Quality of care for patients with sexually transmitted diseases in Zambia

Abstract: QUALITY OF CARE FOR PATIENTS WITH SEXUALLY TRANSMITTED DISEASESIN ZAMBIA Elisabeth Faxelid Factors which have implications for STD care in Zambia have been described andanalysed 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 moresex 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 treatmentat the study clinics. During this period, 60 percent had received modern and/or traditionaltreatment from a variety of other sources. Both women and men continued to have sexduring periods with STD symptoms. Women were less aware of symptoms connected withSTD and over half of them said that they did not know for which type of disease theywere receiving treatment. Patients considered that free treatment and having timeto 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 workingconditions, and their opinions about STD patients and quality of STD care. Half ofthe providers were not satisfied with their working conditions mentioning a heavyworkload, lack of equipment/drugs, poor salary, and lack of continuing educationas the main problems. Treatment and preventive activities were considered importantaspects of quality STD care, but most respondents found patients' compliance poor,especially regarding partner notification. Negative attitudes about STD patientswere common. A method for partner notification was designed and evaluated in a randomized controlledtrial involving 94 women and 302 men. The intervention consisted of health educationabout STD, counselling about how to inform partners, and distribution of contactslips. The proportion of female partners treated, 1.8 partner per male patient, wassignificantly higher in the intervention group compared to the control group, whereit was 1.2 partners per male patient. In a comparative study, quality of STD carewas 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-providerinteractions were observed and the patients were interviewed before as well as afterthe intervention. The results showed that few patients had been examined, counselledabout partner notification and given health education. These aspects improved significantlyat the intervention health centre after the training. Patients did not become moresatisfied, however. The results show that training of health personnel, using interactive methods, canimprove some, but not all aspects of health care, and partner notification can beimproved, at least among men, with counselling and the use of contact slips. Keywords: sexually transmitted diseases, quality of care, patient satisfaction,partner notification, educational intervention. Stockholm, October 1997