[Link] [Link] [Link].

in
i

de
HEALTH SEEKING BEHAVIOUR OF WOMEN IN THE

ko
REPRODUCTIVE AGE GROUP REGARDING

hi
REPRODUCTIVE TRACT INFECTIONS

oz
-K
g
sin
ur
fN

NASEEBA K.

Govt. College of Nursing Kozhikode

eo
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DISSERTATION SUBMITTED IN PARTIAL FULFILLMENT

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OF THE REQUIREMENTS FOR THE DEGREE OF

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MASTER OF SCIENCE IN NURSING

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KERALA UNIVERSITY OF HEALTH SCIENCES

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2022

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HEALTH SEEKING BEHAVIOUR OF WOMEN IN THE

REPRODUCTIVE AGE GROUP REGARDING

ko
REPRODUCTIVE TRACT INFECTIONS

hi
oz
BY

-K
NASEEBA K.

g
Dissertation submitted to the
sin
KERALA UNIVERSITY OF HEALTH SCIENCES
ur
Thrissur
fN

In partial fulfillment of the requirements for degree of

MASTER OF SCIENCE IN NURSING

eo

in
leg

OBSTETRICS AND GYNAECOLOGICAL NURSING

Under the guidance of

ol

[Link] E.K.
.C

Assistant Professor

Govt. College of Nursing Kozhikode

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2022
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DECLARATION BY THE CANDIDATE

ko
I hereby declare that the dissertation entitled HEALTH SEEKING

BEHAVIOUR OF WOMEN IN THE REPRODUCTIVE AGE GROUP

hi
REGARDING REPRODUCTIVE TRACT INFECTIONS is a bonafide and

oz
genuine research work carried out by me under the guidance of Mrs. Babitha E.K.,

Assistant professor, Govt. College of Nursing, Kozhikode.

-K
g
sin NASEEBA K.
ur
fN
eo

04.06.2022

Kozhikode
leg
ol
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vt
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CERTIFICATE BY THE GUIDE

I hereby declare that the dissertation entitled HEALTH SEEKING

ko
BEHAVIOUR OF WOMEN IN THE REPRODUCTIVE AGE GROUP

REGARDING REPRODUCTIVE TRACT INFECTIONS is a bonafide research

hi
work done by Naseeba K. in partial fulfilment of the requirements for the degree of

oz
Master of Science in Nursing.

-K
g
sin Mrs. BABITHA E.K., MSc (N)

Assistant professor
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Govt. College of Nursing
fN

Kozhikode
eo
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04.06.2022

Kozhikode
ol
.C
vt
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ENDORSEMENT BY THE PRINCIPAL

This is to certify that the dissertation entitled HEALTH SEEKING

ko
BEHAVIOUR OF WOMEN IN THE REPRODUCTIVE AGE GROUP

hi
REGARDING REPRODUCTIVE TRACT INFECTIONS is a bonafide research

work done by Naseeba K. in partial fulfillment of the requirements for the degree of

oz
Master of Science in Nursing.

-K
g
sin
Dr. GEETHAKUMARY V.P.,MN., PhD.,LLB
ur
Principal

Govt. College of Nursing

fN

Kozhikode
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leg
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04.06.2022
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Kozhikode
vt
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COPYRIGHT

DECLARATION BY THE CANDIDATE

ko
I hereby declare that the Kerala University of Health Sciences, Thrissur shall

hi
have the rights to preserve, use and disseminate this dissertation in print or electronic

oz
format for academic research purpose.

-K
g
NASEEBA K.

sin
ur
fN
eo

04.06.2022
leg

Kozhikode
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ACKNOWLEDGEMENT

The investigator is very grateful to God almighty, without his graces and

ko
blessings, this study would not have been possible. Immeasurable appreciation and

deepest gratitude for the help and supports are extended to the persons who have

hi
contributed to making this study possible.

oz
The investigator would like to convey her gratitude to Dr. Geethakumary V.P.,

-K
Principal, Govt. College of Nursing, Kozhikode for support for successful completion

of the study.

The investigator extends her sincere gratitude to Prof. Ponnamma K.M.,

g
former Principal, Government College of Nursing, Kozhikode for her guidance,
sin
suggestions and valuable support throughout the research study for its successful

completion.
ur
The present study was done under the expert guidance of Mrs. Babitha E.K.,
fN

Assistant Professor, Govt. College of Nursing, Kozhikode. The investigator

wholeheartedly expresses her sincere gratitude for her excellent and timely guidance,
eo

scholarly advice, suggestions, abundant encouragement and immense support

throughout the study.

leg

The investigator thankfully remembers [Link] K.S., Vice Principal, Govt.

College of Nursing, Kozhikode for great suggestions and encouragement in the study.

The investigator is also thankful for her timely advice and valuable suggestions
ol

throughout the study. The investigator is immensely obliged to [Link] K.P.,

.C

Govt. College of Nursing, Kozhikode for her scholarly corrections, valuable help and

constant support for the successful completion of the dissertation.

vt

It is the investigator’s unavoidable duty to express the heartiest gratitude to

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[Link] George, Associate Professor, Department of Community Medicine, Medical

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College Kozhikode for the enormous guidance and priceless support rendered in the

statistical analysis of the study. The investigator extends her gratitude to District

ko
Medical Officer Malappuram, Medical officer THQH Kondotty and municipal

Chairman Kondotty for granting permission to conduct the study.

hi
The investigator is extremely thankful to the members of Institutional Ethics

oz
Committee for permitting her to conduct the study. The investigator is extremely

thankful for all the experts for the valuable correction, suggestion, translation and re-

-K
translation of the tool.

The investigator expresses her sincere gratitude to all the participants for their

g
willingness to participate in the study and for their whole hearted co-operation during
the study.
sin
The investigator expresses her sincere gratitude to all faculty members,

especially in Obstetrics and gynaecological nursing department of Govt. College of

ur
Nursing, Kozhikode, for their suggestions, critical observations and encouragement.
fN

The investigator owes sincere thanks to the library staff, Govt. College of Nursing,

Kozhikode for their generous support and co-operation throughout the study.
eo

A word of sincere thanks to the staff of Prayag computer Centre, Medical

College, Kozhikode for formulating and setting of this work into its present elegant

form.
leg

Moreover, the investigator is obliged to her family members for their

boundless love, moral support and encouragement.

ol
.C

NASEEBA K.
vt

04.06.2022
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Kozhikode

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ABSTRACT
The present study was to assess health seeking behaviour of women in the

ko
reproductive age group regarding reproductive tract infections in selected wards of
Kondotty Municipality, Malappuram. The objectives of the study were ,to assess the
health seeking behaviour of women in the reproductive age group regarding

hi
reproductive tract infections, find out the prevalence of reproductive tract infections

oz
among women in the reproductive age group, find out the association between
reproductive tract infections and health seeking behaviour among women in the
reproductive age group and find out the association between health seeking behaviour

-K
of women in the reproductive age group regarding reproductive tract infections and
selected variables. The conceptual framework was based on revised health promotion
model by Nola J Pender. A non experimental approach with cross sectional survey

g
design was adopted for study. Two hundred samples were selected by purposive

sin
sampling technique. The tools used were semi structured interview schedule to
identify the health seeking behaviour of women in the reproductive age group
regarding reproductive tract infections and checklist to assess the symptoms of
ur
reproductive tract infections among women in the reproductive age group. Data were
analysed using descriptive and inferential statistics. The study revealed that 35.5%
fN

(71) of participants have symptoms of RTI. Among them, 87.3% have excessive
amount of vaginal discharge and 55% of them have vaginal itching. Out of 200
participants, 29% participants maintaining good health seeking behaviour and 71%
eo

were maintaining moderate health seeking behaviour. In this study, 53.5% the
participants not taking treatment for their present RTI symptoms. There is no
leg

significant association between health seeking behaviour and reproductive tract

infection among women in the reproductive age group and also there is a significant
association of health seeking behaviour with occupation, marital status, parity, type of
ol

chronic illness, mode of treatment to previous RTI and recurrence of RTI among
women in reproductive age group. The study emphasizes the need for awareness
.C

programmes to improve the health seeking behaviour and screening programmes for
early diagnosis and treatment of RTI symptoms.
Key words: Health seeking behaviour; reproductive tract infection; women in
vt

the reproductive age group; prevalence; selected variables.

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TABLE OF CONTENTS

List of tables

ko
List of figures

hi
List of appendices

oz
Chapter Title Page No

-K
1 INTRODUCTION 1-20

2 REVIEW OF LITERATURE 21-41

g
3 METHODOLOGY
sin 42-51

4 ANALYSIS AND INTERPRETATION 52-80

ur

5 RESULTS 81-87
fN

6 DISCUSSION, SUMMARY AND CONCLUSION 88-100

eo

REFERENCES 101-109

APPENDICES 110-139
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LIST OF TABLES

ko
Sl. No Title Page No

hi
1 Distribution of participants based on age, education, occupation 54

oz
and monthly family income

2 Distribution of participants based on religion, type of family, 55

-K
marital status and parity

3 Distribution of participants based on previous information on 56

RTI and source of information

g
4
sin
Distribution of participants based on history of chronic illness,

type of illness and treatment taken

57

5 Distribution of participants based on previous history of RTI 59

ur
symptoms, duration of illness, treatment, mode of treatment and
fN

diagnostic tests

6 Distribution of participants based on recurrence of RTI 60

eo

symptoms and treatment taken

7 Distribution of participants based on family history of RTI 61

leg

8 Distribution of participants based on health seeking behaviour 62

9 Distribution of participants based on measures followed to 63

ol

maintain reproductive health

10 Distribution of participants based on health seeking behaviour 64

.C

with respect to menstrual hygiene and sexual hygiene

11 Distribution of participants based on health seeking behaviour 65

vt

with respect to discussing symptoms with others if they have RTI

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12 Distribution of participants based on health seeking behaviour 67

with respect to treatment taken for previous RTI

ko
13 Distribution of participants based on RTI symptoms 72

hi
14 Distribution of participants based on prevalence of RTI 73

symptoms

oz
15 Association between prevalence of reproductive tract infection 74

-K
and health seeking behaviour among women in the reproductive

age group.

16 Association between health seeking behaviour regarding 76-77

g
reproductive tract infections and selected socio personal variable

17 Association between
sin
health seeking behaviour regarding 78-80

reproductive tract infections and clinical variables.

ur
fN
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LIST OF FIGURES

Sl. No Title Page No

ko
1 Conceptual frame work of the study to assess the health 20

hi
seeking behaviour of women in the reproductive age

oz
group regarding reproductive tract infections based on

revised Health Promotion Model by Nola J Pender

-K
(2006)

2 Schematic representation of the study to assess the health 45

g
seeking behaviour of women in the reproductive age

3
sin
group regarding reproductive tract infections

Distribution of participants based on previous history of 58

ur
RTI

4 Distribution of participants based on history of taking 66

fN

self-medication to treat reproductive tract infections

5 Distribution of participants based on reason for delaying 68

eo

health care for RTI

6 Distribution of participants based on health seeking 69

leg

behaviour with respect for treatment taking for present

RTI
ol

7 Distribution of participants based on treatment 70

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preference

8 Distribution of participants based on presence of 71

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symptoms of RTI
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LIST OF APPENDICES

Sl .No Title Page. No

ko
SECTION I : ENGLISH

hi
A. Approval letter from Institutional Ethics Committee 110

oz
B. Permission letter from district medical officer, 111

-K
Malappuram

C. Permission letter from Secretary, Kondotty Municipality 112

D. Permission letter from medical officer ,THQH, Kondotty 113

g
E.

F. Informed consent
sin
List of experts for content validity 114

116
ur
G. Tool 1: Semi structured interview schedule to identify 117

the health seeking behaviour of women in the

fN

reproductive age group regarding reproductive tract

infections.
eo

H. Tool 2: Checklist to assess the symptoms of reproductive 126

tract infections among women in the reproductive age

leg

group

I. List of Abbreviations 128

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SECTION II : MALAYALAM
.C

J. Informed consent 129

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K. Tool 1: Semi structured interview schedule to identify 130

the health seeking behaviour of women in the

ko
reproductive age group regarding reproductive tract

infections

hi
L. Tool 2: Checklist to assess the symptoms of reproductive 138

oz
tract infections among women in the reproductive age

-K
group

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CHAPTER 1

INTRODUCTION

ko
hi
Background of the problem

oz
Need and significance of the study

-K
Statement of the problem

Objectives

g
Operational definitions

Hypotheses
sin
ur
Conceptual framework
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CHAPTER 1

INTRODUCTION

ko
Women have a critical role in maintaining the health and well-being of their

hi
communities. Traditionally, the health of families and communities is tied to the

oz
health of women. The illness or death of a woman has serious and far-reaching

consequences on the health of her children, family and community.

-K
Women’s reproductive or fertile years are potentially rich and rewarding and

have an enormous impact on their general health and well-being. The health of

g
women during the reproductive or fertile years (between the ages of 15 and 49 years)

sin
is relevant not only to women themselves but also has an impact on the health and

development of the next generation. WHO pointed out the importance of women’s
ur
multiple contributions to society, in both their productive and reproductive roles, as

consumers and just as importantly, as primary caregivers in the family.

fN

Reproductive Tract Infections (RTIs) are being increasingly recognized as a

eo

global health problem with serious impacts on individual women, their families and

communities. RTIs, generally seen as a ‘silent’ epidemic. But the consequences of

leg

RTIs extend beyond the realms of health. The morbidity associated with RTIs affects

economic productivity and the quality of life of many individual men, women and

ultimately of whole communities.1

ol

In India and other developing countries, reproductive tract infections rank

.C

among the top five health conditions. National Family Health Survey has also
vt

reported that 39.2% of women in India have one or more reproductive tract infections

whereas the prevalence of self-reported RTI symptoms is 11–18% in various

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nationally representative studies.2 Majority of women especially those living in rural

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and slum areas of the country continue to suffer from RTIs. Women because of their

shorter reproductive tract are at risk of contracting STIs. In many cases, RTIs remain

ko
asymptomatic and that makes the detection and diagnosis very difficult. In some of

the other cases despite the availability of health services, symptomatic women bear

hi
silence because of shyness and social stigma. A woman with RTIs can represent

oz
various symptoms ranging from simple backache to lower abdominal pain, genital

ulcers, vulval itching, inguinal swelling, abnormal vaginal discharge and genital ulcer.

-K
RTIs if left untreated or there is a delay in treatment can lead to complications like

pelvic inflammatory disease (PID), infertility, cervical cancer, puerperal sepsis,

g
chronic pelvic pain, ectopic pregnancy and pregnancy loss. In recent years the

sin
appearance of HIV and AIDS has further burdened the existing problem as these

infections are closely related to each other.3

ur
Background of the problem
fN

Reproductive tract infections (RTIs) include three types of infection:

1) sexually transmitted diseases (STDs), such as chlamydia, gonorrhea, chancroid and

eo

human immunodeficiency virus (HIV), 2) endogenous infections, which are caused by

an overgrowth of organisms normally present in the genital tract of healthy women,

leg

such as bacterial vaginosis or vulvovaginal candidiasis and 3) iatrogenic infections,

which are associated with improperly performed medical procedures such as unsafe
ol

abortion or poor delivery practices. RTIs are preventable and many are treatable as

well.4
.C

Although RTIs affect women in both developing and industrialized countries,

vt

the infections and their sequelae are an especially urgent public health problem in

resource-poor areas around the world. Demographic changes in developing countries

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have led to a dramatic increase in the number of adolescent and young adult women

and men in their most sexually active years, which translate into a greater proportion

ko
of the population at risk for RTIs. A large number of infants and children in these

countries mean that this trend will continue for several decades. The risk of RTIs is

hi
compounded by rapid urbanization and high male to female ratios in some regions. 5

oz
Female RTIs usually originate in the lower genital tract as vaginitis or

-K
cervicitis and may produce symptoms such as abnormal vaginal discharge, genital

pain, itching and burning feeling with urination. However, a high prevalence of

asymptomatic disease occurs which is a barrier to effective control. Even when

g
symptoms occur, their presentation can overlap with and be diagnosed as a normal
sin
physiological change and normal physiological discharge may be misdiagnosed as

RTIs. Despite the availability of health services, symptomatic persons do not seek or
ur
make delays in seeking treatment.6
fN

The global burden of reproductive tract infections (RTIs) is an enormous and

major public health concern, particularly in developing countries where RTIs are
eo

endemic. The problem is more pronounced in developing and underdeveloped

countries where women often have to deal with unwanted pregnancies, unsafe
leg

abortions, problems arising from poor contraception practices, different socio cultural

norms and lack of economic independence, which further increase the risk of getting
ol

RTI/Sexually transmitted infections. Reproductive tract infections (RTIs) affect the

health and social well being of women, particularly those in the reproductive and
.C

economically most productive age groups and their offspring.7

vt

Some of the more common bacterial infections occurring in developing

countries include gonorrhea, chlamydia, syphilis, bacterial vaginosis (BV),

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lymphogranuloma venereum (LGV), trichomoniasis and chancroid. Viral infections

most common in developing countries include human papillomavirus (HPV), hepatitis

ko
B virus (HBV), herpes genitalis (herpes simplex virus [HSV], primarily type (HSV-2)

and HIV. The pathogens, symptoms, diagnoses and treatment regimens for the most

hi
commonly occurring RTIs.4

oz
Approximately 35% of women with an infertility problem are afflicted with

-K
post-inflammatory changes of the oviduct or surrounding peritoneum that interfere

with tubo ovarian function. Most of these alterations result from infection. Salpingitis

occurs in an estimated 15% of reproductive-age women and 2.5% of all women

g
become infertile as a result of salpingitis by age thirty five.8The burden of untreated
sin
reproductive tract infections is especially heavy for women because these infections

are often asymptomatic or the symptoms are not recognizable. Morbidity and
ur
mortality related to RTIs deprive society of important contributions made by women

in terms of economic, social and cultural development.9

fN

RTIs and their sequelae have widespread effects on the health and well-being
eo

of men, women, young people and newborns. RTIs can pose a threat to a man’s

fertility since certain untreated infections, such as Neisseria gonorrhoeae or

leg

Chlamydia trachomatis, can block the vas deferentia or cause epididymitis, an

inflammation of the tubes through which sperm move from the testes to the vas
ol

deferentia. Although the dangers to men’s reproductive health must be recognized, the

chance of spreading infection from man to woman carries the greater burden of the
.C

disease. Each year thousands of women die from the sequelae of undiagnosed or

untreated RTIs, including cervical cancer, ectopic pregnancy, acute and chronic
vt

infections of the uterus and fallopian tubes and puerperal infections. Other sequelae
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include infertility, fetal wastage, low birth weight, infant blindness, neonatal

pneumonia and mental retardation.4

ko
A reproductive tract infection (RTI) can make feel miserable and can also

hi
cause serious problems if left untreated. Prevention is a key to avoiding the persistent

and sometimes severe complications of infection. While safer sex, good genital

oz
hygiene and personal hygiene are central to preventing an RTI, other practices may

help to prevent the recurrence of infection.10

-K
A community based cross sectional study was conducted among 276 women

in the department of medicine, Government Medical College and Hospital,

g
sin
Chandigarh, India, to determine the prevalence of reproductive tract infection

symptoms and treatment-seeking behaviour among women. Result reveals that about

one-third of 35.5% of women reported symptoms suggestive of RTI. The most

ur
commonly experienced symptoms were foul smelling vaginal discharge 69.4%
fN

followed by lower abdominal pain not associated with menstruation 52.0%. Around

half of those having RTI symptoms have not taken treatment for these symptoms
eo

(42.9%).11 A community-based descriptive study was conducted among 404 women

in the reproductive age group (15-49 years), to describe the prevalence of genital
leg

infections among women in reproductive age group in a rural area, North Kerala.

