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Introduction: Reproductive tract infections including sexually transmitted infections (RTI/STIs) are problems of public health priority compromising the reproductive health of women especially in developing countries. The problem is compounded by the poor health care seeking behaviour among women due to lack of awareness and sociocultural factors. Objectives: This study is an attempt to assess the health care seeking behaviour of women ing RTI symptoms in a rural area of Tamil Nadu state of India and to examine the association of background sociodemographic characteristics with Health care seeking behaviour. Methodology: This was a cross sectional, descriptive study conducted between March to November 2017, among married women aged 18-45 years in a rural area of Kancheepuram district, Tamil Nadu in India. The required sample size was chosen by simple random sampling. The participants were administered a standardized, semi-structured schedule. Results: 520 women participated in the study. 173 women (33.3%) of women ed experiencing symptoms of RTI/STI in the past 12 months. Only 51.45% of those who had RTI/STI symptoms sought health care. Private health care facility was preferred by nearly two-thirds. The health care seeking behaviour showed significant association with age group of women, religion, occupational status, type of family and socioeconomic status. Conclusion: There is a need for increasing awareness among women regarding RTI/STIs and their sequelae. Targeted health education programmes should be necessary to improve health care seeking among women. Introduction Reproductive health of women has several components such as fertility control, safe motherhood and prevention and control of reproductive tract infections including sexually transmitted infections (RTI/STIs). Prevention and treatment of RTI/STIs are integral to the promotion of reproductive health.(1) In poor and developing countries, over one-third of healthy life-years lost among women of reproductive age group are due to reproductive health problems including RTI/STIs, while these account for only 12% in the developed world.(2) According to National Family Health Survey (NFHS) 2 (1998-99) estimates nearly 4 out of 10 currently married women in India ed at least one reproductive health problem that could be symptomatic of a more serious RTI. But only 3 out of 10 women suffering from RTI/STI symptoms sought health care. The prevalence of RTI/STIs in Tamil Nadu was 27.8% (urban 53%; rural 50%). Among these one half (51%) have not sought any treatment.(3,4) According to District Level Household and Facility Survey (DLHS) - 3 (2017-2017) , only 41% of those who had RTI/STI symptoms sought health care. These figures show that the health seeking behaviour among women for RTI/STI symptoms has changed very little over the years.(5) The Piot and Fransen model of RTI/STI management sums up the problems in treatment of RTI and STI. This model illustrates the obstacles in RTI/STI control. The bottom bar represents all women with RTI/STI in a community and the bars above show how many women are identified at each step. The difference in each step describes the lost opportunities in stopping RTI/STI transmission.(6) Methodology: This community-based, descriptive, cross-sectional study was carried out in Karanai Puducheri village of Kancheepuram District, Tamil Nadu during the period March to November 2017. Based on a study by Chellan R in rural South India (1998-99) where the prevalence of women who sought health care for RTI symptoms was 34.6%, the required sample size was calculated to be 497, with an allowable error of 12%. (9) Assuming 10% non-response, the final sample size arrived at was 547. All married women in the age group 18 to 45 years constituted the sampling frame. There were 1733 married women in the age group 18 to 45 years based on the voter’s list. Using this as the sampling frame, 547 women were chosen by simple random sampling using computer generated random numbers. Discussion A total of 520 women participated in the study with a response rate of 95.1%. Of the study population, 33.3% (173 out of 520) ed one or more symptoms of RTI/STI. Only 51.4% of the women with RTI symptoms sought health care. This proportion is higher than that ed by Kumar S (30.6%), Prasad JH et al (35%) and Garg S (27.8%).(10-12) But almost half of the women (48.6%) with symptoms have not sought treatment. Only 42.2% of those with symptoms (73 out of 173) have completed treatment and 32.4% (56 out of 173) have been relieved of the symptoms. So 67.6% of the women with ed RTI/STI symptoms still suffer from symptoms due to lack or of incomplete treatment. This proportion is in agreement with that ed by Bhanderi et al in Gujarat. (8) This high proportion of untreated RTIs suggest that they are retaining their infections for longer durations and are more likely to suffer from severe sequelae. Two thirds of women (62.9%) sought private health care facility. Only 32.6% of the women sought Government health care facility for such symptoms. Samanta et al ed that 46.3% of women sought Government health facilities in a study from rural West Bengal.(13) Our figures are higher than that ed by Prasad JH et al in a study from rural Tamil Nadu. But the pattern of health facility sought is similar in most studies (Prasad JH, Bhanderi MN)) and in national surveys where majority prefer private health care facility for RTI/STI symptoms despite the cost.(8, 11) This scenario persists despite Government adopting syndromic approach for management of RTI/STIs, which ensures easier diagnosis and complete treatment. The main reasons for not seeking health care ed in many studies were stigma & embarrassment, lack of privacy and lack of female doctors at facility.(8,14-17) So there is an urgent need to overcome these barriers especially with reference to Government health facilities to promote utilization of Government health care facilities and completion of treatment. The health care seeking behaviour was significantly associated with age group, educational status of participant, religion, occupational status of participants, type of family and socioeconomic status. Higher proportion of women in age group 26 to 35 years were found to seek healthcare for RTI symptoms compared to those younger or older. This could be due to the fact that this is the age group which would seek health care for antenatal, postnatal and child care services more frequently and thereby are in a position to seek care for them as well. Education is positively associated with health care seeking behaviour though not statistically significant. Increase in educational status is associated with increase in health care seeking behaviour. Similar association with educational status has been ed by Bhanderi et al, Chellan R, Rani et al and Durr E Nayab. (8,9,18,19) Comparing health care seeking behaviour between religions, the proportion was less among Hindus compared with Christians and Muslims. But women from other religions constituted less than 15% in our study. A higher proportion of working women sought health care for RTI/STIs compared to non-working women and this association was significant. This confirms the knowledge revealed by similar studies that employment is associated with economic independence and an increased power in decision making and thereby improving their health care seeking behaviour.(8,20) Joint families typical of Indian culture appear to be a promoting factor in health care seeking for RTI/STI symptoms and this association was statistically significant. Lesser women belonging to lower socioeconomic status sought health care compared to those higher up in social strata. Similar association has been ed by Bhanderi et al, Rani et al and Guo et al. (8,18,21) Conclusion Despite a higher proportion of women presenting with RTI/STI symptoms, only one third of the study women sought heath care and underwent complete treatment. Health education sessions as part of antenatal and postnatal care services should promote awareness about RTI/STIs and the need to seek health care. Accurate information has to be delivered with focus on sequelae associated with untreated or incompletely treated RTI/STIs. Self help groups women can be trained to impart knowledge among women and assist them in seeking health care. Women should be encouraged to 4 share their health problems and experiences with husbands and senior female members of the family. Involving both the spouses in Information, Education and Communication (IEC) sessions will contribute to improving the health seeking behaviour of women for RTI/STIs. Women empowerment is the need of the hour.()，英语论文题目，英语论文 |
