The prevalence of reproductive tract infections in rural Bangladesh
Reproductive tract infections (R TIs), including but not limited to the sexually transmitted infections (STIs), are currently high on the public health agendas of most low-income countries. The reasons for this are manifold, but important contributing factors include the need to control the spread ofIDV, and the high costs to health care systems and infected individuals as a consequence of un- or mis-diagnosed infections. Strategies for the control and management of these infections in resource-poor settings have been advanced at a global policy level: syndromic management of symptomatic men and women is recommended in the absence of comprehensive laboratory facilities. This thesis describes a large cross sectional survey assessing the populationbased prevalence ofRTIs in one rural area of Bangladesh. The prevalence of these infections was determined from random selections of women and men. Patterns of health-care seeking behaviour were analysed, and the correlation between reported 5,ymptoms and the presence of infection was investigated. The prevalence of syphilis in pregnant women, and the incidence of ophthalmia neonatorum were also determined, and the cost-benefit of control strategies for these two problems in this population were investigated. Given that management of symptomatic persons forms a cornerstone of most national RTIISTI control programmes, the study described in this thesis also evaluated the efficacy of the most common syndromic algorithm in use (that for treating women with vaginal discharge). Training requirements for integrating the algorithm at primary health care level are also discussed as part of the findings, and finally the cost-effectiveness of the recommended algorithm was evaluated. Using the results of the five arms of the study, recommendations are advanced for RTIISTI control programmes in areas with similar epidemiological characteristics to those found in the population described in this study. Finally, areas where further research is needed are highlighted in the discussion.