prevalence and influencing factors of the lower reproductive tract infections among sex workers in the centre for treatment - education- labour ii hanoi and evaluation of the intervention

1

MINISTRY OF EUDCATION AND TRAINING MINISTRY OF HEALTH
NATIONAL INSTITUTE OF HYGIENE AND EPIDEMIOLOGY



Nguyen Minh Quang

PREVALENCE AND INFLUENCING FACTORS OF THE LOWER
REPRODUCTIVE TRACT INFECTIONS AMONG FEMALE SEX WORKERS IN THE
CENTRE FOR TREATMENT - REHABILATION - EDUCATION - SOCIAL LABOUR II
HANOI AND EVALUATION OF THE INTERVENTIONS


Speciality: Social Hygiene and Health Administration
Code: 62.72.01.64

THESIS SUMMARY

SUPERVISORS:
1. Associate Prof. Ngo Van Toan, MD., PhD.
2. Do Hoa Binh, MD., PhD



Ha Noi - 2013
2

THE THESIS WAS COMPLETED
NATIONAL INSTITUTE OF HYGIENE AND EPIDEMIOLOGY

SUPERVISORS:
1. Associate Prof. PhD. NGO VAN TOAN
2. DO HOA BINH, MD. PhD



Opponent 1:


Opponent 2:


Opponent 3:




The thesis will be defended at the Assessment Commetee at Institute Level
The defend at National Institute of Hygiene and Epidemiology
Time: date month 2013






The thesis stored at:

- National Library
- National Institute of Hygiene and Epidemiology Library
3

PUBLICATIONS


1.
Nguyen Minh Quang, Bui Van Nhon, Ngo Van Toan (2012),
“Prevalence of lower genital tract infections among female sex workers
in Hanoi Social Education Labor Centre in 2009-2011”, Journal of
Medical Research, Volume 80, N
0
3.
2.
Nguyen Minh Quang, Bui Van Nhon, Ngo Van Toan, Do Hoa Binh,
Nguyen Thi Thuy Duong (2012), “Risk behaviors of the lower sexual
tract infections among female sex workers in Hanoi Social Education
Labor Centre in 2010”, Journal of Preventive Medicine, Volume XXII,
N
0
6 (133).
3.
Nguyen Minh Quang, Bui Van Nhon, Ngo Van Toan, Do Hoa Binh,
Nguyen Thi Thuy Duong (2012), “Effectiveness of intervention
measures to prevent the lower genital tract infections in female sex
workers at Centre 02 in Hanoi city, 2010-2012”, Journal of Preventive
Medicine, Volume XXII, N
0
6 (133).

4

INTRODUCTION

1. Rationale of the thesis
WHO defined that infections of lower reproductive tract (LRTI) are
genitials infections including STDs and others. LRTIs are common, dificult
to determine exactly the the incident rates of the differente teritories,
especial in sex workers (SW). The rate of LRTI is general high from 41-
47% in the world. In Vietnam, a study in 2005 reported 81.3% abnormal of
reproductive tract, including 66.6% LRTI, closely related to HIV, sinificant
hight in FSW. Risks of LRTI in FSW are lack of knowledge and practising
to prevent STD, including unsafty exual, less of condom using, many kinds
of sex partners, unsatisfy contraception The stydy on efectiveness of
LRTI preventive measures was carry out and it is pointed that the most
effected solution is using condom for all sexual intercourses.
In Vietnam, there are some stydies in effectiveness of prevention HIV,
however the systematic studies on LRTI are very rare. This sudy aims to
indicate the risk factors and efectiveness of interventions, in order to

improve the knowledge and practising to prevent LRTI in FSWs , who are
concentrated for treatment, rehabilation, education and social labor in the
Center II, Ba Vi, Hanoi. The subjects of study are:
1. Describe the incidences and risk behaviors of LRTIs in female sex
workers, who are concentrated in the Center for Treatment,
Rehabilitation, Education and Social Labor II of Hanoi in 2011.
2. Evaluate the effectiveness of interventions to prevent lower genital
tract infection for female sex workers and improve the knowledge of
sexually transmitted infections for medical staffs in the Center for
Treatment, Rehabilitation, Education and Social Labor II of Hanoi,
period 2011-2012.
2. New contributions of the thesis
This is the first systemetic study on LRTI with evaluations on incidences
and efectiveness of interventions, in order to improve the knowledge and
pratising for FSW, who were being in the Center II.
The thesis has proved the evidence on effectiveness of interventions by
training, LRTI screening for FSW and performance on training to improve
knowledge on managing LRTI for medical staffs of the center. The thesis
has identified the high incidence of LRTI in FSW and the role of condom
using to prevent LRTI for all sexual intercoureses with all clients, it is also
5

mentioned the effect of media education, advantage of initiative health care
to reduce LRTI diseases in FSW.
The study results are used ful for the policy and planning programs in order
to expand this intervention modul for the other centers over the nation.
3. Scientific and practical meanings of the thesis
Scientific meaning: The study uses community intervention design, meets
to subjects of research , data collection and analysis are exactly , has proved
remarkable effectiveness on interventions by media education, initiative

health care for FSW, has improved knowledge of managing LRTI for
medical staffs of the center.
Practical meaning: The results of the thesis has performed the effectiveness
of the intervention model to help planners and policy makers as well as
presventing LRT for FSW and improve knowledge and pratising STD
managing for health workers, base on that to expand this intervention model
for other centers over the nation.
4. The layout of the thesis
The thesis is presented in 124 pages, excluding appendixes and is divided into:
Introduction: 2 pages
Chapter 1: Overview: 35 pages
Chapter 2: Subjects and Methods of study: 198 pages
Chapter 3: Research Results: 36 pages
Chapter 4: Discussion: 27 pages
Conclusions: 2 pages
Recommendations: 1 page.
There are 41 tables, 11 charts.
The appendix includes 151 references (57 Vietnamese, 94 English),
Questionnaires sheet, List of FSW , List of staffs involved in the training.

