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    Improved treatment services significantly reduce the prevalence of sexually transmitted diseases in rural Tanzania - results of a randomized controlled trial

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    Research article (4.619Mb)
    Publication Date
    1997-08-07
    Authors
    Mosha, Frank
    Todd, James
    Balira, Rebecca
    Mayaud, Frank
    Mgara, Julius
    West, Beryl
    Rusioka, Mary
    Mwijarubi, Ezra
    Gabone, Reverianus
    Gavyole, Awena
    Grosskurth, Heiner
    Hayes, Richard
    Mabey, David
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    (13 total)
    Type
    Article, Journal
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    Abstract/Overview

    Objective: To evaluate the impact of improved case management for sexually transmitted diseases (STD) at the primary health care level on the incidence and prevalence of STD. Design: Community-randomized controlled trial. Setting: Mwanza region, Tanza ni a. Subjects: A random cohort of about 1000 adults aged 15- 54 years from each of12 communities, in six matched pairs. O ne member of each pair was assignee! at random to receive the intervention , and the others served as a comparison community. This cohort was surveyed at baseline and al follow-up 2 years later. About 100 antenatal clinic attenders were also studied in each community on two occasions: the first shortly afte1· the implementation of the intervention, and the second approximately 1 year later. Intervention : Improved services were established for the management of STD, using the syndromic approach, in rural health units. Results: A total of 12 534 individuals were enrolled in the cohort study, oi whom 8844 (7"1 'X,) were seen again 2 years later. The prevalence of serological syphilis · (rapid plasma reagin litre >1 :B, Treponema palidum haemagglubin assay positive) was 6.2% in both intervention and comparison communities al baseline. At followup it was 5.0% in the intervention community and 7.0% in the comparison community adjusted relative risk (RR), 0 .71; 95% confidence level,1 1 (C l ), 0.54 - 0 .93; P < 0.0 2 1. The prevalence of urethritis in males did not differ significantly between intervention and comparison groups al follow-up, but the prevalence of symptomatic urethritis was reduced by about 50% (adjusted RR , 0.51; 95% Cl, 0.24-1 .1 O; P = 0.08). There was no significant difference between the groups in the incidence of self-reported STD symptoms over the last year of the follow-up period, or in the prevalence of any STD in antenatal clinic attenders. Conclusion: The reduction in HIV incidence previously reported in this intervention study can be al attributed to a reduction in the duration, and hence the prevalence of symptomatic STD.

    Subject/Keywords
    Sexually transmitted diseases; Syndromic management; Africa; Impact evaluation
    Further Details

    Requests for reprints to: Professor David Mabey, London School of Hygiene and Tropical Medicine, Keppel Street, London WCI E 7HT, UK.

    Publisher
    AIDS: Rapid Science Publishers
    Permalink
    https://repository.amref.ac.ke/handle/123456789/498
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    • General - GEN [355]

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