Advisory Committee Chair
Sibylle Kristensen
Advisory Committee Members
Eric Chamot
Rodney C P Go
Gerald McGwin Jr
Sten H Vermund
Document Type
Dissertation
Date of Award
2008
Degree Name by School
Doctor of Public Health (DrPH) School of Public Health
Abstract
This dissertation puts together three closely related articles on partner referral for sexually transmitted diseases (STD). The first paper sought to understand feasibility and acceptability of partner referral for STD in less developed countries using a systematic literature review. The results summarized from 39 articles indicate that partner referral outcome was more common for spousal partners than for causal partners. Client's reported barriers included stigma and fear of abuse while infrastructural barriers included limited resources are important. Client centered counseling was found to be effective in increasing partner referral in Africa. The second paper aimed to determine if intention of partner referral are associated with partner referral among STD patients in Dhaka, Bangladesh. Results from 451 STD patients indicate that 62% had positive intention of partner referral, whereas, 27% of the 321 patients who accepted referral cards actually referred their partners. In multivariate model, partner referral intention was positively associated with positive attitudes (prevalence ratio 2.5, 95% confidence interval 1.8 - 3.6) and social norm (PR 1.7, 95% CI 1.0-3.0). STD clients with positive partner referral intention were significantly more likely to refer their partners [PR=3.2; 95% CI=1.0-9.9]. The third paper was a quasi-randomized trial to assess the role of single session counseling among STD patients in Dhaka, Bangladesh on partner referral outcome. Of the 692 patients accepted partner referral cards, 33.4% referred their partner in the counseling group compared to 26.8% in the control group. Probability of partner referral was 1.2 times higher in the counseling group [PR: 1.2 (95% CI: 0.9 -1.6)] compared to the control group but the finding was not statistically significant. The study concludes that client-centered counseling to promote partner referral in Dhaka, Bangladesh should be further developed and studied to improve its effectiveness. Our findings may help policymakers to formulate strategies to overcome barriers in implementing partner referral programs in less developed countries. Intention of index STD patients was found to be associated with actual partner referral by mediating the effect of psychosocial and demographic factors. Counseling and other intervention programs can be guided by the theory driven intervention that deals psychosocial factors to improve partner referral in Bangladesh.
Recommended Citation
Alam, Nazmul, "Partner Referral Among Patients With Sexually Transmitted Diseases in Dhaka, Bangladesh" (2008). All ETDs from UAB. 1.
https://digitalcommons.library.uab.edu/etd-collection/1