Chapter 1
OVERVIEW
1.1. Basic conceptions of LRTI:
By WHO, infections of lower reproductive tract (LRTI) are infection
disease caused by or not by sexual transmition disease (STD) including
vulgaris, vaginalis and cervicitis.
1.2. Prevalance of LRTI and risk behaviors
1.2.1. Prevalence of LRTI
Gonorrhea: caused by Streptococcus Gonorrhea. Studies in 5 provinces
showed the incidence is 3.2 %. Nguyen Trong Thuc reported on his

Sentinel surveillence
6

Research in 4 southest province, the Gonorrhea incidence in FSW was 4.64
%. This ratio is higher in the North and Middle of Vietname, the research in
5 North border provinces described with 11.9% Gonorrhea in FSW. The
Gonorrhea ratio in the neiboring contries are 5.7 % in Cambodia and 9.5 %
in China.
Syphilis: caused by Treponema pallidum . Research in 5 border provinces
of Vietnam showed the incidence rate is 10.7 % in general, highest is
Quang ninh (24.8 %) and Lai Chau (20.2 %) and 03 remains provinces of
Dong Thap, An Giang, Kien Giang have rates ranging 5.7 - 9.4 %.
Chlamydiasis: is one of STD cause by Chlamydia,a parasite stained Gram
(-) color. A research in Provinces of Mekong Delata indicated 3.5 % FSW
has positive with Chlamydia. Foreign researches on FSW reported
incidence rate ranging 12% -2 7.0 % in Asia and Europe countries.
Trichomatis: caused by Trichomonas, a parasite of anaerobic protozoa,
round shape with diameter 10-20 μm. The incidence rate ranging 2-2.5 % in
general and 50-70 % in FSW over the world. In Vietnam LRT Trichomatis
incidence rate 8.13 % in FSW and 0.84 % in pregnants are reported.
Fungal LRTI: cause by Candidas Albicans and some time by other strains.
Candidas Albicans is also causing fungal diseases in many organs such as
the skin and mucosal infections, Septicaemia, endocarditis, meningitis. The
incidence in Haiphong province is 10.7%, highest among 5 researched
provinces. Research in 2005 showed fungal LRTI incidence rate is 11.9 %
of FSW in 4 South provinces.
Reproductive papiloma: caused by Human Papiloma Virus (HPV).
Typical sumptoms are red-brown soft warts, glomerate in vulva, vagina,
cervix. The lessions evoke itching, discomfort due to increasing secretion,
easy to bleed by touch. Dianosistic based on physical symptoms, cervix

luminate, HPV determine by PCR technique. HPV papiloma has high ratio
in FSW, accounting for 9.2 %.
Reproductive Herpes: caused by Herpes Simplex Virus type I, II. It 's
leading to obstetric accidences such as miscarriage, premature give birth,
premature placental detachment. Research in Hai Phong province showed
the incidence rate in FSW is 3.9 % in FSW, 32.8 times higher than the
lower risk groups.
Complex microbial LRTI - vulgaris, vaginalis: the pathogens are
nonspecific, diversity. Clinic symptoms are homogeneous liquid discharge
with white or gray color, stinking smell. Some local and overseas studies
7

reported the incidence rate of complex microbial vulgaris, vaginalis
without symtoms are quite hight (50-70 %).
1.2.2. Factors and risk behaviors afects to LRTI in FSW
Age is an important factor of LRTI in teenagers. Studied in Central Institute
of Dermatology of Vietnam 2003-2005 and other researches indicated the
incidence rate tend to be higher in women over 20 years old than the
women under 19 years old.
The incidence rate of LRTI is usually higher in group has low education
and and unstable careers. This is also a difficult matter on education to
improve practising of LRTI prevention. In fact, the low education group has
shown the poor knowledge of LRTI and unsafty sexual activities, unsafety
injection that entrain to high incidence of HIV and LRTI.
Career is important factor related to LRTI and HIV infection, the incidence
rate are 14.7 %; 13.1%; 13.1 % and 8.4 %, correlatively in the groups of
workers, freelances, market sellers and students.
Having unsafty sex is risk to be infected HIV and LRTI, in countries with
high prevalences of HIV & LRTI, were recognised the main cause of very
low rate of condom using (condoms). In a study in the southern provinces

showed that 65% of female sex workers do not use condoms during
sexcourses, HIV prevalence in this group was 5.2% and the proportion
accounted for LRTI is high (above 80%). Average number of customers
/ month is one of the high-risk factor to be infected HIV and STD in
FSWs. Research by Centre for Disease Prevention and Control showed
up to 80% of cases LRTI does not use condoms regularly, compared
with 2% of LRTI cases in FSWs often use of condoms in sexcourses
with clients and partners. The initiative to get the tests of LRTI is
meaningful in preventing infection LRTI for their clients, husband /
partner and also help the women be able to access the treatment in cases
of LRTIs.
1.3. The LRTI prevention models
1.3.1. Communication programs for behavior change
The main purpose of communication programs for behavior change is to
increase awareness, knowledge, understanding of transmission LRTI and
prevention measures for all the people, forthe high risk groups, eapecial
FSWs. Communication programs for behavior change aims to access the
high-risk groups, differentiate to the other media is for community. This
program also provide information of to prevent LRTIs and provide
services, which support to change behaviors and maintain safety sex by
using condoms, resist drug abuse and personal hygiene guide.
8

1.3.2. The program of 100% condom using
The program encourages FSWs to use condom for 100% sexual
intercourses (says as program 100% condom) is not simply to provide
condom, but it includes many activities to improve the awareness,
knowlege about distribution of condoms, peer education and screening of
STD and reproductive tract infections. The aims of program is to prevent
and reduce HIV and LRTI with effectiveness and low cost.

1.3.3. Program of Management LRTI
The person, sho is sufered from LRTI diseases likely to be HIV infected
more than 2-9 time compare with the ordinary subject. Therefore, early
detection and treatment of STD are not only make sense to restrict the
spread of HIV through sexual, also are meaningful in management,
monitoring LRTI among indicated population.
1.3.4. Peer education program
Peer education program is reachable enough to understand that "the sharing
of knowledge, skills and life experiences between those who have the same
characters of social and ecomomy such as age, gender, occupation, religion,
hobbies, in order to change their behaviors". Peer education program is also
called "program of communication accessibilities". In many countries,
people have implemented the programs to reduce harm in community such
as peer education.

Chapter 2
SUBJECTS AND METHODS
2.1. Object, location and study duration
2.1.1. Subjects of study
- The women are training in the CenterII (for Treatment,Rehabilitation,
Education, Social Labor), located in Yen Bai commune, Ba Vi District, Ha
Noi City, from 2011 to 2012. The time of concentrated training should be t
least 12 months to warranty the time of intervention by research and the
participants have to voluntary invole to the study.
- 15 medical staffs and managing persons, who are working in the Center II
for Rehabilitation, Education, Social Labor, Hanoi.
2.1.2. Study site
The study was conducted at the Center II for Rehabilitation, Education,
Social Labor, belongs to Department of Labour, Indisable and Social
Affairs of Hanoi, located in Yen Bai commune, Ba Vi district.

