Quality of care for patients with sexually transmitted diseases in Zambia

Factors which have implications for STD care in Zambia have been described and analysed in order to find strategies for quality improvements. A total of 684 patients with STD were interviewed about health seeking behaviour, sex partners, and satisfaction with quality of care. The male patients had had more sex partners than the female patients, but both groups knew the identity partners. Women had had STD symptoms for two, and men for one week before seeking treatment at the study clinics. During this period, 60 percent had received modern and/or traditional treatment from a variety of other sources. Both women and men continued to have sex during periods with STD symptoms. Women were less aware of symptoms connected with STD and over half of them said that they did not know for which type of disease they were receiving treatment. Patients considered that free treatment and having time to talk to the provider about their disease were important components of STD care. About 50 percent of the patients were not satisfied with the way they had been treated, mainly due to long waits at the clinic, and lack of time talking to the provider. Eighty-two primary health care providers answered a questionnaire about their working conditions, and their opinions about STD patients and quality of STD care. Half of the providers were not satisfied with their working conditions mentioning a heavy workload, lack of equipment/drugs, poor salary, and lack of continuing education as the main problems. Treatment and preventive activities were considered important aspects of quality STD care, but most respondents found patients' compliance poor, especially regarding partner notification. Negative attitudes about STD patients were common.

A method for partner notification was designed and evaluated in a randomized controlled trial involving 94 women and 302 men. The intervention consisted of health education about STD, counselling about how to inform partners, and distribution of contact slips. The proportion of female partners treated, 1.8 partner per male patient, was significantly higher in the intervention group compared to the control group, where it was 1.2 partners per male patient. In a comparative study, quality of STD care was assessed at two health centres and the impact of an STD management training course, using interactive training methods was evaluated. At each health centre, 100 patient-provider interactions were observed and the patients were interviewed before as well as after the intervention. The results showed that few patients had been examined, counselled about partner notification and given health education. These aspects improved significantly at the intervention health centre after the training. Patients did not become more satisfied, however. The results show that training of health personnel, using interactive methods, can improve some, but not all aspects of health care, and partner notification can be improved, at least among men, with counselling and the use of contact slips.