Are providers missing opportunities to address reproductive tract infections? Experience from Bangladesh (PDF)
Chowdhury,Syeda Nahid Mukith; Bhuiya,Ismat; Huda,Sheikh Najmul; Faisel,Abu Jamil
International Family Planning Perspectives 25(2): 92-97
Publication date: 1999
Reproductive tract infections are a common problem among women of reproductive age in Bangladesh, and it would be helpful if the identification and treatment of these infections could be integrated in family planning and maternal and child health programs.
A total of 172 clients in 46 purposively selected family planning service facilities were interviewed, and their interaction with health care providers was observed during November and December of 1996. In addition, 112 doctors and family welfare visitors were interviewed at the end of the observation period.
Seventy-seven percent of clients reported at least one symptom associated with reproductive tract infections at the time of the intake interview, but service providers only followed up on these complaints or obtained a comprehensive reproductive history in 22% of the cases: Twenty-one percent of symptomatic women were diagnosed with a reproductive tract infection, and one-third of these women received specific, as opposed to symptomatic, treatment. Of 18 women receiving a new IUD, only six were screened for reproductive tract infections. Providers explored the symptoms of only half of all women using the injectable who reported problems typical of reproductive tract infections. Pelvic examinations were performed on 40 out of 68 new family planning clients and on 21 out of 50 family planning clients making follow-up visits. During pelvic examinations, a speculum was used in 20 out of 35 exams in public clinics and 23 out of 33 exams in nongovernment clinics. During most pelvic examinations, providers did not follow basic practices for preventing infection.
Health service delivery in the observed clinics was driven by the client's primary reason for visiting. As a result of this singular focus, health care providers missed multiple opportunities to explore and address the needs of clients who reported symptoms of reproductive tract infection.