2.1.3.Duration of research and data collection
From 1/2011 - 12/2012, at Ba Vi district, Hanoi.
2.2. Research Methodology

9

2.2.1. Study Design
An intervention experimental design, without comparative.
2.2.2. Research sample and sampling
2.2.2.1. Female Sex Workers:
Sample sizes:
2
21
2
22111)2/1(
21
)(
])1()1([)1(2[
pp
ppppZppZ
nn
−
−+−+−
==
−−
βα

Includings:
n
1

: sample size before intervention
n
2
: sample size after intervention
p
1
: prevalence of FSW using condoms for all sexual intercourses, before
intervention (estimated 52 %)
p
2
: prevalence of FSW using condoms for all sexual intercourses, after
intervention (estimated 65 %)
p: (p1 + p2) / 2, Z1-α / 2: reability coefficient, determined at 95 % (=1.96)
z
1-β
: force sample (= 80%)
Total: 407 FSWs were studied.
Sampling: The FSWs were selected by the single random sampling, based
on a list of all FSWs, who are training in Center II, Ba Vi, Hanoi.
2.2.2.2. Medical staffs
All medical staffs included all 15 doctors, nurses who are working in Center
II, Ba vi, Hanoi to be selected in the study.
2.2.3. Process and means of data collection
2.2.3.1. Process of data collection
2.2.3.1.1. Interview
Interviewed FSWs following questionnaire sheet to collect information of
individuals, families, and knowledge of risk behaviors of LRTI of FSWs.
Interviewed medical staffs to collect personal information and LRTI
knowledge of the medical staff of the Centre.
2.2.3.1.2. Clinical examination

Clinical exam to identify the symptoms of LRTsI. Take exam to detect the
exsisting STDs: genital ulcer, urethral and vaginal discharge, stinking odor
of discharge, urticaria, abnomal pain, papilome.
2.2.3.1.3. Tests
The dicharge of lower genital tract and blood are testing find the pathogens
of LRTIs. The LRTIs to be studied are including: Gonorrhea, Syphilis,
Trichomoniasis, Chlamydia, fungi and complex bacterial.
10

2.2.3.2. Means of data collection
The interview questions sheet contains: the administrative part, personal
characteristics, risk behaviors of FSWs and knowledge, skills of medical
staffs. Clinical examination leaflet, blood tests, discharge test.
2.2.4. Technical tests
The testing techniques to find pathogens were performed under the
guidlines of WHO and the Central Hospital of Dermatology.
2.2.5. Content and intervention process
Examination, treatment for FSWs and monitoring of clinical and laborator
expressions. Communication and education activities focused on prevention
of sexually transmitted diseases, which is currently conducted at the Center,
included: organized the direct education, communication via leaflets, media
by film/television, consult directly. Training for medical staffs to perform
screening, exam and treatment of LRTI and STDs for FSWs.
2.2.6. Analysis
The data has been analysis and presented by frequency and % ratio. Test χ
2
and p value expressed the difference between independent variable and
dependent variable. Estimation Test (OR) and 95% CI was used to identify the
relation between LRTI ratio and individual characteristics, risk behaviours of
FSWs. Multivariable regress analysis to be used for error exclussion of

indipendent and depend variables relationship. Effectiveness indicator to be count
for determining of intervention effects.
2.2.8. Ethics in Research
The objects have informed the aims of study and to be volunteered. All
information is secured by encription and used for this dtudy only. The
research author have not to utilitize any inlegal supplemtation or service
during study process.

Chapter 3
RESULTS OF STUDY
3.1. Some personal characteristics of FSWs
Among 407 FSWs, the youngest is 15 years old and the oldest is 40 years
old. Mean age was 26.8 ± 6.29 years, minimum 15 and maximum is 40
years old. Most FSWs were currently concentrated on training in the Center
are Kinh ethnic group, accounting for 59%, the proportion of FSWs used to
live in rural areas is very high, accounting for 93.4%. Before to be FSWs,
11

most of them were worked in agriculture (63.6%), continuous by groups of
jobless and freelance (14.3% and 14%). The education level of FSWs was
low, averaging 6 ± 3.8 years. FSW illiteracy rate was 14%, primary school
was 28%, secondary school was 45.5% and high school was 12.5% only.
Medical staffs group ≤ 30 years has highest for proportion (60.0%). Mean
age was 29.8 ± 6.6 years old. There are 60 % of medical staffs are women,
highest proportion is nurse (46.7 %). Working experience of medical staffs
devided 02 groups: under 5 years, accountd for 46.6 % including 3 staffs just got
01 working year; 5-10 years and 11-20 years, accounted for 26.7 %. One of them
has trained of LRTI treatment (6.6 %).
3.2. Incidence prevalence, influent factors and risk behaviors of female
sex workers

3.2.1. The clinical symptoms of LRTIs
In FSWs, the rate of at least one symptom associated with LRTI when
entering the Center was 34.2%. The most common symptoms reported in
FSWs is abnormal vaginal discharge (24.8%), followed by itching in the
genital area (14.7%), abdominal pain (13.3%). Other symptoms were
genital sores (10.6%), sharp pain urine (9.3%) and lowest was genital ulcers
(8.4%).
3.2.2. Incidence prevalence in FSWs
Incidence prevalence of LRTI in FSWs when entering the center is high in
clinical, accounted for 67.1%.
7.9%
49.9%
12%
21.9%
8.8%
0
10
20
30
40
50
60
Single
vulgaris
Single
vaginalis
Single
cervicitis
Vu lg a -
vaginalis

Exposed
cervical

Chart 3.9. The lession morphology of lower genital/reproductive tract
infections
12

The most common infection was vulvo-vaginalis (49.9%), single vaginalis
(21.9%), single cervicitis (8.8%). Especially with 7.9% of FSWs had
cervical cervicitis.

10.1%
44.7%
2.5%
0.5%
4.4%
0
10
20
30
40
50
T.Vaginalis Gonorrhea Syphilis Complex
microbial
Fungal

Chart 3:10. Ratio of pathogens of lower genital tract infection (n = 273)
When entering the center, rate of complex microbial infection in FSWs was
highet, accounted 44.7%, following by fungal infection 10.1%, Trichomonas,
4.4%, syphilis 2.5% and gonorrhea is lowest, accounted for 0.5%.

3.2.3. Analysis the affected factors and pathogens of lower genital tract
infections in FSWs
Table 3.17. The relation between pratising/whored time and LRTIs
Whored time
Infection
(n=273)
Non-infection
(n=134)
OR 95%CI
Quantity % Quantity %
≥ 1 months
< 1 month
174
99
72.8
58.9
65
69
27.2
41.1
1
0.6

0.38-0.81
FSW group < 18 years old had a higher rate than the FSW group > 18 years
old (70% compared with 66.2%). There was 58.7% FSWs had whored time
≥ 1 month . The rate of LRTI in FSW group of whored time ≥ 1 months is
higher than FSW group of whored time < 1 month (72.8% compared with
58.9%). This difference was statistic meaning.

