Hostname: page-component-8448b6f56d-t5pn6 Total loading time: 0 Render date: 2024-04-23T09:16:12.903Z Has data issue: false hasContentIssue false
  • English
  • Français

COMMUNITY PERCEPTIONS AND TREATMENT-SEEKING BEHAVIOUR REGARDING REPRODUCTIVE TRACT INFECTIONS INCLUDING SEXUALLY TRANSMITTED INFECTIONS IN LAO PDR: A QUALITATIVE STUDY

Published online by Cambridge University Press:  07 January 2011

AMPHOY SIHAVONG ,
CECILIA STÅLSBY LUNDBORG ,
LAMPHONE SYHAKHANG ,
SENGCHANH KOUNNAVONG ,
ROLF WAHLSTRÖM  and
SOLVEIG FREUDENTHAL
AMPHOY SIHAVONG
Affiliation:
Vientiane Capital Health Department, Ministry of Health, Lao PDR
CECILIA STÅLSBY LUNDBORG
Affiliation:
Division of Global Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
LAMPHONE SYHAKHANG
Affiliation:
Food and Drug Department, MOH, Lao PDR
SENGCHANH KOUNNAVONG
Affiliation:
National Institute of Public Health, MOH, Lao PDR
ROLF WAHLSTRÖM
Affiliation:
Division of Global Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
SOLVEIG FREUDENTHAL
Affiliation:
Skaraborg Institute for Research and Development, Skövde, Sweden
Get access Rights & Permissions [Opens in a new window]

Summary

Creating community awareness of reproductive tract infections (RTI), including sexually transmitted infections (STI), and how to prevent them is essential to minimize their spread. Data on people's views about RTI/STI are entirely lacking in Laos. The aim of this study was thus to explore people's perceptions, treatment-seeking behaviour and understanding of information about RTI/STI, in urban and rural communities in two provinces in Laos. Fourteen focus group discussions and 20 in-depth interviews were held with 76 women and 56 men, selected purposively to provide diversity of socio-demographic backgrounds. Qualitative content analysis was employed for the data analysis. The major finding was that both male and female participants had a variety of misconceptions about the causes and symptoms of RTI/STI and their cure, and a reluctance to seek health care, which could cause delay in appropriate diagnosis and treatment. The most common treatment-seeking behaviour was self-medication through private pharmacies, following advice mostly given by friends and drug sellers. The main reasons for not going to health facilities were fear of social discrimination or shyness of genital examination. Complaints were also made about clinicians' negative attitudes towards ‘dirty disease’. Although condom use was mentioned as a way to prevent RTI/STI, an unwillingness to use condoms was commonly expressed. The main media sources of RTI/STI information were radio and television, and access to health information was more difficult in rural areas. The health messages provided were mostly understood, except for some technical terms. The findings indicate that strengthening health education and promotion through interventions at the community level is recommended to improve quality of RTI/STI management. Health education messages should be more accessible in rural areas. There is also an urgent need to improve communication between RTI/STI patients and clinicians.

