reproductive tract infections

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District Action Plan to Reduce Prevalence of reproductive tract infections among women in reproductive age group in CHITTOOR- District of A.P. Dr . MOHANA KRISHNA REDDY.E.B., C.A.S.,AREA HOSPITAL,APVVP, SRIKALAHASTHI, CHITTOOR-DT.

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INTRODUCTION

DEFINITIONS : 

DEFINITIONS Reproductive Tract Infections (RTIs) IN WOMEN: Any infection of the reproductive tract in WOMEN RTIs in women include: STIs Disruption of normal vaginal flora (candidiasis and bacterial vaginosis) Postpartum and post-abortion infections Infections following procedures (e.g. IUD insertion)

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…..Ice- berg Phenomenon Hidden facts are more than Visible problems……RTI’S in women Symptomatic Asymptomatic

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Age group:15 to 49 yrs Illiterates:especially 18 to 30 yrs Sex:Female > Male Occupation:CSW etc MSM:Jogappa etc Women who have multiple partners Adolescent girls & boys Sex workers and their clients Intravenous Drug Users(IDU’S) women who have to stay away from families for longtime Partners of various high-risk groups WOMEN- WHO ARE AT RISK

FACTORS RESPONSIBLE-women proneness: : 

FACTORS RESPONSIBLE-women proneness: Biological differences Thin lining of vaginal mucosa Larger exposed area Genital fluids stay in contact for a longer time Young women - immature genital tract Symptoms - less reliable indicator Use of vaginal douches Influence of hormonal contraceptives Human behavior – high-risk behavior Lack of access to health care Lack of awareness about RTIs Migrant population Health care providers not adequately trained Poor medical services Hygiene and environmental factors Hormonal factors Socio-economic and other factors

RTIs – A PUBLIC HEALTH PROBLEM : 

RTIs – A PUBLIC HEALTH PROBLEM Major cause of ill health in country Cause serious complications in women Increase risk of HIV transmission Responsible for reproductive loss Increase cost to health system & loss of women hours

What happens if RTI’S is not treated correctly and completely? : 

What happens if RTI’S is not treated correctly and completely? RTI’s can: Be serious and painful Cause permanent damage to reproductive organs Lead to infertility in both men and women Spread to other sex partners or needle sharing partners Infect newborns possibly leading to serious complications or even death of the infant Cause heart disease, blindness, arthritis, brain damage, or death Many RTI’s increase susceptibility to HIV/AIDS

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PATHOGENESIS & MODES OF TRANSMISSION

RTI’s - Causative : 

RTI’s - Causative Bacteria Chlamydia trachomatis Neisseria gonorrhoeae Treponema pallidum Gardnerella vaginalis Haemophilus ducreyi Klebsiella granulomatis Shigella Mycoplasmas Ureaplasma urealyticum Mycoplasma genitalium Parasites Sarcoptes scabiei Phthirus pubis Viruses Herpes simplex virus types 1 and 2 Wart virus (papillomavirus) Molluscum contagiosum Hepatitis A, B, and C HIV Protozoa Entamoeba histolytica Giardia lamblia Trichomonas vaginalis Fungi Candida albicans

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GENITAL ULCER IN THE FEMALE : NOTE POSITION

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GENITAL ULCER

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LOWER ABDOMINAL PAIN PAIN DURING SEX

Clinical Manifestations of Genital Warts : 

Clinical Manifestations of Genital Warts Smooth papular warts Flat cervical condylomata Keratotic flat wart

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Syndromic Diagnosis and Treatment Follow up Urethral Discharge Discharge, Pain and burning micturation Discharge Present No Discharge Gonorrhoea & Chlamydia If Symptoms persists think again Give Treatment Inguinal Bubo LGV Treat Genital Ulcers Syphylis Chancroid Treat Treat Follow up 7 days after treatment

Drugs: Pre-packaged kits : 

Drugs: Pre-packaged kits Kit 1: Grey Kit 2: Green Kit 3: White Kit 4: Blue Kit 5: Red Kit 6: Yellow Kit 7: Black 1: Vaginal discharge 2: Urethral discharge in men 3: Genital ulcer disease in men and women 4: Swollen scrotum 5: Lower abdominal pain 6: Inguinal bubo (swelling) 7: Eye discharge

Complications of RTIs : 

Complications of RTIs OTHER problems DIFFERENT CANCERS Neurological :syphilis Chronic liver disease Congenital malformations Recurrent infection Chronic Infection Infertility DUB Anemia Lower Backache Dyspareunia Preterm Premature Deliveries Low Birth weight babies Congenital anomalies – syphilis Gonococcal - ophthalmia neonatorum

OBJECTIVE : 

OBJECTIVE OBJECTIVE TO REDUCE PREVALANCE OF R T I’ s FROM THE CURRENT LEVEL OF 34% TO 20% IN THE YEAR-2010-11 IN CHITTOOR-Dt.