13

Table 3.18. The relationship between the average sex client and LRTI
Number of the
clients
Infection
(n=273)
Non-infection
(n=134)
OR 95%CI
Quantity % Quantity %
Clients / month
1-9 clients
10-19 clients
≥ 20 clients

96
38
139

66.2
70.4
66.8

49
16
69

33.8

29.6
33.2

1
1.2
1.0


0.58-2.53
0.64-1.65
New clients / month
0 client
1-2 clients
3-5 clients
≥ 6 clients

18
131
19
25

52.9
71.3
64.5
67.6

16
56
50
12

47.1
38.7
35.5
32.4

1
2.1
1.5
1.9


0.93-4.65
0.85-3.24
0.64-5.44
In general, LRTI rate of FSW group had 10-19 clients/month is higher than
the other FSW groups (70.4% compared with 66.2% and 66.8%) .
However, this difference is not statistic meaning. Rate of LRTI of FSW
group had 1-2 new clients / day was higher than the other groups (71.3%
compared with 67.6%, 64.5% and 52.9%). This difference is also not
statistic meaning. LRTI rate of FSW group had ≥ 6 regular client was
higher than the other FSW groups (71.1% compared with 64.2%, and
58.7% ). This difference was statistic meaningl.
Table 3.19. The relation between behavior of condom use and LRTI
Behavior of condom
use
Infection
(n=273)
Non-infection
(n=134)

OR 95%CI
Quantity % Quantity %
With new clients
No
All times

240
33

69.2
55.0

107
27

30.8
45.0

1
0.6


0.32-0.95
With regular clients
All time
No

140
133

60.9
75.1

90
44

39.1
24.9

1
1.9


1.21-3.34
With husband and lover
Yes
No

108
165

65.5
68.2

57
77

34.5
31.8

1
1.1


0.58-1.34
14

The LRTI rate of FSW with new clients groups had used condoms for all
sexualcourses was lower than the FSW of correlative group had'nt used
condom for all sexualcourses (55 % compared with 69.2%). The LRTI rate
of FSW with regular clients groups had used condoms for all sexualcourses
was lower than the FSW in correlative group had'nt used condom for all
sexualcourses (60 , 9% compared with 75.1%).
Table 3.20. Initiative health screening behavior and LRTIs
Initiative
medical care
behavior
Infection
(n=273)
Non-infection
(n=134)
OR 95%CI
Quantit
y
% Quantit
y
%
Initiative examine
No
Yes

181
92

69.6
62.2

79
55

30.4
37.4

1
0.7


0.51-1.20
Initiative test
No
Yes

179
94

69.9
62.3

77
57

30.1
37.7

1
0.7


0.92-2.15
Only 36.5% FSWs got initiative medical exam and 37.1% FSWs got
initiative test. The LRTI rate of FSWs without initative exam and test was higher
than correlativeness. However, this difference is not statistic meaning.
Table 3.21. Understanding of infedelity sex, condom use and LRTIs
Understanding
Infection
(n=273)
Non infection
(n=134)
OR 95%CI
Quantit
y
% Quantit
y
%
Infidelity sex
Right
Wron
g

203
22

66.6
71.0

102
9

33.4
39.0

1
1.2


0.81-1.82
Condom use
Right
Wrong

226
15

67.7
68.2

108
7

32.3
31.8

1
1.1


0.36-3.84
Right understanding FSW group had LRTI rate lower than the wrong group
(66% compared with 71%). However, this difference was not statistic
15

meaning. Percentage of LRTI in FSW who wellknowed of condom use for
all sexcourses was lower than the misunderstading group (67.7% compared
with 68.2%). However, this difference is not statistically meaningful.
Table 3.22. The relation between self-assessment of risks and LRTIs
Self-assessment
Infection
(n=273)
Non-infection
(n=134)
OR 95%CI
Quantity % Quantity %
High risk
Low rist
No risk
Did'nt know
29
39
98

107
75.2
57.4
72.6
66.2
11
29
37
57
27.5
42.6
27.4
34.8
1
0.5
1.0
0.7

0.20-1.28
0.42-2.36
0.71-1.62
Only 9.8% FSWs had self assessment for LRTI risks (for both FSWs with
or without the disease), 16.7% self-assessment for low risk, 33.2% self-
assessment in no risk and 40.3% did not know whether they were at risk of
LRTI or not. No relation was statistic significant between self-assessment
and risk of LRTIs.
Table 3:25. Relation between personal characteristics, risk behaviors and
LTRIs by multivariative regression model
Personal characteristics and behavior risks O
R

95% CI
A
g
e 1.2 0.78-1.79
Ethnic
g
rou
p
0.8 0.53-1.34
Teritor
y
0.6 0.60-1.51
Education 1.1 0.66-1.36
A
g
e of 1st sexcourse 1.2 0.72-2.08
Number of clients / month 1.1 0.81-1.36
New clients / da
y
1.1 0.78-1.49
Re
g
ular clients / da
y
1.0 0.78-1.33
New clients used condom for all sexcouses 2.5 1.07-4.09
Re
g
ular clients used condom for all sexcouses 2.3 1.12-4.10
Initiative medical exam 0.9 0.43-2.05

Iniative medical test 1.5 0.69-3.31
Self-assessment LRTI risks 1.0 0.95-1.09
Study with multivariative regression model of the relation between personal
characteristics and risk behaviors with LRTI showed that no condom use
for all sexcourses lead to incease risks of LRTIs. The other factors was not
significantly influenceto the incidence statistics of LRTIs.

16

3.3. The effectiveness of the intervention measures to prevent LRTIs
3.3.1. Knowledge:
FSW understanding rate of the clinical symptoms of LRTI was much
higher compared with the it's figure when FSW entered the center (51.4% to
98%). This difference was significantly meaningful for statistic with p
<0.001 and efficiency indicators (EI) was 86.1%.
3.3.2. Attitude:
Table 3.27. Effectiveness of improvement to prevent LRTI
Preventive attitude
Before intervetion
(n=407)
After prevention
(n=407)
p
Effectievness
figure (%)
Quantity % Quantity %
Infidelity sex
Right
Wrong
Does'nt know

305
31
71

74.9
7.6
17.4

403
0
4

99.3
0
0.7

<0.001

32.6
All sex uses condom
Right
Wrong
Does'nt know

334
22
51

82.1

5.4
12.5

403
0
4

99.3
0
0.7

<0.01

30.0
FSW attitude to prevent LRTI also highly increased and had significant
statistic with high effectivness figure. Increased level of attitude on the
prevention / control LRTI was not as fast as the growth of knowledge.
Table 3.28. Effective of improvement attitude on self-evaluation LRTI risk
Self-
assessement of
LRTI risk
Before
intervention
(n=407)
After intervention
(n=407)
p
Effectiveness
figure (%)
Quantity % Quantity %