Type
Research Article
Information
Journal of Biosocial Science , Volume 43 , Issue 3 , May 2011 , pp. 285 - 303
Copyright
Copyright © Cambridge University Press 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Abdullah, A. S., Fielding, R., Hedley, A. J., Ebrahim, S. H. & Luk, Y. K. (2002) Reasons for not using condoms among the Hong Kong Chinese population: implications for HIV and STD prevention. Sexually Transmitted Infections 78(3), 180–184.CrossRefGoogle ScholarPubMed
Arkell, J., Osborn, D. P. J., Ivens, D. & King, M. B. (2006) Factors associated with anxiety in patients attending a sexually transmitted infection clinic: qualitative survey. International Journal of STD & AIDS 17, 299–303.CrossRefGoogle ScholarPubMed
Beyrer, C., Razak, M. H., Labrique, A. et al. (2003) Assessing the magnitude of the HIV/AIDS epidemic in Burma. AIDS 32, 311–317.Google Scholar
Bhatti, L. I. & Fikree, F. F. (2002) Health-seeking behaviour of Karachi women with reproductive tract infections. Social Science & Medicine 54, 105–117.Google ScholarPubMed
Canales, M. K., Carr, J. & Wohlberg, J. (2005) ‘It's about time’: college women's perceptions of gynecologic health. Journal of the American Academy of Nurse Practitioners 17(6), 225–232.CrossRefGoogle ScholarPubMed
Chalker, J., Chuc, N. T. K., Falkenberg, T. et al. (2000) STD management by private pharmacies in Hanoi: practice and knowledge of drug sellers. Sexually Transmitted Infections 76, 299–302.CrossRefGoogle ScholarPubMed
Chapple, A. (2001) Vaginal thrush: perceptions and experiences of women on South Asian descent. Health Education Research 16(1), 9–19.CrossRefGoogle ScholarPubMed
Chuc, N. T. K., Larsson, M., Do, N. T. et al. (2002) Improving private pharmacy practice: a multi-intervention experiment in Hanoi, Vietnam. Journal of Clinical Epidemiology 55, 1148–1155.CrossRefGoogle ScholarPubMed
Crosby, R. A., Yarber, W. L., Sanders, S. A. et al. (2007) Men with broken condoms: who and why? Sexually Transmitted Infections 83, 71–75.CrossRefGoogle ScholarPubMed
Feleke, W., Ghindinelli, M., Desta, S. & Yusuf, M. (1990) Some social features of STD patients in Addis Ababa. Ethiopia Journal of Health Development 4, 143–147.Google Scholar
Garcia, P., Hughes, J., Carcamo, C. et al. (2003) Training pharmacy workers in recognition, management, and prevention of STDs: district-randomized controlled trial. Bulletin of World Health Organization 81, 806–814.Google ScholarPubMed
Go, V. F., Quang, V. M., Chung, A., Zenilman, J., Hanh, V. T. & Celentano, D. (2002) Gender gaps, gender traps: sexual identity and vulnerability to STDs among women in Vietnam. Social Science & Medicine 55, 467–481.CrossRefGoogle ScholarPubMed
Gomez, G. B., Garnett, G. P. & Ward, H. (2009) Self-medication prevalence for sexually transmitted diseases: meta-analysis and meta-regression of population level determinants. Sexually Transmitted Diseases 36(2), 112–119.CrossRefGoogle ScholarPubMed
Graneheim, U. H. & Lundman, B. (2004) Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Education Today 24, 105–112.CrossRefGoogle ScholarPubMed
Green, E. C. (1992) Sexually transmitted diseases, ethnomedicine and health policy in Africa. Social Science & Medicine 35, 121–130.CrossRefGoogle ScholarPubMed
Karasz, A. & Anderson, M. (2003) The vaginitis monologues: women's experiences of vaginal complaints in a primary care setting. Social Science & Medicine 56, 1013–1021.CrossRefGoogle Scholar
Kelly, J. A., St Lawrence, J. S., Diaz, Y. E. et al. (1991) HIV risk behaviours reduction following intervention with key opinion leaders of population: an experimental analysis. American Journal of Public Health 81, 168–171.CrossRefGoogle Scholar
Kim, A. A., Sun, L. P., Chhorvann, C. et al. (2005) High prevalence of HIV and sexually transmitted infections among indirect sex workers in Cambodia. Sexually Transmitted Diseases 32, 745–751.CrossRefGoogle ScholarPubMed
