V^ CAC BENH LAY TRUYDN QUA DU'aNG TiNH DUC

• " TAP CHi NGHieN CCPU Y HQC

KHA NANG THLFC HANH CGA CAN BO Y T ^ TUY^N c a s6 V^ CAC BENH LAY TRUYDN QUA DU'aNG TiNH DUC

Trdn Vdn T i i n \ Phgm Thj Lan^

^Binh vidn Da liiu Tmng uang, 'Tmdng Dgi hgc Y Hd Ndi Bdnh lay tmyin qua dudng tinh dgc hay cdc nhiim tmng Idy tmyin qua dudng tinh due (Sexually Trans- mitted Infections - STI) khdng phdi Id it gdp d Vidt Nam. Khd ndng thgc hdnh cda cdn bd y ti (CBYT) d tuyin y te ca sd ddng vai tni rit quan tmng tmng cdng tdc phdng chdng va ngdn ngO-a cdc biin chimg cua STI. Nghien cOv nhim mgc tidu md ti thgc trgng vd cdc yiu ti dnh hudng din khd ndng thgc hdnh vi STI cua CBYT tgi huygn Ba Vi. Hd Ndi. Kit qud cho thiy kha ndng thuc hdnh vi STI cua CBYT huygn Ba VI rit ttiap va chiu dnh hudng cua mdt s6 yiu ti. Tmng binh diem thuc hdnh dgt dugc Id 4,4/24. Cdc yeu ti dnh tiudng tich cgc din khd ndng thgc hdnh vi STI cua CBYT bao gim cd tiip xuc vdi bdnh nhdn, tham gia cdc ldp tdp huin vi STI hode cdc nhiim tmng dudng sinh sdn (hd si hdi quy Id 2,2 va 1.2. p <0.05) Tuy nhien, tiidu qua cua cdc chuong trinh ldp huin khdng cao vd mdi chl d mOc dd thip. Kit ludn: Kha ndng thgc hanh ve STI cho CBYT tgi tuyin y ti co sd Id rit thip Cin cd nhdng bidn phap can thigp giup cho CBYT ndng cao kha nSng xu ly cdc tinh huing Idm sdng STI phi biin tgi tuyin ca sa

TCF khoa: STI, thi,Fc hanh, cdn bp y t l , Ba Vi

I. DAT

V A N

Dt

Gdc benh lay truyen qua dudng tinh due (Sexually Transmitted Diseases - STI) ngay cang duoc coi la van d i cua y t i todn cau Cdc hdu qua ve y t i va xd hdi do STI gdy nen dd trd thdnh ganh ndng cho ngdnh y vd cho cdng d i n g [1]. Ngodi ra, STI eOng cd vai trd lam tdng Idy truyen HIV [ 1 , 2], vi vdy viec phdng chong STI cOng gdp p h i n rat tich cue va quan trong vao phdng c h i n g HIV/AIDS.

Viet Nam tuy Id n u d c cd ty Id n h i i m HIV thdp, khoang 0,53% dan so trong dp t u i i 15 din 49, nhung lai cd nguy cd tiem an v i s u bung no HIV vd STI do nhO'ng thay doi v i kinh t i xd hpi trong thdi ki kinh t i thj trudng. Phan Idn cdc tardng hp'p nhidm HIV mdi dup-c cho la do Idy nhiim qua d u d n g quan hd tinh dye Trong khi dd, mdt so nghidn cO'U tgi Vidt Nam 3a cho thay cd nhUng quan nidm sai l i m v i STI trong cdng ddng, cd sp" ki thi cua cdn bd y td (CBYT) d i i vdi bdnh nhdn STI [3]; CBYT thiiu kiin thirc vd quan nidm sai lam ve STI vd HIV, phu nu' ndng t h d n t h u d n g trdm tre

trong vide khdm chO'a STI [4] Kha nang thuc hanh cua" CBYT v i STI Id rdt quan trpng trong chan dodn sdm, d i i u tn kjp thdi vd t u v i n hop ly, ngdn chdn s u Idy lan bdnh trong cdng d i n g va de phdng cac b i i n chirng cua benh Tuy nhidn. trong thuc t i tai cd r i t it nghien ciru v i ITnh Vuc ndy. Do vdy, chiing tdi t i i n hdnh nghidn ciru nay vdi muc tidu danh gid vd phdn tich mdt so y i u to anh hudng d i n kha ndng thuc hdnh ve STI eua CBYT tuyin co s d trdn dia bdn huydn Ba VI, thdnh p h i Hd Npi K i t qua eua nghien ciru dup'c su dung lam b i n g chirng cho vide xdy dung c h i i n luce can thidp nhdm nang cao chat lup'ng quan ly STI d t u y i n y t i c o s d