OBJECTIVE : 

OBJECTIVE PROFILE

AP PROFILE : 

AP PROFILE

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Peddatippasamudram B.Kothakota Molakalacheruvu Buchinayanikandriga Forest K.V.B. Puram Narayanvanam Satyavedu Forest Varadaiah palem Nindra Nagalapuram Erpedu Pitchatur Nagari Vijayapuram Puttur Karvetinagaram Vadamalpet Tirupati (R) Vedurukuppam Ramachadrapuram S.R.Puram G.D.Nellore Renigunta Tottambedu Srikalahasthi Tirupati(U) Palasamudram Putalapattu Penumuru Chittoor Chandragiri Chinnagottigallu Yerravaripalem Pakala Pulicherla Rompicherla Tavanampalle Irala Piler Sadum Kambamvaripalle Bangarupalem Kalikiri Gudipala Yadamarri Kalakada Nimmanapalli Vayalpadu Gurramkonda Somala Chowdepalli Peddapanjani Punganur Madanapalli Ramasamudram Peddamandyam Kurabalakota Thamballapalle Gangavaram Palamaner Baireddypalle V.Kota Santhipuram Ramakuppam Gudupalli Kuppam MEDICAL INSTITUTIONS IN CHITTOOR DISTRICT ANANTHAPUR DISTRICT KARNATAKA TAMILNADU KADAPA DISTRICT Empedu Sub Centres - 644

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HEALTH PROFILE:

OBJECTIVE : 

OBJECTIVE SITUATIONAL ANALYSIS

Estimated new cases of curable RTI* among adults, 1999 : 

Estimated new cases of curable RTI* among adults, 1999 Western Europe 17 million Eastern Europe and Central Asia 22 million North Africa & Middle East 10 million South & South-East Asia 151 million Australasia 1 million Sub-Saharan Africa 69 million * gonorrhoea, chlamydial infection, syphilis and trichomoniasis North America 14 million Latin America & The Caribbean 38 million East Asia & Pacific 18 million Global total: 340 million

SITUATION IN INDIA : 

SITUATION IN INDIA Prevalence of suggestive symptoms of RTIs Women: 23 – 43%; Men: 4 – 9% 6% of men and 12% of women attending OPDs found to be having symptoms suggestive of RTI (ICMR, 2005; multi-centric study, NIRRH, Mumbai) STI clinic data indicate: Syphilis: 12.6 – 57% ; Chlamydia: 20-30% Chancroid: 9.9 – 34.7% ; Gonorrhoea: 8.5 – 23.9% Hospital-based studies among men indicate: HSV : 3 –14.9% HPV: 4.9 –14.3% Community-based laboratory-supported STI/RTI prevalence study,2002 (ICMR-NACO) Prevalence of STIs/RTIs: 6% among adult population

Sex and Age-Specific RTI Rates (2000-2007) (cases per 1000 person-years) : 

Sex and Age-Specific RTI Rates (2000-2007) (cases per 1000 person-years) Source: NWT Communicable Disease Registry

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The present scenario in the District CHITTOOR-DT Awareness among rural RTI in males 26 per cent and females 17 per cent STI in males 32 per cent and females 18 per cent Awareness among urban RTI in males 42 per cent and females 30 per cent STI in males 53 per cent and females 25 per cent

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RTI’S IN CHITTOOR-DISTRICT-34% RTI’S --TREATMENT 55.8 50.4 50.8 49.2

The Detailed Statistical Report of RTI Cases in Gynec OPD of Area Hospital, SRIKALAHASTHI Chittoor-Dt for the years 2004-05 TO 2008-09. : 

The Detailed Statistical Report of RTI Cases in Gynec OPD of Area Hospital, SRIKALAHASTHI Chittoor-Dt for the years 2004-05 TO 2008-09.

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RTI-PARTNER TREATMENT STATUS JAN = AUG 2009-CHITTOOR-DT

OBJECTIVE : 

OBJECTIVE S W O T ANALYSIS

SWOT Analysis : 

SWOT Analysis Exhisting infrastructure All PHC, APVVP Hospital s have got Lab Technicians. RTI clinic with Councillor & LMO IN all A.P.V.V.P.hospitals Health Personnel are aware of RTI. IEC Activities- Carrying out IEC Activities on regular basis. 104 Fixed day services & ASHAS Co-operation from Private Doctors & Nursing Homes , NGO’S who are doing a lot to the society. STRENGTHS Non availability of safe delivery MTP services. Lack of Equipment & and Laboratory Services poor Referral System (Gynaecology Dermatology, Micorbiological services) Iiiteracy & poverty, Ignorance, Shyness Lack of LMO’S at PHC Level. Under reporting of RTI – by public and Health Staff. EARLY Marriage Unsafe family planning methods Unsafe delivery & MTP procedure WEAKNESS

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CO-ORDINATED ACTION -104(FDS)-ASHA-ANM Safe Family Planning Methods. Safe delivery & MTP procedures Availability of Health Staff & Lt’s. Health Camps--RTI CLINIC. School Health- SAFE SEX education Family Health awareness camps Inter-sectoral Co-ordination from education NGO’s , Mahila Sangh IEC Activities. OPPORTUNITIES Negligent attitude towards RTI. Seeking Health care by Quakes & Traditional healers. Iow- socio-economic status. Poor Involvement of community members. Negligence of partners treatment. THREATS