Results revealed that 52.7% of the study population had genital infections, with
ol

40.6% having symptoms of reproductive tract infections and 12.1% having symptoms

of urinary tract infections. Only 39.0%of the women with infections had sought
.C

treatment.12
vt

Limited decision making by women, inability to recognize symptoms as an

important problem, embarrassment and healthcare facility-related factors, such as lack

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of privacy, absence of a female doctor, etc. have been reported as reasons for not

availing treatment from healthcare facilities. It is well documented that knowledge

ko
about a health problem is an important precursor for recognizing it and taking steps to

prevent it or treat it. There is a significant gap in understanding the reproductive tract

hi
infections as well as their consequences on women's lives.13

oz
Need and significance of the study

-K
A woman’s reproductive system is delicate and complex in the body. It is

important to take steps to protect it from infections and injury and prevent problems

including some long term health problems. Taking care of themselves and making

g
sin
healthy choices can help protect them and their loved ones. Protecting women’s

reproductive system also means having control of their health. 14

ur
Reproductive tract infections pose a serious and continuing threat to the health

status of women in the reproductive age group. RTIs cause huge morbidity whether it
fN

is in males or in females. But the major brunt of the morbidity is borne by the female

population (six times), which includes women in the reproductive age group in
eo

resource-poor settings, where most of the cases go undiagnosed and untreated.

Adolescents also, due to the ignorance regarding menstrual hygiene are at a high risk
leg

for RTIs which in the long run can lead to various complications like carcinoma

cervix, pelvic inflammatory disease, infertility, spontaneous abortion and ectopic

ol

pregnancy. Reproductive health is a universal concern and a crucial part of health that
.C

forms the center of human development. It mirrors one’s life right from childhood and

adolescence until adulthood and sets a platform for wellness much beyond the
vt

reproductive years in both men and women. The health of the newborn is inherently

dependent upon the well being of the mother. The prevalence of RTI symptoms
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among women is ranging from 17% to 44% in national and international studies.

Studies have explored the woman’s pattern of seeking health care for their RTI

ko
symptoms and have reported that few of them seek treatment from healthcare

professionals.15

hi
According to WHO estimates in 2008, globally 499 million new cases of RTIs

oz
occur annually among women in the reproductive age group. In India, one among four

-K
women in the reproductive age group has any one type of RTI and the annual

incidence of RTI estimated is about 5%.16 As per, a district level household and

facility survey (2007-2008) in Kerala, women who have heard of reproductive tract

g
infection/sexually transmitted infection was 77%, women who have heard of
sin
HIV/AIDS were 98.1% and women who have any symptoms of reproductive tract

infection /sexually transmitted infection was 12.2%, women who know the place to go
ur
for testing of HIV/AIDS was 51.8% and women underwent a test for detecting

HIV/AIDS was17.2%.17
fN

An estimated 340 million new cases of RTIs, including STIs, emerge every
eo

year, with 151 million of them occurring in Asia. A district level household survey-3

conducted in Mumbai, reports shows that 18.3% prevalence of symptoms of RTI/STI

leg

in women of India and among them, only around 40% took treatment.18

In India and other developing countries, RTI infections rank among the top
ol

five health conditions. National Family Health Survey has also reported that 39.2% of
.C

women in India have one or more reproductive tract infections whereas the prevalence

of self reported RTI symptoms is 11–18% in various nationally representative

vt

studies.19
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The health of women is of particular concern because in many societies, they

are disadvantaged by discrimination rooted in sociocultural factors. Women need to

ko
breach many social barriers to empower and get access to quality health care services.

Health seeking behaviour is one of the important determinants of women's health. It is

hi
very essential to identify and understand health seeking behaviour to provide basic

oz
healthcare services and develop strategies for improving the utilization of health

services by the community, particularly women. Some of the sociocultural factors that

-K
prevent women to benefit from quality health services and attaining the best possible

level of health include unequal power relationships between men and women, social

g
norms that decrease education and paid employment opportunities, an exclusive focus

sin
on women's reproductive roles and potential or actual experience of physical, sexual

and emotional violence.20 Health seeking behaviour is influenced by the individual

ur
knowledge, disease perception, socio demographic factors and the availability and

accessibility of health services. Depending on these determinants and their

fN

interactions, healthcare seeking behaviour is a complex outcome of many factors

operating at individual, family and community level.21

eo

The Global Strategy for Women’s, Children’s and Adolescents, health calls

for increased investment in the health of young people, an area that has not received
leg

sufficient attention in most countries. Sexual and reproductive health (SRH) is an area

of particular concern during adolescence, due to physical changes as well as the social
ol

and gender norms that play a significant role during this period. Common strategies to
.C

improve sexual and reproductive health among adolescent girls include improving

related knowledge, treatment seeking and health outcomes amongst adolescents which
vt

include community based outreach, peer education, adolescent friendly health

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services and school health education.22

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Gynaecological morbidities constitute an important health problem among

women of the reproductive age group in India. Many of them did not seek care and

ko
bare it silently. A healthy reproductive life is an essential component of the general

health and well-being of a woman. Reproductive health problems constitute the

hi
leading cause of ill health in women of reproductive age group worldwide, especially

oz
to those in developing countries. 23

-K
The health seeking behaviour of women also depends on the conducive

atmosphere of the institution created by the health care staff members. The women

perceive the physical examination as unpleasant and traumatic, being inspected while

g
undressed, having her body touched, palpated and assuming uncomfortable and
sin
embarrassing positions make her feel a loss of privacy, dignity and control. These

may create women to avoid health care, especially gynaecological problems. 24

ur
Women particularly those living in low and middle income countries are
fN

highly vulnerable to RTIs/STIs due to poverty and gender inequity which act as an

important barrier to accessing health care services. In India, the prevalence of self-
eo

reported RTI symptoms among women varies from 11-72% and most of the women

with symptoms of RTI either never seek treatment or delay seeking treatment.18
leg

Despite the availability of low cost and appropriate technologies for the management

of RTIs/STIs, very few seek treatment either due to a lack of knowledge about it or
ol

due to the existing taboos regarding sexual and reproductive health. This is an

important aspect to be taken care of, as the majority of RTIs/STIs have no symptoms,
.C

or mild symptoms, which if left untreated can lead to serious complications.25

Acceptability of services remains a persistent challenge for adolescents, especially

vt

related to shame, community stigma and provider attitudes regarding sexual activity.
Go

Moreover, underlying social determinants, particularly structural inequities and

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gender norms, play a major role in influencing sexual reproductive health outcomes

among adolescence.26

ko
A large body of community-based research in India has consistently identified

hi
individual, social, cultural and health system barriers to seeking sexual and

reproductive health services amongst women and girls. Studies indicate that between

oz
one-quarter to one-half of married adolescent girls an especially vulnerable group

seek treatment for reproductive tract infection symptoms.27

-K
Health seeking behaviour is the outcome of health education, it is essential to

know about the health seeking behaviour as it imparts about the access and the barrier

g
sin
involved in the treatment modality for health ailments and also helps to know the

mode of patient choice, so that the decision making and planning of health services

can be guided by the outcomes observed concerning the utilization. Hence it is

ur
important to know the health-seeking practice of the community at the level of
fN

primary care. The nurses working in the primary care level play a vital role in

sensitizing health care practices to the women to prevent RTI, early recognize it and
eo

treatment of symptoms. It helps to attain the sustainable development goal that can be

achieved by delivering health services via the primary care system.

leg

Studies on RTIs suggest that about half the women with RTI do not present

symptoms and those RTIs are not limited to high risk populations anymore. A
ol

community based cross-sectional study was conducted on reproductive tract infection

.C

and health seeking behaviour in the rural area near Mumbai among 265 women. There

was a high prevalence of reproductive tract infection among study subjects (53.96%),
vt

only 13.74% visiting a qualified medical practitioner for their complaints. 28 Increased

prevalence of RTIs/STIs constitutes huge health and economic burden for developing
Go

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countries and accounts for economic losses because of ill health. Therefore, some of

the studies have demanded a comprehensive culture-sensitive approach for all

ko
RTIs/STIs and their integration and implementation into basic reproductive health

services. Although programmatic initiatives in the field of adolescent and youth

hi
sexual and reproductive health have begun,findings suggested that married men and

oz
women are at risk of adverse sexual and reproductive health outcomes and efforts to

reach them are inadequate.18

-K
The investigator during her clinical practice noticed many women have

reproductive tract infections. While interacting with patients, some of them

g
considered the symptoms normal. Some others do not disclose the symptoms to
sin
anyone, they find it difficult to describe their genital symptoms openly to family

friends and health care workers. The investigator also interacted with women in the
ur
society and noticed that women do not seek treatment for RTIs due to lack of
fN

awareness, asymptomatic nature of the illness, shame and humiliation, as many

women's reproductive organs and areas are considered something as unclean.

eo

From the background information, it is clear that over the year’s prevalence of

RTIs has not much changed in India. Knowledge of women regarding RTIs and
leg

utilization of health care services for the treatment of RTIs is poor. Very limited

studies related to this area are conducted in Kerala.

ol

As reproductive health is a fundamental right, early diagnosis and treatment of

.C

reproductive tract infections are very important. It helps to maintain a healthy

reproductive population and healthy generation. Health seeking behaviour consists of

vt

sexual hygiene, menstrual hygiene and healthy lifestyles. The most important of RTI

is that it is completely curable. Here comes the importance of health-seeking

Go

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behaviour as it helps a woman to adopt hygienic practices and a healthy lifestyle to

prevent the occurrence of RTI, helps to early identification of RTI symptoms and

ko
timely treatment. It is necessary to improve the health-seeking behaviour of women.

Then we can prevent RTIs and STIs effectively. Through this study, the researcher

hi
would be able to identify the healthy practices of the women in the reproductive age

oz
group and also the researcher focused on the current prevalence of RTI symptoms

among women and their health-seeking behaviour and pattern of health seeking

-K
behaviour. It is an initial step and it helps to identify the health-seeking behaviour of a

group population, which information would be useful to formulate strategies to

g
improve the health seeking behaviour regarding RTIs. For this purpose, the researcher

sin
undertook a study on health seeking behaviour of women in the reproductive age

group regarding RTI in the community setting.

ur
Purpose of the study
fN

The purpose of the study is to identify the health seeking behaviour of women

in the reproductive age group regarding reproductive tract infections in order to create
eo

awareness among women regarding benefits of health seeking behaviour and

promoting reproductive health.

leg

Statement of the problem

A study to assess the health seeking behaviour of women in the reproductive

ol

age group regarding reproductive tract infections in selected wards of Kondotty

.C

Municipality, Malappuram district.

Objectives
vt

 Assess the health seeking behaviour of women in the reproductive age group
Go

regarding reproductive tract infections.

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 Find out the prevalence of reproductive tract infections among women in the

reproductive age group.

ko
 Find out the association between reproductive tract infections and health

seeking behaviour among women in the reproductive age group.

hi
 Find out the association between health seeking behaviour regarding

oz
reproductive tract infections and selected variables.

-K
Operational definitions

Health seeking behaviour: refers to the activities undertaken by women in the

reproductive age group to maintain good reproductive health, to prevent ill health, as

g
sin
well as dealing with any deviation from a good state of reproductive health as

measured by semi structured interview schedule.

ur
Women in the reproductive age group: refers to females within an age group of

18-45 years residing in selected wards of Kondotty Municipality in Malappuram

fN

district.

Reproductive tract infections: refers to the presence of symptoms such as abnormal

eo

vaginal discharge with foul smell, colour changes, excessive amount, vaginal itching,

lower abdominal pain, fever, lower back ache, genital ulcers, inguinal bubo, urethral
leg

discharge, menstrual irregularities, dysmenorrhoea, bleeding after intercourse,

dyspareunia and dysuria as per the NACO guidelines for the prevention and
ol

management of reproductive tract infections as measured by symptoms checklist.

.C

Prevalence: refers to the number of existing cases of women with symptom/

symptoms of reproductive tract infections from the total number of women studied as
vt

measured by symptoms checklist and expressed in frequency and percentage.

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Selected variables: refers to socio personal and clinical variables of women in the

reproductive age group. Socio personal variables includes age, religion, education,

ko
occupation, economic status, type of family, parity, previous information on RTI and

source of information. Clinical variables include history of chronic illness, previous

hi
history of RTI, recurrence of RTI symptoms and family history of RTI.

oz
Assumptions

-K
 Health seeking behaviour varies among women in the reproductive age group.

 Women of reproductive age have chances of getting RTIs.

g
Presence of reproductive tract infections influences health seeking behaviour

sin
among women in the reproductive age group.

Hypotheses
ur
H1: There is a significant association between health seeking behaviour and
fN

reproductive tract infections among women in the reproductive age group.

H2: There is a significant association between health seeking behaviour of women in

eo

the reproductive age group with selected variables.

Conceptual framework
leg

The conceptual frame work of this study is based on revised health promotion

model by Nola J Pender (2006). It postulates the importance of cognitive process in

ol

the changing of behaviour.

.C

A Theoretical frame work presents a broad general explanation of the

relationship between the concepts of research study, based on the existing theory.
vt

According to Nola J Pender, health is a positive dynamic state, not merely the
Go

absence of disease. Health promotion is directed at increasing a client’s well being.

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16

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The health promotion describes a multi-dimensional nature of person as they interact

with in their environment to pursue health.

ko
Health promoting behaviours may be defined as any action directed towards

hi
attaining positive healthy outcome such as an optimal well-being, personal fulfilment

and productive living. Hygienic practices, regular follow up, early identification and

oz
treatment are the health promoting behaviours in this study.

-K
This frame work depicts how personal history of related behaviour and

experiences influenced by biological, psychological and socio cultural factors play a

role in an individual’s cognition and perception relating to health promoting

g

sin
behaviour. Major concepts and definitions of health promotion model include:-

Individual characteristics and experiences

ur
 Behaviour specific cognition and affect

 Behaviour outcome.
fN

Individual characteristics and experiences

eo

Individual characteristics and experiences include personal factors and prior

related behaviour.
leg

Prior related behaviour

It refers to the past frequency of behaviours such as practices and previous

ol

experiences. Direct and indirect effect on the likelihood of engaging in health

.C

promoting behaviour.
vt
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Personal factors

It includes biological, psychological and socio- cultural factor that directly influences

ko
the health promoting behaviours. This model notes that each person has unique

hi
personal characteristics and experiences that affect subsequent actions.

oz
Biological factors include age and parity. Psychological factors include

attitude, lack of awareness, negligence and shyness. Socio cultural factors such as

-K
education, race, ethnicity, acculturation, occupation, marital status, financial status,

family structure and religion.

g
Behaviour specific cognition and affect

sin
It includes perceived benefits of action, perceived barriers of action,

perceived self-efficacy, activity related affect, interpersonal influences and situational

ur
influences that are considered as major motivational significance and these variables

are modifiable through nursing action.

fN

Perceived benefits of actions are anticipated positive outcomes that will occur
eo

from health behaviour. Perceived barriers to actions are the real and imagined block to

the health behaviour change. Perceived self-efficacy refers to the judgement of

leg

personal capability to organize and execute a health promoting behaviour. Higher

efficacy results in lowered perceptions of barriers to the performance of the

behaviour.
ol

Activity related affect refers to the positive or negative feelings that occur
.C

before, during and following behaviour based on the stimulus properties of the

behaviour itself. The more the subject feeling, the more the efficacy. An interpersonal
vt

influence refers to the cognition concerning behaviours, beliefs and attitudes of the
Go

others. Interpersonal influences include norms, social support and modelling. Primary

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18

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sources are families, peers and health care providers. Situational influences are the

personal perceptions and cognitions on any given situation or context that can

ko
facilitate or impede behaviour.

hi
Behavioural outcome

oz
It includes commitment to plan of action, immediate competing demands,

Preferences and health promoting behaviour.

-K
Immediate competing demands and preferences are those alternative

behaviour over which individuals have low control because there are environmental

g
contingencies such as work or family care responsibilities and preferences are

sin
personal likes over which the individual have high control.

Commitment to plan of action refers to the concept of intention and

ur
identification of a planned strategy leads to implementation of health behaviour.

Health promoting behaviour is the endpoint or action outcome directed towards

fN

attaining positive health outcome such as optimal well-being, personal fulfilment and

productive living.
eo

In the present study, the prior related behaviours are previous experiences of
leg

reproductive tract infections and health seeking practice.

Biological factors like age, parity are considered. Psychological factors like
ol

health seeking behaviour, lack of awareness, negligence and shyness. The socio-

cultural factors like education, occupation marital status, socioeconomic status, family
.C

structure and religion are included. In behaviour specific cognition and affect,

perceived benefits of action include early recognition of symptoms of reproductive

vt

tract infections and appropriate health seeking behaviour to management of

Go

symptoms.

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19

de
In this study, perceived barriers to action are lack of health care facilities, lack

of transportation facilities, breach of confidentiality and poor support system.

ko
In this study, perceived self efficacy is the personal competency for health

hi
seeking behaviour and self-motivation.

oz
In this study, activity related affect includes subjective positive feelings like

appropriate health seeking behaviour for the symptoms of reproductive tract

-K
infections and subjective negative feelings like misbelief.

Inter personal influence include the health personal, family members, peer

g
group and society. Situational influences are available health care facilities and mass

media.
sin
In behavioural outcomes, immediate competing demands and preferences are:
ur
Low control: Socioeconomic status, parity, age and type of family
fN

High control: Health seeking behaviour, awareness, follow up and partner treatment.

Health promoting behaviour is the end point or action outcome directed toward
eo

attaining positive health outcome. In this study, health promoting behaviour is the

adoption of good self-care practices to prevent reproductive tract infections and

leg

seeking treatment for symptoms, if present.

Commitment to plan of action includes early recognition of reproductive tract

ol

infection symptoms and appropriate health seeking behaviour for the management of
.C

reproductive tract infection.

Conceptual framework based on revised health promotion model Nola J

vt

Pender (2006) is depicted in Figure 1.

Go

[Link] [Link] [Link]

 ko
[Link] [Link] [Link]

hi
oz
Individual characteristics and Behaviour specific cognition and affect
experiences
Behavioural outcome

-K
Perceived benefits of action: Early recognition of
symptoms of reproductive tract infections & appropriate
Prior related behaviour
health seeking behaviour to management of reproductive Immediate competing
Previous experiences of tract infections demands and preferences
.
reproductive tract infections

g
Low control: age, parity, socio
and health seeking practice Perceived barriers of action: Lack of health care economic status, type of family

sin
facilities, lack of transportation facilities, breach of High control: health seeking
confidentiality and poor support system behaviour and awareness
.
Perceived self-efficacy: Personal competency for health

ur
seeking behaviour and self-motivation Health
Personal factors Commitment to
promoting
plan of action: -
behaviour:-

fN
Biologic: age, parity Early recognition
Activity related affect: Appropriate health seeking Adoption of
of reproductive
behaviour for the symptoms of reproductive tract good self-care
Psychological: health tract infection
infections practices to
seeking behaviour, lack of symptoms,
eo
prevent
awareness,negligence and appropriate health
reproductive
shyness Interpersonal influence: Health personnel, family seeking behaviour
tract infections&
members, peer group and society for the
Socio cultural: marital seeking
management of
leg

status, religion, economic treatment for

reproductive tract
status, occupation and Situational factors: Available health care facility and symptoms, if
infections
mass media present.
family structure
ol

Figure 1: Conceptual frame work of the study to assess the health seeking behaviour of women in the reproductive age group regarding
.C

reproductive tract infections based on revised Health Promotion Model by Nola J Pender (2006) .
vt

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21

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CHAPTER 2

REVIEW OF LITERATURE

ko
Reproductive health and reproductive tract infections

hi
Prevalence of reproductive tract infections (RTIs) among women.

oz
Health seeking behaviour of women regarding reproductive tract infections

-K
g
sin
ur
fN
eo
leg
ol
.C
vt
Go

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CHAPTER 2

REVIEW OF LITERATURE

ko
A review of literature is one of the most important steps in the research

hi
process. It is an account of what is already known about a particular phenomenon.

oz
The main purpose of the literature review is to convey to the readers the work already

done and the knowledge and ideas that have been already established on a particular

-K
topic of research.