II. D6\ TU'gNG VA PHU'aNG PHAP

Dja ban nghien cii-u: todn bd 32 xd cua huydn B a V i , Hd Ndi

T h i i t k i nghien cu-u va d i i t y o n g nghidn cii'u

Ddy Id nghidn ciru md ta edt ngang, duoc t i i n hdnh trong ndm 2006 tgi huydn Ba VI, S6

TAP CHi NGHIEN Cl^U Y HQC

lup'ng dii tup'ng tham gia nghidn ciru Id 465, bao gim ede bde sT, y sT, y td,-nO' hO sinh vd dup'c sT/dup-c td Idm vide tgi cdc co sd y vd dup'c cdng vd tu nhdn tii' tuyin huydn din tuyin y t i thdn bdn,

Cdng eg nghidn cCi-u BO cdu hdi dup'c thiit

ke, thu nghidm. chinh sOa vd dua vdo sCr dpng cho diiu tra, Phiiu hdi bao gim cdc cau hdi v i thdng tin cd nhdn vd khd ndng thyc hdnh v i STI thdng qua 4 trudng hp'p bdnh nhdn gid djnh vdi 4 hOi chirng thudng gdp nhit cua STI, dd Id' hdi chirng tiit djch dm dgo d nO', hii chirng tiit djch nidu dgo d nam, hdi chirng lodt sinh dye vd hdi chirng dau bung dudi d nO',

Thu th$p va phdn tich so li^u

Dii tup'ng nghidn ciru dup'c mdi theo tirng nhdm v i trung tdm y t i huydn hode trgm y t i xd d i diin thdng tin tra Idi vdo phiiu hdi dudi su gidm sdt cua cdn bd nghidn cuu Chiing tdi cho 1 dlim dii vdi tat ca nhii'ng y tra Idi dung, vd 0 diem cho nhO'ng y tra ldi sai hode khdng biet Ting so diem thyc hdnh toi da Id 24

So lieu duoc xu ly vd phdn tich bdng phin mim SPSS 17.

Cdc thudt todn thing kd d l md td vd cdc md hinh da biin dup'c su dyng d i ddnh fjid mii lidn quan giO'a diim thuc hdnh vdi cdc biin dOc ldp nhu tuoi, gidi, nghi nghidp, trlnh dd chuydn mdn, noi cdng tdc, tiip xiic vdi benh nhdn, tham gia tdp huin, T-test vd ANOVA dup'c sir dung d i so sdnh sy khdc bidt giu'a cdc nhdm dii tup'ng nghidn eiru hode cac yeu t i lidn quan din diim thyc hdnh Sy khde bidt dup'c coi Id ed y nghTa thing ke khi gid tn p < 0,05,

III. KtT QUA

1. D^c dlim chung ciia ddi typ'ng nghidn cii'u

Cd 465 CBYT tham gia nghidn cu'u, Ddc diim chung cua dii tup'ng nghidn ciru dirpc md ta chl tiit d-bang 1.

Bdng 1 cho thiy da s i cdn b i y t i tgi huyin Ba VI Id nu', chiim gin 2/3, Cd 60,6%

s i cdn bd Id y sT hode y td, hiu hit cd trlnh dO trung cip (55,3%) vd so cip (34,6%), s i cdn b i cd trinh dd dai hpc trd Idn Id rit thap (9,9%). Trong todn huydn Ba Vi, cd 45,4% so edn bO cho biit Id hp cd tiip xiic vdi bdnh nhdn STI (gim khdm, diiu tri, tu vin, hode bdn thuic cho bdnh nhdn STI). trong khi so ngudi dd tirng dup'c tdp huin It nhat 1 lan ve STI hode nhiem triing dudng sinh san chl cd 16,8%

Kha ndng thyc hdnh ve STI

Cd khoang 40% cdn bd y te tra Idi c6 bidt v i phuong phdp quan ly STI bdng tiip cdn hpi chirng, nhung trong phan chin dodn vd xu tri ca 4 trudng hp'p b$nh nhdn gia djnh thi khdng cd tru'dng hp-p ndo dya vdo phuong phdp ndy Diim thyc hdnh trung binh Id 4,44, diem thip nhit Id 0, cao nhat Id 17