High risk
Low rist
No risk
Does'nt know
40
68
135
164
9.8
16.7
33.2
40.3
130
31
74
172
31.9
7.5
18.2
42.4
<0.01


225.5


After the intervention, the rate of self-assessment of LRTI risk by FSW was
increased from 9.8% to 31.9%. This difference had significant statistic with
p <0.01 and EF is 69.3%.
17

3.3.3. Reduce symptoms and LRTIs
Table 3.29. Effective in reducing the clinical symptoms LRTI
Clinical
symptoms
B
e
f
ore
i
n
t
erven
ti
on
(
n=407
)

Aft
er
i
n
t
erven
ti
on
(
n=407
)

p
Eff. Fig.
(%)
Q
uan
tity

%

Q
uan
tity
%
L
ower a
b
nona
l
pa
i
n
Yes
No

54
353

13.3
86.7

15
392
3.7
96.3
<0.01 72.2
Di
sc
h
arge
/
pus
Yes
No

101
306

24.8
75.2

12
395
2.9
97.1
<0.001 88.7
U
r
i
nary pa
i

n
Yes
No

38
369

9.3
90.7

6
401
1.5
98.5
<0.001 83.9
G
en
i
ta
l
sore pa
i
n
Yes
No

43
364

10.6

89.4

17
390
4.4
95.6
<0.01 58.5
G
en
i
ta
l

l
ess
i
on
Yes
No

34
373

8.4
91.6

3
404
0.7
99.3

<0.01 88.1
G
en
i
ta
l
prur
i
tus
Yes
No

60
347

14.7
85.3

25
372
6.3
93.7
<0.01 57.1

Some typical symptoms of LRTI as discharge / pus, urinary pain, genital
pain pain, genital ulcer / sarchome, genital pruritus were much reduced.
These differences were significanct statistic with p ranging from less than
0.01 to 0.001 and EF ranged from 58.5% to 88.7%.
Table 3.30. The effectiveness of reduced LRTI clinical symptoms
Reduce LRTI

B
e
f
ore
i
ntervent
i
on
(
n=407
)

Af
ter
i
ntervent
i
on
(
n=407
)
p
Eff. Fig.
(%)
Q
uant
i
t
y

%

Q
uant
i
t
y

%
V
u
l
gar
i
s
Yes
N
o

36
371

8.8
91.2

17
390
3.9
96.1
<0.01 55.7

V
ag
i
na
li
s
Yes
N
o

89
318

21.9
78.1

5
402
1.2
98.8
<0.001 94.5
V
u
l
vo-vag
i
na
li
s
Yes

N
o

203
204

49.9
50.1

87
320
21.2
78.8
<0.001 57.5
C
erv
i
t
i
s
Yes
N
o

49
358

12.0
88.0

18
389
8.3
91.7
<0.01 30.8
E
xpose
d
cerv
i
t
i
s
Yes
N
o

32
375

7.9
92.1

2
403
0.5
99.5
<0.01 93.7
18

Vulgaris declined from 8.8% to 3.9%. Vaginalis dropped from 21.9% to
1.2%. Vulvo-vaginalis decreased from 49.9% to 21.2%. Cervitis reduced
from 12% to 8.3%. Exposed cervicitis decreased from 7.9% to 0.5%. These
differences were significant statistics with p ranged from less than 0.01 to
0.001 and EF ranged from 30.8% to 94.5%.
Table 3.31. Effective in reducing LTRI by testevidence
Reduced LRTI
B
e
f
ore
i
n
t
erven
ti
on
(
n=407
)
Aft
er
i
n
t
erven
ti
on
(
n=407

)
p
Eff. Fig.
(%)
Q
uan
tity
%
Q
uan
tity
%
T
r
i
c
h
omonas vag
i
na
li
s
Yes
N
o
18
389
4.4
95.6
0

407
0
100.0
- 100.0
G
onorr
h
ea
Yes
N
o
2
405
0.5
99.5
0
407
0
100.0
- 100.0
S
yp
hili
s
Yes
N
o
10
397
2.5

97.5
0
407
0
100.0
- 100.0
C
omp
l
ex
b
acter
i
a
l

Yes
N
o
179
228
44.7
55.3
71
336
17.7
82.3
<0.01 62.9
F
ung

i

L
eveus
Yes
N
o
41
366
10.1
89.9
16
391
3.9
96.1
<0.01 61.4
The pathogens of LRTIs on FSWs decreased very significantly compared to
this figure when FSWs entering the center. These differences were significant
statistics with p less than 0.01 and EF ranged from 61.4% to 100%.
3.4. Change knowledge of LRTI of medical workers
3.4.1. Change general knowledge of LRTI by interventions
Table 3.32. Changing knowledge of the clinical symptoms of LRTI before
and after intervention
C
l
i
n
i
cal
s

y
mtoms
B
e
f
ore
i
nvent
i
on
Af
ter
i
ntervent
i
on
p
Yatess

Q
uant
i
t
y
%
Q
uant
i
t
y

%
S
cretc
h
Y
es
11
73
.
3
10
66
.
7
p>0.05
N
o
4
26
.
7
5
33
.
3
Ul
ce
r
Y
es

13
86
.
7
14
93
.
3
p>0.05
N
o
2
13
.
3
1
6
.
7
S
arc
h
ome
Y
es
5
33
.
3
15

100
.
0
p<0.001
N
o
10
66
.
7
0
0
.
0
V
as
i
cu
l
a
r
Y
es
8
53
.
3
12
80
.

0
p>0.05
N
o
7
46
.
7
3
20
.
0
P
ustu
l
es
Y
es
10
66
.
7
11
73
.
3
p>0.05
N
o
5

33
.
3
4
26
.
7
P
a
p
u
l
a
r
Y
es
5
33
.
3
6
40
.
0
p>0.05
N
o
10
66
.

7
9
60
.
0
Bl
ee
di
n
g
/

p
us
Y
es
10
66
.
7
8
53
.
3
p>0.05
N
o
5
33
.

