艾滋病母婴阻断及子代随访体系效果评价

正母婴传播是儿童感染艾滋病病毒(HIV)的主要途径,直接威胁出生人口素质和儿童健康水平[1]。阻断母婴传播已成为一项重要的预防工作[2],预防艾滋病母婴传播(prevention of mother-to-child transmission,PMTCT)综合干预措施可直接减少儿童的新发感染。嘉兴市开展PMTCT项目以来,经历了从无到有、从单一妇女保健、产科团队到整合儿科、儿童保健、传染科等不断发展的过程,取得了一定的成绩。但是,艾     

昆明市流动育龄妇女预防艾滋病母婴传播知识知晓及服务需求情况分析

目的了解云南省昆明市流动育龄妇女关于艾滋病母婴传播风险和预防的相关知识和态度、相关服务需求。方法在昆明市流动人口聚居地区,采用滚雪球和方便抽样方法,对流动育龄妇女进行问卷调查。结果198名妇女中,33.8%(67人)对艾滋病基本知识的知晓率50%;64.1%(127人)完全不知道预防母婴传播(PMTCT)的阻断措施。在孕组艾滋病基本知识的知晓率为76.1%,未孕组为57.6%,差异有统计学意义(P=0.006),而母婴阻断知识的知晓率在孕组为40.2%,未孕组为32.1%,差异无统计学意义(P=0.23)。结论昆明市流动育龄妇女对于艾滋病及PMTCT的知识知晓率很低,知识来源不可靠,公共卫生服务人员的咨询、宣传、服务意识和水平亟待提高。     

新疆男男性行为者艾防知识知晓率及影响因素

目的了解男男性行为者(MSM)的艾滋病防治知识(简称艾防知识)知晓率及相关因素,为制定艾滋病健康教育措施提供参考。方法利用2010年至2015年期间新疆MSM调查中艾滋病疫情较严重的阿克苏市、伊宁市、乌鲁木齐市三地的资料,分析MSM艾防知识知晓率及相关影响因素。结果共有1 084名MSM完成调查。艾滋病知识知晓人数929人,总体知晓率为85.7%,乌鲁木齐市MSM艾防知识知晓率为93.5%,阿克苏市为90.9%,伊宁市为59.8%。多因素分析结果显示,地区为乌鲁木齐市(OR=7.035,P=0.001,95%CI:2.294～21.578)、文化程度大专及以上(OR=1.861,P=0.005,95%CI:1.206～2.873)、月收入2 000元(OR=1.831,P=0.010,95%CI:1.159～2.893)、最近一次男男性行为使用安全套(OR=2.978,P=0.003,95%CI:1.436～6.177)、近6个月男男性行为坚持每次使用安全套(OR=4.650,P=0.001,95%CI:1.815～11.915)是影响新疆MSM艾防知识知晓率较高的因素。结论新疆MSM艾防知识知晓率较低,月收入较低、文化程度较低、安全套使用率较低的MSM是健康教育工作的重点,需要提高该亚人群的艾防知识知晓率。     

重庆市临床医生丙型病毒性肝炎防治知识知晓率调查北大核心CSCD

目的 了解临床医务人员对丙型病毒性肝炎（简称丙肝）防治知识认知现状,为下一步防治工作提供参考。方法 采用问卷调查的方式对重庆市4家医院的临床医生开展丙肝防治基本知识及专业知识知晓率调查,并对调查结果进行统计分析。结果 共调查413名临床医生,医生对丙肝防治基本知识知晓率为94.4%,三级医院医生知晓率高于二级医院（OR=6.078,95%CI:2.339～15.791）,其中医生对“丙肝可以治愈”知晓率最低（83.3%）。医生对丙肝防治专业知识知晓率为35.6%,三级医院（OR=11.581,95%CI:5.819～23.051）、内科医生（OR=1.898,95%CI:1.009～3.572）、工作年限6～10年（OR=2.976,95%CI:1.655～5.351）及10年以上（OR=2.737,95%CI:1.524～4.913）者知晓率更高。医生对丙肝病例的诊断分类及临床病例的诊断依据认知最低,完全正确认知率分别为24.2%和29.1%;仅有40.7%的医生能完全认知感染HCV的高风险人群,61.7%的医生能完全正确认知HCV筛查的实验室检测项目,49.6%的医生认为治疗丙肝最有效的药物是直接抗病毒药物（DAAs）。结论 重庆市临床医生对丙肝防治专业知识知晓率较低,今后应加强医务人员丙肝防治专业知识的培训,从而提高丙肝病例发现率和诊治水平。     

