Improved management of sexually transmitted infections (STIs) can reduce the rate of new HIV cases by up to 40 per cent. AMREF (African Medical and Research Foundation) provided training in STI treatment for the six hundred licensed private providers (doctors, nurses and clinical officers) in Nyanza province in western Kenya. But what happens when people use untrained providers or self-medicate?

Research co-ordinated by Futures Group asked:

• What proportion of patients with STIs seeks treatment from trained providers?
• What do the other people with STIs do?
• How many patients who visit trained providers receive the correct drugs?
• What about people who want to buy drugs without a prescription?

The researchers surveyed 2500 young adults at urban and rural markets about sources of treatment for STIs. This showed that:

• Less than one third of people with STIs seek immediate treatment.
• 44 per cent go to a government clinic, while 37 per cent visit an untrained private provider. Only 17 per cent seek care from one of the trained private providers.
• 64 per cent of people seeking treatment had received an injection – a popular form of treatment in Kenya, but not part of the Ministery of Health's correct STI treatment guidelines.

Researchers also recruited 286 young actors to visit medicine shops – half of them seeking treatment for STI symptoms and half with prescriptions for drugs that treat STIs. The ‘mystery shoppers’ reported that 58 per cent of prescriptions were filled correctly. Another 21 per cent of customers were told that the drugs were unavailable and they should go elsewhere. However, 21 per cent were sold different drugs from those prescribed, usually because the drugs were out of stock. In the survey, ten per cent of women and 25 per cent of men with STI symptoms said they had self-medicated. Of the ‘mystery shoppers’ who visited medicine shops without a prescription, 40 per cent were advised to seek advice from a doctor. The rest were sold a range of drugs but very few were given the correct medicines for either syphilis or gonnorhoea.

The researchers discuss several cost-effective strategies to improve STI treatment, including:

• persuading people to seek prompt treatment for STIs from government facilities or trained private providers, using active marketing techniques
• training the more competent unlicensed private providers – the preferred source of treatment for many people
• ensuring that drugs are available and affordable
• providing incentives for drug sellers to refer people with STI symptoms to a trained provider
• improving the knowledge of STI treatment among drug vendors.

Source(s):
‘Treating STIs in Kenya: the role of the private sector’, Futures Group Briefing, by B. Mackay, C. Nkatha, A. Vallely and E. Akach, November 2002 Full document.
'Mwanza revisited - lessons for STI treatment in rural areas', taken from ‘Operational performance of an STD control programme in Mwanza Region, Tanzania’ Sexually Transmitted Infections 76: 426-436, by H. Grosskurth et al., 2000

Funded by: UK Department for International Development

id21 Research Highlight: 14 January 2003

Further Information:
Bruce Mackay
Futures Group Europe
Edgar Buildings
17 George Street
Bath
BA1 2EN
UK

Tel: +44 (0) 1225 321840
Fax: +44 (0) 1225 443656
Contact the contributor: b.mackay@tfgi.com

Futures Group International

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