Awareness of sexually transmitted disease among women and service providers in rural Bangladesh
Sexually transmitted disease (STD) in rural Bangladesh is currently a topic of great concern. To date, little information is available in the literature regarding its prevalence. It is now known, however, that the current level of STD awareness among the rural population with regard to modes of transmission and means of prevention is inadequate. In 1994, the MCH-FP Extension Project (Rural) of ICDDR, B surveyed 8674 married women of reproductive age (MWRA) in 4 rural thanas to examine their awareness of STDs. The association between socio-demographic and programmatic factors (variables which affect STD information availability) and awareness of STDs was examined by both bivariate and multivariate analyses. Seven focus group discussions were conducted among groups of government health and family planning workers and paramedics to assess their knowledge of STDs and attitudes about their prevention. Only 12% of the original group had even a basic understanding about STDs and how to protect themselves from them. Twenty-five per cent of the women surveyed had ever heard of either syphilis or gonorrhoea. Of these women, less than half could mention specific mechanisms involved in the transmission of these diseases. Seven per cent reported that syphilis and gonorrhoea are transmitted through sexual intercourse. Thirteen per cent reported that the infections are transmitted from spouses to their partners. Four per cent reported that STDs can be spread by having multiple sexual partners. The results of logistic regression analysis indicate that awareness of STDs was higher among relatively older women than among younger women. Awareness of STDs was most strongly and positively associated with the education of both the women and their husbands. Awareness of STDs was also found to be higher among women who were more socially mobile (e.g. those who frequent cinemas or mothers' clubs). The findings of focus group discussions indicate that family planning and health care service providers have a moderate level of STD awareness. Modes of transmission and means of prevention, however, were areas of weakness. It will, therefore, be necessary, whether to prevent a potential STD epidemic or to combat current STD prevalence, to implement culturally acceptable and affordable means of disseminating knowledge in rural areas of Bangladesh. Training of health care providers will be an essential first step. PIP: Both a 1994 survey of 8674 married women of reproductive age from four rural thanas (Abhoynagar, Bagherpara, Keshobpur, and Sirajganj) of Bangladesh and focus group discussions conducted among government health and family planning providers in the same thanas revealed inadequate awareness of sexually transmitted diseases (STDs) and their transmission. Only 12% of survey respondents were considered to have a basic understanding of STDs and how to protect themselves from infection. Even after probing, only 25% of married women had ever heard of syphilis or gonorrhea; of these, just half knew the mechanisms of disease transmission. In the logistic regression analysis, awareness of STDs and their transmission was significantly associated with older age, higher educational level, Muslim religion, attendance at a family health and welfare center, current contraceptive use, and women's mobility outside the home. Although service providers had moderate levels of STD knowledge, there were many misconceptions (e.g., that STDs could be transmitted by wearing the clothes of an infected person). Providers agreed couples should be counseled to use condoms and avoid brothels. Awareness of AIDS was even lower than knowledge of syphilis and gonorrhea among both married women and health care workers. Training of health care providers is recommended as a first step in a national campaign aimed at disseminating accurate, culturally acceptable knowledge about STDs throughout rural Bangladesh.
Int J STD AIDS 1997 Nov;8(11):688-96