In this study, the literature was reviewed and organized under the following headings.

g
 Reproductive health and reproductive tract infection


sin
Prevalence of reproductive tract infections (RTIs) among women.

 Health seeking behaviour of women regarding reproductive tract infections.

ur

Reproductive health and reproductive tract infections

fN

“Reproductive health is a state of complete physical, mental and social well-

being and not merely the absence of disease or infirmity, in all matters relating to the
eo

reproductive system and its functions and processes at all stages of life. Reproductive

health, therefore, implies that people can have a responsible, satisfying, and safe sex
leg

life and that they can reproduce and have the freedom to decide if, when, and how

often to do so. Implicit in this last condition is the right of men and women to be
ol

informed and to have access to safe, effective, affordable and acceptable methods of
.C

fertility regulation of their choice and the right of access to appropriate healthcare

services that will enable women to go safely through pregnancy and childbirth and
vt

provide couples with the best chance of having a healthy infant”.26

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In an International Conference on Population and Development (ICPD) in

Cairo, conducted in the year 1994, a new definition for reproductive health was

ko
formulated and was accepted by 165 nations and it was “reproductive health refers to

a spectrum of conditions, events and processes throughout life, ranging from healthy

hi
sexual development and maturation, responsible relationship and joys of childbearing

oz
to abuse, violence, illness, disease, disability and death”.25

-K
Globally, reproductive ill health accounts for 36.6% of the total disease burden

in women as compared to 12.3% for men of the same age.27The burden of RTIs

particularly STDs falls most heavily on women of reproductive age group and the

g
term RTIs is invariably used to refer to infections among women. STDs are now the
sin
commonest group of notifiable infectious diseases in most countries. Despite some

fluctuations, their incidence remains unacceptably high. 28

ur
Reproductive tract infections
fN

Reproductive tract infection is a broad term that includes sexually transmitted

infections as well as other infections of the reproductive tract that are not transmitted
eo

through sexual intercourse. In women, RTI includes infections of the outer genitals,

vagina, cervix, uterus, tubes or ovaries. In men, RTI involves the penis, testes,
leg

scrotum or prostate. RTI is caused by bacteria, viruses or protozoa that a person gets

either through sexual contact or by a non-sexual route.29

ol

Reproductive tract infections (RTI) refer to three different types of infections

.C

affecting the reproductive tract. Endogenous infections are probably the most

common RTI worldwide. Iatrogenic infections occur when the cause of infection
vt

(bacteria or other microorganisms) is introduced into the reproductive tract via a

Go

medical procedure. This can happen if the surgical instruments used during the

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24

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procedure have not been properly sterilized or an infection, which was already present

in the lower reproductive tract, is pushed through the cervix into the upper

ko
reproductive tract. Sexually transmitted diseases (STDs) are caused by viruses,

bacteria or parasites microorganisms that are transmitted through sexual activity with

hi
an infected partner. About 30 different sexually transmitted infections have been

oz
identified, some of which are easily treatable, many of which are not. STDs affect

men and women, and can also be transmitted from mother to child during pregnancy

-K
and childbirth.4

Female RTI usually originates in the lower genital tract, such as vaginitis or

g
cervicitis, and can produce symptoms such as abnormal vaginal discharge, genital
sin
pain, burning feeling with urination, itching, abdominal pain, irregular menstrual

cycle and blood-stained discharge.30

ur
In bacterial vaginosis, some women are asymptomatic carriers of infection, but
fN

the majority complain of vaginal discharge which has a “musty” or fishy odor but

minimal or no vulval irritation. Chlamydia is often asymptomatic but may develop

eo

vaginal discharge, dysuria, frequency of micturition and at times cervicitis. Ascending

infection may cause PID and infertility. Gonorrhea may be associated with a vaginal
leg

discharge and dysuria. However, approximately 20-50% of all infected women are

asymptomatic. Infection may ascend and cause cervicitis and PID. 28 Candidiasis is
ol

manifested by vulval or vaginal pruritus, the presence of white clumpy discharge that

clings to the vaginal wall and erythema. Trichomoniasis is characterized by a vaginal

.C

discharge that is profuse, thin, creamy or slightly green, irritating and frothy. Signs

and symptoms of erythema, edema, a foul odor and pruritus of the external genitalia
vt

will also be present.31

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Cervical cancer is the most common cancer among women in the third world.

Although questions regarding the mechanism by which HPV causes cervical cancer

ko
remain unanswered, available evidence suggests that HPV infections play a major role

in the causation of cervical cancer throughout the world. Poor pregnancy outcomes

hi
linked to RTIs include fetal wastage (spontaneous abortions and stillbirths), low birth

oz
weight (premature delivery or IUGR) and congenital or perinatal infections (including

potentially blinding eye infections, infant pneumonia and mental retardation). As such

-K
the impact of RTIs on pregnancy outcome depends upon the organism involved, the

chronicity of infection and the stage of gestation during which women becomes

g
infected.32

sin
Although early detection and treatment of RTIs can prevent complications and

minimize the severity of long term sequelae, many infections go untreated. Cultural
ur
barriers as well as poor understanding of the significance of symptoms may also
fN

reduce care-seeking by women. Since a large proportion of women suffer morbidity

silently and are reluctant to seek care, it is difficult to assess the true magnitude of the
eo

problem or the patterns of morbidity from which women suffer. Ultimately this leads

to complicating the situation even worse.31

leg

RTI/STI as a community health problem needs exploration in different strata

and risk areas to understand the extent, pattern and community behaviour of the
ol

disorder.
.C

Prevalence of reproductive tract infections (RTIs) among women

The worldwide spread of sexually transmitted diseases has been one of the
vt

major disappointments in public health in the past two decades. STIs are projected as
Go

a major public health challenge in RCH not only in India but all over the world. WHO

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26

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estimates that between 150 and 330 million new cases of curable STDs occur

worldwide. RTIs are a global health problem, especially in resource-poor settings the

ko
world.33Studies amongst women in India, Bangladesh, Egypt and Kenya have found

RTI prevalence rates ranging from 52 to 92% and fewer than half of these women

hi
recognized the condition as abnormal. Indian prevalence surveys show that the annual

oz
incidence of RTI/STI in India is estimated at 5% and approximately 40 million new

infections take place every year.34

-K
A systematic review was conducted on the prevalence and utilization of

healthcare services for reproductive tract infections/sexually transmitted infections,

g
evidences from India. A structured search strategy was used to identify relevant
sin
articles, published during years 2000 to 2012. Forty one full text papers discussing

prevalence and treatment utilization pattern were included as per PRISMA guidelines.
ur
Papers examining the prevalence of sexually transmitted diseases use biochemical
fN

methods and standard protocol for diagnosis while studies on RTIs used different

methods for diagnosis. The prevalence of RTIs was found to vary from 11% to 72%
eo

in the community based studies. Stigma, embarrassment, illiteracy, lack of privacy

and cost of care were found to limit the use of services. Lack of methodological rigor,

statistical power, specificity in case definitions as well as too little discussion on the
leg

limitation of selected method of diagnosis and reliance on observational evidence

hampered the quality of studies on RTIs. The study suggest that raising awareness
ol

among women regarding symptoms of RTIs and sexually transmitted infections as

.C

important as treatment to RTI remains as a neglected area .35

A descriptive study was conducted on prevalence and etiologic agents of

vt

female reproductive tract infection among in patients and out patients of a tertiary
Go

hospital in Benin city, Nigeria to determine the prevalence and causes of reproductive

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tract infections. High vaginal swabs or endocervical swabs and blood were collected

from 957 patients consisting of 755 out-patients and 202 in patients. The swabs were

ko
processed and microbial isolates identified using standard technique, revealed no

significant difference in the prevalence of reproductive tract infections between

hi
in patients (52.48%) and out patients (47.02%). An overall prevalence of 48.17% of

oz
reproductive tract infection was noticed. Although there was no significant difference

between in-patients and out patients, in patients appeared to have 1 to 3 fold increase

-K
risk of developing mixed infections. Candida albicans was the most prevalent

etiologic agent among out-patients studied while Staphylococcus aureus was the most

g
prevalent etiologic agent among in-patients.36

sin
A descriptive study was conducted on risk factors for reproductive tract

infections among married women in rural areas of Anhui Province, China, to identify
ur
factors that contribute to reproductive tract infections (RTIs) among women,
fN

prevalence of RTI, influence of socio demographic characteristics, knowledge,

hygienic behaviours, history of childbearing, menstruation and abortion. A stratified

eo

cluster sampling technique was used to select 200 women. It was found that, 58%

married women were suffering from RTIs. The three most frequent RTIs were

endocervicitis, bacterial vaginosis (BV) and trichomoniasis, with prevalence of

leg

41.7%, 12.0% and 4.5%, respectively. Multiple infections were prevalent.

Multivariate analysis showed that women's age, education, occupation, dysmenorrhea,

ol

number of deliveries, personal hygiene habit, menstrual cycle, menstruation, abortion,

.C

the interval between abortion and sexual intercourse afterwards, RTI knowledge and

the frequency of sexual intercourse per month were all related to RTIs. Study
vt

concluded that, the prevalence of RTIs was high among married women in rural
Go

China, it indicating the need for health education.37

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A population based prevalence survey was conducted on the prevalence of

bacterial vaginosis among women in the 15-49 age group in Delhi, India. This survey

ko
result gives a high percentage though asymptomatic (31.2%) were found to have

bacterial vaginosis. The highest prevalence was seen in the urban slum (38.6%)

hi
followed by rural (28.8%) and urban middle-class communities (25.4%). All women

oz
with vaginal trichomoniasis were found to have bacterial vaginosis while 50 percent

of subjects having syphilis also had bacterial vaginosis. The asymptomatic women

-K
having bacterial vaginosis are less likely to seek treatment for the morbidity and thus

are more likely to acquire other STIs. The study concluded that women attending

g
various healthcare facilities should be screened and treated for bacterial vaginosis to

sin
reduce the risk of acquisition of other STIs. 38

A community-based comparative study was performed on RTI/STI prevalence

ur
among urban and rural women of Surratt, to estimate the prevalence of RTI/STI
fN

among women and analyse the influence of socioeconomic, socio demographic and

other determinants possibly related to RTI/STI. Women aged 15-49 years (n = 102)
eo

were interviewed and underwent gynaecological examination. 45% reported having

symptoms suggestive of RTI/STI in past. Out of 102 women, 42 (41%) presented with

discharge, 10 (10%) with itching, 8 (8%) with burning micturition, 3 (3%) with pelvic
leg

pain, and only 1 (1%) presented with ulcer. Out of 45 women, having symptoms

suggestive of RTI/STI, 21(21%) reported consulted government hospital for seeking

ol

treatment while only 9(9%) consulted private hospital, 3(3%) took self-treatment,
.C

while 11(11%) did not take any treatment for RTI/STI.39

A cross-sectional study was conducted on reproductive tract infections among

vt

women of the reproductive age group in the urban health training center area in Hubli,
Go

Karnataka, to find out the prevalence and socio-demographic factors influencing the

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occurrence of RTIs among women. The study was conducted from September 2003 to

August 2004. A sample of 656 women of 15-45 years was selected by a simple

ko
random sampling technique. The study revealed that the prevalence of RTIs based on

symptoms was 40.4%, with the majority having abnormal vaginal discharge. The

hi
prevalence of RTIs based on clinical findings was 37.4% with the majority having

oz
vaginitis. The laboratory test revealed a prevalence of 34.3% with the majority having

candidiasis. The influence of socio-demographic factors like increased parity, poor

-K
socio economic conditions, poor menstrual hygiene and illiteracy has direct effect on

RTIs. This depicts that wherever possible; clinical and laboratory findings should

g
support self-reported morbidity to know the exact prevalence of any disease in the

sin
community. The study highlights the need for community based studies requiring

laboratory investigations with feasible tests to know the exact prevalence of the
ur
disease, as the self-reported morbidity alone cannot measure the burden of any disease

in the community to necessitate proper prevention and control measures.40

fN

A community based descriptive study was conducted on the prevalence of

eo

genital infections among women in the reproductive age group in a rural area in North

Kerala, in the Kulappuram area of Cheruthazham Panchayat, Pariyaram from June

2017 to July 2018. A house-to-house visit was done and a total of 404 women
leg

participated in the study. Information was collected by directly interviewing each

woman using a pre-tested, semi structured questionnaire. The mean age of the study
ol

population was 32.20±10.741years. 52.7% of the study population had a genital

.C

infection, with 40.6% having symptoms of RTI and 12.1% having symptoms of

urinary tract infections. The presence of UTI was significantly associated with
vt

menstrual disorders, cloth, and menstrual pad users, marriage, sexual activity and
Go

parity. Only 39.0% of the women with infections had sought treatment. This study

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finds shows that there was a high prevalence of genital infections among the study

population, the treatment-seeking behaviour was very low and the study concluded

ko
that there is a need for sustained motivation and support to promote women to seek

timely medical care than to suffer silently.12

hi
A descriptive study was conducted on prevalence of RTI/STI among women

oz
of reproductive age in District Sundergarh (Orissa), to estimate the prevalence of

-K
RTI/STI among women of reproductive age, identify the common signs and

symptoms of RTI/STI among women, and to find out other socio demographic

variables associated with causation of RTI/STI in women. Study conducted among

g
600 married women in the reproductive age group, from February 2004 to January
sin
2005. Study results shows that the prevalence of RTI was 39.2% with a higher rural

(44%) than urban (32%). Almost half of the symptom positive women were of 25- 34
ur
years of age. Prevalence of RTI/STI was found to be highest among women with 1 or
fN

2 live children (26.7% and 30.00%) in rural and urban areas respectively. The

commonest symptom of RTI/STD was vaginal discharge (91%) followed by backache

eo

(76%), lower abdominal pain (64%), vulval itching (51%) and burning during

urination (34%). Study recommended that primary health care level needs to be

strengthened in respect of reproductive health, and awareness about reproductive

leg

health issues should be raised through suitable communication in order to bring about

a positive behaviour change.41

ol

A prospective study was conducted on the prevalence and risk factors of

.C

lower reproductive tract infections in symptomatic women in Dakar, aimed to

establish the prevalence and risk factors of lower genital tract infections among
vt

women of reproductive age. The study was conducted in 6 maternity hospitals from
Go

July to November 2015. Participants ranged in age from 18 to 49 years and presented

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at health facilities with signs and symptoms of genital infection. 276 patients were

enrolled. The prevalence of any genital infection was 69.6% (192 /276). The most

ko
common vaginal infections were bacterial vaginosis (39.5%), vaginal candidiasis

(29%), and trichomoniasis (2.5%). Among the microorganisms responsible for

hi
cervical infections, Ureaplasma urealyticum was the most frequent (27.5%), followed

oz
by Mycoplasma hominis (14.5%), Chlamydia trachomatis (4.7%), and Neisseria

gonorrhoeae (1.1%). Multivariate analysis showed that young women and women

-K
with low levels of education were at increased risk for vaginal and cervical infections.

This study revealed a high prevalence of bacterial vaginosis and vaginal candidiasis

g
and suggests that health care providers should increase awareness and communication

sin
to improve vaginal hygiene practices.42

A descriptive study conducted on reproductive tract infections and treatment

ur
seeking behaviour among married adolescent women 15-19 years in India, among
fN

39,164 women, using data from third round of the India District Level Household

Survey. Factor analysis was used to create an index using all the 11 symptoms of
eo

RTI/STI reported in the survey. Results show that about 15% of adolescent women

reported having any symptoms of RTI/STI. The main symptoms reported were low

backache, pain in the lower abdomen, pain during intercourse and itching or irritation
leg

around the vulvar region. Factor analysis showed the concentration of diseases in

three clusters - infection in around the vulva, other reproductive infection and
ol

abnormal discharge; and intercourse related problems.43

.C

Health seeking behaviour of women regarding reproductive tract infections

vt

A community based descriptive study was conducted on health seeking

attitude of women regarding reproductive tract infections in a rural area of

Go

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Surendra Nagar district, to assess the health seeking attitude of women regarding

reproductive tract infections, elicit their history about it, and assess the personal

ko
hygiene measures relevant to it. The overall prevalence in this study is 56.5. Out of

400 samples, 75.3% of women narrated treatment was necessary, 44% preferred to

hi
take treatment from the doctor and 24.7% should not be taken treatment because of

oz
social and personal reasons. Women with poor menstrual and personal hygiene have

got 2.5 times the chances of reproductive tract infections (OR= 2.35, CI= 1.374-4.01,

-K
p value: 0.001). It was found that women who used clothes were two times more

symptomatic as compared to women who used sanitary pads and also there was a

g
significant association between women having symptoms of reproductive tract

sin
infections and their sexual history. Women who used sanitary pads during menstrual

periods had a lower prevalence, 19.8% of women gave a history of reproductive tract
ur
infections and out of that 15.16% of women had taken treatment for it. Regarding

health seeking attitude of symptomatic women, 61.94% of women had taken

fN

treatment and the majority of them had taken treatment from doctors. Women with

complaints of dyspareunia, bleeding during and or after intercourse and a history of

eo

forceful intercourse had a maximum prevalence of reproductive tract infections. This

study concluded that health intervention measures directed towards reducing

leg

morbidity from reproductive tract infections need not focus mainly on the treatment of

reproductive tract infections but rather on disease preventing strategies. 44

ol

A community based cross-sectional study was undertaken on knowledge,

.C

health seeking behaviour and barriers to treatment of reproductive tract infections

among married women of reproductive age in Delhi from November 2017 to April
vt

2019, to assess the knowledge, health seeking behaviour and barriers to treatment of
Go

reproductive tract infections among married women of reproductive age. A sample

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size of 270 women in the reproductive age group was included in the study and data

was collected using a predesigned and pre tested questionnaire. Around 16.6% of the

ko
women knew about the symptoms of RTI/STIs. Out of 81 women having RTI/STI in

the past 3 months, 30% did not seek treatment and out of 70% who took treatment for

hi
RTI, 30% did not complete treatment. The majority of the women who sought

oz
treatment preferred government hospitals. The main barrier to seeking treatment was

embarrassment, not considering it as an important health problem and lack of time.