Biiu d i 1 eho thiy kha ndng thuc hanh cua cdc nhdm dii tup'ng nghien ciru nhin Chung dat d mire dd rat thip (< 50%) vd cd si/

chdnh Ideh giira cdc nhdm. Nhdm nu- hi smh cd ty Id diim trung binh ve thuc hdnh cao nh^t vd eao hon ca nhdm bdc sT va y sT, trong ktii ty Id ndy d nhdm duoc sT/dup-c ta lai thdp nhat Khd ndng thyc hanh cao hon d nhom CBYT cd thdm nien tir 20 nam trd ldn va a nhCrng ngudi da tirng duoc tham du tdp huin

TCNCYH 79 (2) - 2012

• T « P CHl N G H « N C1>U Y HQC B d n g 1 . Cdc Sic 6iivn cita d d i tu'Q'ng n g h i d n ciPu

TUOI (nSm)

(%)

< 3 5 3 5 - 4 5

> 4 5

Tham ni6n cong t^c (n5m)

< 5 6 - 1 9

146 149 170

(31,4) (32,0) (36,6)

185 170

(39,8) (366)

>19 Gidi tinh

Nam Nil

110 167 298

(23,7)

(35.9) (64,1) Nghe nghidp

BdesT YsT Y t d NO' hd sinh Dup'c sT/dup'c td Khdc*

37

127 155

49 75 22

161 257

(8,0) (27,3) (33,3) (10,5) (161) (4,7)

(34.6) (55,3) Trlnh dp chuyen m d n "

So c i p ( 6 - 1 2 thdng) Trung c i p ( 2 - 3 ndm)

'Ky thudt vien xdt nghi$m, ddng y, duoc sT trung dp/duQC ta Idm nghi y.

"1 trudng hgp khdng bdo cdo

B i i u d i 1 . T y le t r u n g b i n h d i i m t h y c h d n h c u a cdc n h o m CBYT 2. Cac y i u t d anh h y d ' n g d i n kha nang t h y c hanh

^•*P CHl NGHliN CU'U Y HQC •

Bdng 2, Cdc y6u t6 dnh hiring din th^c hdnh cua CBYT

Tl«u chl xdt

Tu6i (ndm)

< 3 5 3 5 - 4 5

> 4 5 Thdm ni6n cflng tdc

< 5 5-19

> 1 9 Gjdi linh

Nam NO Ngh^ nghidp

BdcsT Y s i Y t a NO' hO smh Du'ac sT/doffc td Noi cong tdc

Huyen Xa Thon ban Nha thuoc/quay thuoc Tiep xuc vii bdnh nhdn STI

CiS Khdng Tham d y tdp hu^n

C6 Khong

Didm thM'C h d n h Phdn tich d e n b i ^ n D i 4 m t r u n g binh ciia

4,3 4,2 3,9

3,9 4,5 6,5

3,1 4,7

4,4 5,4 2.7 8,2 2,6

6,0 6,3 1,0 2,8

6,1 2,5

7.4 3,5

n h 6 m P H^

0,76 7

0,00 1

0.00 1

0,00 0

0,00 0

0,00 0

0,00 0

Phan t i c h da s 6 h 6 i q u i

- 0 , 4 0 - 0 , 1

1,3 0 1,3

- 0 , 9 0

2,3 3,8 3,4 5,5 0

- 0 , 7 - 0 . 9 - 4 , 4 0

2,2

1,2

bi4n

P

0,486 0 0,779

0,025 0 0,05

0,062 0

0.267 0.036 0,066 0.004 0

0,697 0,63 0.014 0

0.000 0

0.06 0

Bang 2 cho thiy, khi phdn tich don biin thi cdc yiu t i gidi, nghi nghidp, noi cdng tdc, cd tiep xiic vdi bdnh nhdn, dd tirng tham gia tdp huin cd anh hudng din diim thyc hdnh mdt cdch c6 J nghTa (p < 0,05). Nam cdn b i y t i ed diim thyc hdnh thap hon nO- (3,1 diim so vdi 4,7), tuy vdy, trong md hlnh da biin, sy khdc bi§t ndy thyc sy khdng cd y nghTa thing kd (hd so hdi quy -0,9;

p > 0,05) NO' h i siph cd diem thyc hdnh cao nhit 8,2 vdi hd s i hii qui 5,5 (p < 0,05), cdn Igi cdc nhdm bdc sT, y sT, y td ed diim thyc hdnh khdng khdc nhdm dyp'c sT/dup-c td (p > 0,05)

Cdn bd y te thdn ban cd diim thyc hdnh thip nhat vd thip hon ca nhdm Idm vide d nhd thuoc/

quiy thuic/khoa dup'c (hd s i hii qui -4,4, p < 0,05).

