Quality of sexually transmitted disease case management in Nairobi, Kenya - A comparison among different types of healthcare facilities

Background: In Nairobi, the prevalence for sexually transmitted diseases (S TDs) among attenders at antenatal and family planning clinics is substantia l, but knowledge about the quality of STD case management is scarce. Goal: To assess quality of STD case management in Nairobi healthcare facili ties. Study Design: All the facilities in five sublocations were enumerated. In 1 42 facilities, 165 providers were interviewed, observed during 441 interact ions with patients who had STDs, and visited by a simulated patient. Results: For observations of patients with STDs, correct history-taking ran ged from 60% to 92% among the various types of facilities, correct examinat ion from 31% to 66%, and correct treatment from 30% to 75%. The percentage of correctness for all three aspects (World Health Organization prevention indicator 6) varied between 14% and 48%. Public clinics equipped for STD ca re performed best in all aspects, whereas treatment was poorest in pharmaci es and private clinics. The providers trained in STD management performed b etter than those without training. Conclusions: Quality of STD case management was unsatisfactory except in pu blic STD-equipped clinics. This indicates the need for improvement by inter ventions such as further training in syndromic management, improved supervi sion, and the introduction of prepackaged syndromic management kits.