-K
The overall knowledge about symptoms and mode of spread of RTIs/STIs was very

poor among the study participants. This study suggests that there a is need to

g
emphasize spreading knowledge about symptoms, mode of spread, need for treatment

sin
and its completion and clearing barriers related to RTI/STI among women. 45

A community based cross sectional study was conducted on reproductive tract

ur
infection and health seeking behaviour in the rural area near Mumbai, to assess the
fN

prevalence of reproductive tract infections and socio demographic factors responsible

among married women. A simple random sampling method was used to select the
eo

sample size of 265 women in the reproductive age group. The prevalence of

reproductive tract infections was 53.96% (143). The most common morbidity found

was vaginal discharge 22.26% (59). The result of this study shows that there was a
leg

significant difference between the proportions of study subjects with reproductive

tract infection concerning their educational status and occupation. The study
ol

concluded that there was a high prevalence of reproductive tract infection among
.C

study subjects with only 13.74% visited a qualified medical practitioner for their

complaints.46
vt

A descriptive cross sectional survey was conducted on female reproductive

Go

tract infections: understandings and care-seeking behaviour among women of

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reproductive age in Lagos, Nigeria between 1st June 2008 and 31st August 2008 using

a pre tested questionnaire. A sample size of 500 women in the reproductive age group

ko
was included in the study. Most of the respondents (77.2%) had heard of RTIs. The

toilet was the most perceived mode of contracting RTIs (44.6%), followed by sexual

hi
intercourse and poor hygiene. 37.4% of the respondents had experienced symptoms of

oz
RTIs in the preceding six months. Vaginal discharge was the commonest symptom

reported (21.8%) and the majority of those who reported symptoms sought medical

-K
treatment. The majority of the women who sought treatment preferred government

hospitals. Even though most of the respondents have heard of RTIs and sought

g
treatment when symptomatic, they demonstrated knowledge of the symptoms and

sin
complications of RTIs. The study recommended that there is a need to educate women

on preventive strategies, as RTIs are often asymptomatic.47

ur
A community based cross sectional study was conducted on care seeking
fN

behaviour and barriers to accessing services for sexual health problems among

women in rural areas of Tamilnadu in India, to assess the care seeking behaviour and
eo

barriers to accessing services for sexual health problems among young married

women in rural areas of Thiruvarur district. The study was conducted in 28 villages

selected using a multistage sampling technique for selecting 605 women in the age
leg

group of 15–24 years from July 2010 to April 2011. The prevalence rate of

reproductive tract infections (RTIs) and STIs was14.5% and 8.8%, respectively,
ol

among the study population. Itching/irritation over the vulva, thick white discharge,
.C

discharge with an unpleasant odor, and frequent and uncomfortable urination were the

most experienced symptoms of sexual health problems. Around three fourths of the
vt

women received treatment for sexual health problems. Perception of symptoms as

Go

normal, feeling shy, lack of female health workers, distance to the health facility and

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lack of availability of treatment were identified as major barriers to not seeking

treatment for RTIs/STIs. Traditional families and poor socioeconomic conditions of

ko
the family appear to be the main reasons for not utilizing the health facility for sexual

health problems. An integrated approach is strongly suggested for creating awareness

hi
to control the spread of sexual health problems among young people. 48

oz
A descriptive study was conducted on healthcare seeking behaviour for

-K
symptoms of reproductive tract infections among rural married women of

Kancheepuram district, Tamil Nadu, to assess the health care seeking behaviour of

women reporting RTI symptoms and association of background socio demographic

g
characteristics with health care seeking behaviour. The study was conducted between
sin
March to November 2011, among 520 married women aged 18-45 years by using

simple random sampling method. The participants were administered a standardized,

ur
semi-structured interview schedule. 173 women (33.3%) of women reported
fN

experiencing symptoms of RTI/STI in the past 12 months. Only 51.45% of those who

had RTI/STI symptoms sought health care. Private health care facility was preferred
eo

by nearly two-thirds. The health care seeking behaviour showed significant

association with the age group of women, religion, occupational status, type of family

and socioeconomic status. This study recommended that there is a need for increasing
leg

awareness among women regarding RTI/STIs and their sequelae and targeted health

education programs should be necessary to improve health care seeking among

ol

women.49
.C

A cross-sectional, population based surveillance survey was conducted on

frequency and determinants of health care utilization for symptomatic reproductive

vt

tract infections among 3,600 rural non pregnant women in Odisha, India, from 2013
Go

to 2014, to identify determinants of care seeking behaviour and analyze the difference

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in utilization of health care resources in response to symptoms of an RTI versus non-

RTI disease symptoms in rural India. The findings of the study revealed that married

ko
women were significantly more likely to seek health care for RTI symptoms (OR) =

1.9, 95% Confidence Interval (CI): 1.2–3.0) while unmarried adolescents were less

hi
likely to seek treatment (OR = 0.4, CI: 0.2–0.6). There was no association between

oz
RTI health care seeking with education level, belief about whether symptoms can be

treated, or poverty. The majority (73.8%) of women who did not seek treatment for

-K
RTI symptoms because they did not know the treatment was needed. Women utilized

formal health care providers at a higher rate in response to RTI symptoms than in

g
response to their most recent symptoms of any kind (p=0.003).The study

sin
recommended that community based reproductive health education interventions are

needed to increase health care seeking behaviour for RTIs in rural Indian women and
ur
also interventions should target unmarried women and focus on both sexual health

education and access to care.50

fN

A descriptive study was conducted on the prevalence of reproductive tract

eo

infections and health seeking behaviour among women of reproductive age group to

assess the prevalence of symptoms of RTIs and health seeking behaviour among 60

women of reproductive age group (15-49 years) residing in village Abhipur, Mohali,
leg

Punjab. The participants were selected by a simple random sampling method (lottery

method) after conducting a house to house survey. The study findings show that the
ol

prevalence of various symptoms of RTIs among the subjects was found to be as high
.C

as 45%. Most of the subjects (45%) reported backache, whereas the least reported

symptom was burning micturition (1%). Most of the respondents (82%) had
vt

satisfactory health seeking behaviour. Results revealed that there was a significant
Go

association between income and health seeking behaviour. This study recommended

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that there is a need for community based approaches and research on RTIs and their

prevention and it will be a step in the right direction of fostering local, national and

ko
political commitment to the overall reproductive health needs of the average Indian

women.51

hi
A hospital based descriptive, cross-sectional study was carried out on

oz
treatment seeking behaviour among married women of reproductive age presenting

-K
with symptoms of STI/RTI. Study was carried out at the STI/RTI Clinic of Urban

Health Centre, Shivaji Nagar, Mumbai, India. The study involved a total of 273

married females from January to March 2012. Participants were interviewed using a

g
pretested questionnaire to explore the detail of the treatment seeking behaviour
sin
regarding STIs/RTIs. Out of the total women who participated in the study, only

47.6% of the women with STIs/RTIs symptoms sought health care. Among those who
ur
did not seek treatment, 58.65 % of females were belonging to the 21-25 years of age
fN

group. Maximum 65.6% of females who were illiterate had not sought any treatment

for symptoms of these diseases as compared to 65% who had taken treatment for the
eo

presented symptoms who were educated up to higher secondary and above level. This

study showed that poor health seeking behaviour was associated with the literacy and

socioeconomic class of the participants. The private sector was the most favored place
leg

for taking treatment. The commonest reason for not seeking treatment was no female

doctor at the clinic. The study recommended that Information, Education, and
ol

Communication (IEC) sessions, about STI symptoms and the benefits of treatment,
.C

especially targeted at women and low socioeconomic groups sight be an immediately

feasible measure that will help to reduce the burden of the disease.52
vt

A cross sectional study was conducted on health care seeking behaviour of

Go

women with symptoms of reproductive tract infections in the urban field practice

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area, Hubli, Karnataka, among 656 women in the reproductive age group selected by

using simple random technique, to estimate the pattern of healthcare-seeking

ko
behaviour and reasons for those not seeking help. A pre tested structured

questionnaire was used to collect data on reproductive history, current and past RTI

hi
symptoms and their health seeking behaviour. The study findings revealed that among

oz
265 women who had symptoms of RTI, only 55.09% (146) women with symptoms

had sought some form of treatment, while 44.91% (119) had not sought any treatment.

-K
It was found that the majority 49.32% (72) of symptomatic women, sought treatment.

Among those who did not prefer any treatment, 79.83% (95) had an attitude that it

g
will get cured by itself. Among those who had not sought treatment, 98.32% (117)

sin
women had evidence of RTI. In this study, the health care seeking behaviour of

women with RTI is low. The study concluded that women must be given health
ur
education to seek health care earlier to prevent further complications of the disease.53
fN

A cross sectional study was conducted on knowledge, behaviours and prevalence

of reproductive tract infections, among 190 rural Chinese women in Hunchun,

eo

China,to determine the prevalence, knowledge, and behaviour about reproductive tract

infections (RTIs). A convenience sampling method was used for sample selection. In

this study, more than half (57.3%) of study participants had an RTI at the time of
leg

examination and 92.3% reported having had at least one RTI symptom. Participants

who exhibited RTI symptoms reported no utilization of any healthcare services. Age,
ol

the number of pregnancies, RTI knowledge and behaviour were found to be

.C

significant correlates in the sample. This study concluded that the prevalence of RTI

among low income rural Chinese women was extremely high, indicating the urgent
vt

need for effective and culturally sensitive health education, particularly targeted at the
Go

poor rural population.54

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A hospital-based cross-sectional study was carried out on knowledge, attitude

and treatment seeking behaviour for reproductive tract infections (RTI) and sexually

ko
transmitted infections (STIs) among married women attending Suraksha Clinic,

Madhya Pradesh, India. This study was conducted with the objective of evaluating the

hi
socio demographic profile, knowledge, attitudes and treatment-seeking behaviour

oz
related to RTIs and STIs, and safe sexual practice, among married women of

reproductive age group. A verbally administered questionnaire was used to collect

-K
data from 440 study particpants. Out of 440 patients diagnosed with RTIs, 312 (71%)

had some knowledge of reproductive tract infections. The most commonly

g
experienced symptom was vaginal discharge, experienced by 305 (69%) of the

sin
women. The main barriers to seeking treatment were embarrassment and only

considering the symptoms to be a minor disease that did not warrant medical
ur
attention.55
fN

A descriptive study was conducted on the prevalence of reproductive tract

infection symptoms and treatment-seeking behaviour among married women of

eo

reproductive age group Chandigarh, to assess the prevalence of RTI symptoms and

treatment-seeking behaviour. A total of 276 women were interviewed. About one-

third, 35.5% (98/276) of women reported symptoms suggestive of RTI. The most
leg

commonly experienced symptoms were foul-smelling vaginal discharge 69.4%

(68/98), followed by lower abdominal pain not associated with menstruation 52.0%
ol

(51/98). Around half of those having RTI symptoms sought treatment for their
.C

problem (57.1%), among them 66% preferred a government hospital for seeking

treatment. This study shows that 37 % of participants will discuss their symptoms
vt

with others if they have RTI, and among them, 94.9% will discuss with their husbands
Go

and 72.5 % with family members. The study recommended that healthcare

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professionals in India should focus on strengthening women's knowledge of RTI

symptoms and encouraging them to seek healthcare.11

ko
A comparative study was conducted on prevalence of RTI/STI symptoms and

hi
treatment seeking behaviour among the married women in urban and rural areas of

Delhi, to compare the prevalence and treatment seeking behaviour about RTI/STI

oz
symptoms among the married women of reproductive age group (18–45 years).Simple

-K
random sampling technique was used to select 215 study participants. In this study,

the prevalence of RTI/STI symptoms was found to be similar in both urban (42.3%)

and rural area (42%). In urban area, 73% sought treatment, while in rural area only

g
45.6% sought treatment. Prevalence of the symptoms was found to be higher among
sin
the study subjects who were not using any contraceptive method, had history of

abortion and were with lower educational status, in both urban and rural areas.
ur
Treatment seeking behaviour was significantly higher among the educated women,
fN

contraceptive users, and older age group women in both rural and urban area. The

study concluded that, there is a need to educate women about the symptoms of
eo

RTI/STI, their prevention and the importance of timely treatment in both urban and

rural areas. The availability of the RTI/STI treatment kits should be ensured in all the

primary health centres to increase the usage of the government services.56

leg

Reproductive tract infection (RTI) is a public health problem in developing

ol

countries. It is estimated that every day nearly one million people globally acquire a

new RTI. Untreated RTIs in women often leads to infertility and increase the risks of
.C

transmission of human immunodeficiency virus (HIV) infection. Foul-smelling

vaginal discharge along with lower abdominal pain is an important cause of

vt

healthcare visits among women.23

Go

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The World Health Organization (WHO) recommends a syndromic approach

for the management of RTIs. In this approach, the diagnosis is based on the

ko
identification of a group of symptoms and signs associated with infection. Socio

demographic factors along with behavioural practices influence the dynamics of RTI

hi
health-seeking behaviour.57The prevalence of RTI symptoms among women is

oz
ranging from 17% to 44% in national and international studies. Studies have explored

the woman's pattern of seeking health care for their RTI symptoms and have reported

-K
that few of them seek treatment from healthcare professionals.58

From the literature reviewed, it is clear that, despite being a serious public

g
health issue, studies on the prevalence of RTI symptoms coupled with treatment-
sin
seeking behaviour are limited. Thus, the present study was conducted to study the

prevalence of RTI symptoms and treatment-seeking behaviour among women of

ur
reproductive age.
fN
eo
leg
ol
.C
vt
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CHAPTER 3

METHODOLOGY

ko
hi
Research approach

oz
Research design

-K
Variables

Schematic representation of the study

Setting of the study

g
Population

Sample and sampling technique

sin
Inclusion criteria
ur
Exclusion criteria
fN

Tool

Development of the tool

eo

Description of the tool

Content validity
leg

Reliability of the tool

Translation of the tool

ol

Pretesting
.C

Pilot study

Data collection process

vt

Plan for data analysis

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CHAPTER 3

METHODOLOGY

ko
Research methodology includes the steps, procedures and strategies for

hi
gathering and analysing data in an investigation. This chapter deals with the research

oz
methodology adopted for the study. It includes the research approach adopted,

research design, variables, schematic representation of the study, setting of the study,

-K
population, sample, sampling, description of the tool, pilot study, data collection

process and plan for data analysis.

g
Research approach

sin
A non-experimental approach is used in the present study as the purpose is to

assess the health seeking behaviour of women in the reproductive age group regarding
ur
reproductive tract infections.
fN

Research design

Research design consists of blueprint for the collection, measurement and the
eo

analysis of data. The design selected for the present study was a cross sectional survey

design.
leg

Variables under study

ol

Variables are concepts at various levels of abstractions that are measured,

manipulated and controlled in the study. The variables in this study are health seeking
.C

behaviour, symptoms of reproductive tract infections, selected personal variables and

clinical variables.
vt
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Selected variables include are age, religion, education, occupation, economic

status, type of family, parity, previous information on reproductive tract infection and

ko
source of information. Clinical variables include includes history of chronic illness,

previous history of RTI, recurrence of RTI symptoms and family history of RTI.

hi
Schematic representation of the study

oz
Schematic representation of the study is shown in the figure 2.

-K
g
sin
ur
fN
eo
leg
ol
.C
vt
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hi
oz
Variables/tools Outcome

-K
Variables
Population: - Women in the reproductive age group.
 Prevalence of
Setting: - Selected wards of Kondotty Municipality,  Prevalence of RTI
Malappuram district.  Socio personal and RTI

g
Sampling technique:-Nonprobability purposive clinical variables  Health seeking

sin
sampling.  Health seeking
behaviour of women. behaviour of
Sample: - Women in the reproductive age group of 18-
45 years in selected wards of Kondotty Municipality. women in the

ur
Sample size:-200 women Tools
reproductive age
Inclusion criteria: - Women who are Prevalence of RTI

fN
group regarding
 Able to read and write Malayalam
 RTI symptoms
 Willing to participate reproductive tract
checklist
eo
Exclusion criteria: - Women who are infections.
Health seeking behaviour
 Having vision or hearing problems
 Semi structured
 Mentally challenged
leg

interview schedule.

Figure 2. Schematic representation of the study to assess the health seeking behaviour of women in the reproductive age group regarding
ol

reproductive tract infections.

.C

45
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Setting of the study

The study is conducted in selected wards of Kondotty Municipality,

ko
Malappuram district. The setting was selected based on the familiarity of the setting

hi
and feasibility of getting sample.

oz
Population:

The population were women in the reproductive age group.

-K
Sample: Women in the reproductive age group of 18-45 years in selected wards of

Kondotty Municipality.

g
Sample and Sampling technique
sin
Sample is the subset of the population selected for a particular study. Sample
ur
for the present study consist of 200 women of selected wards of Kondotty

Municipality and sampling technique adopted for the study was nonprobability
fN

Purposive sampling.

Sample size
eo

200

Sample size (n) = 4pq/d2

leg

Here p= 53.96% q=100-53.96= 46.04% d=15% of 46.04%. Hence sample

size is 208. It can be taken as 200.

ol

A community based cross sectional study on reproductive tract infection and

.C

health seeking behaviour, published in International Journal of Community Medicine

and Public Health. Vol 5, No 4(2018). The result of the study shows Prevalence of
vt

reproductive tract infections was 53.96% 46.

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Inclusion criteria: Women who are

 Able to read and write Malayalam

ko
 Willing to participate

hi
Exclusion criteria: Women who are

oz
 Having vision or hearing problems

 Mentally challenged

-K
Tools and technique

Tool 1: Semi structured interview schedule to identify the health seeking behaviour of

g
sin
women in the reproductive age group regarding reproductive tract infections.

Section A: Socio personal data

ur
Section B: Health seeking behaviour regarding reproductive tract infections
fN

Tool 2: Checklist to assess the symptoms of reproductive tract infections among

women in the reproductive age group.

eo

Technique: Technique is self report and record review.

Development of the tool

leg

The tools were developed based on the research problem, objectives of the

study, review of the related literature, guidance and suggestion of the subject experts
ol

in the field of obstetrics and gynaecology department, obstetrics and gynaecological

.C

nursing department, the development of the final tool was prepared with the guidance

and suggestions of the guide.

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Description of the tool

Tool 1: Semi structured interview schedule to identify the health seeking behaviour of

ko
women in the reproductive age group regarding reproductive tract infections.

hi
Section A -Socio personal data

oz
It includes age, religion, education, occupation, economic status, type of

family, parity, previous information on RTI, source of information and clinical

-K
variables includes history of chronic illness, previous history of RTI, recurrence of

RTI symptoms and family history of RTI.

g
Section B – Health seeking behaviour regarding reproductive tract infections.

sin
It includes measures followed to maintain reproductive health, menstrual

hygiene, sexual hygiene and treatment taken for RTI symptoms. It consists of 19
ur
questions. Scoring given for 11questions and others measured by frequency and
fN

percentage. Each positive response carries 1 mark and negative response carries 0

mark. The score obtained for participants are categorized in to low, moderate, high
eo

health seeking behaviour and total score for health seeking behaviour 0-11 for married

and 0-10 for unmarried women. Score is categorized in to

leg

Married Unmarried

Good>8 High >7

ol

Moderate 5-8 Moderate 5-7

.C

Poor<5 Low <5

vt

Tool 2: Checklist to assess the symptoms of reproductive tract infections among

women in the reproductive age group. It consists of 18 items. The score ranges from
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0-18. Based on the score the prevalence of RTI symptoms were arbitrarily classified

in to 3 categories.

ko
 High prevalence (>14)

hi
 Moderate prevalence (9-14)

 Low prevalence (<9).

oz
Content validity

-K
To ensure the content validity, the tool was given to 15 experts along with

blue print and response sheet. The experts include two from obstetrics and

g
gynaecology department and 13 from obstetrics and gynaecological nursing

department. sin
As per the expert’s suggestion in tool 1, record review included for questions
ur
11-23, section B modified into tool 2 as symptom check list and scoring was given. In
fN

tool 1, some questions are modified and new questions are added regarding practice as

per the suggestion of the expert. The suggestion of the experts was discussed with
eo

guide and necessary modifications were made.

Reliability
leg

Reliability of the tools were tested by test-retest method and analysed

intraclass correlation coefficient, and the correlation coefficient for tool 1 is 0 .98 and
ol

tool 2 is 0.90. This indicates the tools are reliable.