3
7
46
.
7
19

Knowledge of health workers in the majority of clinical symptoms of LRTI had
improved after intervention, including ulcers, sachome/chancre, vasicular, pustules.
Table 3.33. Changes in knowledge of LRTI diagnosis tests before and after
intervention
Diagnosis tests
Before intervention After intervention
P
Yatess

Quantit
y
% Quantit
y
%
Pap
Yes 11 73.3 14 93.3
p>0.05
No 4 26.7 1 6.7
Cell culture
Yes 7 46.7 6 40.0
p>0.05
No 8 53.3 9 60.0
Serum test

Yes 3 20.0 10 66.7
p<0.05
No 12 80.0 5 33.3
Proportion of health workers with knowledge of direct examination tests to
diagnosis LRTI after intervention (93.3%) was higher than before the
intervention (73.3%). Besides, knowledge of the medical staff of serum
tests in the diagnosis of LRTI after intervention (66.7%) had increased
significantly compared to before intervention (20.0%) (with p <0,05).
While the knowledge of the medical staff of cells culture decreased after the
intervention than before the intervention, but this difference was not
significant statistic (p> 0.05).
Table 3:34. Change knowledge of management LRTI before and after
intervention
Mana
g
emen
t direction
Before intervention After intervention
P
Yatess

Quantit
y
% Quantit
y
%
S
p
ecific treatment
Yes 14 93.3 14 93.3

p>0.05
No 1 6.7 1 6.7
Combination treatment
Yes 12 80.0 12 80.0
p>0.05
No 3 20.0 3 20.0
LRTI treatment knowledge of medical staffs after intervention NTDSDD
had no changed compared with before intervention. Before and after
intervention the rates of specific treatment was 93.3%, LRTI specific
treatment and combination treatment were 80.0%.



20

Chapter 4
DISCUSSION
4.1. Some personal characteristics of FSW
Our results was complied with findings in Vinh Long province [18] and 3
provinces of the Mekong Delta. Results of this study showed that the rate of
FSWs in age group from 20-29 years old (respectively 74%, 65%),
followed by the under 20 years old (17%, 25%). Group aged 30 and older
accounted for the low rate (9%, 10%). Most FSWs inthe center II-Hanoi
had low education levels, average 6 ± 3.8 years, lower than FSW edcation
in the Mekong Delta and Vinh Long (secondary school up to 53.5%,
followed by the primary 36%, secondary or higher education accounted for
8.3% and illiterate 2.2%).
Although unmarried FSW rate was relatively low, but this group was at
high risk of transmission of sexually transmitted infections for both
husband and lover by having sex with clients and with her husband / lover

concomittently. This also confirmed by a number of studies around the
world. In particular, the results of this study showed that almost FSWs had
sexual intercouses with clients and her husband or lover.
4.2. The prevalence and risk behaviors of the lower genital tract
infection in female sex workers
4.2.1. LRTI prevalence in FSW
Our study indicated that the rate of FSW with lower genital tract infection
quite high, accounted up 67.1%. It was clear that while the high of icidence
but the symptoms were manifested low (about ½), to prove the undetectable
LRTIs in FSWs. The results of some other domestic and foreign studies
were comformed with the results of this study to point out the high rate of
LRTIs.
Reported by WHO, the incidence of sexually transmitted infections,
including infections of the lower genital tract and upper genital tract
infection is approximately 333 million people every year. Lower genital
tract infection is not too severe or leading to death, but greatly affects the
quality of life for the welfare of the family, causing discomfort, infertility
affects and reduce labor productivity. This study's results showed that the
LRTI prevalence in FSW when entering the center was high, accounting for
67.1%. The most common kinds were vulvo-vaginalis (49.9%), vaginitis
(21.9%), cervicitis (8.8%), especial with exposed cervicitis 7.9%. The
other study results showed that LRTIs were spread in the world,
concentrated in the developing countries such as Africa, Latin America and
South Easth Asia. By WHO, estimated 2003 there were 390 million case of
STDs, including: Gonorrhea, Syphilus, Trichomonas, Chlamydia chromatis
with highest risk group of FSWs, female workers in the restaurants, hotels.
WHO announced that the rate of uper genital and lower genital tract infections
were highest in South Asia and South East Asia (151 millions case, accounting
21

44%), following by area next to Sahara, Africa (60 million case, accounting
20%); Caribien countries, Latin America (38 million cases, accounting 11%).
A stydy on actual situation of LRTIs reported that in the end of XX century,
in the countries of Asia, Africa and Latin America the incidence of LRTI
icluded Chlamydia chromatis, gonorrhea, Trichomonas vaginalis and
siphylus were at high risk women accounting for 14%, 24%, 17% and 15%,
respectively, while this rate in the low risk women (ex. pregnant) were 8%,
6%, 12% and 8%. Vietnam has achieved on controling STD, including
Gonorrhea, Syphilus with low incidence in the common but STD/HIV
infections are tend to increase.
According to WHO, the incidence of Gonorrhea reached to 62 million case
per year, where are 29 million cases in South East Asia, estimated rate
Cambodia3%, other contries 1%, China 2%; there was 89 million case of
Trichomonas Trachomatis over the world. The subjects to be inffected
mostly women in high riskg roups, such as FSW and unsafty sexual
behaviour. In America 1997, the incidence of Chlamydia without symtomps
in man was 3-5% in the health care agents and 15-20% in the STD agents.
Through literature reference for lower genital tract infections in FSW in
Vietnam we found there was a few studies on this issue and even less for
FSW. Currently, there are some researchs on the lower genital tract
infection of women in the community and women in the military. However,
the study of infections of lower genital tract for FSW in Vietnam still rare
and used to research with sentinel surveillance in the provinces / cities, in
groups at high risk of LRTI, combined with other STDs and HIV/AIDS.
In Vietnam, during the period 2006 - 2010 Ministry of Health and the
related hospital has conducted study of sentinel surveillance in 10 provinces
/ cities with the objects at high or low risk as FSW, recruits, pregnant
women According to sentinel surveillance in Vietnam, the period 2006 -
2010, it showed that FSWs had incidence of syphilis and gonorrhea at the
high level, relatively stable at around 2.0% incidence and trend to be down.

Reported cases of chlamydia and fungi in FSW were very high percentages,
and higher than the incidence of syphilis and gonorrhea. Especially the
incidence of Chlamydia, was highest in 2007 (14.0%), then decreased
gradually from 2007 to 2010. Meanwhile, the percentage of fungal
fluctuated from 4.0% to 8.0% during the period 2006-2010. According to
sentinel surveillance in FSW among the monitores provinces, the highest
incidence of Syphilus is in HCM city and Hanoi (4.5%), following were Da
Nang (3.0%), Hai Phong (2.7%). There was neither case of Syphilus in
Quang Ninh province; the highest incidence of Gonorrhea in HCMC
(5.5%), Following by Hanoi and Da Nang (are 3%), Hai Phong (2.7%) and
Quang Ninh (0.5%); the incidence of Chlamydia is 4.3% overall; Syphilis
prevalence was highest in sex workers in Ho Chi Minh City (6.5%),
followed by Hanoi (5.0%), Da Nang (3.5%), Hai Phong (3, 3%) and Quang
Ninh (3.0%).
22

