Reproductive Tract Infections Among Married Adolescents in Rural Tamil Nadu

As part of a collaborative project with the International Center for Research on Women (ICRW), the Vellore-based Christian Medical College's Community Health and Development department (CMC) is conducting research in an effort to reduce the burden of Reproductive Tract Infections (RTIs) among young, married women in Rural Tamil Nadu, southern India. The study aim is to test the feasibility, effectiveness, and acceptability of 2 alternative approaches to examine, diagnose, and treat RTIs among rural married women ages 15-30 and their male partners. The intervention is examining how to increase health-seeking and improve diagnosis andtreatment of RTIs among this population.

Since 1999, ICRW has been coordinating multi-site intervention research studies on adolescent reproductive health and sexuality in India, with a focus on developing effective programmes within the broader context of adolescents' lives, their families, and their communities. As part of this project, in 2002 CMC conducted a baseline, quantitative, community survey of a random sample of 616 young, married women on RTI knowledge, self-reported symptoms suggestive of RTIs, whether treatment was sought, provider choice, and information about their husbands, including any experience with RTIs. Women respondents were, on average, younger (25 versus 33 years) and somewhat less educated (6 versus 7.5 years) than their husbands.

In general, these data show high levels of awareness of RTI symptoms. Specifically, the great majority of women (87%) identified at least one symptom that could indicate the presence of an RTI. Nearly 40% correctly identified 3 or more RTI symptoms. Nearly 24% reported that they currently experienced a symptom suggestive of an RTI with 8% reporting multiple symptoms. Another 19% had experienced an RTI symptom in the last year, with vaginal discharge the most common.

However, researchers found that health-seeking by symptomatic women remains low. Although 75% of women sought treatment for symptoms experienced in the past year, only 57% sought treatment for symptoms they currently experienced. Researchers found that the symptoms for which women are more likely to seek treatment may be those seen as abnormal, such as genital ulcers. They concluded that the intervention needs to help women distinguish when other symptoms that are less-frequently treated - like abdominal pain or burning while urinating - signify a potential RTI and, therefore, warrant treatment.

With regard to the pattern of lower levels of treatment-seeking for current symptoms than for symptoms in the last year, researchers articulated the following hypotheses: 1) lack of time to assess if a current condition requires treatment, convince family decision-makers of that need, and access services, or 2) women are reluctant to seek care until symptoms persist over time. In either case, they concluded, the intervention needs to assess which strategy is more effective at increasing attention to current symptoms, particularly as delayed treatment of RTIs can increase the risk of long-term sequelae.

Based on this research, CMC is testing 2 alternate methods to increase the correct diagnosis and effective treatment of RTIs:

• Approach A: 10 trained female village health aides examine, diagnose, and treat women in their homes during regular, biweekly visits - more approachable but less-highly trained.
• Approach B: Health aides refer symptomatic women to 2 female doctors who are available once every 6 weeks - less approachable but more highly-trained.

The study design will be quasi-experimental, with Approaches A and B assigned randomly to 2 catchment areas, with a third as a control site. Feasibility is key, since one aim of this study is to provide state government with models to apply in their health systems. Ongoing monitoring data will provide additional information on reliability of diagnosis and treatment patterns and outcomes.To request a copy of this document, or for more information, contact:

Dr. Rohini Pande

Project Director, ICRW

1717 Massachusetts Avenue, NW, Suite 302

Washington, DC 20036 USA

Tel.: (202) 797-0007

rpande@icrw.org

Project page on ICRW site