.C

Translation of tool

The tool was translated to Malayalam and retranslated in to English with the
vt

help of language experts. It was found that, the tool was valid regarding language.
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Pretesting

Pretesting was done by administering the tool to 20 women. Tool modified for

ko
its clarity. The tool was found feasible, unambiguous, relevant and clear. The final

hi
tool was prepared with guidance and suggestion of the guide.

oz
Pilot study

After obtaining formal permission from the concerned authority the pilot study

-K
was conducted in ward 33 of Kondotty Municipality. The data were collected from

09.02.2022 to 14.02.2022 among 20 women. The investigator met the women

g
personally, established rapport with them, and explained the purpose and significance

sin
of the study. After obtaining their consent participants were interviewed for obtaining

data regarding socio personal variables, health seeking behaviour regarding

ur
reproductive tract infections and prevalence of RTI infection symptoms. Pilot study

revealed the appropriateness of the methodology selected and feasibility of the tool.
fN

The collected data were amenable to statistical analysis and thus the study was found

feasible.
eo

Data collection process

leg

The study was conducted after getting approval from the Scientific Review

Committee, Institutional Ethical Committee of Govt. College of Nursing Kozhikode,

Kerala University of Health Sciences (KUHS) and formal administrative permission

ol

from the District Medical Officer Malappuram, Medical Officer Taluk Head Quarters
.C

Hospital Kondotty, and Municipality Kondotty, the data collection was done from

28.02.2022-02.04.2022. The investigator selected 200 samples from wards 35 and 36,
vt

according to inclusion criteria through purposive sampling. The investigator met the
Go

participants at their homes, introduced herself, was comfortably seated, and

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established a good rapport. The purpose and nature of the study were explained,

confidentiality was ensured, and informed consent was taken. The investigator

ko
collected the socio-personal data and health-seeking behaviour regarding reproductive

tract infections using a semi-structured interview schedule, through direct interview

hi
and record review. After that presence of reproductive tract infections was assessed

oz
by using RTI symptoms checklist. It was taken 25-30 minutes for data collection from

each participant. Daily the data were collected from 5-6 participants. The study

-K
subjects were very cooperative and willing to answer the questions. Researcher

enquired about the treatment taken by the participant with symptoms of RTI and

g
emphasized the importance of treatment and completing the course of treatment. The

sin
relevant information regarding the presence of RTI was handed over to JPHN,

subcentre Kancheeraparamba for further management.

ur
Plan for data analysis
fN

The data will be analysed using descriptive and inferential statistics․

 Socio personal variables of women in the reproductive age group would be

eo

analysed by frequency and percentage.

 Health seeking behaviour of women in the reproductive age group regarding

leg

reproductive tract infections would be analysed by frequency and percentage.

 Prevalence of reproductive tract infection among women in the reproductive

ol

age group would be analysed by frequency and percentage.

 Association between reproductive tract infections and health seeking

.C

behaviour among women in the reproductive age group would be analysed by

chi-square test․
vt

 Association between health seeking behaviour regarding reproductive tract

Go

infections and selected variables would be analysed by chi-square test․

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CHAPTER 4

ANALYSIS AND INTERPRETATION

ko
hi
Section I: Socio personal and clinical variables of women in the

reproductive age group.

oz
Section II: Health seeking behaviour of women in the reproductive age

-K
group regarding reproductive tract infections.

Section III: Prevalence of reproductive tract infection among women in the

reproductive age group.

g
Section IV: Association between reproductive tract infections and health
sin
seeking behaviour among women in the reproductive age

group.
ur
Section V: Association between health seeking behaviour of women in the
fN

reproductive age group and selected variables

eo
leg
ol
.C
vt
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CHAPTER 4

ANALYSIS AND INTERPRETATION

ko
This section deals with analysis and interpretations of the data to assess the

hi
health seeking behaviour of women in the reproductive age group regarding

reproductive tract infections. The data were collected from 200 samples.

oz
The collected data were analysed based on the objectives of the study using

-K
descriptive and inferential statistical analysis with the help of 18th version of SPSS.

The findings of the study are presented under the following headings.

g
Section I: Socio personal and clinical variables of women in the reproductive age

group.
sin
Section II: Health seeking behaviour of women in the reproductive age group
ur
regarding reproductive tract infections.
fN

Section III: Prevalence of reproductive tract infection among women in the

reproductive age group.

eo

Section IV: Association between reproductive tract infections and health seeking

behaviour among women in the reproductive age group.

leg

Section V: Association between health seeking behaviour of women in the

reproductive age group and selected variables.

ol

Section I: Socio personal and clinical variables of women in the reproductive age
.C

group

This section deals with frequency and percentage distribution of women in the
vt

reproductive age group based on socio personal and clinical variables. Socio personal
Go

variables including age, education, occupation, family income, religion, type of

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family, marital status, parity, information regarding reproductive tract infections and

source of information. Clinical variables include history of chronic illness, previous

ko
history of RTI, recurrence of RTI symptoms and family history of RTI. The findings

of the study are presented in figures and tables.

hi
Table 1

oz
Distribution of participants based on age, education, occupation and monthly
family income

-K
(n=200)
Socio personal variables f %
Age in years
18-27 72 36.0

g
28-35 63 31.5
>35
Education
Primary
sin 65

38
32.5

19.0
Secondary 49 24.5
ur
Higher secondary 95 47.5
Degree and above 15 7.50
fN

Professional/technical 3 1.50
Occupation
Home maker 135 67.5
eo

Self-employed 4 2.00
Private employee 26 13.0
Government employee 3 1.50
Students 32 16.0
leg

Monthly family income

<Rs 1500 105 52.5
Rs 1501-6000 82 41.0
ol

Rs 6001-10000 6 3.00
>Rs 10000 7 3.50
.C

Table 1 shows that 36% of participants belonged to the age group of 18-27
years,47.5% participants have higher secondary education,67.5% participants were
vt

homemakers and 52.5% of them have monthly income of <Rs 1500/.

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Table 2
Distribution of participants based on religion, type of family, marital status and

ko
parity
(n=200)
Socio personal variables f %

hi
Religion

oz
Islam 149 74.5
Hindu 51 25.5

-K
Type of family
Nuclear family 125 62.5
Extended family 73 36.5
Joint family 2 1.00

g
Marital status
Married
Unmarried
sin 148
25
74.0
12.5
Widow 22 11.0
ur
Divorced/separated 5 2.50
Parity
fN

Nullipara 37 18.5
1 59 29.5
eo

2 67 33.5
3 12 6.00
>3 25 12.5
leg

Table 2 shows that 74.5% of the participants were belonged to Islam religion,
ol

62.5% participants belong to nuclear family,74% participants were married and 18.5

% participants were nullipara.

.C
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Table 3

Distribution of participants based on previous information on RTI and source of

ko
information

hi
(n-=200)

oz
Socio personal variables f %

-K
Information on RTI

Yes 152 76.0

g
No 48 24.0

Source of information (n=152)

Mass media
sin 97 48.5
ur
Anganwadi worker 82 41.0

Family member 60 30.0

fN

Friends 24 12.0

Health care workers 20 10.0

eo

Asha worker 14 7.0

leg

Table 3 reveals that 76% participants have information regarding reproductive

tract infections, among them 48.5% obtained information from mass media and 41 %

obtained information from an anganwadi worker.

ol
.C
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Table 4

Distribution of participants based on history of chronic illness, type of illness and

ko
treatment taken

hi
(n=200)

oz
Clinical variables f %

-K
History of chronic illness

Yes 31 15.5

g
No 169 84.5

Type of illness (n=31)

Diabetes mellitus
sin 17 54.8
ur
Hypertension 11 35.4

Asthma 2 6.4
fN

Arthritis 1 3.2

Treatment taken for the illness(n=31)

eo

Yes 31 100
leg

Table 4 shows that 15.5% of the participants have history of chronic illness

and among them, 54.8% of them are diabetic and 35.4% are hypertensive and all of
ol

them are taking treatment for the same.

.C
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Distribution of participants based on previous history of RTI shown in figure 3

ko
66.5

hi
70
60

oz
50 33.5
40
Percentage

-K
30
20
10

g
0
Yes No

sin
Previous history of RTI
ur
Figure [Link] of participants based on previous history of RTI (n=200)

Figure 3 Shows that 66.5% (133) of the participants had previous history of
fN

RTI.
eo
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ol
.C
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Table 5
Distribution of participants based on previous history of RTI symptoms,
duration of illness, treatment, mode of treatment and diagnostic tests.

ko
(n=133)

Clinical variables f %
RTI symptoms

hi
Vaginal discharge with foul smell 70 52.60
Vaginal discharge with colour changes 24 18.00

oz
Lower abdominal pain 41 30.00
Vaginal itching 21 15.78
Duration of illness

-K
Last for days 34 25.56
Last for weeks 55 41.35
Last for months 44 33.09
Sought treatment
Yes 123 92.50

g
No 10 7.50
Mode of treatment (n=123)
Home remedies
Self-treatment
Allopathy
sin 19
1
62
15.45
0.81
50.40
Homeopathy 41 3 3.34
ur
Diagnostic test done

Yes 59 44.36
fN

No 74 55.64
Type of diagnostic tests (n=59)
Urine test 55 107.2
Blood test 18 30.50
eo

Ultrasonography 5 8.47

Table 5 shows that among 133 participants, 52.6% have history of vaginal
leg

discharge with foul smell as symptom, 92.5% sought treatment. History of RTI

symptoms lasts for weeks in 41.35% participants, 50.4% of them took allopathy as
ol

treatment. 44.36% did diagnostic test with regard to RTI and among them 107.2%
.C

participants done urine test.

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Table 6

Distribution of participants based on recurrence of RTI symptoms, treatment

ko
taken

hi
(n=133)

oz
Clinical variables f %

History of recurrence of RTI symptoms

-K
Yes 41 30.8

No 92 69.2

g
Treatment for recurrence of RTI(n=41)

sin
Treatment from health care facility 26 63.4

Self-treatment 6 14.6
ur
Home remedies 4 9.8
fN

No treatment taken 5 12.2

eo

Table 6 shows that 30.8% have history of recurrence of RTI symptoms,

among them 63.4% sought treatment from health care facility and 12.2% not taken
leg

any treatment.
ol
.C
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Table 7

Distribution of participants based on family history of RTI

ko
(n=200)

Clinical variables f %

hi
Family history of RTI

oz
Yes 49 24.5

No 151 75.5

-K
RTI to family member (n=49)

Mother 16 32.7

g
Daughter 9 18.4

Husband

Siblings
sin 19

10
38.8

5.0
ur
Treatment taken by family member

Yes 39 79.6
fN

No 10 20.4
eo

Table 7 shows that 24.5 % have family history of RTI, among them 38.8%

have history of RTI to their husband and 20.41% of family members were not taken
leg

treatment.

Section II: Health seeking behaviour of women in the reproductive age group
ol

regarding reproductive tract infections.

.C

This section deals with health seeking behaviour of women in reproductive

age group regarding reproductive tract infections, which consists of measures

vt

followed to maintain reproductive health, menstrual hygiene, sexual hygiene and

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treatment taken.

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Health seeking behaviour of women were categorised into low, moderate,

high health seeking behaviour and total score for health seeking behaviour ranges

ko
from 0-11 for married and 0-10 for unmarried women. Score is categorised in to

hi
Married Unmarried

oz
Good >8 Good >7

-K
Moderate 5-8 Moderate 5-7

Poor <5 Poor <5

g
Table 8
sin
Distribution of participants based on health seeking behaviour
ur
(n=200)
fN

Health seeking behaviour f %

eo

Good 58 29.0

Moderate 142 71.0

Poor 0 00.0
leg
ol

Table 8 shows only 29% participants maintaining good health seeking

behaviour and 71% were maintaining moderate health seeking behaviour.

.C
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Table 9

Distribution of participants based on measures followed to maintain

ko
reproductive health

hi
(n=200)

oz
Measures followed to maintain reproductive health f %

-K
Measures followed to maintain reproductive health

Personal hygiene 200 100.0

g
Menstrual hygiene 200 100.0

Sexual hygiene sin

Screening of reproductive health problems
136

51.0
68.0

25.50
ur
fN

Table 9 shows 68% of participants maintaining sexual hygiene and only

25.5% of the participants done screening for their reproductive health problems.100%
eo

participants were following personal and menstrual hygiene.

leg
ol
.C
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Table 10

Distribution of participants based on health seeking behaviour with respect to

ko
menstrual hygiene and sexual hygiene

hi
(n=200)

oz
Menstrual hygiene and sexual hygiene f %

Material used for absorbing menstrual blood

-K
Cotton clothes 190 95.0

Sanitary napkins 44 22.0

g
Changing of pads/clothes

Every 6th hourly

More than 6 hours

sin 155

45
77.5

22.5
ur
Washing and drying of cotton clothes in sunlight(n=190)

Always 177 93.0

fN

Sometimes 13 7.0

Reuse of cotton clothes in each menstrual cycle (n=190)

eo

Only in one cycle 32 16.8

Two cycles 42 22.2

leg

Three cycles 60 31.5

More than 3 cycles 56 29.5

ol

Intercourse during reproductive tract infection period (n=148)

.C

Yes 43 29.0

No 105 71.0
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Table 10 shows that 95% participants were using cotton clothes as adsorbents

during menstrual days, 77.5% of them were used to change the pad/ clothes every 6th

ko
hourly, 31.5% of participants reuse the same cotton clothes in three menstrual cycles.

Among 148 married participants, 29% of have history of intercourse during

hi
reproductive tract infection period.

oz
Table 11

-K
Distribution of participants based on health seeking behaviour with respect to

discussing symptoms with others if they have RTI

g
(n=200)

Health seeking behaviour

sin f %
ur
Discuss symptoms of RTI with others
fN

Yes 74 37.0

No 126 63.0
eo

Discuss the symptom of RTI with

whom(n=74)
leg

Husband 71 94.9

Family member 56 72.9

Health workers 11 14.8

ol

Friends 10 13.5
.C

Table 11 reveals that 37% participants will discuss their symptoms with others
vt

if they have RTI, 94.9% will discuss with husband and 72.9% with family members.
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Distribution of participants based on history of taking self-medication to treat

reproductive tract infections shown in figure 4

ko
hi
23.5%

oz
-K
Yes

No

g
76.5%

sin
History of taking self medication
ur

Figure 4. Distribution of participants based history of taking self-medication to

fN

treat RTI (n=133)

eo

Figure 4 shows that 23.5% of participants taken self-medication to treat RTI.

leg
ol
.C
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Table 12

Distribution of participants based on health seeking behaviour with respect to

ko
treatment taken for previous RTI

hi
(n=133)

oz
Health seeking behaviour f %

-K
Took treatment to previous RTI

Within a day 16 12.0

g
Within two days 20 15.0

Within a week

Within one month

sin 32

37
24.0

27.0
ur
Not taken treatment 28 22.0

Completed course of treatment

fN

Yes 108 81.0

No 25 19.0
eo

Reason for not completing the treatment(n=25)

Financial problems 12 48.0

leg

Shame 13 52.0
ol

Table 12shows 27% took treatment for their previous RTI symptoms within
.C

one month, 81% completed their course of treatment, 52% of them have shame as a

reason for not completing their treatment.

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Distribution of participants based on reason for delaying health care for RTI shown in

figure 5

ko
hi
69
70

oz
60

50

-K
40 24
25
30
Percentage

g
20 7.5
10

0
Shame
sin
Lack of Lack of Financial
awareness privacy problem
ur

Reason for delaying health care for RTI

fN

Figure [Link] of participants based on reason for delaying health care for
eo

RTI (n=133)

Figure 5 shows that the reason for delaying health care for RTI was shame for
leg

69% participants and for 25% it was lack of awareness.

ol
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Distribution of participants based on health seeking behaviour with respect for

treatment taking for present RTI shown in figure 6

ko
53.5

hi
54

oz
52

50

-K
46.5
Percentage

48

46

g
44

42
Yes
sin No

Taking treatment for present RTI

ur
fN

Figure 6. Distribution of participants based on health seeking behaviour with

respect to taking treatment for present RTI (n=71)

eo

Figure 6 shows that 53.5% of the participants not taking treatment for present

RTI symptoms.
leg
ol
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Distribution of participants based on treatment preference shown in figure 7

3.50% 2%

ko
hi
22.50%

oz
Government
hospital

-K
Private hospital

Self treatment

g
Traditional
sin healers
ur

Treatment preference
fN
eo

Figure [Link] of participants based on treatment preference (n=200)

Figure 7 shows that 72% of participants treatment preference was government

leg

hospitals.
ol
.C
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Section III: Prevalence of reproductive tract infections among women in

the reproductive age group.

ko
This section deals symptoms of reproductive tract infections. Total score for

hi
symptom check list is 18. Based on the score the prevalence of RTI symptoms were

arbitrarily classified in to 3 categories. High prevalence (>14), moderate prevalence

oz
(9-14) and low prevalence (<9).

-K
Findings were presented in figure 8, table 13 and 14

Distribution of participants based on presence of symptoms of RTI, shown in figure 8

g
sin
ur
fN

35.5% Yes
No
64.5%
eo
leg

Presence of symptoms of RTI

ol
.C

Figure [Link] of participants based on presence of symptoms of RTI

(n=200)
vt

Figure 8 shows that 35.5% (71) of participants have symptoms of RTI.

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Table 13

Distribution of participants based on RTI symptoms

ko
(n=71)

hi
oz
RTI Symptoms f %

Abnormal vaginal discharge with foul smell 34 47.9

-K
Vaginal discharge with colour changes 28 39.5

Excessive amount of vaginal discharge 62 87.3

g
Fever 24 33.8

Lower abdominal pain

Back ache
sin 20

21
28.2

29.6
ur
Dysmenorrhoea 28 39.4

Vaginal itching 43 60.5

fN

Heavy menstrual bleeding 16 22.5

eo

Dyspareunia 14 19.7

Dysuria 28 39.4

Inguinal bubo 1 1.4

leg

Bleeding after intercourse 3 4.2

ol

Table13 shows that 87.3% of the participants have excessive amount of

.C

vaginal discharge and 60.5% of them have vaginal itching.

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Table 14

Distribution of participants based on prevalence of RTI symptoms

ko
(n=71)

hi
Prevalence of RTI symptoms f %

oz
High (>14) 0 00.0

-K
Moderate (9-14) 23 33.0

Low (<9) 48 67.0

g
sin
Table 14 shows 33% of participants have moderate prevalence of RTI

symptoms and none of them have high prevalence of RTI.

ur
Section IV: Association between reproductive tract infection and health
fN

seeking behaviour among women in the reproductive age group

This section deals with the association between reproductive tract infections and
eo

health seeking behaviour. To find out the association following null hypothesis was

stated.
leg

H01: There is no significant association between reproductive tract infections and

health seeking behaviour among women in the reproductive age group.

ol

Inorder to test the hypothesis, chi-square test is used at 0.05 level of

.C

significance and findings were presented in table 15.

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Table 15

Association between prevalence of reproductive tract infection and health

ko
seeking behaviour among women in the reproductive age group.

hi
(n=71)

oz
Prevalence of Health seeking behaviour χ2 df p value

RTI

-K
Poor Moderate Good

f(%) f(%) f(%)

g
Low

Moderate
0(0.0)

0(0.0)
sin
42(59.15)

23(32.40)
4(5.65)

2(2.80) 0.488 1 0.488

Good 0(0.0) 0(0.0) 0(0.0)

ur
fN

Table 15 shows that computed “p” value for the association between health
eo

seeking behaviour and reproductive tract infection symptoms greater than 0.05 and

hence null hypothesis is accepted. So it can be interpreted that there is no significant

leg

association between health seeking behaviour and presence of reproductive tract

infection.
ol

Section V: Association between health seeking behaviour regarding reproductive

.C

tract infections and selected variables.

This section deals with association between health seeking behaviour and
vt

selected variables. Selected variables include socio personal and clinical variables of
Go

women in the reproductive age group. Socio personal variables including age,

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75

de
education, occupation, family income, religion, type of family, marital status, parity,

information regarding reproductive tract infections and source of information. Clinical

ko
variables include history of chronic illness, previous history of RTI, recurrence of RTI

symptoms and family history of RTI. Inorder to find out the association between

hi
health seeking behaviour and selected variables, the following null hypothesis was

oz
stated.