130 TCNCYH 79 (2) - 2012

Vigc t i i p xiie vdi bdnh nhan cOng cd tdc dgng thuc s u Idm ndng eao kha ndng thyc hdnh cua CBYT (p < 0,001). Vide tham d y tdp hudn CO lam nang cao kha ndng thuc hdnh ve STI, CU the la ngudi tham d u tdp h u i n ed s i dlim la 7,4, trong khi ngudi khdng dup'c tdp huan Chi dat 3,5 d i i m . S y khdc bidt ndy cd ^ nghTa thong kd vdi p < 0,001, Sau khi khCr cdc yeu to nhldu, trong md hinh da b i i n cho t h i y vide tdp h u i n v i n ed tdc dpng ndng eao kha ndng thuc hanh cua CBYT (hd so h i i quy 1, 2, p = 0,05).

IV. BAN LUAN

Nghidn ciru ndy cho t h i y khd ndng thyc hdnh cua nhu'ng ngudi hdnh nghe d u y c Id ddc biet han che Nhung tren thuc t i , hidu thuic lai chinh Id noi benh nhan STI thudng tim d i n de duoc d i i u tri va t u van trudc khi d^n cac co s d y t i , cd t h i do tinh tien loi, gid hp'p ly va it bj ki thj Mdt nghien eiru tai Hd Npi cho thiy cd tdi tren 80% nha thude ed dieu tr;

benh nhdn STI [5]. VI vgy, viec trang bi, ndng cao kiin thu-c vd thue hdnh ve ST! cho nhd thuic, nhu'ng ngudi bdn thudc cd the gdp phan nang cao hidu qua hoat ddng eua chLro'ng trinh phdng c h i n g STI

TCr k i t qua nghidn cu'u chung tdi t h i y dii v\dc tiep xiic vdi bdnh nhan cd Idm tdng kha ndng thuc hanh ve STI thi nhin chung d i i m thuc hanh cua doi tup'ng nghien eiru vdn d mire do rdt t h i p (chi dat 6,1 trong tong so 24 3iem), Nhdm nir h i sinh ed diem thuc hdnh

;ao hon cac nhdm khac, ed t h i do mdi trudng am vide ho ludn t i i p xiie vdi cac van d i lien luan d i n sire khde smh san, bao gom ca STI

Theo khuyin cdo eua To chuc Y t i T h i Jidi, phuong phap quan ly hdi chirng STi' Id iy tiep can d i i u tri cdc dau hieu/tridu chirng :iia m i l hdi chirng gdy ra bdi cdc tdc nhan hLFdng gap nhat Phuong phdp t i i p cdn ndy

•d hieu qua va dde biet phii hp'p doi vdi

TAP CHi NGHIEN C(>U Y HQC nhQ'ng noi cd n g u i n luc han c h i . Nghien ciru eua ChOng tdi eho thiy, tuy ed khdng it ngudi tra Idi ed biit v i phuong phdp qudn II STI bdng t i i p edn hdi chirng, nhung thue t i , khdng ai trong s i ho sir dyng phuong phdp ndy trong c h i n dodn vd d i i u tri cho 4 trudng hep bdnh.

Trong nghidn eiru ndy, s i ngudi 3d tirng dup'c tham gia tdp h u i n v i STI vd RTI Id rat t h i p , chi cd 17%. Cd the do mdt thuc t i d nudc ta dd Id ed qua nhiiu n6 luc ddnh cho chuong trlnh phdng c h i n g HIV/AIDS, cu t h i Id cd tdi 97,5% kinh phi ciia nhd nudc cap ddnh cho phdng c h i n g vd chdm sdc HIV/AIDS, trong khi chi cd 2,5% ddnh cho cae hoat dong phdng chong STI [6] Trong khi dd, cac khda ddo tao, tdp huan ed tac dung tich cue ddi vdi kha ndng thyc hanh nhung d mire dp thdp. Vi vdy, c i n phai cd them ngudn luc ddnh cho viec tdp h u i n nhdm nang eao kien thirc va kha nang thue hdnh cua CBYT v i STI, ndi dung va phuong phap tap h u i n nen phai duoc bien soan sao cho phii hop vdi cac nhdm CBYT.