Ki-moon, B. (2008) Redefining AIDS in Asia. Crafting an Effective Response. Report of the Commission on AIDS in Asia. Oxford University Press, New Delhi.Google Scholar
Krueger, R. A. (1998) Focus Groups: A Practical Guide for Applied Research. Sage, Newbury Park, CA.Google Scholar
Lan, P. T., Faxilid, E., Chuc, N. T. K., Mogren, I. & Lundborg, C. S. (2008) Perceptions and attitudes in relation to reproductive tract infections including sexually transmitted infections in rural Vietnam: a qualitative study. Health Policy 86, 308–317.CrossRefGoogle ScholarPubMed
Lazaro, N. (2006) Sexually Transmitted Infections in Primary Care. Royal College of General Practitioners, British Association for Sexual Health and HIV, London.Google Scholar
Lieber, E. L. L., Wu, Z., Rotheram-Borus, M. J., Guan, J. & The National Institute of Mental Health Collaborative HIV Prevention Trial Group (2006) HIV/STD stigmatization fears as health seeking barriers in China. AIDS Behaviour 10(5), 463–471.CrossRefGoogle ScholarPubMed
Lincoln, Y. S. & Guba, E. G. (1985) Naturalistic Inquiry. Publications/International Educational and Professional Publisher, Sage, Newbury Park, London, New Delhi.CrossRefGoogle Scholar
Ministry of Health (2003) Food and Drug Department. National Drug Policy Programme 1993–2003. Ministry of Health, Lao PDR.Google Scholar
National Statistics Centre (2003) Basic Statistics 2002. Lao PDR.Google Scholar
Nuwaha, F., Faxelid, E., Neema, S. & Höjer, B. (1999) Lay people's perceptions of sexually transmitted infections in Uganda. International Journal of STD & AIDS 10, 709–717.CrossRefGoogle ScholarPubMed
Okeke, I. N., Laxminarayan, R., Bhutta, Z. A. et al. (2005) Antimicrobial resistance in developing countries. Part I: recent trends and current status. Lancet Infectious Diseases 5, 481–493.CrossRefGoogle ScholarPubMed
Patton, M. Q. (1990) Qualitative Evaluation and Research Methods, 2nd edition. Sage Publications, Newbury Park, CA, pp. 169–171.Google Scholar
Phimphachanh, C. & Sayabounthavong, K. (2004) The HIV/AIDS/STI situation in Lao People's Democratic Republic. AIDS Education and Prevention 16 (Supplement A), 91–99.CrossRefGoogle Scholar
Ramos, M. C., da Silva, R. D., Gobbato, R. O. et al. (2004) Pharmacy clerks' prescribing practices for STD patients in Porto Alegre, Brazil: missed opportunities for improving STD control. International Journal of STD & AIDS 15, 333–336.CrossRefGoogle Scholar
Rizvi, N. & Luby, S. (2004) Vaginal discharge: perceptions and health seeking behaviour among Nepalese women. Journal of the Pakistan Medical Association 54, 620–624.Google ScholarPubMed
Roberts, J. (2008) Aids epidemic in Thailand: good news, bad news, and a warning. Journal of Social Science 16(1), 79–80.Google Scholar
Rojanapithayakorn, W. (2006) The 100% condom use programme in Asia. Reproductive Health Matters 14(28), 41–52.CrossRefGoogle ScholarPubMed
Saphonn, V., Sopheab, H., Sun, L. P. et al. (2004) Current HIV/AIDS/STI epidemic: intervention programs in Cambodia, 1993–2003. AIDS Education and Prevention 16(3) (Supplement A), 64–77.CrossRefGoogle ScholarPubMed
Scott-Sheldon, L. A., Carey, M. P., Vanable, P. A., Senn, T. E., Coury-Doniger, P. & Urban, M. A. (2009) Alcohol consumption, drug use, and condom use among STD clinic patients. Journal of Studies on Alcohol and Drugs 70(5), 762–770.Google ScholarPubMed
Sihavong, A., Lundborg, C. S., Syhakhang, L., Akkhavong, K., Tomson, G. & Wahlstrom, R. (2006) Antimicrobial self medication for reproductive tract infections in two provinces in Lao People's Democratic Republic. Sexually Transmitted Infections 82, 182–186.CrossRefGoogle ScholarPubMed
Sihavong, A., Lundborg, C. S., Syhakhang, L. et al. (2007a) Health providers' competence in the management of reproductive tract infections in Vientiane, Lao People's Democratic Republic. International of STD & AIDS 18, 774–781.CrossRefGoogle ScholarPubMed