OBJECTIVE : 

OBJECTIVE STRATEGIES & ACTIVITIES

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STRATEGIES PRINCIPLES FOR SELECTION OF STRATEGY COMMUNITY THE RISK OF INFECTION BURDON OF THE DISEASE AVAILABILITY OF DIAGNOSTIC TESTS SERVICE UTILISATION & ACCESSIBILITY HEALTH SYSTEM AVAILABILITY OF INFRASTRUCTURE AVAILABILITY OF EFFECTIVE TREATMENT LIKELIHOOD OF DISEASE SPREAD IF NOT TREATED (EPIDEMIOLOGICALLY) COMMON STRATEGIES ARE: STRENGTHENING OF INFRASTRUCTURE DRUG SUPPLY SPECIAL RTI CLINICS,COUNCILLING CENTERS CAPACITY BUILDING OF HEALTH STAFF AVAILABILITY OF SERVICES STRENGTHENING OF I E C STRENGTHENING OF REFERRAL SYSTEM FOLLOW-UP SERVICES(COLOUR CARDS) MAINTAINANCE OF RECORDS MOBILE COUNCILLING CENTERS OUTSIDE SCHOOL HOURS UTILISATION OF 104(FDS) & 104 HELPLINE

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ACTIVITIES- PRINCIPLES “C O M M U N I T Y” PROMOTIVE: RAISE AWARENESS PROMOTE EARLY USE OF CLINICAL SERVICES PROMOTE SAFER SEXUAL PRACTICES PREVENTIVE: PREVENT IATROGENIC INFECTIONS PERSONAL HYGIENE CURATIVE: DETECT INFECTIONS SYNDROMIC MANAGEMENT-RTI PARTNER TRACING & TREATMENT COUNCILLING & REHABILITATION “H E A L T H S Y S T E M” STRENGTHENING OF INFRASTRUCTURE FILLING UP OF VACANCIES CAPACITY BUILDING TRAINING AT REGULAR INTERVALS TIMELY DRUG SUPPLY EFFECTIVE & FULL COURSE AVAILABILITY OF SERVICES ACCESSIBILITY—TIME,PLACE , PERSON COMMUNICATION SYSTEM WITH IN THE DISTRICT RECORDING & REPORTING CROSS COMMUNICATION OUT-SIDE THE DISTRICT & STATE TO CONTROL THE SOURCE & SPREAD INTERSECTORAL CO-ORDINATION WITH OTHER DEPARTMENTS

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1.activity Capacity building – training of manpower, village link worker, ASHA’S,AWW,ANM, staff nurses, OT assistants, medical officers .

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Detection RTI’S THROUGH ASHA’S-ANM-104(FDS) Identify the RTI’S and list them in village register. Organize screening camps for confirmation (refer to base hospital). Transport the severe PID to the base hospital. Free Necessary intervention at base hospital. Follow-up of treated cases, carrying out for better patient compliance. 2.activity

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Effective IEC campaign mainly – Demand generation of RTI CLINIC SEEKING CARE. Awareness of screening camp places. Awareness of facilities – base hospitals. To improve the quality of services at Govt., NGO and private sectors. By improving facilities Maximum utilization of services. Minimizing the complications. 3.activity

4.COUNCILLING : 

4.COUNCILLING Behavior change Safer sex and risk reduction Condom promotion Hepatitis B vaccination Future RTI care

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OTHER ACTIVITIES Comprehensive care services – special RTI clinics to be arranged with full lab facilities and gynaecological services Promote partner treatment irrespective of symptoms along with consistent and correct condom usage. Monitoring of quality control and periodic review by concerned authorities. Establishing linkages with NGO’s (ppp) ex:- STEPS Location of CSW areas --- like Gokak / Saudatti where RTI clinic are to be made available at least once a month. Budget support

OBJECTIVE : 

OBJECTIVE BUDGET

BUDGET : 

BUDGET POPULATON: =3745875 No of FEMALES =2032479 IN CHITTOOR-Dt. RTI CASES(30%OF FEMALE POPULATION) =609743 BUDGET RESOURCE AVAILABLE: BUDGET REQUIRED IN ONE YEAR

OBJECTIVE : 

OBJECTIVE TIME LINE CHART 2010-11

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Hurdles may be plenty, Yet PATH can be traced to reach the Goal

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Respect yourself ... Protect yourself A program to help reduce RTI rates by empowering youth to make safer sexual choices

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Acknowledgements: Organisers: All Faculty Members for the opportunity to make this presentation Patients: Whose symptoms become a source of our learning ALL OF YOU: For your patient listening, participation & involvement A N D Dr. A.BALASUBRAMANYAM, Medical Superintendent, Area Hospital, Srikalahasthi for nominating me for this excellent course.

Thank you : 

52 Thank you