北京市两家三级综合医院医务人员艾滋病职业暴露防护知识调查与影响因素分析

目的了解医务人员艾滋病知识以及艾滋病职业防护知识知晓现状,为开展医务人员艾滋病相关培训提供依据。方法采用整群抽样方法,于2013年11月对北京市两家三级综合医院的医务人员进行艾滋病基础知识和职业暴露相关知识知晓情况问的卷调查,分析医务人员艾滋病职业暴露知识的影响因素。结果两家医院共获取有效问卷1077份,对艾滋病职业暴露相关知识知晓率为57.9%（624/1077）,发生职业暴露后伤口处理措施和艾滋病病毒（HIV）职业暴露后抗体检测时间的知晓率分别为29.3%（316/1077）和35.0%（377/1077）。以前接受过艾滋病相关培训、职称、学历、工作年限等因素影响医务人员对艾滋病职业暴露防护知识的了解,其中接受过艾滋病相关培训对知晓率的影响最大[比值比（OR）=2.32,95%可信区间（CI）1.80-2.99]。结论此两家综合医院医务人员的艾滋病职业暴露知识知晓率偏低,应加强对新入职、学历低的医务人员的艾滋病及职业暴露防护知识的相关培训。     

江门市低档女性性服务人群艾滋病知识知晓情况及安全套使用现状分析

目的了解江门市低档女性性服务人群(FSW)艾滋病相关知识、安全套使用情况及其影响因素,为控制艾滋病的蔓延提供科学依据。方法利用2010-2013年国家级暗娼监测哨点的数据资料进行分析。结果调查的1272名FSW中,艾滋病相关知识知晓率为72.25%(919人);最近一个月与客人发生性行为时每次都使用安全套的比例为55.42%。经多因素Logistic回归分析结果显示,最近一年曾患过性病[比值比(OR)=0.717,95%可信区间(CI):0.509~0.940]、接受过干预服务(OR=0.0668,95%CI:0.473~0.944)、艾滋病检测服务(OR=0.608,95%CI:0.417~0.887)及同伴教育(OR=0.612,95%CI:0.404~0.928)是安全套使用的促进因素,而文化程度低(OR=1.362,95%CI:1.109~1.594)、艾滋病相关知识知晓率低(OR=2.076,95%CI:1.559~1.765)是安全套使用的阻碍因素。结论江门市低档FSW的安全套使用比例逐年增加,但坚持每次使用安全套的比例仍较低,提高该人群艾滋病相关知识知晓率可促进安全套的使用。     

贵州省青年学生艾滋病防治知识知晓现状调查

目的 了解贵州省青年学生艾滋病防治相关知识的知晓情况,为开展青年学生艾滋病防治工作提供依据.方法 采用自愿网络问卷方式调查2019-2020年参加贵州省艾滋病防治项目47所高校学生的艾滋病防治知识知晓情况.结果 73 073名青年学生参与网络调查,艾滋病防治知识总知晓率为70.5％;学生对性传播、血液传播和母婴传播是艾滋病传播途径的知晓率高于非艾滋病传播途径的知晓率(x2=1 531.642,P＜0.05).多因素分析显示,女生艾滋病防治知识知晓率高于男生(OR=1.245,95％CI=1.203～1.288,P＜0.05);与研究生相比,本科生(OR=0.684,95％CI=0.480～0.974)和专科生(OR=0.315,95％CI=0.221～0.450)知晓率较低(P＜0.05);与贵阳市相比,黔南州(OR=0.514,95％CI=0.482～0.549)和铜仁市(OR=0.841,95％CI=0.791～0.894)学生的知晓率较低(P＜0.05),毕节市(OR=2.379,95％CI=1.919～2.950)学生的知晓率较高(P＜0.05).结论 在青年学生中仍需进一步普及艾滋病防治知识,有针对性地强化不同性别和不同教育程度学生的薄弱知识点,着重对非艾滋病的传播途径、流行状况、检测及治疗等知识开展形式多样的宣传教育.     

