7/29/2019 Technical Report - STIs and Women's Health in Rural Guatemalan Communities

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Technical Report

Interim Report on Womens Health Programming(Data through May 2013)

May 9, 2013

Wuqu Kawoq2 Calle 5-43 Zona 1, Santiago Sacatepquez, Guatemala

peter@wuqukawoq.org

Peter Rohloff

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Background

Following initial baseline evaluations in several of our partner communities in 2011 and

2012, which showed large knowledge deficits among women about family planning and

sexual health, as well as significant access barriers to womens health care services,Wuqu Kawoq began a systematic expansion of its womens health care programs in Fall

2012.

These services include:

1. Family planning services (oral contraceptive pills, condoms, Depo-Provera)2. Cervical cancer screening (pap smears)3. Syndromic detection and treatment of STIs4. Small group educational sessions covering domestic violence, family planning,

STIs, HIV, breast cancer, cervical cancer, and menopause.

5.

Clinical needs assessments

Results of Data Analysis

Demographics

This report incorporates data from 178 participants from 4 beneficiary indigenous

communities. One community is located in the department of Suchitepquez, two in the

department of Chimaltenango, and one in the department of Solol. The average age of

participants was 37.9 12.1 years. 74% of participants were of childbearing age (15-44

years).

Obstetrical and Sexual History

Among the participants of childbearing age (n-131), only 1% were currently pregnant.

Table 1: Obstetrical/Gynecological History of Participants

Childbearing Older P BetweenCommunities

(P)

Number of Pregnancies 5.1 3.1 8.0 0.41 0.00 0.31

Term Deliveries 3.6 2.2 7.0 2.9 0.00 0.08Premature Deliveries 0.13 0.05 0.13 0.03 0.97 0.26

Miscarriages 0.37 0.06 0.94 017 0.0001 0.19

Living Children 3.5 0.2 6.3 0.4 0.00 0.23

Cesarean (#) 0.37 0.07 0.09 0.04 0.02 0.19

Cesarean (%) 24.4 8.9 0.02 0.25

Age at First Pregnancy 19.1 0.36 21.7 1.14 0.005 0.59

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Age at Menarche 13.48 0.12 13.57 0.21 0.69 0.05

Postmenopausal (%) 0 72 0.00 0.52

Contraceptive Use (%) Condoms: 2

Depo: 39

Implant: 3

IUD: 1Rhythm: 3

OCP: 2

Tubal: 12No SA: 7

None: 34

n/a 0.001

There was considerable heterogeneity between communities on types of contraceptivemethod used. For example Depo usage in Suchitepquez was as high as 36%, but ranged

from 17-29% in the Altiplano communities. Rates of no contraceptive usage ranged from

27-60%.

Table 2: Sexual History of Participants

Childbearing Older P Between

Communities(P)

Age at Sexual Debut 18.16 0.36 20.4 1.06 0.01 0.14

Number of Lifetime

Partners1.11 0.03 1.06 0.04 0.52 0.22

History of Prior STI (%) Yes: 13

No: 66

Unsure: 20

Yes: 6

No: 77

Unsure: 15

0.16 0.09

Cervical Cancer Screening/STI

Table 3: Prior Cervical Cancer Screening History of Participants

Childbearing Older P Between

Communities(P)

Has Had Screening in

Past (%)

67 74 0.41 0.00

Years since LastScreening

2.95 0.37 6.86 1.22 0.0001 0.0002

Results of Last

Screening (%)

Normal: 43

Abnormal

cytology: 2Infection: 28

Unknown: 26

Normal: 49

Abnormal

cytology: 3Infection: 23

Unknown: 26

0.85 0.009

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History of Prior STI (%) Yes: 13

No: 66Unsure: 20

Yes: 6

No: 77Unsure: 15

0.16 0.09

Between-communities differences in prior cervical cancer screening rates were controlled

largely by the relatively low rates of prior screening in the Suchitepquez community(56%) as compared to the other Altiplano communities (75-88%). Between communitiesdifferences in date of last screening were also similarly explained, with mean years since

last screening in Suchitepquez of 6.5 6.4 years (range for Altiplano communities of

1.7-3.7 years). On the other hand, the difference in distribution of reported results could

not be easily explained by a difference between the Suchitepquez and Altiplano

communities, as the four communities all showed considerably heterogeneity on thisresponse item. Of note, most of the respondents who answered unknown did so either

because they never received a copy of their screening results or because they were lost to

follow-up.

Table 4: Current GU Symptoms among Participants

Childbearing Older P Between

Communities(P)

Bothersome Vaginal

Discharge (%)

36 19 0.03 0.49

Vaginal Pruritus (%) 27 19 0.29 0.00

Dysuria (%) 24 11 0.05 0.33

Dyspareunia (%) 30 15 0.07 0.17

Table 5: Results of Clinical Encounters/Pap Smears

Childbearing Older P Between

Communities

(P)

Pap Smear Cytology(%)

Normal

Abnormal

Bacterial Vaginosis

Presumed STI

87

0

2

11

59

0

0

41

0.001 0.58

Syndromic Rx (%)

STIPID

Bacterial Vaginosis

101

1

383

0

0.002 0.47

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Initial Programming Conclusions

1. This is a convenience sample of participants presenting to our programs, thereforethe results may not be representative of wider trends in the participating

communities

2.

The representation of pregnant women in the sample is very low. More effortsshould be made to make participating communities aware that services are

available to pregnant women

3. Rates of no contraceptive use among women of childbearing age could beimproved. Since prior needs analysis has shown that women of childbearing ageoften site lack of access to contraceptive methods as a major barrier, more efforts

should be made to educate women regarding the availability of these methods

through our programs

4. Age at sexual debut and first child were surprisingly lower among youngerparticipants. This highlights the need for more outreach to adolescents and young

women.

5.

Historical access to cervical cancer screening in the Suchitepquez communitywas surprisingly low; therefore this program is providing a much needed servicethere.

6. Fully 25% of women reported prior cervical cancer screening but did not knowthe results. On further questioning, most of these instances were cases in which

they did not return to a provider to receive their results. Importantly, our programstaff are making considerable efforts to have follow-up encounters with each

women to review results personally; these efforts should be continued.

7. There is considerable unmet need in the diagnosis of STIs among older women. Inthis group only 6% reported a prior diagnosis, but 41% were diagnosed

syndromically and/or by cytology here.

8.

Self reporting of GU symptoms were an unreliable indicator of clinical exam andcytology results. Women of childbearing age tended to over report GU symptoms,whereas older women underreported.