Sihavong, A., Phouthavane, T., Lundborg, C. S., Sayabounthavong, K., Syhakhang, L. & Wahlström, R. (2007b) Reproductive tract infections among women attending a gynaecology out-patient department in Vientiane, Lao PDR. Sexually Transmitted Diseases 34, 791–795.CrossRefGoogle Scholar
Sopheab, H., Morineau, G., Neal, J. J., Saphonn, V. & Fylkesnes, K. (2008) Sustained high prevalence of sexually transmitted infections among female sex workers in Cambodia: high turnover seriously challenges the 100% condom use programme. BMC Infectious Diseases 8, 167, doi:10.1186/1471-2334-8-167.CrossRefGoogle ScholarPubMed
Syhakhang, L., Freudenthal, S., Tomson, G. & Wahlstrom, R. (2004) Knowledge and perceptions of drug quality among drug sellers and consumers in Lao PDR. Health Policy and Planning 19(6), 391–401.CrossRefGoogle ScholarPubMed
Thammalangsy, S., Sihavong, A., Phouthavane, T. et al. (2006) The prevalence of lower genital tract infections among ante-natal care clinic patients in two central hospitals, Vientiane, Lao People's Democratic Republic. Southeast Asian Journal of Tropical Medicine and Public Health 37, 190–199.Google ScholarPubMed
Theroux, R. (2002) Bypassing the middleman: a grounded theory of women's self-care for vaginal symptoms. Health Care for Women International 23, 417–431.CrossRefGoogle Scholar
Toole, M. J., Coghlan, B., Xeuatvongsa, A., Holmes, W. R., Pheualavong, S. & Chanlivong, N. (2006) Understanding male sexual behavior in planning HIV prevention programmes: lessons from Laos, a low prevalence country. Sexually Transmitted Infections 82, 135–138.CrossRefGoogle Scholar
Tuladha, S. M., Mills, S., Acharya, S. et al. (1998) The role of pharmacists in HIV/STD prevention: evaluation of an STD syndromic management intervention in Nepal. AIDS 12 (Supplement 2), S81–87.Google Scholar
UNAIDS & WHO (2007) 2007 AIDS Epidemic Update. UNAIDS, Geneva.Google Scholar
UNFPA & Population Council (2001) Reproductive Tract Infections: A Guide for Programme Managers. UNFPA and Population Council, New Delhi.Google Scholar
United Nations Population Fund (2004) Sexually Transmitted Infections: Breaking the Cycle of Transmission. UNFPA, New York. URL: www.unfpa.org.Google Scholar
Ward, H. (2007) Prevention strategies for sexually transmitted infections: importance of sexual network structure and epidemic phase. Sexually Transmitted Infections 83 (Supplement I), i43–49. Epub 2007 March 27th 2007.CrossRefGoogle ScholarPubMed
Ward, H., Mertens, T. E. & Thomas, C. (1997) Health seeking behaviour and the control of sexually transmitted disease. Health Policy Planning 12, 19–28.CrossRefGoogle ScholarPubMed
Warner, L., Newman, D. R., Kamb, M. L. et al. (2008) Problems with condom use among patients attending sexually transmitted disease clinics: prevalence, predictors, and relation to incident gonorrhea and chlamydia. American Journal of Epidemiology 167, 341–349.CrossRefGoogle ScholarPubMed
Whittaker, A. (2002) Introduction: reflections on gender, power and health in mainland Southeast Asia. Women Health 35, 1–6.CrossRefGoogle Scholar
WHO (2001a) Global Prevalence and Incidence of Selected Curable Sexually Transmitted Infections: Overview and Estimates. WHO, Geneva.Google Scholar
WHO (2001b) Regional Offices for the Western Pacific and South-East Asia. STI/HIV/AIDS – Surveillance Report. WHO, Manila.Google Scholar
WHO (2002) Regional Office for the Western Pacific. STI/HIV/AIDS – Surveillance Report. WHO, Manila.Google Scholar
WHO (2004) Regional Office for the Western Pacific. Experiences of 100% Condom Use Programme in Selected Countries of Asia. WHO, Geneva.Google Scholar
WHO (2005a) Sexually Transmitted and Other Reproductive Tract Infections. WHO, Geneva.Google Scholar
WHO (2005b) Regional Office for the Western Pacific. STI/HIV/AIDS – Surveillance Report. WHO, Manila.Google Scholar
WHO (2006) Global Strategy for the Prevention and Control of Sexually Transmitted Infections: 2006–2015 Key Messages. WHO, Geneva.Google Scholar