乌鲁木齐市食管癌高危人群接受胃镜检查认知的影响因素及健康教育效果评价

目的探讨乌鲁木齐市食管癌高危人群接受胃镜检查的认知程度及健康教育对提高高危人群相关认知的效果。方法选取2011年5月至2013年5月在该院就诊的1 382例食管癌高危人群作为研究对象,调查其对胃镜检查的认知程度及影响因素,并对其进行相关知识的健康教育,评价健康教育效果。结果低文化程度(OR=1.102,95%CI=1.081⁴.552)、低经济收入水平(OR=2.126,95%CI=1.1634.552)、低经济收入水平(OR=2.126,95%CI=1.163³.971)、未接受过健康教育(OR=2.974,95%CI=1.1273.971)、未接受过健康教育(OR=2.974,95%CI=1.127⁴.471)为高危人群愿意接受胃镜检查认知的不利因素;健康教育前、后,高危人群对于胃镜检查的接受率分别为60.71%和85.31%,相关知识知晓率分别为41.25%和93.92%,认为胃镜是早发现的重要手段率分别为59.05%和90.88%,差异均有统计学意义(均P<0.05);对胃镜检查的认知程度与食管癌早期检出率存在正相关关系(r=0.731,P<0.05)。结论乌鲁木齐市食管癌高危人群对胃镜检查的认知程度不高,相关知识匮乏是主要影响因素,对其进行相关知识的健康教育后对检查的认知程度明显提高,应开展高危人群胃镜检查的相关健康教育。     

精准防艾信息系统在凉山州预防艾滋病母婴传播工作中的应用现状

正母婴传播是我国15岁及以下儿童感染艾滋病病毒的主要途径~([1-2])。凉山彝族自治州属于预防艾滋病母婴传播(prevention of mother-to-child transmission,PMTCT)相关工作的前沿地区~([3-4]),自2018年11月起,在凉山州盖茨项目覆盖的昭觉县、布拖县、美姑县和越西县的10个乡镇推广精准防艾信息系统,其内置健康宣传、快速检测、计生妇保、物料发放及重点家庭管理等功能,其开放端口主要包括APP用户端(N端)、管理后台用户端(M端)和大屏幕用户端,分别服务于防艾员、乡镇卫生院院长与工作人员、州级与县级妇计中心,本文以各端口用户为对象,就PMTCT相关工作中应用该系统的现状、存在问题及原因分析如下。     

成都市农村地区中老年男性高危性行为的发生情况及影响因素

目的了解成都市农村地区≥50岁的男性高危性行为发生情况及其影响因素,提出针对性预防建议。方法随机抽取6个乡镇797名调查对象,在私密环境接受男性调查员一对一问卷调查。结果 797名调查对象年龄(64.46±7.93)岁,艾滋病知识知晓率为31.47%,129名(16.19%)发生过高危性行为。Logistic回归分析显示:50～59岁的高危性行为发生率是70岁以上人群的2.853倍;上过初中的比高中及以上更易发生高危性行为[比值比(OR)=5.772,95%可信区间(CI):1.686～19.756];近一年外出务工(OR=3.059,95%CI:1.537～4.550)和一年前有过外出务工(OR=2.644,95%CI:1.530～6.116)者比从未外出务工者发生高危性行为的风险更高;对商业性性行为持不反对态度的调查对象高危性行为发生率是持反对态度者6.158倍。结论成都市农村地区中老年男性艾滋病相关知识知晓率低,存在一定比例的高危性行为。有必要正视中老年男性性行为特点,提高艾滋病防治知识,普及提高安全套使用率,将艾滋病防治工作从事后干预向事前预防转移。     

