS are frequently inaccurate, their attitudes often negative. High level of awareness is needed among health care providers to provide health education to the general population. For this, flow charts and algorithm for each syndrome have been developed by World Health Organization (WHO) and National AIDS Control Organization (NACO) in India. These can be used easily to make rapid decision by different health workers, supervisors and doctors [4,5]. In India, the main strategy aimed at achieving effective management for people with established infections has been to integrate STD services into the existing health care system, with a special emphasis on integration at the primary health care level. Syndromic management is recommended by the NACO for case management at this level [6].
Awareness and positive attitudinal change of health care providers will also eliminate that fear and prejudice when they are dealing with AIDS. With the above in view, need to undertake this study was felt to identify areas related to STDs and HIV prevention amongst health care providers Public Health Review: International Journal of Public health Research Available online at:www.publichealthreview.in 16|P a g e working in primary health care level who are very close to the community by requiring conceptual clarification. The objective of this study was to assess the knowledge about STDs including HIV/AIDS among health care providers.  Table 4]. 84.4% of the total participants opined that there is an association of Sexually transmitted Diseases and HIV infection. [ Table 5]. 92.1% of the participants had the view that treatment of the spouse is also important [ Table 6]. 73.1 % of the total respondents opined that STDs leads to infertility as a complication also 72.8% of the respondents mentioned repeated abortion as other complication [

Discussion
Health care providers are called upon to provide care and accurate information about sexually transmitted diseases to the patients and their relatives as well as to the general population for prevention and control. But in this study health care provider demonstrated low level of knowledge except medical officers. To prevent and control STDs, the knowledge of the front-line workers working in the field with the general population must be up to the mark but as found in this study, knowledge of the health care providers especially the front line workers is less than expected. According to this study, health care providers had inadequate knowledge regarding the various aspects of Sexually transmitted diseases. Similarly the study conducted in Kathmandu, Nepal, also shows that knowledge and practice regarding STI/HIV has not been found sufficient among health workers [7,8].
According to the Windhoek, Namibia, where the knowledge for urethral discharge was 55.3% and 56.5%, respectively [10,11]. This might be because these studies only focused on knowledge of general practitioners while our study included health care providers working in the public health facilities. When asked about the treatment of spouse, 92.1% of respondents gave a positive response while a study conducted in Vietnam 70% of respondents believed partner treatment is necessary for bacterial vaginosis or candidiasis cases. [9 ]. Knowledge about treatment from health care facilities for STDs is the most pivotal point and crucial for the further referring. But in our study onefourth of the health care respondents did not know about the health care facilities. Low level of knowledge is mainly attributed to the poor training of the health care provider. Hence extensive awareness campaign and training to the health care provider must be conducted to improve their knowledge.

Conclusion
This study concluded that even medical officers did not have that level of knowledge about Sexually Transmitted. Similar finding was revealed among other health care providers also. It is recommended that Health staff members should be empowered through various in-service training courses, so that they can disseminate the correct and authenticated information to general population which is a social vaccine for prevention of the HIV/AIDS which is a serious new generation Sexually transmitted disease.