Syndromic Approach and Spatial Analysis of Chlamydia trachomatis among Mother with Vaginal Discharge in Medan

Abstract

Limitations of laboratory facilities in developing countries, makes difficult to diagnose the etiology of sexually transmitted diseases, while effectiveness of using WHO’s syndromic approach can vary widely. The aim of this study is to develop a model of syndromic approach in diagnosing chlamydial infection and perform spatial analysis of primary health care coverage to the spread of chlamydial infection in Medan. Three hundred and twenty women who came to the gynecology clinic with complaints of vaginal discharge were recruited as participants and cervical swab specimens examined by using PCR. Signs and symptoms of vaginal discharge had been assessed by physical and gynecological examination. GIS data coordinate was obtained by visiting subject’s residence and mapping using GPS Garmin's eTrex. The results showed the proportion of chlamydial infection in Medan was 35% and syndromic approach model based on odor, color, and consistency of discharge, and inflammation of the cervix has a sensitivity value of 67% (95% CI:58-76%) and specificity 57% (95% CI:50-64%) and PPV of 46% (95% CI:38-53%) and NPV of 76% (95% CI:70-83%). The spreading pattern of chlamydial infection were distributed evenly throughout the area of ??Medan with a tendency to cluster in the central region (NNA with a value of R=0.78 and the value of Z=-4.4). Primary health care range with radius of 3 km allows it to provide health services to women with vaginal discharge even though their perceptions of facilities availability and health workers capability remain low. The results of the study indicated that the spread of chlamydial infection in the low-risk group was relatively high and evenly spread throughout Medan. Therefore syndromic approach models obtained from this research can be used as a useful and simple approach in diagnosing chlamydial infection.

Keywords: Chlamydia trachomatis, vaginal discharge, syndromic approach, spatial analysis