预防艾滋病母婴传播健康教育对孕妇艾滋病知识的干预效果评价

目的评价预防艾滋病母婴传播健康教育对孕妇艾滋病知识知晓率的干预效果,为开展预防艾滋病母婴传播的健康教育提供科学依据。方法选择条件接近的两个地区作为干预地区和对照地区,开展预防艾滋病母婴传播健康教育干预研究。干预措施包括举办讲座和发放预防艾滋病母婴传播宣传资料等。通过干预前及干预后的两次问卷调查,了解孕妇预防艾滋病母婴传播知识及艾滋病一般防治知识知晓率的变化,评价干预效果。结果共完成1 541名孕妇的调查,其中干预组933人,对照组608人。干预前两组对象预防艾滋病母婴传播知识知晓率的差异无统计学意义(P>0.05),对照组对艾滋病一般防治知识的知晓率高于干预组。实施干预后,干预组孕妇的预防艾滋病母婴传播知识及艾滋病一般防治的知识知晓率均高于对照组(P<0.001)。结论预防艾滋病母婴传播健康教育干预措施提高了孕妇艾滋病相关知识知晓率,以预防艾滋病母婴传播知识知晓率的提高较为明显,因此,应继续开展综合的预防艾滋病母婴传播健康教育干预活动。     

尿路结石的规范治疗知识在广西试点基层医院培训效果评价

目的探讨在广西基层医院推广"尿路结石治疗的规范诊疗技术"的必要性及推广效果,制定适合我区基层医院使用的尿路结石诊疗规范。方法选择马山县为试点,对县、镇、乡村等各级医院的相关医务人员进行集中培训,并对培训前后医生的泌尿系结石诊疗水平进行考核,评估培训效果和意义。结果前期调查发现马山县各级医院的医生对泌尿系结石的诊疗知识存在明显缺陷。经过培训,受训医生对"泌尿系结石"知识的知晓率由44.8%提高到82.3%,成绩从培训前(44.27±17.21)分提高到(80.07±5.77)分,培训后的各级医院成绩均有所提高(P0.01),培训效果良好。结论广西基层医院医生的尿路结石诊疗知识存在明显缺陷,急需专业培训。通过培训,受训医生尿路结石的诊疗水平得到显著提高,值得在广西各基层医院推广。     

Predictors of HIV positivity among pregnant women presenting for obstetric care in South India - a case-control study

Feminization of the HIV epidemic in India has increasingly burdened the public health infrastructure to provide prevention of mother-to-child transmission (PMTCT) services. A mere 20% of pregnant women in the country receive HIV counseling and testing. One of the strategies, for expansion of PMTCT services is to ascertain an accurate identification of HIV-positive pregnant women. Thus, we sought to characterize a demographic profile of pregnant women at high-risk for HIV infection. We performed a retrospective case-control study. We included as cases, all HIV-positive women identified in a PMTCT program implemented in 23 charitable faith-based hospitals in four states in South India over a period of 75 months, starting in January 2003. Thus a total of 320 HIV-positive cases were frequency matched using stratified random sampling to 365 HIV-negative pregnant women presenting for antenatal care during the same time period. Cases and controls were compared using Chi-square test for categorical variables and Student's t-test for continuous variables. Multivariate step-wise logistic regression analysis was performed. On multivariate analysis, following factors were independently predictive of HIV positivity: age ≤25 years (odds ratio [OR] 0.50; confidence interval [CI] 0.33-0.76; p = 0.001); illiteracy (OR 4.89; CI 2.79-8.57; p <0.0001); woman holding a service and/or professional job (OR 0.27; CI 0.14-0.53; p <0.0001); spouses holding a service or higher job (OR 3.13; CI 2.13-4.59; p <0.0001); being married ≤5 years (OR 2.89; CI 1.68-4.95; p <0.0001); late gestational age at presentation (OR 3.06; CI 2.04-4.59; p <0.0001); history of fetal and/or live born loss (OR 2.36; CI 1.51-3.67; p <0.0001). To our knowledge this is the first large study to evaluate factors predictive of HIV positivity among women presenting for antenatal care in the Indian setting. This type of profiling of HIV-positive pregnant women may help expand PMTCT services in a focused and cost-effective manner in India.     

