Slide 1: 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.,
CHITTOOR-DT. Slide 2: INTRODUCTION DEFINITIONS : DEFINITIONS Reproductive Tract Infections (RTIs) IN WOMEN:
Any infection of the reproductive tract in WOMEN RTIs in women include:
Disruption of normal vaginal flora (candidiasis and bacterial vaginosis)
Postpartum and post-abortion infections
Infections following procedures (e.g. IUD insertion) Slide 4: …..Ice- berg Phenomenon Hidden facts are more than Visible problems……RTI’S in women Symptomatic Asymptomatic Slide 5: Age group:15 to 49 yrs
Illiterates:especially 18 to 30 yrs
Sex:Female > Male
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
Health care providers not adequately trained
Poor medical services
Hygiene and environmental 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 Slide 9: PATHOGENESIS & MODES OF TRANSMISSION RTI’s - Causative : RTI’s - Causative Bacteria
Phthirus pubis Viruses
Herpes simplex virus types 1 and 2
Wart virus (papillomavirus)
Hepatitis A, B, and C
Candida albicans Slide 11: GENITAL ULCER IN THE FEMALE : NOTE POSITION Slide 12: GENITAL ULCER Slide 13: 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 Slide 15: 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
Chronic liver disease
Congenital malformations Recurrent infection
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 Slide 21: 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 Slide 25: 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 &
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 Slide 30: 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 Slide 31: 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. Slide 33: 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.
Unsafe family planning methods
Unsafe delivery & MTP procedure WEAKNESS Slide 36: 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 Slide 38: STRATEGIES PRINCIPLES FOR SELECTION OF STRATEGY
THE RISK OF INFECTION
BURDON OF THE DISEASE
AVAILABILITY OF DIAGNOSTIC TESTS
SERVICE UTILISATION & ACCESSIBILITY
AVAILABILITY OF INFRASTRUCTURE
AVAILABILITY OF EFFECTIVE TREATMENT
LIKELIHOOD OF DISEASE SPREAD IF NOT TREATED
(EPIDEMIOLOGICALLY) COMMON STRATEGIES ARE:
STRENGTHENING OF INFRASTRUCTURE
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 Slide 39: ACTIVITIES- PRINCIPLES “C O M M U N I T Y”
PROMOTE EARLY USE OF CLINICAL SERVICES
PROMOTE SAFER SEXUAL PRACTICES
PREVENT IATROGENIC INFECTIONS
PARTNER TRACING & TREATMENT
COUNCILLING & REHABILITATION “H E A L T H S Y S T E M”
STRENGTHENING OF INFRASTRUCTURE
FILLING UP OF VACANCIES
TRAINING AT REGULAR INTERVALS
TIMELY DRUG SUPPLY
EFFECTIVE & FULL COURSE
AVAILABILITY OF SERVICES
ACCESSIBILITY—TIME,PLACE , PERSON
WITH IN THE DISTRICT
RECORDING & REPORTING
OUT-SIDE THE DISTRICT & STATE
TO CONTROL THE SOURCE & SPREAD
WITH OTHER DEPARTMENTS Slide 40: 1.activity Capacity building – training of manpower, village link worker, ASHA’S,AWW,ANM, staff nurses, OT assistants, medical officers . Slide 41: 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 Slide 42: 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
Hepatitis B vaccination
Future RTI care Slide 44: 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 Slide 49: Hurdles may be plenty, Yet PATH can be traced to reach the Goal Slide 50: Respect yourself ... Protect yourself
A program to help reduce RTI rates by empowering youth
to make safer sexual choices Slide 51: Acknowledgements:
All Faculty Members for the opportunity to make this presentation
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