The results of our study conformed to results of sentinel surveillance studies
in Vietnam. Test results showed that the proportion of contamination
bacterial in FSW when enter the center was the highest, accounted for
44.7%, followed by fungal infections, accounted for 10.1%, trichomoniasis
4.4%, syphilis accounted for 2.5%, and the lowest 0.5% of gonorrhea. The
studies of LRTI was quite different and ranged. This is easy to undertand
because for lower genital infections, the incidence will much reduced when
using only 1-2 antibiotics (buy and use by self or get direction by the
hospital. Over sea studies reported the consequancy in FSW of Chlamydia
in Europe and Asia countries ranged from 12-27%. Study in Bangkok
figured Chlamydia trachomatis in female massage workers was 43%, in
FSW in Bali, Indonesia was 26.5%.
4.2.2. The factors and pathogens affected to lower genital tract
infections in FSWs

Our study showed that the age group from 20-29 of FSW had highest rate
(70.1%), followed by the under 20 age group (63.9%) and lowest in the
group FSW ≥ 30 years old (61.5%). The incidencce of LRTI tend to high in
young women, who had early sexual activity, unsafety sexual behavior, and
becoming more severe, especial in high risk group such as FSW, teenage.
WHO estimated 1/3 cases of STD in women below 25 years old should be
cured every year. The recurent STD of teen age group should be more than
the adult. A study in California, America reported that age is important
factors of STD in teenager group. Among 3.579 teenagers, who had sexual
with alcohol, narcotic, the LRTIs as much as young. Reseach of Vu Thi
Huong in hai Phong province informed some groups of high risk of LRTI
including FSW and aged > 40 years old had highest incidence of Phylitus
accounting 5% while the lowest belongs to aged 30-39 year old. Research
of Nguyen Van Thuc in Ho Chi Minh city showed the highest rate of
Gonorrhea were FSWs aged 21-30.
The results of this study also figured that FSW group living in rural areas
had a higher proportion of LRTI than the FSW group in urban areas (67.6%
compared with 59.3%). FSW group widowed had highest rate of LRTI
(80%), followed by the FSW groups of married and unmarried (70.7% and
68.8%), lowest FSW groups had separated or divorced (62.5% and 56.9%).
Group of illiteracy FSW was highest at LRTI rate (70.2%), followed by the
FSW groups had secondary or high school education (67.6% and 66.7%),
the lowest was primary education FSW group (64.9%). The results of this
study was quite consistent with the results of the other previous researches
in Vietnam. The incidence of Phylitu in free-job group was higher (1.7%)
than the other job groups (0.7%).
The results of this study complied with some research results on indentified
study on relation between lower genital infection were sex and whored
locations. The study indicated that the FSW whored in gardens, parks,
motels, massage places with no conditions and difficult to apply hygiene

23

measures for safety sexual compare with the FSW whored in the hotels.
The results of a study of HIV / STI in Vinh Long province reported FSW
group had whored time of 1 month or more with a higher rate of LRTI than
the FSW group had whored time less than 1 month (72.8 % compared with
58.9%). The study also said that the age of sexual behavior was also a risk
of lower genital tract infections and HIV. A number of domestic and
international research showed that the young FSWs had sexcourse early,
before the age to be able to fully understand the risk of lower genital tract
infections were very susceptible to the disease. The findings of Nguyen
Manh Cuong 2008 on FSW in 3 provinces of An Giang, Kien Giang and
Dong Thap in the Mekong Delta showed the age of first sexual intercourse
is 19.2 years old and there was no statistic meaning to differentiate between
female sex workers in streets and restaurants (19.3 years old and 19.2 years
old). This result was reasonable, because in fact in Vietnam, the FSW in
streets were older than FSW in restaurants, no longer able to attract clients
and have to relocate their whored place.
In Thailand, India, Indonesia and some African countries as well as in
Vietnam in Ha Noi and neighboring provinces, high rates of lower genital
tract infection in high-risk populations. One of the characteristics of FSW is
the nature mobility, due to the inferiority of their career, they do not want to
live in a place fixed for a long time. On the other hand they also have to
move from one province to another, one district to another depending on the
number of clients and income for themselves. Especial as of the current
globalization, tourism development, travel conditions should ease the
prostitution abroad is not difficult for female sex workers. Some local
studies have shown the average number of clients / month is one of the risk
behaviors of lower genital tract infection for female sex workers and and
reverse. For female sex workers use condoms for all sexcourses, the

average number of clients more or less is not very important, but for female
sex workers without using condoms for all sexcourses with clients, this is a
very important issue. The research results showed that at Vinh Long in the
past month, the proportion of women to sell sex from 1-9 clients is 15%,
10-19 clients accounted for 52.6%, from 20 clients and more accounted for
32,5%. Average number of clients /months was 18.8 ± 13.5. The research
results of the other topics in the Mekong Delta province showed the average
number of sexual partners of FSW is 18.9 clients / month. The authors also
said there is a difference in the rate of HIV / STI and the average number of
sexual partners, as many clients as much of risk of infection, however the
affectivness of condom using or not have to be considered.
Normally, very little FSW had initiative medical check and test by for
sexually transmitted infections as of guilt, partly due to not knowing the
benefits and did not know where tests should be done. Research results in
Vinh Long province said only a low percentage of FSW (20%) answered
that had been tested for HIV and sexually transmitted infections, while up
24

to 80% of FSWs have no tested for STD . Among FSWs have been tested
for HIV, there were 77.5% initiatived and 22.5% forced.
Our study shows that the rate of FSW of correct understanding of condom
use for all sexual intercourse was lower than misundersting group (67.7%
compared with 68.2%). On multivariable regression model of the relation
between the risk behaviors and LRTI, only FSW did not used condom for
all sexcourses (both newregular clients) lead to increase incidence of LRTI
(from 2.1 to 2.2 times). The other factors were not statistic significant
influence to the incidence of LRTI in FSW. The results of this study have
confirmed effectiveness of using condoms for all sexcourses are very good
for preventing LRTI in female sex workers. The researches in Vietnam and
around the world have also confirmed the role of condoms in preventing