Implementing a rural programme of prevention of mother-to-child transmission of HIV in Zimbabwe: first 18 months of experience

OBJECTIVE: To report on activities and lessons learned during the first 18 months of a rural programme of prevention of mother-to-child transmission of HIV (PMTCT) in Zimbabwe. METHODS: The PMTCT services were introduced in Murambinda Mission Hospital (120 beds), Buhera, in 2001. Programme strategies consisted in recruiting counselling staff, training health professionals, improving mother-child health (MCH) facilities and conducting information, education and communication activities within the community to address HIV/AIDS awareness and stigma. The following components were implemented within MCH services: voluntary counselling and testing of HIV using rapid testing, nevirapine short regimen proposed to all HIV-infected mothers identified and their newborns, support to exclusive breastfeeding for 6- and 18-month mother-child follow-up. Routine monitoring data collected from August 2001 to February 2003 were used to estimate programme uptake. RESULTS: Of 2471 pregnant women using antenatal services, 2298 were pre-test counselled, the acceptance of HIV testing reached 92.9%. Of the women who decided to take an HIV test, 1588 (74.3%) returned to collect their result. Overall HIV prevalence was 20.4% (n = 437); 326 of the HIV-positive women were counselled and 104 (24%) received complete mother-child antiretroviral prophylaxis. CONCLUSIONS: Acceptability of HIV testing after counselling has remained above 90% since the onset of the programme. Collection of test results and mother-child follow-up are among the most challenging activities of the programme. A district approach and community participation are critical to develop PMTCT programmes in rural settings, even with reasonably good MCH services.     

无锡市医疗机构疟疾镜检能力现状调查与分析

目的对无锡市各级医疗机构疟原虫镜检能力建设情况进行分析,为今后疟疾防治工作提供科学依据。方法收集2016年无锡市各级医疗机构镜检员问卷调查数据,建立数据库,并采用Logistic回归对镜检员疟原虫检测能力的影响因素进行分析。结果共调查全市54家医疗机构54名镜检员,男性16人,女性38人,男女性别比0.42∶1;有12名镜检员曾在工作中检出疟原虫,占被调查者的22.22%。多因素分析结果表明:女性镜检员在工作中检测出疟原虫的能力比男性镜检员弱(调整OR=0.11,95%CI:0.02~0.53),中级及以上职称镜检员在工作中检测出疟原虫的能力高于初级职称镜检员(调整OR=5.31,95%CI:1.04~27.19),县乡级医疗机构镜检员在工作中检测出疟原虫的能力比其他机构的镜检员弱(调整OR=0.04,95%CI:0.01~0.98)。结论无锡市各级镜检站均具备一定的疟疾诊治能力,需进一步加强基层医疗机构的镜检能力建设。     

山西省老年住院患者生前预嘱认知度和接受度现状调查

目的通过调查山西省老年住院患者对生前预嘱的认知度、接受度现状,分析是否愿意制定生前预嘱的相关因素,为探讨如何在山西省老年住院患者中推广生前预嘱提供依据。方法采用自制问卷对2017年1—12月山西省老年住院患者进行随机抽样调查,共收集411例老年住院患者有效问卷,收集内容包括一般社会学资料(年龄、性别、民族、宗教信仰、居住地、文化水平、职业、有无子女、有无配偶)、生前预嘱认知及是否愿意签署生前预嘱"我的五个愿望"文件。采用χ2检验和Logistic回归模型分析老年住院患者签署生前预嘱文件意愿的相关因素。结果山西省411例老年住院患者对生前预嘱的认知水平低(146例,35.5%),在一般资料中,文化水平和职业与老年住院患者对生前预嘱的认知水平相关(χ2=12.093、11.906,P=0.001、0.008);多元Logistic回归分析结果显示,与60~69岁年龄段相比,70~79岁(OR=0.592,95%CI:0.360~0.974)和80~89岁(OR=0.408,95%CI:0.238~0.701)的老年住院患者对签署生前预嘱文件持消极态度,城市(OR=2.293,95%CI:1.335~3.940)、医务工作者(OR=3.156,95%CI:1.419~7.020)和无子女的老年住院患者(OR=3.156,95%CI:1.287~7.740)较农村、其他职业(除外教师和公务员)以及有子女的老年住院患者更愿意提前签署生前预嘱文件。结论山西省老年住院患者对生前预嘱认知水平低,对提前签署"我的五个愿望"文件接受度差,为使其惠及大众,需加大在我省范围内的推广和普及。     

Mother-to-child transmission of HIV and its prevention: awareness and knowledge in Uganda and Tanzania

