STD RAPID ASSESSMENT IN RWANDAN REFUGEE CAMPS IN TANZANIA

Objective: To obtain baseline information on sexually transmitted dise ases (STDs) in the Rwandan refugees camps in Tanzania, prior to establ ishment of STD services. Setting: The largest camps of Rwandan refugee s in the Ngara District of Tanzania (estimated population 300 000). Th e study was carried out in 8 days in August 1994. Subjects and methods : A rapid assessment technique was used to measure STD prevalences amo ng: (i) 100 antenatal clinic attenders (ANC); (ii) 239 men from outpat ient clinics (OPD); and (iii) 289 men from the community. Interviews ( by questionnaire) and genital examination were performed for all parti cipants; sampling for females included genital swabs for the the diagn osis of Neisseria gonorrhoeae (NG), Candida albicans (CA), Trichomonas vaginalis (TV), bacterial vaginosis (BV) and a blood sample for syphi lis serology. Men provided urine samples which were screened for leuco cytes using the leucocyte esterase (LE) dipstick; urethral swabs for G ram stain were taken from men with a reactive LE test and from those w ith symptoms or signs of urethritis. OPD males provided a blood sample for syphilis serology. Results: All groups reported frequent experien ce with STDs and engaging in risky sexual behaviour prior to the surve y. During the establishment of the camps, sexual activity was reported ly low. Over 50% of ANC attenders were infected with agents causing va ginitis (TV/BV/CA) and 3% were infected with NG. The prevalence of act ive syphilis was 4%. In the male outpatients, the prevalence of urethr itis was 2.6% and of serological. syphilis was 6.1%. Among males in th e community, the prevalence of urethritis was 2.9% (the majority being asymptomatic infections). We noted frequent over-reporting of STD sym ptoms, unconfirmed clinically or biologically. Conclusions: STD case d etection and management should be improved by training health workers in using the WHO syndromic approach, and through IEC campaigns encoura ging attendance at clinics. Rapid epidemiological methods provide quic k and useful information at low cost in refugee camps.