SEXUALLY-TRANSMITTED DISEASES - A SURVEY OF CASE-MANAGEMENT IN MALAWI

A national survey of sexually transmitted disease (STD) case managemen t was carried out at 39 health care facilities in Malawi in 1994. Fift y-four health care providers were observed managing 150 patients prese nting with selected STD syndromes and 103 providers were interviewed. STD case management was assessed by calculation of WHO/GPA prevention indicators (PIs) from observation data. The overall rate for PI-6, whi ch measures correct assessment and treatment of STD patients was 11% ( 81% for history taking, 46% in physical examination, and 13% correct a ntibiotic treatment according to national guidelines). The score for P I-7, which measures overall patient counselling was 29% (65% for partn er notification and 40% for condom advice). Although Haemophilus ducre yi is at least as common as Treponema pallidium as the causative agent for genital ulcers, only 16% of patients with genital ulcers were tre ated effectively for chancroid vs 56% fdr syphilis. Female patients re ceived less comprehensive care than male STD patients. Only 20% of STD patients were offered condoms. Overall, the survey results support th e policy decision to adopt syndromic management of STDs, and provide b aseline information for planning and evaluation of a national control programme.