A study of factors that influence the utilization of services for the management of sexually transmitted infections in Nairobi City Council Clinics

Abstract

Effective control of sexually transmitted infections (STI) requires among others, that clients must seek care promptly and follow instructions provided by health care providers. Prompt and effective treatment of STI has been found to reduce the incidence of Human Immunodeficiency Syndrome (HIV) infection by 40%. In many developing counties however, many of the people affected by STI are reluctant to seek health care in public facilities. A cross-sectional study was carried out to establish how health seeking behaviour, quality of case management and organization of health facilities affect the utilization of services for STI in Nairobi. Two hundred and fifty one subjects who sought care for STI were recruited from four health facilities managed by the Nairobi City Council. Ten health workers caring for people with STI were also interviewed.

The results revealed that 65% of clients were females. Twenty three percent of the clients experienced symptoms for three to five weeks or more before seeking care and it took males longer than females to seek care for STI (c2 = 23.312, df=4, p=0.00011). Clients visiting for the first time were 43% and among this group, females were 3.7% (c2 = 39.054, df=3, p=0.000). Quality of care in general was valued as good by 69% of the clients and 84% of them were willing to continue using the same health facility. Adequate information was provided to 63% of the clients with 53% being told how to prevent infections, and only 31% being counselled on HIV infection as a possible risk for STI. Although 84% of the clients reported their intentions to ask their partners to seek care, partner referral was evident in only 13.5% of them. Clients expressed satisfaction with services provided, but their health seeking habits were not in harmony with these feelings. There is need for intensified educational campaigns to raise awareness about the advantages of seeking treatment early for those infected and their partners in public facilities.