-K
H02: There is no significant association between health seeking behaviour of women

in reproductive age group regarding reproductive tract infections and selected

variables.

g
sin
In order to test the hypothesis, chi-square test is used at 0.05 level of

significance and findings were presented in table 16 and 17.

ur
fN
eo
leg
ol
.C
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Table 16

Association between health seeking behaviour regarding reproductive tract

ko
infections and selected socio personal variables.

hi
(n=200)

Variables Health seeking behaviour χ2 df p value

oz
Poor Moderate Good
f(%) f(%) f(%)

-K
Age in years

18-27 46(23.0) 26(13.0) 5.293 2 0.071

28-35 45(22.5) 18(9.00)

g
>35

Education
sin
53(26.5) 12(6.00)

Primary 33(16.5) 5(2.5) 5.738 4 0.220

ur
Secondary 35(17.5) 14(7.0)
fN

Higher secondary 63(31.5) 32(16.0)

Degree & above 11(5.50) 4(2.00)

eo

Professional/technical 2(1.00) 1(0.50)

Occupation
leg

Home maker 105(52.5) 30(15.0) 11.186 4 0.025*

Self-employee 4(2.00) 0(0.0)

ol

Private employee 15(7.50) 11(5.50)

Government employee 1(0.50) 2(1.00)

.C

Students 19(9.50) 13(6.50)

vt

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Monthly family income
<Rs 1500 82(41.0) 23(11.5) 4.228 3 0.238

ko
Rs 1501-6000 53(26.5) 29(14.5)
Rs 6000-10000 5(2.50) 2(1.00)
>Rs 10000 4(2.00) 4(2.00)

hi
Religion
Islam 110(55.0) 39(19.5) 0.966 1 0.326

oz
Hindu 34(17.0) 17(8.50)
Family type

-K
Nuclear family 91(45.5) 34(17.0) 0.983 2 0.612
Extended family 51(25.5) 22(11.0)
Joint family 2(1.00) 0(0.0)

g
Marital status
Married
Unmarried
sin
106(53.0)
13(6.50)
44(22.0)
12(6.00)
10.817 3 0.013*

Widow 20(10.0) 2(1.00)

ur
Divorced/separated 5(1.0) 0(0.0)
Parity
fN

Nullipara 24(12.0) 13(6.50)

1 38(19.0) 21(10.5) 10.535 4 0.032*

eo

2 48(24.0) 19(9.50)
3 10(5.00) 2(1.00)
>3 24(12.0) 1(0.50)
leg

Information on RTI

Yes 106(53.0) 46(23.0) 19.886 1 0.030*

No 37(18.5) 1(5.00)
ol

*Significance at <0.05 level

.C

Table 16 depicts that computed “p” value for the association between health
vt

seeking behaviour with selected variables such as parity, marital status and occupation
Go

are less than 0.05 level and null hypothesis is not accepted for these variables. So, it

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can be interpreted that there is a significant association between health seeking

behaviour and occupation, marital status and parity of women in reproductive age

ko
group. Since the “p” value is greater than 0.05 for variables like age, education,

income, religion and source of information, the null hypothesis is accepted for these

hi
variables and it can be interpreted that there is no association between health seeking

oz
behaviour and other socio personal variables like age, education, income, religion,

family type and prior information.

-K
Table 17

Association between health seeking behaviour regarding reproductive tract

g
infections and clinical variables.

Clinical variables
sin
Health seeking behaviour χ2 df p
ur
value

Poor Moderate Good

fN

f(%) f(%) f(%)

History of chronic illness

eo

Yes 26(13.0) 5(2.50) 2.564 1 0.109

No 118(59.0) 51(25.5)
leg

Type of illness

Diabetes mellitus 16(51.60) 1(3.20) 9.612 4 0.047*

ol

Hypertension 8(25.92) 3(9.68)

.C

Asthma 1(3.200) 1(3.20)

Arthritis 0(0.00) 1(3.20)

vt

Treatment taken for illness

Yes 25(80.65) 6(19.35) 3.174 2 0.205

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ko
Previous history of RTI
Yes 91(45.50) 42(21.0) 2.522 1 0.112

hi
No 53(26.50) 14(7.00)
Duration of illness

oz
Last for days 18(13.50) 16(12.03) 4.921 3 0.178
Last for weeks 34(26.00) 21(15.64)

-K
Last for months 35(26.13) 9(6.700)
Sought treatment
Yes 82(61.62) 41(30.83) 2.663 1 0.103
No 9(6.80) 1(0.750)

g
Mode of treatment
Home remedies
Self treatment
sin
18(15.00)
1(0.810)
1(0.810)
0(0.00)
11.929 5 0.036*

Allopathy 39(31.00) 23(19.00)

ur
Homeopathy 26(21.00) 15(12.38)
Diagnostic test done
fN

Yes 42(31.58) 17(12.78) 0.012 1 0.913

No 49(35.32) 25(20.32)
eo

History of reccurence of RTI

Yes 27(20.30) 14(10.52) 0.856 1 0.356
No 66(49.63) 26(19.55)
leg

Treatment for recurrence

Treatment from health 14(34.0) 12(29.0) 10.6 4 0.031*
care facility
ol

Self treatment 2(5.00) 4(9.80)

Home remedies 2(5.00) 2(5.00)
.C

No treatment 4(9.80) 1(2.40)

Family history of RTI
vt

Yes 35(17.50) 14(7.00) 3.93 2 0.141

No 104(52.0) 47(23.50)
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Treatment taken by

ko
family member

Yes 29(60.0) 10(20.0) 2.506 1 0.113

hi
No 5(10.0) 5(10.0)

oz
*Significance at <0.05 level

-K
Table 17 depicts that computed “p” value for the association between health

seeking behaviour with selected clinical variables such as type of chronic illness,

mode of treatment to previous RTI, treatment for recurrence are less than 0.05 level

g
and null hypothesis is not accepted for these variables. So, it can be interpreted that
sin
there is a significant association between health seeking behaviour and type of chronic

illness, mode of treatment to previous RTI and to recurrence of RTI among women in
ur
reproductive age group. Since the p value is greater than 0.05 for variables like history
fN

of chronic illness and treatment taken, previous history of RTI ,its treatment taken,

duration of illness, family history of RTI and treatment taken by family member, so
eo

the null hypothesis is accepted for these variables and it can be interpreted that there

is no association between health seeking behaviour and other clinical variables like

history of chronic illness and treatment taken, previous history of RTI, its treatment
leg

taken, duration of illness, family history of RTI and treatment taken by family

member.
ol
.C
vt
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CHAPTER 5

RESULTS

ko
hi
Objectives

oz
Hypotheses

Results

-K
g
sin
ur
fN
eo
leg
ol
.C
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CHAPTER 5

RESULTS

ko
This chapter deals with the major findings of the study. The study was under

hi
taken to assess the health seeking behaviour of women in the reproductive age group

oz
regarding reproductive tract infections.

Objectives

-K
1. Assess the health seeking behaviour of women in the reproductive age group

regarding reproductive tract infections.

g
2. Find out the prevalence of reproductive tract infections among women in the

reproductive age group.

sin
3. Find out the association between reproductive tract infections and health
ur
seeking behaviour among women in the reproductive age group.
fN

4. Find out the association between health seeking behaviour of women in the

reproductive age group regarding reproductive tract infections and selected

eo

variables.

Hypotheses
leg

H1: There is a significant association between health seeking behaviour and

reproductive tract infections among women in the reproductive age group.

ol

H2: There is a significant association between health seeking behaviour regarding

.C

reproductive tract infections with selected socio personal variables among women in

the reproductive age group.

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Results

The major findings of the present study are discussed among the following

ko
headings

hi
Section I: Socio personal and clinical variables of women in the reproductive age

oz
group.

Section II: Health seeking behaviour of women in the reproductive age group

-K
regarding reproductive tract infections.

Section III: Prevalence of reproductive tract infection among women in the

g
reproductive age group.

sin
Section IV: Association between reproductive tract infections and health seeking

behaviour among women in the reproductive age group.

ur
Section V: Association between health seeking behaviour regarding reproductive
fN

tract infections and selected variables.

Section I: Socio personal and clinical variables of women in the reproductive age
eo

group

 Among 200 participants, 36% of participants belonged to the age group of 18-
leg

27 years,47.5% women have higher secondary education, 67.5% participants

were homemakers and 52.5% of them have monthly income of < Rs 1500/.
ol

 Among 200 participants, 74.5% of the participants were belonged to Islam

.C

religion, 62.5% participants belong to nuclear family, 74% participants were

married, and 18.5 % participants were nullipara.

vt
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 Among women, 76% participants have information regarding reproductive

tract infections, among them 48.5% obtained information from mass media

ko
and 41% obtained information from an anganwadi worker.

 Around 15.5% of the participants have history of chronic illness and among

hi
them 54.8% of them are diabetic and all of them are taking treatment for the

oz
same.

 Among 200 participants, 66.5% (133) of the participants had previous history

-K
of RTI.

 Among 133 participants 52.6% have history of vaginal discharge with foul

g
smell as symptom, 92.5% sought treatment. History of RTI symptoms lasts for

sin
months in 50.4% people, 44.36% of them took allopathy as treatment. 44.36%

did diagnostic test with regard to RTI and among them 107.2% participants
ur
done urine test.

 Around 30.82% have history of recurrence of RTI symptoms, among them

fN

63.41% sought health care facility, about 24.5 % have family history of RTI,

among them 38.77% have history of RTI to their husband and 20.41% of
eo

family members were not taken treatment.

leg

Section II: Health seeking behaviour of women in the reproductive age group

regarding reproductive tract infections.

ol

 Around 68% of participants maintaining sexual hygiene and only 25.5%

participants done screening for their reproductive health problems. All the
.C

participants were following personal and menstrual hygiene.


vt

95% participants were using cotton clothes during menstrual days, 77.5 % of

them were used to change the pad/ clothes every 6th hourly, 31.57 % of
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participants reuse the same cotton clothes in three menstrual cycles. Among

148 married participants 29% of have history of intercourse during RTI

ko
infection period.

 37% participants will discuss their symptoms with others if they have RTI,

hi
94.9% will discuss with husbands and 72.97% with family members.

oz
 Around 23.5% of participants taken self-medication to treat RTI.

 Among 133 participants,21% took treatment for their previous RTI symptoms

-K
within one month,82% completed their course of treatment, 52% of them have

shame as a reason for not completing treatment.

g
 72% of participants treatment preference was government hospital.

 sin
Reason for delaying health care for RTI was shame for 69% and for 25% it

was lack of awareness.

ur
 Out of 200 participants, 29% participants maintaining good health seeking

behaviour.
fN

 53.5% of the participants not taking treatment for their present RTI symptoms.
eo

Section III: Prevalence of reproductive tract infections among women in the

reproductive age group.

leg

 Among 200 participants, 35.5% (71) of participants have RTI symptoms.

 Majority (87.3%) of them have excessive amount of vaginal discharge and

ol

55% of them have vaginal itching.


.C

33% of participants have moderate prevalence of RTI symptoms.

vt
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Section IV: Association between reproductive tract infection and health seeking

behaviour among women in the reproductive age group

ko
It is clearly found that computed “p” value for the association between health

hi
seeking behaviour and reproductive tract infection symptoms greater than 0.05 level

of significance. So, it can be interpreted that there is no significant association

oz
between health seeking behaviour and reproductive tract infection.

-K
Section V: Association between health seeking behaviour regarding reproductive

tract infections and selected variables.

g
It is evident that computed “p” value for the association between health

sin
seeking behaviour with selected variables such as parity, marital status and occupation

are less than 0.05 level of significance. So, it can be interpreted that there is a
ur
significant association between health seeking behaviour and occupation, marital

status and parity of women in reproductive age group. Since the p value is greater
fN

than 0.05 level of significance for variables like age, education, income, religion and

source of information and it can be interpreted that there is no association between

eo

health seeking behaviour and other socio personal variables like age, education,

income, religion, family type, and prior information at 0.05 level of significance.
leg

The study also found that computed “p”value for the association between

health seeking behaviour with selected clinical variables such as type of chronic
ol

illness, mode of treatment to previous RTI, treatment for recurrence are less than 0.05
.C

level of significance. So, it can be interpreted that there is a significant association

between health seeking behaviour and type of chronic illness, mode of treatment to
vt

previous RTI and to recurrence of RTI among women in reproductive age group.
Go

Since the p value is greater than 0.05 for variables like history of chronic illness and

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treatment taken, previous history of RTI, its treatment taken, duration of illness,

family history of RTI and treatment taken by family member, so the null hypothesis

ko
was accepted for these variables and it can be interpreted that there is no association

between health seeking behaviour and other clinical variables like history of chronic

hi
illness and treatment taken, previous history of RTI, its treatment taken, duration of

oz
illness, family history of RTI and treatment taken by family member.

-K
This chapter deals with the result of data collected on health seeking behaviour

of women in the reproductive age group regarding reproductive tract infection among

200 women. The stated major findings of the study were consistent with objectives

g
framed for the study. This chapter helped the investigator to interpret the study
sin
findings and equipped the investigator for further discussion.
ur
fN
eo
leg
ol
.C
vt
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CHAPTER 6

DISCUSSION, SUMMARY AND CONCLUSION

ko
hi
oz
Discussion

Summary

-K
Conclusion

Nursing implication

g
Limitation sin
Recommendation
ur
fN
eo
leg
ol
.C
vt
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CHAPTER 6

DISCUSSION, SUMMARY AND CONCLUSION

ko
This chapter presents the discussions, summary, conclusions drawn,

hi
implications, limitations, suggestions and recommendations. The purpose of the study

oz
was to assess the health seeking behaviour of women in the reproductive age group

regarding reproductive tract infection in selected wards of Kondotty Municipality of

-K
Malappuram District. A cross sectional survey design was used in this study. The data

were collected from 200 samples using the purposive sampling technique.

g
Discussion

sin
The study findings are discussed in detail about the findings of other studies

which the investigator reviewed.

ur

The present study reveals that 33.5% (71) of women have symptoms of RTI.
fN

Out of that, 46.5% took treatment for symptoms of RTI. This is consistent with the

findings of the study on the prevalence of reproductive tract infection symptoms and
eo

treatment seeking behaviour among women in India, showing that 35.5% (98/276) of

women reported symptoms suggestive of RTI, among that 57.1% sought treatment for
leg

their RTI symptoms.11

The present study shows that 76% of participants have information regarding
ol

reproductive tract infections. This is consistent with the findings of the study on
.C

female reproductive tract infections: understandings and care seeking behaviour

among women of reproductive age in Lagos, Nigeria. It shows most of the

vt

respondents (77.2%) had heard of RTIs. 47

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The present study reveals that 66.5% of participants had a previous history of

RTI, out of that 52.6% have a history of vaginal discharge with a foul smell as a

ko
symptom and 91.73% sought treatment. This is consistent with the findings of the

study on the prevalence of reproductive tract infection symptoms and treatment-

hi
seeking behaviour among women, which shows that 35.5% of women reported

oz
symptoms suggestive of RTI, 69.4% had foul smelling vaginal discharge as symptom

and 57.1%with RTI symptoms sought treatment for their problem. 11

-K
The present study shows, that 87.3% of the participants have an excessive

amount of vaginal discharge and 60.5% of them have vaginal itching as an RTI

g
symptom. This is consistent with the study findings on the prevalence of RTI/STI
sin
among women of reproductive age in district Sundergarh (Orissa), shows that the

commonest symptom of RTI/STD was vaginal discharge (91%) followed by backache

ur
(76%), lower abdominal pain (64%), vulval itching (51%) and burning during

urination (34%).41
fN

The present study found that 29% of participants maintained good health
eo

seeking behaviour and 71% were maintaining moderate health seeking behaviour and

no one have poor health seeking behaviour. This was contrary to findings in the study
leg

on prevalence and health seeking behaviour among women of the reproductive age

group. It shows that the majority of subjects (82%) were having satisfactory health
ol

seeking behaviour whereas only 18% of subjects were found to have non- satisfactory

health seeking behaviour.51

.C

The present study reveals that 72% of participants treatment preference was
vt

government hospitals. This was consistent with the study findings on the prevalence

of reproductive tract infection symptoms and treatment seeking behaviour among

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women. It shows among 98 women who suffered from RTI symptoms, 66% preferred

a government hospital for seeking treatment. 11

ko
The present study shows that 37 % of participants will discuss their symptoms

hi
with others if they have RTI, and among them, 94.9% will discuss with their husbands

and 72.97 % with family members. This result is contrary to the result of study

oz
findings on the prevalence of reproductive tract infection symptoms and treatment-

-K
seeking behaviour among women, which shows that 72.5%did not share/disclose the

symptoms with family members/friends. 11

The present study indicates the reason for delaying health care for RTI was a

g
sin
shame for 69% of participants and for 25% it was a lack of awareness. This was in

concordance with the study findings on knowledge, attitude and treatment seeking

behaviour for reproductive tract infections (RTI) and sexually transmitted infections
ur
(STIs) among married women attending Suraksha Clinic, Madhya Pradesh, which
fN

shows that the main barriers to seeking treatment were embarrassment and only

considering the symptoms to be a minor disease that did not warrant medical
eo

attention.55

The present study found that, a significant association between health seeking
leg

behaviour and occupation, information on RTI, parity and marital status of the

women. This was consistent with the study findings on healthcare seeking behaviour
ol

for symptoms of reproductive tract infections among rural married women in Tamil
.C

Nadu, shows that health care seeking behaviour showed a significant association with

occupational status of women.49 The present study also reveals, that there is no
vt

significant association between health seeking behaviour and education, this was

contrary with the findings on a comparative study of the prevalence of RTI/STI

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symptoms and treatment seeking behaviour among the married women in urban and

rural areas of Delhi, shows treatment seeking behaviour increased with the

ko
educational status of the study subjects.56

hi
The present study also shows a significant association between health seeking

behaviour and information on RTI, it was in concordance with the study findings on

oz
reproductive tract infections and treatment seeking behaviour among married

-K
adolescent women 15-19 years in India, shows awareness about RTIs/STIs are

significant determinants of care seeking behaviour among women.43

The present study identified that there is no significant association between

g
sin
health seeking behaviour and monthly family income, it was contrary to the study

findings on reproductive tract infections: prevalence and health seeking behaviour

among women of reproductive age group. The findings of this study reveal that
ur
income was found to have a statistically significant association with the health
fN

seeking behaviour.51

Summary
eo

The present study aimed to assess the health seeking behaviour of women in

the reproductive age group regarding reproductive tract infections, in selected wards
leg

of Kondotty Municipality, Malappuram district. The objectives of the study were to

assess the health seeking behaviour of women in the reproductive age group regarding
ol

reproductive tract infections, find out the prevalence of reproductive tract infections
.C

among women in the reproductive age group, find out the association between

reproductive tract infections and health seeking behaviour among women in the
vt

reproductive age group and find out the association between health seeking behaviour
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of women in the reproductive age group regarding reproductive tract infections and

selected variables.

ko
The study was based on revised health promotion model by Nola J Pender. A

hi
non-experimental approach was used for the study. The research design selected was

a cross sectional survey. The sample size was 200 women in the reproductive age

oz
group. The tool used for data collection was semi structured interview schedule to

-K
identify the health seeking behaviour of women in the reproductive age group

regarding reproductive tract infections and a symptoms checklist to assess the

symptoms of reproductive tract infections among women in the reproductive age

g
group. The tool was validated by 15 experts and was found to be feasible and reliable.
sin
The reliability of the tools was tested by the test-retest method and analysed by

intraclass correlation coefficient. The techniques used for data collection were
ur
self report interview and record reviews.
fN

A pilot study was conducted among 20 women from 09.02.2022 to 14.02.2022

and the study was found feasible. The actual study was conducted from 28.02.2022 to
eo

02.04.2022. The investigator selected 200 samples according to inclusion criteria

through purposive sampling. Among 200 participants, seventy one were found to have
leg

symptoms of RTI. Among them, 46.5% were taking treatment for RTI symptoms, and

the rest of the participants were not taking treatment. Only 29% of participants
ol

maintained good health seeking behaviour and 71% were maintaining moderate health

seeking behaviour. Among 133 participants with RTI, 87.3% of the participants have
.C

an excessive amount of vaginal discharge and 60.5% of them have vaginal itching.

