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Advisory Committee Chair

Pauline E Jolly

Advisory Committee Members

Dwight J Rouse

Jane R Schwebke

Sten H Vermund

Heidi L Weiss

Document Type

Dissertation

Date of Award

2010

Degree Name by School

Doctor of Public Health (DrPH) School of Public Health

Abstract

Reproductive tract infections include sexually transmitted infections, endogenous infections caused by overgrowth of organisms that can be present in the genital tract of a healthy woman, and iatrogenic infections. In Jamaica, women in the reproductive age group of 15-44 years old accounts for 95% of all RTIs. RTIs among Jamaican women of reproductive age can seriously impact the health of the women and their children. The advent of HIV/AIDS has had a significant impact on increasing awareness of the effect of STIs. Health care organizations have reacted with great commit-ment to STI prevention and treatment as a significant factor in preventing the spread of HIV/AIDS. The traditional approach for diagnosing and managing infections in most devel-oped countries is by identification of etiological agents by laboratory tests. The SCM ap-proach has been recommended by the World Health Organization (WHO) as a cost-effective method of managing RTIs. SCM uses groups of symptoms and easily rec-ognized signs in the identification of well defined pathogens that cause RTIs. This al-lows management of the patient's RTI in a single visit by providing treatment even where tests for etiological agents are unavailable. In 1997, the use of SCM among pregnant women was evaluated in Jamaica. The results of previous analyses show that SCM algorithm based solely on vaginal discharge has a marginal validity among pregnant women. In this study an algorithm with two components was used: a risk assessment portion which contains behavioral risk factors predictive of RTI and a clinical portion which includes clinical assessment of vaginal dis-charge. During the implementation of this study, several other clinical signs such as cer-vical erosion, friable cervix, color of discharges were integrated in the algorithm. The va-lidity of these added signs and the other clinical signs used in SCM have not been as-sessed. The present study aims to evaluate the validity of the added clinical risk factors together with the current clinical signs used in SCM in diagnosing RTIs among pregnant women in Jamaica. From the results of these analyses, this study aims to develop mod-ified algorithms/s that best suit this specific population.

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