Introduction

In 1999, researchers found that sexually transmitted diseases (STDs) such as gonorrhoea, syphilis, and chlamydia are common communicable diseases in Nepal. STDs produce many complications if left untreated. Gonorrhoea is the common cause of urethral stricture among men and salpingitis in women. Pelvic inflammatory diseases (PID) are often the causes of chronic sexually transmitted diseases and can lead to high levels of adverse pregnancy outcome such as infertility, ectopic pregnancy. The presence of STD raises the risk of HIV transmission. It is known that HIV-infected person who also has STD is nine times more likely to pass HIV to his/her sex partner. Almost all cases of STDs are treatable.

In many developing countries, where prevalence of STD is high and the facilities for etiological diagnosis of STD are largely limited, the World Health Organization (WHO) has recommended syndromic case management as an appropriate strategy for the prevention and control of STDs. Syndromic case management is based on identification of combination of signs and symptoms, knowledge of common causative organisms of those symptoms and their antibiotic sensitivity. It is cost-effective, does not require a specialist as well as laboratory facilities, and is suitable for any level of health system, including primary health care.

Nepal has adopted the syndromic case management method as a viable approach to prevent and reduce STDs. As a result a national guidelines on syndromic case management were developed. Health care providers, medical and other health professionals were trained on syndromic case management.

Family Health International (FHI/Nepal), a USAID-funded agency, has supported both governmental and non-governmental agencies in many areas of AIDS prevention and control program in the country. FHI provided support to Nepal Medical Association (NMA) for training physicians on syndromic STD case management, as they play an important role in diagnosis and treatment of STDs. Similarly it provided support to Family Planning Association of Nepal (FPAN) for training its outreach workers such as Nurses, Health Assistants and Auxiliary Health Workers who are often the first to encounter STD patients. Objectives The present study was carried out a) to measure the output of FHI-supported training in terms of STD case management practices by trained physicians and b) to obtain baseline measure of STD case management skills of FPAN outreach workers.

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