Among participants with symptoms of RTI, 33% of participants have a moderate

vt

prevalence of RTI symptoms and none of them have a high prevalence of RTI.
Go

Analysis of the study revealed that there was no significant association between health

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seeking behaviour and reproductive tract infection and the study also found that there

was a significant association between health seeking behaviour and occupation,

ko
marital status, parity, type of chronic illness, mode of treatment to previous RTI and

recurrence of RTI among women in reproductive age group.

hi
Conclusion

oz
The present study was conducted to assess the health seeking behaviour of

-K
women in the reproductive age group regarding reproductive tract infections, in

selected wards of Kondotty Municipality, Malappuram district. It was found that

among 200 participants, 71% were found to have symptoms of RTI and among them,

g
sin
46.5% were taking treatment for RTI symptoms. Only 29% of participants maintained

good health seeking behaviour and 71% were maintaining moderate health seeking

behaviour and among 66.5% of participants with a previous history of RTI, 87.3% of
ur
the participants have an excessive amount of vaginal discharge and 60.5% of them
fN

have vaginal itching. It was found that 33% of participants have a moderate

prevalence of RTI symptoms and none of them have a high prevalence of RTI. It was
eo

also found that there is no significant association between health seeking behaviour

and reproductive tract infection and there is a significant association between health
leg

seeking behaviour and occupation, marital status and parity of women in the

reproductive age group. Study findings also show that there is no association between
ol

health seeking behaviour and other socio-personal variables like age, education,

income, religion, family type and prior information. Analysis of the study revealed
.C

that there is a significant association between health seeking behaviour and type of

chronic illness, mode of treatment to previous RTI, and recurrence of RTI among
vt

women in the reproductive age group and there is no association between health
Go

seeking behaviour and other clinical variables like the history of chronic illness and

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treatment taken, previous history of RTI, its treatment taken, duration of illness,

family history of RTI and treatment taken by a family member.

ko
In conclusion, RTI was common among the females of the reproductive age

hi
group with a prevalence of 33.5%. This is mainly because of the reason that

symptomatic patients do not seek treatment for their complaints. The study shows a

oz
significant association between health seeking behaviour and occupation, parity, and

-K
marital status of women in the reproductive age group, also women with previous

information on RTIs have more health seeking behaviour. It implies the need for

awareness programs and screening campaigns for women in the reproductive age

g
group regarding RTIs and recurrence of RTIs at PHC or grass root level and ensure
sin
check-ups for RTIs at regular intervals among women and adolescent girls. Health

education in the area of menstrual hygiene and personal hygiene should be provided
ur
not only to the females in the reproductive age group but also to the females of the
fN

adolescent age group which helps in reduction in the prevalence of RTI. During the

treatment of RTI, it should be made sure that the partner is also treated for that
eo

particular infection to prevent the recurrence of the infection. The present study

suggests that health education should focus more on females of low socioeconomic

class and early adults to overcome the symptoms of RTI and this might be an
leg

immediately feasible method to decrease the burden of RTI/STI in the community.

ol

Implications of Study
.C

The findings of the study have implications for nursing practice, nursing

education, nursing administration and nursing research.

vt
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Nursing Practice

The professional obligation of nursing is the provision of caring services to

ko
human beings. Health personnel can serve as the foundation for understanding the

hi
relationship between health services and promoting quality of life. Nurses have the

capacity and opportunity to disseminate information about sexual and reproductive

oz
health to adolescents and their parents in communities, schools, public health clinics

-K
and acute care settings. This study reflects the women in the community have a

recurrence of RTI and moderate health seeking behaviour regarding RTI symptoms.

Hence it necessitates a need for an awareness program. As educators, nurses and

g
JPHN need to organize regular health education programs in community settings and
sin
equip and empower the women. By identifying the factors affecting the utilization of

services, nurses can implement interventions that improve their health seeking
ur
behaviour. Most of the RTI symptoms can be treated and hence prevent complications
fN

if it detects earlier. Thus, providing health education programs, and also conducting

screening programs for diagnosis of RTI, can be promoted the utilization of services.
eo

Using a patient-friendly approach helps to reduce their shame and also to clarify their

doubts. Nurses can assess the health status of the women and their health seeking

behaviour regarding RTIs. Through school health programs, nurses can impart
leg

awareness regarding RTIs, and menstrual hygiene to school going girls. In the

community setting, can conduct awareness programs for couples in reproductive age
ol

group regarding sexual hygiene. Based on the results, new strategies and plans can be
.C

incorporated into nursing practice, which will help in the prevention and management

of various RTIs. Nurses should motivate and encourage the public for these simple
vt

measures. Proper awareness, motivation, and utilization of available services help to

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decrease morbidity and mortality of women.

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Nursing education

Education is the key component to updating and improving the knowledge of

ko
an individual. The nursing curriculum should be highly equipped with adequate

hi
knowledge and skill among students to identify the reproductive health problems of

women and to assist the client and community in developing their potential to

oz
promote good self-care practices. Nurse as an educator needs to understand the

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various problems and needs of the community. Good communication of information

on prevention, especially on behaviour change, linked with effective treatment is key

to the control of RTI. Nursing teachers should emphasize health education and

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method of imparting education regarding reproductive tract infections during the
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student training period. Students should get the opportunity to give health education

appropriately, and conduct student camps and workshops during their clinical
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practice. In community settings, this will be further helpful in planning education
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programs for the community and reproductive-aged women.

The findings of the study revealed that women with symptoms of RTI were
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not taken treatment due to various reasons like shame, lack of awareness, lack of

privacy, and financial problems. It necessitates the nurse educator to plan clinical
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experience and focus their student practice in these areas to render health education

on primary and secondary preventive measures. Primary prevention mainly focused

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on creating awareness and imparting knowledge about RTI, maintaining healthy

lifestyle, and removing stigma and bias in the community and health care providers
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for improving the treatment seeking behaviour, screening and referral of reproductive

health problems. Secondary prevention includes early diagnosis and prompt treatment
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by trained health care personnel preventing the spread of infection, correct and
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adequate treatment, treatment of both the partners simultaneously, strengthening the

[Link] [Link] [Link]

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referral system and accessible and affordable RTI services at low cost. Nurse

educators should take initiative in organizing periodic health awareness programs in

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community areas with the community health nursing department to improve

awareness, by improving health seeking behaviour and reducing reproductive tract

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infections. The nurse educator can promote a positive attitude and make the student

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willing to work in these areas after the training.

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Nursing Administration

It is a fact that every project needs to be implemented with adequate support

from the concerned administrative authority. Administrators are the policy makers,

g
sin
they should take initiative to organize screening programs to detect reproductive tract

infections. Administrative help must be made available to the health personnel for

conducting health talks regarding RTI and reproductive health and should take
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initiative in planning and motivating the health personnel for preparing audio visual
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aids like posters and videos. The nurse administrator must collaborate with the

governing bodies to formulate standards for reproductive health care. The nurse
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administrators can organize teaching programs in communities where poor health

seeking behaviour and utilization of services among women with RTIs. The findings
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of the study can be reported to the concerned authorities of health. The nurse

administrator can extend her duties to plan and make a change in the practice field
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and the attitude of health care personnel towards women in community areas. As the

manpower and facilities are very minimum in the urban health center, measures can
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be taken to improve the condition of the center. As nurse administrators, it is their

responsibility to react to such problems and to improve the facilities. Nurse

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administrators along with government authorities can organize various plans and
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programs for their development. Organization of mass health camps, screening

[Link] [Link] [Link]

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facilities and strengthening the referral system is important for early diagnosis and

treatment of gynaecological morbidities. The nurse administrator should coordinate

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her work along with the preventive, creative, and rehabilitative aspects of care. This

type of study helps the nursing administration to apply the various strategies to

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enhance the community people for maintenance of positive reproductive health.

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Nursing Research

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The main goal of nursing research is to generate evidence to improve nursing

baseline practice. The present study provides baseline data for conducting other

research studies. The study will be a motivation for budding researchers to conduct

g
sin
similar studies on a large scale. While disseminating the results of the study, health

care personnel including those working in other areas can utilize this information for

identification, early detection and treatment of reproductive health problems.

ur
Research should be done to assess the magnitude of RTIs in the community and also
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to find out various innovative methods for effective teaching to improve the

knowledge regarding the prevention and management of RTIs. There is ample scope
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for research in the field of gynaecology. Few studies were conducted in this area in

Kerala. So, it necessitates further research in the same aspects in various areas. If the
leg

resources are available, the area of research can be expanded. While disseminating the

results of the study, health care personnel including those working in community
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areas can utilize the information for identification, early detection, and treatment of

RTIs.
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Limitations

 The generalization of the study findings was limited due to the small sample

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size and lack of a standardized tool for exploring health-seeking behaviour

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regarding RTIs.

 Symptoms are not clinically validated, it is taken as reported by the

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participants.

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 Prevalence of RTI is based on symptoms reported by the participants.

Recommendations

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 A similar study can be replicated in different setting and in large number of


samples. sin
A study can be conducted to identify the barriers of health seeking behaviour
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regarding RTIs.

 A similar study can be done to identify the effect of structured teaching

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programmes on health seeking behaviour regarding RTIs.

 A comparative study can be carried out to assess the health seeking behaviour
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of rural and urban women.

 A knowledge, attitude and practice study can be conducted on reproductive

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tract infections among adolescents.

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REFERENCES

1. National Reproductive Tract Infections (RTIs) Policy Guidelines. Available

ko
from: [Link]

hi
2. IIPS O. National Family Health Survey (NFHS-3), 2005-06: India. Vol. I.

Mumbai: International Institute for Population Sciences. 2007.

oz
3. Geneva. World Health Organization. Global prevalence and incidence of selected

-K
curable sexually transmitted diseases: Overview and estimates. 2011 [Google

Scholar]

4. Divya A. Patel, Nancy M. Burnett, Kathryn M. Curtis. Reproductive health

g
Epidemiology Series Module [Link] publication, 2003. epi_module_

03a_tag508.pdf
sin
5. Trollope-Kumar K. Symptoms of reproductive tract infection-not all they seem to
ur
be. Lancet. 1999; 354(9192):1745–1746. doi: 10.1016/S0140-6736(99)00272-X.
fN

6. Vaginal candidiasis. Centers for Disease Control and Prevention. [Link]

[Link]/fungal/diseases/candidiasis/genital/. Accessed Sept. 19, 2021.

eo

7. Jejee Bhoy, Shireen. (2010). Addressing women&apos;s reproductive health

needs: Priorities for the family welfare programme. Economic and Political
leg

Weekly. 32.

8. Dalal [Link] and Infertility. In Genital Infections and Infertility. 2016.

IntechOpen. [Link]
ol

9. Novy,Eschenbach,[Link]. libr. women's med,(ISSN: 1756-2228) 2008; DOI

.C

10.3843/GLOWM.10328

10. The United Nations Children’s Fund. Adolescents: An Age-old opportunity.

vt

Division of Communication, 2011, New York, UNICEF, The state of the world’s
Go

[Link] [Link] [Link]

 [Link] [Link] [Link]
102

de
children 2011. Available at:[Link]

Main-Report_EN_02092011.pdf. Accessed July 1, 2012

ko
11. Deepak Sharma, Naveen Krishan Goel ,Meenal Madhukar Thakare. Prevalence

of reproductive tract infection symptoms and treatment-seeking behaviour among

hi
women: A community based study. Indian Journal of Sexually Transmitted

oz
Diseases&AIDS.2018Jul

Dec;39(2):[Link].4103/ijstd.IJSTD_97_1[Link]

-K
/articles/PMC6298149/

12. Enid Elizabeth Thomas, Jayasree Ananda bhavan Kumaran. Prevalence of genital

g
infections among women in reproductive age group in a rural area in North

Jul;6(7):2996-3002. DOI:
sin
Kerala. International Journal of Community Medicine and Public Health. 2019

[Link]
ur
20192841.

13. [Link] transmitted diseases and infertility. Sex Transm Dis 21:
fN

532– 537, 1994

14. [Link] from:[Link] [Link]/reproductive health/ womensrh/

eo

[Link]

15. National Guidelines on Prevention, Management and Control of Reproductive

leg

Tract Infections Including Sexually Transmitted Infections. [Last accessed on

2016 Jul29].Available from: [Link] STI%20RTI%2 0

ol

services/National_Guidelines_on_PMC_of_RTI_Including_STI%[Link] .
.C

16. World Health Organization. Global incidence and prevalence of selected curable

sexually transmitted infections – 2008 [Internet]. 2014 [cited 2019 Jul 08].
vt

Available from: [Link] rtis/sties

stimates/en/.
Go

[Link] [Link] [Link]

 [Link] [Link] [Link]
103

de
17. IIPS [Link] Family Health Survey (NFHS-3), 2005-06: India. Vol. I.

Mumbai: International Institute for Population Sciences. 2007.

ko
[Link]

18. Delhi N. Ministry of Health and Family Welfare; 2010. Ministry of Health and

hi
Family Welfare. Indian Public Health Standards (IPHS) for. 2010:101-200.

oz
19. IIPS and Macro International, National Family Health Survey (NFHS-3), 2005-

06: India, vol. 1, IIPS, Mumbai, India, 2007.

-K
20. World Health Organisation. Health topics: Women's health. [Last accessed on

2019 Aug 12]. Available from: [Link]

g
21. World Health Organization. Neonatal and perinatal mortality: country, regional

sin
and global estimates. World Health Organization; 2006.

22. WorldHealthOrganization.2006.[Link]
ur
blications/en/ (accessed July 5, 2006).

23. World Health Organization. Adolescent health and development: the key to the
fN

future. Geneva: WHO, 1994, Global Commission on Women’s Health.

24. Santhya KG, Jejeebhoy SJ. Sexual and reproductive health and rights of
eo

adolescent girls: evidence from low- and middle-income countries. Glob Public

Health. 2015;10(2):189-221. doi: 10.1080/17441692.2014.986169. Epub 2015

leg

Jan 2. PMID: 25554828; PMCID: PMC4318087.

25. United Nations Report of the International Conference on Population and

ol

Development,Cairo,September5–13,1994. Available at: [Link]

.C

icpd/conference/offeng/[Link]. Accessed :December2, 2009

26. Sivakami M, Rai S. What do we know about sexual and reproductive health of
vt

adolescents and youth in india: A synthesis of literature. Health and Wellbeing of

India's Young People. 2019:121-56.

Go

[Link] [Link] [Link]

 [Link] [Link] [Link]
104

de
27. World health organization, Regional office for South East Asia, New Delhi.

Reproductive Health in the South East Asia Region (50 years commemorative

ko
series-5), New Delhi, 1999.

28. National AIDS Control Organization (NACO) and MOHFW, National AIDS

hi
Control Programme, Phase III (2006-2011): Training for Medical to deliver

oz
STI/RTI Services. Participants Hand out. New Delhi: NACO, 2006. Available

from: [Link] Medical%20Officer%20

-K
[Link]

29. Marrazzo J, Cates [Link] tract infections, including HIV and other

g
sexually transmitted infections. In: Hatcher RA, Trussell J, Nelson A, et al.

sin
Contraceptive Technology. 20th edition. New York: Ardent Media, Inc., 2011.

30. Business Bliss Consultants FZE. Reproductive Tract Infections (RTI): Symptoms
ur
and Causes [Internet]. November 2018. [Accessed 1 September 2022]; Available

from: https:// nursinganswers. net/essays/reproductive- tract-infections-rti-

fN

symptoms- 2093 .php?vref=1.

31. Wasserheit JN. The significance and scope of reproductive tract infections among
eo

third world women. Int J Gynecol Obstet 1989; Suppl 3: 145–68.

32. Workowski, KA, Bachmann, LH, Chang, PA, et. al. Sexually Transmitted
leg

Infections Treatment Guidelines, 2021. MMWR Recomm Rep 2021; 70(No. 4):

1-187.
ol

33. Lande R. Controlling sexually transmitted diseases. Population Reports, SeriesL,

.C

No 9. Baltimore, MA: Johns Hopkins School of Public Health,

PopulationInformation Programme, June 1993.

vt

34. [Link] Level Push to Tackle Priorities in Sexual and Reproductive Health.

United Nations Population Fund, New York, NY, USA, 2006.

Go

[Link] [Link] [Link]

 [Link] [Link] [Link]
105

de
35. Nagarkar A, Mhaskar P. A systematic review on the prevalence and utilization of

health care services for reproductive tract infections/sexually transmitted

ko
infections: Evidence from India. Indian J Sex Transm Dis AIDS. 2015 Jan-

Jun;36(1):18-25. doi: 10.4103/0253-7184.156690. PMID: 26392649; PMCID:

hi
PMC4555893.

oz
36. Omoregie R, Egbe CA, Igbarumah IO, Ogefere H, Okorie E. Prevalence and

etiologic agents of female reproductive tract infection among in-patients and out-

-K
patients of a tertiary hospital in Benin city, Nigeria. North American Journal of

Medical Sciences. 2010 Oct;2(10):473.

g
37. Zhang XJ, Shen Q, Wang GY, Yu YL, Sun YH, Yu GB, Zhao D, Ye DQ. Risk

sin
factors for reproductive tract infections among married women in rural areas of

Anhui Province, China. European Journal of Obstetrics & Gynecology and

ur
Reproductive Biology. 2009 Dec 1;147(2):187-91.

38. Bhalla P, Rohit Chawla, Garg S,Singh M M, Ruchira Bhalla etal. Prevalence of
fN

bacterial vaginosis among women in Delhi, India. Indian J Med Res 125,

February 2007, pp 167-172

eo

39. Kosambiya JK, Desai VK, Bhardwaj P, Chakraborty T. RTI/STI prevalence

among urban and rural women of Surat: A community-based study. Indian J Sex
leg

Transm Dis AIDS. 2009 Jul;30(2):89-93. doi: 10.4103/0253-7184.62764. PMID:

21938127; PMCID: PMC3168065.

ol

40. Balamurugan SS, Bendigeri N. Community-based study of reproductive tract

.C

infections among women of the reproductive age group in the urban health

training centre area in hubli, karnataka. Indian J Community Med. 2012

vt

Jan;37(1):34-8. doi: 10.4103/0970-0218.94020. PMID: 22529538; PMCID:

PMC3326805.
Go

[Link] [Link] [Link]

 [Link] [Link] [Link]
106

de
41. Panda SC, Sarangi L, Bebartta D, Parida S, Panigrahi OP. Prevalence of RTI/STI

among women of reproductive age in district Sundergarh (Orissa). Indian J Pract

ko
Doct. 2007;4(1). 13-16.18203/2394-6040.ijcmph20185268.

42. Diadhiou M, Ba Diallo A, Barry MS, Alavo SC, Mall I, Gassama O, Ndiaye

hi
Guèye MD, Ndao Fall A, Gawa E, Gaye Diallo A, Moreau JC. Prevalence and

oz
Risk Factors of Lower Reproductive Tract Infections in Symptomatic Women in

Dakar, Senegal. Infect Dis (Auckl). 2019 May 31;12:1178633719851825. doi:

-K
10.1177/1178633719851825. PMID: 31210732; PMCID: PMC6545636.

43. Prusty RK, Unisa S. Reproductive Tract Infections and Treatment Seeking

g
Behaviour among Married Adolescent Women 15-19 Years in India. Int J MCH

sin
AIDS. 2013;2(1):103-10. doi: 10.21106/ijma.15. PMID: 27621963; PMCID:

PMC4948135.
ur
44. Thekdi, Komal , Patel, Nita , Patel K , Thekdi, Pukur. Health seeking attitude of

women regarding reproductive tract infections in a rural area of Surendranagar

fN

district. International Journal of Research in Medical Sciences. (2013).1. 552.