Hgn c h i cua nghien cu'u Id d i i m thuc hanh cd t h i khdng phan anh duoc kha nang thuc hanh thuc s u ve STI cua doi tuong nghien ciru do cdc trudng hop bdnh chi Id gia dinh Trong khi cd the cd mot sd y i u to anh hudng d i n cdc y tra Idi. V i du, s i ngudi thye su dieu tn benh nhdn STI trong thuc t i cd the cao hon nhiiu nhung trong nghien ciru nay cd the hg da khdng cdng khai r i n g hp cd tham gia kham/dieu trj/bdn thudc cho bdnh nhan STI vi theo quy dtnh cua phap ludt nude ta, chi cd bac sT hode y sT mdi d u o c kd don dieu tn

V. K^T LUAN

Kha ndng thuc hanh v i STI cCia CBYT tgi huydn Ba V! Id r i t thap Cde y i u to ehlnh anh hudng d i n thye hanh bao gom n g h i nghiep, cd t i i p xiie vdi bdnh nhan, tham d u tap h u i n

TAP CHl NGHliN Ct>U Y HQC • Hidu qud eua cdc chuong trlnh tdp huin khdng cao vd mdi chi 6 mire dd thip. VI vdy cin cd nhO'ng bidn phdp can thidp d i ndng cao kiin thirc vd thyc hdnh v i STI cho CBYT tuyin CO sd, Chuong trlnh vd cdch thirc t$p huin ndn dup'c thiit k i sao cho phu hp'p d i dgt dup'c hidu qud cao nhit,

TAI LI$U THAM K H A O 1. WHO (2007). Global strategy for the prevention and control of sexually transmitted infections 2006-2015. Breaking the chain of transmission,

2. Grosskurth H, Mosha F, Todd J, et al (1995). Impact of improved treatment of sexu- ally transmitted diseases on HIV infection in rural Tanzania' randomised controlled trial Lancet, 346 530 - 536

3. Lan PT, Faxelid E, Chuc NT, et al (2008). Perceptions and attitudes in relation to reproductive tract infections including sexually transmitted infections in rural Vietnam: A qualitative study. Health Policy; 86: 308-317,

4. Thi Thu H, Ziersch A, Hart G (2007).

Healthcare-seeking behaviours for sexually transmitted infections among women attending the National Institute of Dermatology and Venereology in Vietnam, Sex Transm Infect; 83 406-410,

5. Chalker J, Chuc NT, Falkenberg T et al (2000). STD management by private phar- macies in Hanoi: practice and knowledge of drug sellers Sex Transm Infect; 76; 299 - 302 6. Nguyen TH, Nguyen TL, Trinh QH (2004). HIV/AIDS epidemics in Vietnam; evo- lution and responses AIDS Educ Prev; 16:

137-154.

Summary

PRACTICE CAPACITY ON SEXUALLY TRANSMITTED INFECTIONS AMONG HEALTH CARE PROVIDER AT

GRASSROOT HEALTHCARE LEVEL

Sexually Transmitted Infections (STI) are not uncommon in Vietnam Practice capacity of health care providers (HCPs) at grassroot level plays an important role in STI control and preven- tion of its complications. The study was earned out to descnbe the situation and factors influence on practice capacity on STI among HCPs in Bavi district, Hanoi. The results indicated that STI practice of HCPs in Bavi district is at low level and influenced by several factors On avereage, practice score is 4.4/24. Factors eontnbute good impact on practice levels include dealing with STI patients, participating STI/RTI trainings (regression coefficient 2.2 and 1.2; p < 0,05).

However, effective of training programs is still at low level. Conclusion and recommendations: At grassroot healthcare level, practise on STI is very poor among HCPs, There is a need to develop intervention activities in order to improve practice capacity for HCPs in dealing with common STI syndromes.

Keywords: STI, practice, health care providers, Bavi district

TCNCYH 79 (2) - 2012