A POPULATION-BASED STUDY OF SYPHILIS AND SEXUALLY-TRANSMITTED DISEASESYNDROMES IN NORTH-WESTERN TANZANIA .2. RISK-FACTORS AND HEALTH SEEKING BEHAVIOR

Objective-To determine risk factors for syphilis and sexually transmit ted disease (STD) syndromes, and to study health seeking behaviour amo ng those with STD syndromes, in the population of Mwanza Region, North -Western Tanzania. Methods-A population-based random cluster sample su rvey, stratified by rural, roadside or urban residence, of 4173 indivi duals aged 15-54 years was performed in 1990-91. The seroprevalence of syphilis and the prevalence and incidence of self-reported genital ul cer syndrome (GUS) and genital discharge syndrome (GDS) are reported i n the accompanying paper. This paper reports on risk factors for these conditions and on health seeking behaviour among those reporting them . Results-In both sexes, the risk of STDs increased with the reported number of sexual partners in the previous five years. Men who were sep arated, divorced or widowed were at increased risk of STDs, but this w as not the case among women. Higher educational status was associated with an increased risk of urethral discharge in males but with a decre ased prevalence of syphilis in females. Male circumcision was associat ed with an increased risk of urethral discharge but a reduced prevalen ce of syphilis. Nearly all men, and 90% of women, reporting symptoms o f genital discharge or ulceration had sought treatment. Of these, appr oximately 70% of males and 60% of females had sought treatment in the official health sector. Conclusions-Targetted health education concern ing risk reduction for HIV infection and other STDs should be a high p riority in this population. Improved case management of STDs in health centres and dispensaries may have a substantial impact on the inciden ce of these infections.