10.5455/2320-6012.ijrms20131143.
eo

45. Doley, Preety,Yadav, Geeta ,Gupta, Monika ,Muralidhar, Sumathi. Knowledge,

health seeking behaviour and barriers for treatment of reproductive tract

leg

infections among married women of reproductive age in Delhi. International

Journal of Reproduction, Contraception, Obstetrics and Gynecology. (2021). 10.

ol

591. 10.18203/2320-1770.ijrcog20210310.
.C

46. Kanchan B. Gawande, Abhay S. Srivastava, Purushottam Kumar. Reproductive

tract infection and health seeking behaviour: a cross sectional community-based

vt

study. International Journal of Community Medicine and Public Health Gawande

KB et al. Int J Community Med Public Health. 2018 Apr;5(4):1524-

Go

[Link] [Link] [Link]

 [Link] [Link] [Link]
107

de
1528.[Link] DOI: [Link] 10.18203/ 2394 -

6040.ijcmph20181229

ko
47. Rabiu KA, Adewunmi AA, Akinlusi FM, Akinola OI. Female reproductive tract

infections: understandings and care seeking behaviour among women of

hi
reproductive age in Lagos, Nigeria. BMC Womens Health. 2010 Mar 23;10:8.

oz
doi: 10.1186/1472-6874-10-8. PMID: 20331888; PMCID: PMC2851660.

48. Puthuchira Ravi R, Athimulam Kulasekaran R. Care Seeking Behaviour and

-K
Barriers to Accessing Services for Sexual Health Problems among Women in

Rural Areas of Tamilnadu State in India. J Sex Transm Dis. 2014;2014:292157.

g
doi: 10.1155/2014/292157. Epub 2014 Mar 20. PMID: 26316973; PMCID:

PMC4437401. sin
49. Mani Geetha, Annadurai, Kalaivani,Danasekaran, [Link] Seeking
ur
Behaviour for Symptoms of Reproductive Tract Infections among Rural Married

Women in Tamil Nadu - A Community Based Study. Online Journal of Health

fN

and AlliedSciences.12(3).July2013. [Link] [Link]/publication/

289343078_
eo

50. Kinkor MA, Padhi BK, Panigrahi P, Baker KK. Frequency and determinants of

health care utilization for symptomatic reproductive tract infections in rural

leg

Indian women: A cross-sectional study. PLoS One. 2019 Dec 5;14(12):e0225687.

doi: 10.1371/[Link].0225687. PMID: 31805087; PMCID: PMC6894837.

ol

51. Mamta, Navdeep Kaur. Reproductive Tract Infections: Prevalence and Health
.C

Seeking Behaviour among Women of Reproductive Age Group. International

Journal of Science and Research (IJSR) .ISSN (Online): 2319-7064. Volume 3

vt

Issue 4, April 2014 .[Link]

Go

[Link] [Link] [Link]

 [Link] [Link] [Link]
108

de
52. Shingade PP, Kazi Y, LH M. Treatment seeking behaviour for sexually

transmitted infections/reproductive tract infections among married women in

ko
urban slums of Mumbai, India. SE Asia J. Pub. Health [Internet]. 2016 Jul. 25

[cited 2022 Jul. 21];5(2):[Link]: [Link]

hi
/[Link]/SEAJPH/article/view/28315

oz
53. Balamurugan SS, Bendigeri N D. Community-based study of reproductive tract

infections among women of the reproductive age group in the urban health

-K
training centre area in Hubli, Karnataka. Indian J Community Med [serial online]

2012 [cited 2016 Apr 9];37:34-8. Available from: [Link]

g
[Link]/[Link]? 2012/37/1/34/94020

sin
54. Li C, Han HR, Lee JE, Lee M, Lee Y, Kim MT. Knowledge, behaviours and

prevalence of reproductive tract infections: a descriptive study on rural women in

ur
hunchun, china. Asian Nurs Res (Korean Soc Nurs Sci). 2010 Sep;4(3):122-9.

doi: 10.1016/S1976-1317(10)60012-6. PMID: 25031093.

fN

55. Agarwal, Anil & Mishra, Jaya & Mahore, Ramniwas & Verma, Rani. (2022).

Knowledge, attitude and treatment seeking behaviour for reproductive tract

eo

infections (RTI) and sexually transmitted infections (STIs) among married

women attending Suraksha Clinic, Madhya Pradesh, India. 11. 2022.

leg

56. Verma A, Kumar Meena J, Banerjee B. A Comparative Study of Prevalence of

RTI/STI Symptoms and Treatment Seeking Behaviour among the Married

ol

Women in Urban and Rural Areas of Delhi. Int J Reprod Med.

.C

2015;2015:563031. doi: 10.1155/2015/563031. Epub 2015 Jan 27. PMID:

25763407; PMCID: PMC4333591.

vt
Go

[Link] [Link] [Link]

 [Link] [Link] [Link]
109

de
57. National Guidelines on Prevention, Management and Control of Reproductive

Tract Infections Including Sexually Transmitted Infections. [Last accessed on

ko
2016 Jul 29]. Available from: [Link] STI% 20RTI%

20services/National_Guidelines_on_PMC_of_RTI_Including_STI%[Link] .

hi
58. Paneru DP. Prevalence and factors associated with reproductive tract infections

oz
among married women of reproductive age in Kaski district, Nepal. Asian J Med

Sci. 2012;3:1–7. [Google Scholar]

-K
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APPENDIX A

PERMISSION LETTER FROM INSTITUTIONAL ETHICS

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COMMITTEE

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APPENDIX B
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APPENDIX B

PERMISSION LETTER FROM DISTRICT MEDICAL OFFICER,

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MALAPPURAM

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APPENDIX C
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APPENDIX C

PERMISSION LETTER FROM SECRETARY, KONDOTTY

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MUNICIPALITY

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APPENDIX D

PERMISSION LETTER FROM MEDICAL OFFICER, THQH

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KONDOTTY

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APPENDIX E
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APPENDIX E
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APPENDIX E

LIST OF EXPERTS FOR CONTENT VALIDITY

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1 Prof. Laly K.S. 6 Dr. Beena Guhan

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Professor Professor

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Govt. College of Nursing Dept. Obstetrics & Gynaecology

Kozhikode IMCH, Kozhikode

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2 Prof. Isha S. 7 Dr. Sajala Vimal Raj

Professor Associate Professor

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MIMS College of Nursing Dept. Obstetrics& Gynaecology

3
Kozhikode

Prof. Seenath K.P.

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IMCH, Kozhikode

Dr. Biju George

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Professor Associate Professor

Govt. College of Nursing Dept. of Community Medicine

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Kozhikode Govt. Medical college, Kozhikode

4 Dr. Sreedevi J. 9 Dr. Vijayasree K.V.

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Associate Professor Assistant Professor

Govt. College of Nursing Govt. College of Nursing

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Kozhikode Kozhikode

5 Mrs. Saramma V.V. 10 Mrs. Jasmine M.K.

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Associate Professor Assistant Professor

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Govt. College of Nursing Govt. College of Nursing

Kozhikode Kottayam
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11 Mrs. Rassiya K.K. 14 Mrs. Jyothi. K. Divakaran

Assistant Professor Assistant Professor

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Govt. College of Nursing Govt. College of Nursing

Kozhikode Alappuzha

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12 [Link] S. 15 Mrs. Bhajisha U.

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Associate Professor Assistant Professor

E M S College Of Nursing Govt. College of Nursing

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Perinthalmanna Kozhikode

13 [Link] Varghese

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Associate Professor

Moulana College Of Nursing

Perinthalmanna
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APPENDIX F
INFORMED CONSENT

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In signing this document, I am giving consent to be a subject for the research

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study conducted by Mrs. Naseeba K., MSc Nursing student, Govt. College of

Nursing.I understand that I will be a part of the research study on health seeking

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behaviour of women in the reproductive age group regarding reproductive tract

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infections.

I have been informed that my willingness to participate in the study is entirely

voluntary and even in the course of the study, I can withdraw from the study. I have

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been told that my answers to the question will not be published for any other purpose

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and will be kept confidential. I also have been informed that I have no financial
commitments for the study and there is nothing that will adversely affect my health.

If I have any question about the study or about my right as a participant,

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Mrs. Naseeba K. is whom I should contact.
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I will honour all agreements.

Respondent' Signature:
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Respondent's name:

Investigator's name and address:

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Mrs. Naseeba K.
MSc Nursing
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Govt. College of Nursing,

Kozhikode
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9605360891
Date:
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Kozhikode
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APPENDIX G

TOOL 1

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SEMI-STRUCTURED INTERVIEW SCHEDULE TO IDENTIFY THE

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HEALTH SEEKING BEHAVIOUR OF WOMEN IN THE REPRODUCTIVE

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AGE GROUP REGARDING REPRODUCTIVE TRACT INFECTIONS

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Instructions to interviewer:

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1. Ask questions listed in the schedule using one to one interview technique.

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2. Put a tick mark (✔ ) against the appropriate space provided and fill up wherever

necessary according to the response of participants.

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3. Under section B, question numbers 27,28,29,30,33,34,35,36,38,40 and 44 have
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score. Each correct response carries one mark.

Code no
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Section A:-Socio-Personal Data

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1. Age (in Years):………………..

2. Educational status

a) Primary [ ]
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b) Secondary [ ]
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c) Higher secondary [ ]

d) Degree and above [ ]

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e) Professional /technical [ ]
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3. Occupation

a) Home maker [ ]

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b) Self-employed [ ]

c) Private employee [ ]

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d) Government employee [ ]

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e) Others Specify ………………… [ ]

4. Family income per month in Rs.

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a) <1500 [ ]

b) 1501-6000 [ ]

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c) 6001-10000 [ ]

5.
d) >10000

Religion
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a) Hindu [ ]

b) Muslim [ ]
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c) Christian [ ]

d) Others Specify ………………..

eo

6. Type of family

a) Nuclear family [ ]
leg

b) Extended family [ ]

c) Joint family [ ]
ol

7. Marital status
.C

a) Married [ ]

b) Unmarried [ ]
vt

c) Widow [ ]

d) Divorced/Separated. [ ]
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8. Parity

a) Nullipara [ ]

ko
b) 1 [ ]

c) 2 [ ]

hi
d) 3 [ ]

oz
e)> 3 [ ]

9 Do you have any information on reproductive tract infections & its

-K
management?

a) Yes [ ]

g
b)No [ ]

a) Mass media
sin
10. If yes, specify the sources of information

[ ]
ur
b) Relatives [ ]

c)Friends [ ]
fN

d)Health professionals [ ]

e)Asha worker [ ]
eo

f) Anganwadi worker [ ]

g) Others specify……………….
leg

[Questions from 11-25 assessed by record review]

11. Do you have any history of chronic illness? [ ]

ol

a) Yes [ ]
.C

b) No [ ]

12. If yes, please specify……………………………

vt

13. Have you taken treatment for the same?

a) Yes [ ]
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b) No [ ]

14. Do you have any history of reproductive tract infections?

ko
a) Yes [ ]

b) No [ ]

hi
15. If yes, please specify …………….

oz
16. If yes, what was the duration of the illness?

a) Days [ ]

-K
b) Weeks [ ]

c) Months [ ]

g
d) Years [ ]

Specify……………………. sin
17. Have you taken treatment for the previous RTI symptoms?
ur
a) Yes [ ]

b) No [ ]
fN

18. What treatment you opted for those symptoms?

a) Traditional [ ]
eo

b) Self-treatment [ ]

c) Allopathy [ ]
leg

d) Homeopathy [ ]

e) Ayurveda [ ]
ol

f) No treatment [ ]
.C

19. Did you undergone any diagnostic test/procedure for detecting

reproductive tract infections?

vt

a)Yes [ ]

b) No [ ]
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20. If yes, specify the details…………

21. Whether you have any history of recurrence of reproductive tract

ko
Infection symptoms?

a) Yes [ ]

hi
b) No [ ]

oz
22. If yes, how did you manage it?

a) Sought treatment from healthcare facility [ ]

-K
b) Self treatment [ ]

c) Home remedies [ ]

g
d) Ignored it [ ]

a) Yes
sin
23. Do you have any family history of reproductive tract infections?

[ ]
ur
b) No [ ]

24. If yes, specify the person…………………

fN

25. If yes, whether they have taken treatment for the same?

a) Yes [ ]
eo

b) No [ ]

Section B- Health seeking behaviour regarding reproductive tract infections

leg

26. What are the measures you follow to maintain good reproductive

health?
ol

a) Maintaining good Personal hygiene [ ]

.C

b) Menstrual hygiene [ ]

c) Sexual hygiene [ ]
vt

d ) Screening for reproductive health problems [ ]

e) Others specify...
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27. Do you take bath daily?

a) Yes [ ]

ko
b) No [ ]

28. Do you change your undergarments daily?

hi
a) Yes [ ]

oz
b) No [ ]

29. Do you share undergarments with others?

-K
a)Yes [ ]

b)No [ ]

g
30. Do you dry undergarments properly in the sunlight?

a) Yes

b) No
sin [ ]

[ ]
ur
31. Which of the following items, you use for absorbing menstrual blood?

a)Cotton cloths [ ]
fN

b) Sanitary napkins [ ]

c)menstrual cup [ ]
eo

32. If cotton clothes are using, do you wash and dry it in sunlight?

a) Yes [ ]
leg

b) No [ ]

33. How many hours do you use a sanitary pad / clothes continuously?
ol

a) Every 6th hourly [ ]

.C

b) More than 6 hours [ ]

34. How many times do you re-use the cotton clothes?

vt

a) Only in one cycle [ ]

b)Two cycle [ ]
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c) Three cycle [ ]

d)More than three cycle [ ]

ko
(Question No:35, applicable to married women only)

35. Whether do you have any history of intercourse during the period of

hi
reproductive tract infection?

oz
a) Yes [ ]

b) No [ ]

-K
36. Do you ever discuss the symptoms of reproductive tract infection with

anyone?

g
a) Yes [ ]

b) No

37. If yes, to whom?

sin [ ]
ur
a) Husband [ ]

b) Family member [ ]
fN

c) Friends [ ]

d) Health workers [ ]
eo

e) None [ ]

38. Did you take self-medicine to treat your reproductive tract infection
leg

symptoms?

a) Yes [ ]
ol

b) No [ ]
.C

39. For your previous health problem when would you consult and took

treatment?
vt

a) On the same day [ ]

b) Within two days [ ]

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c) Within a week [ ]

d) Within one month [ ]

ko
e) Not taken treatment [ ]

40. Did you complete the course of treatment for your previous

hi
reproductive tract infection symptoms?

oz
a) Yes [ ]

b) No [ ]

-K
41. If no, specify the reason?

a) Financial problems [ ]

g
b) Breach of confidentiality [ ]

sin
c) Absence of female health care provider

d) Inaccessibility to health care service

[ ]

[ ]
ur
e) Others, please specify-------------------------------------------- [ ]

42. Are you currently experiencing any symptoms of reproductive tract

fN

infections?

a)Yes [ ]
eo

b)No [ ]

43. If yes, have you taken treatment for the same?

leg

a) Yes [ ]

b) No [ ]
ol

44. If you have reproductive tract infection, from where you will seek
.C

treatment?

a) Government hospital [ ]
vt

b) Private hospital [ ]

c) Pharmacy without prescription [ ]

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d) Traditional healers [ ]

e) Self-treatment [ ]

ko
45. What were the reasons for delaying health care to your symptoms?

a) Lack of awareness [ ]

hi
b) Unsatisfactory services [ ]

oz
c) Lack of privacy [ ]

d) Lack of transport facilities [ ]

-K
e) Shame [ ]

f) Negligence [ ]

g
g) Lack of health care facilities near to home [ ]

i)Inability to go alone
sin
h) Lack of support from relatives [ ]

[ ]
ur
j) Financial problems [ ]

k) Any other, please specify---------------------------- [ ]

fN

Scoring:
eo

Each positive response carries one mark and negative response carries zero mark.

Total score for section is 11. Score >8 is categorised as good, 5-8 as moderate and
leg

< 5 as poor health seeking behaviour.

ol
.C
vt
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APPENDIX H

TOOL-II

ko
CHECK LIST TO ASSESS THE SYMPTOMS OF REPRODUCTIVE TRACT

hi
INFECTIONS AMONG WOMEN IN REPRODUCTIVE AGE GROUP

oz
Instructions to the investigator: -

-K
a) Read out the statements to the participants.

b) Ask the respondents to give Yes or No on their problems.

g
c) Put a tick mark [✔] in the appropriate column.

d) Each symptom carries one mark sin

Do you experience any of the following symptoms given below? Please put  mark
ur
fN

SL No Symptoms Yes No
eo

1 Abnormal vaginal discharge

a)Vaginal discharge with foul smell

b)Vaginal discharge with colour changes

leg

c)Excessive amount of vaginal discharge

2 Lower abdominal pain

ol

a)With fever
.C

b)With backache

c)Lower abdominal tenderness or guarding

vt
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3 Vaginal itching

4 Urethral discharge

ko
a)Mucopurulent urethral discharge

b)Urethral discharge with foul smell

hi
c)Inflamed (red or tender) urethra

oz
5 Inguinal bubo

-K
6 Genital ulcers

a)Painful ulcers located in external genitalia

b)Painless ulcers located in external genitalia

g
7 Menstrual irregularities

a)Heavy irregular bleeding

sin
b)Dysmenorrhoea
ur
8 Dyspareunia
fN

9 Dysuria

10 Bleeding after intercourse

eo

Scoring:-
leg

For the items 1-10, if yes, score is 1 and if no, score is 0.

Total score for all symptoms of RTI is [Link] >14 is categorised as high
ol

prevalence, 9-14 as moderate and < 9 as low prevalence.

.C
vt
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APPENDIX I

LIST OF ABBREVIATIONS

ko
KUHS - Kerala University of Health Science

hi
WHO - World Health Organisation

oz
RTI - Reproductive Tract infection

STI - Sexually Transmitted Infection

-K
HIV - Human Immuno Deficiency Virus

AIDS - Acquired Immuno Deficiency syndrome

g
STD - Sexually Transmitted diseases

PID

HPV
sin
- Pelvic Inflammatory Disease

- Human Papilloma Virus

ur
RCH - Reproductive and Child Health

VDRL - Venereal Disease Research Laboratory

fN

PRISMA - Preferred Reporting Items for Systematic Reviews and Meta-Analyses

UTI - Urinary Tract Infection

eo

THQH - Taluk Head Quarters Hospital

JPHN - Junior Public Health Nurse

leg
ol
.C
vt
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APPENDIX J

ko
hi
oz
-K
g
sin
ur
fN
eo
leg
ol
.C
vt
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APPENDIX K

ko
hi
oz
-K


g
sin
ur
fN
eo
leg
ol
.C
vt
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ko
hi
oz
-K
g
sin
ur
fN
eo
leg
ol
.C
vt
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ko
hi
oz
-K
g
sin
ur
fN
eo
leg
ol
.C
vt
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ko
hi
oz
-K
g
sin
ur
fN
eo
leg
ol
.C
vt
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ko
hi
oz
-K
g
sin
ur
fN
eo
leg
ol
.C
vt
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ko
hi
oz
-K
g
sin
ur
fN
eo
leg
ol
.C
vt
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ko
hi
oz
-K
g
sin
ur
fN
eo
leg
ol
.C
vt
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ko
hi
oz
-K
g
sin
ur
fN
eo
leg
ol
.C
vt
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APPENDIX L

ko
hi
oz



-K
 

g


sin

ur
fN
eo
leg
ol
.C
vt
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ko
hi
oz
-K
g
sin
ur
fN
eo
leg
ol
.C
vt
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