HIV and sexually transmitted infections.
4.3. Effectiveness of intervention to change knowledge and attitudes of
preventing transmission of lower genital tract disease
4.3.1. Knowledge and attitudes
In education and communication interventions, the health knowledge
indicators was the fastest growing, then to the attitude indicator and the
practising indicator were slowly increased. The results of this study on the
improvement of knowledge on preventing sexually transmitted infections is
quite in line with the results of the study by Nguyen Khac Hien and Nguyen
Manh Cuong with such research of intervention by HIV education and
communication Mekong Delta provinces. Our report is also complied to the
results of several intervention studies have been done in the early years of
twenty-first century, which collaborated between the health sector and
international organizations on the role of communication in reproductive
health care.
4.3.2. Reduce symptoms and NTDSDD
After a period of training at the Centre, the rate of vaginal infection reduced
from 8.8% to 3.9%. Vaginalis dropped from 21.9% to 1.2%. The vulvo-
vaginalis decreased from 49.9% to 21.2%. Cervititis reduced from 12% to
8.3%. Exposed cervicitis decreased from 7.9% to 0.5%. These differences
are of statistical significance with p ranging from less than 0.01 to 0.001
and EF ranged from 30.8% to 94.5%. The lower genital tract infections
were not only in reducing in clinical but also in the incidence through the
test results. Tested results showed the pathogens in FSWs were marked
decreased compared to entering center timepoint. Holmes and colleagues
studied the effect of Gonorrhea prevention programs in Africa, including
treatment for FSW in the community, also concluded that intervention
effectiveness by counseling, screening and treatment for FSW is feasible
effective. Nguyen Manh Cuong conducted the intervention study of HIV
prevention in 3 Mekong Delta provinces also concluded that the rate of new

HIV infections in FSW decreased over time of intervention.
25

4.4. Effectiveness of intervention to improve clinical knowledge of
medical staffs
In parallel with the study, medical staffs have been training on examination,
detection testing and treatment regimens at the center, the other activities as
providing support materials "International Standard of reproductive health
"of the Ministry of Health and other specialized documents, monitored and
supported activities to medical exam, tests, treatment were implented
regularly. This is to ensure the effectiveness of interventions to improve the
quality of clinical management of lower genital tract infection in center.
Through the process of training the medical staffs at the Center, I realize
that the training activities, provide documentation to guide medical care and
monitoring support was very helpful for them, because the Centre under the
Department of Labor War Invalids and Social Affairs in Hanoi, so they are
less of updated well-trained and re-trained for theit practising daily.
After intervention the rate of medical staffs who have knowledge of syphilis
rised higher than before intervention, including syphilis diseas, syphilis
classification, clinical signs, its complications (narrow foreskin, swelling
foreskin) and treatment regimen. Proportion of health workers have
knowledge of genital herpes increased after intervention than before the
intervention. After intervention knowledge of understanding of genital
herpes (100%), diagnostic tests for genital herpes (100%), diagnostic
criteria for genital herpes (93.3%), topical treatment (100 %) and systemic
treatment (93.3%), increased significantly compared with before
intervention. After intervention rate of medical staffs have knowledge of
chancroid disease was higher than before the intervention. Post-intervention
the knowledge of clinical symptoms (100%), diagnostic tests (73.3%),
diagnosis (93.3%), the principle of treatment (100%) and systemic

treatment (86.7%) were significantly increased compared to pre-
intervention.

CONCLUSIONS
1. The prevalence and risk behaviors of LRTI
1.1. LRTI prevalence in FSW
The prevalence of at least one of the lower genital tract infection in FSW
when entering the Center was high in clinical, accounted for 67.1%. The
most common infections were vulvo-vaginalis (49.9%), vaginalis (21.9%),
cervicitis (8.8%), especial with 7.9% of FSW had exposed cervicitis. When
entering the center, FSWs inffected complex bacterial at highest rate,
accounted for 44.7%, followed by fungal infections, accounted for 10.1%,
trichomonas 4.4%, syphilis 2.5% and the lowest was gonorrhea accounted
for 0.5%.


26

1.2. Affected factors and pathogens with lower genital tract infections
in FSW
According to monovariative analysis, FSW group in parks, gardens and
streets have the highest LRTI rate compare with the group at motels (100%
compared with 62%). The FSWs with no initiative health screening had
higher incidence rate of LRTI than the initiative group. In multivariaive
regression models, FSW without behaviour of used condom for all
sexcourse (both new and regular clients) lead to LRTI (increased from 2.1
to 2.2 times ).
2. Effectiveness of interventions to change knowledge and attitudes for
preventing transmission of lower genital tract disease
2.1. Changing knowledge and attitudes about sexually transmitted

infections
Effectiveness of interventios to change knowledge and attitudes were
expressed very clearly. Rate of FSW understanding of the clinical LRTI
symptoms is higher when they entering center (51.4% to 98%). FSW
attitude of control LRTI was also significantly higher after the intervention.
FSWs, who had self-assessment of high risk of LRTI havd rates increased
from 9.8% to 31.9% after intervention.
2.2. Effectiveness of reducing symptoms and LRTI
The typical clinical symptoms of LRTI are including flow discharge / pus,
painful urination, genital burning pain, ulcers, pappilome/sarchome and
genital itching were significantly decreased after the intervention. The
genital tract infections as well as markedly and rapidlly decreased after the
intervention, the rate of vulgaris reduced from 8.8% to 3.9%, vaginalis
decreased from 21.9% to 1.2%, vulvo-vaginalis decreased from 49.9% to
21.2%, cervicitis reduced from 12% to 8.3%, cervical/exposed cervicitis
decreased from 7 , 9% to 0.5%.
The LRTI pathogen was markable decreased after the intervention.
Trichomonas, gonorrhea and syphilis decreased from 4.4%, 0.5% and 2.5%,
respectively to abcense of LRTI; complex microbial reducted from 44.7%
to 17.7%, fungal decresed from 10.1% to 3.9%.
3. Effectiveness of interventions to improve initiative health care
capacity of health workers
Effectiveness to improve ability of STD screening on clinical was
significantly improved after the intervention. Proportion of health workers
with knowledge of direct exam tests to diagnosis LRTI was significantly
higher after the intervention (93.3% compared with 73.3%), knowledge of
health workers about serum tests was higher after intervention (66.7%
compared with 20.0%).

27

RECOMMENDATION
1. Intervention model for FSW and medical staffs at the Center II for
Treatment - Rehabilation - Education - Social Labor of Hanoi is very
effective. It is nessesary to be multiple this intervention for the Centers for
Treatment - Rehabilation - Education - Social Labor over country.
2. Have to continue education and communications for FSW after training
in focus for their pratising of using condoms for all sexual encounters (both
new and regular clients). Have to get exam and test initiatively to detect and
treat disease on time. This behavior was not really concern and also was the
most effectiveness to decrease LRTI in FSW.
3. The training courses for health stafffs of the Center II for Treatment -
Rehabiltion - Education - Social Labor of Hanoi has achieved initial
success. However, the details of genitial tract infection disease in the
training were not really adequated for. So that still need to continue to
update the knowledge and skills for them to improve the quality and
efficiency of detection and the treatment of genital infections.
4. Have to continue monitoring of interventions for female sex workers and
the medical staffs of the Center II for Treatment - Rehabilation - Education
- Social Labor of Hanoi to assess the long-term efficiency and the durability
of sustainable interventions.