Reproductive tract infections and sexually transmitted infections of women in Bangladehs: a literature review
PublisherJames P Grant School of Public Health, BRAC University
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This literature review focuses on what is known about reproductive tract infections and sexually transmitted infections (RTIs/STIs) in Bangladesh from published studies. TIS/STIs can have negative consequences on the health, social life, and economic situation of women. Negative consequences on health include not just physical discomfort but also infertility, ectopic pregnancy, cervical cancer, fetal wastage, low birth weight, infant blindness, neonatal pneumonia and mental retardation. Socially, lack of awareness and cultural taboos increase a woman’s risk of contracting RTI/STI due to unsafe behavior and then inhibit them from discussing their problems and seeking appropriate treatment. Economically, STIs rank among the five most important causes of loss of productive life lost in developing countries, accounting for the wastage of several million dollars a year. Thus it is imperative that RTIs/STIs be addressed. Currently, there is no prevalence data available on RTIs/ STIS in Bangladesh. This paper compiled findings from 6 qualitative studies and 12 quantitative cross sectional studies on sex workers, rural women and health providers. It looks at five issues. First it looks at the occurrence of RTIs/STIs among different populations – pregnant women, sex workers, rural women, women visiting an urban healthcare clinic, and views of health providers with RTI/STI infected patients. Some of the prevalence studies found high STIs among sex workers in brothels and among women living near truck stands as compared to rural women and urban slum women. Second, it looks at their perceptions about RTIs/ STIs. The qualitative studies found that women did not view RTIs as purely a biomedical problem, but blamed it on the larger stresses in their lives, social economic and financial. However, many of the urban and rural women were aware of RTIs/STIs but perceived no clear difference in symptoms and consequences between RTIs and STIs. Other studies revealed that 65% of 260 homeless people were aware of STIs while 79% of 401 teagarden workers were not aware of STIs. Hygiene (washing one’s private parts after intercourse), use of condom and observing religious rules were perceived as preventive measures for RTIs/STIs among rural women in a study. Third, it discusses some of the factors that are causing RTIs/STIs among Bangladeshi women. Literature shows these factors include side effects of contraceptives, low condom use and poor negotiation skills, lack of partner communication and partner management, menstrual hygiene, and high-risk behavior. Fourth, it looks at some of the health providers Bangladeshi women seek health care from for their RTIs/STIs. The review found that treatment was sought mostly from female relatives and friends, healers, homeopaths, pharmacists and the least from allopathic doctors as it is culturally prohibited for women to be seen, let alone be physically examined, by any male other than her husband. Fifth it discusses how RTIs and STIs are managed – through programmatic forms and diagnosis. Programmatic forms include dissemination of STI knowledge through NGOled health forums, epidemiological treatment for populations with high STI prevalence, incorporation of both biomedical and cultural aspects to treatment of vaginal discharge so that the deep psychological and / or spiritual dimensions don’t go unattended. Furthermore, studies in cross-cultural psychiatry help clarify the associations between emotional distress (including depression) and unexplained gynecological symptoms. Multisectoral and interdisciplinary coalitions are needed to address lack of coordination among policy makers, weak programme management and structure as well as political unwillingness which inhibit the progress of policy into action. A study on diagnosis of STIs found that the speculum-based algorithm might be a cheap and effective diagnostic and management tool. Syndromic diagnosis and management of cervical STIs is highly compromised due to lack of diagnostic tools and by the low specificity or absence of clinical signs.