Awareness and knowledge about HIV mother-to-child transmission (MTCT) and preventive measures in different population groups and health personnel were analysed in future intervention areas in western Uganda and south-western Tanzania. In Uganda, a total of 751 persons (440 clients of antenatal and outpatient clinics, 43 health workers, 239 villagers, 29 traditional birth attendants) and in Tanzania, 574 persons (410 clients, 49 health workers, 93 villagers, 18 traditional birth attendants) were interviewed. When given options, knowledge on transmission during pregnancy and delivery in women was 93% and 67% in Uganda and Tanzania respectively, and 86% and 78% for transmission during breastfeeding. In Uganda 59% of male interviewees did not believe that HIV is transmitted during breastfeeding. Expressed acceptance of HIV testing was above 90% in men and women in both countries, but only 10% of the clients in Uganda and 14% in Tanzania had been tested for HIV infection. Health workers' knowledge regarding MTCT was acceptable, while traditional birth attendants' knowledge on both MTCT and preventive measures was extremely poor. Recommendations on infant feeding were not compatible with WHO recommendations for HIV-infected women. If prevention of MTCT (PMTCT) interventions are to be accepted by the population and promoted by health personnel, thorough orientation and training are mandatory.     

Socio-demographic factors associated with loss to follow-up of HIV-infected women attending a private sector PMTCT program in Maharashtra, India

Currently, 40% of HIV-infected women enrolled in national prevention of mother-to-child transmission (PMTCT) program in India are loss to follow-up (LTF) before they can receive single dose Nevirapine. To date no study from India has examined the reasons for inadequate utilization of PMTCT services. This study sought to examine the socio-demographic factors associated with LTF of HIV-infected women enrolled during 2002-2008 in a large-scale private sector PMTCT program in Maharashtra, India. Data on HIV-infected women who were enrolled during pregnancy (N=734) and who reported live birth (N=770) were used to analyze factors associated with LTF before delivery and after delivery, respectively. Univariate and multivariate analyses were conducted to estimate the associations between being LTF and socio-demographic factors using generalized linear models. Eighty (10.9%) women were LTF before delivery and 151 (19.6%) women were LTF after delivery. Women with less than graduate level education (RR = 6.32), from a poor family (RR = 1.61), who were registered after 20 weeks of pregnancy (RR = 2.02) and whose partners were HIV non-infected or with unknown HIV status (RR = 2.69) were more likely to be LTF before delivery. Similarly, the significant factors for LTF after delivery were less than graduate level education (RR = 1.82), poor family (RR = 1.42), and registration after 20 weeks of pregnancy (RR = 1.75). This study highlights the need for innovative and effective counseling techniques for less educated women, economic empowerment of women, better strategies to increase uptake of partner's HIV testing, and early registration of women in the program for preventing LTF in PMTCT programs. This need for innovative counseling techniques is even greater for PMTCT programs in the public health sector as the women accessing care in the public sector are likely to be less educated and economically more deprived.     

Acceptance of HIV testing among women attending antenatal care in south-western Uganda: risk factors and reasons for test refusal

A problem commonly encountered in programs for prevention of mother-to-child-transmission (PMTCT) of HIV in sub-Saharan Africa is low rates of HIV test acceptance among pregnant women. In this study, we examined risk factors and reasons for HIV test refusal among 432 women attending three antenatal care clinics offering PMTCT in urban and semi-urban parts of the Mbarara district, Uganda. Structured interviews were performed following pre-test counselling. Three-hundred-eighty women were included in the study, 323 (85%) of whom accepted HIV testing. In multivariate analysis, testing site (Site A: OR = 1.0; Site B: OR = 3.08; 95%CI: 1.12-8.46; Site C: OR = 5.93; 95%CI: 2.94-11.98), age between 30 and 34 years (<20 years: OR = 1.0; 20-24 years: OR = 1.81; 95%CI: 0.58-5.67; 25-29 years: OR = 2.15; 95%CI: 0.66-6.97; 30-34 years: OR = 3.88; 95%CI: 1.21-13.41), mistrust in reliability of the HIV test (OR = 20.60; 95%CI: 3.24-131.0) and not having been tested for HIV previously (OR = 2.15; 95%CI: 1.02-4.54) were associated with test refusal. Testing sites operating for longer durations had higher rates of acceptance. The most common reasons claimed for test refusal were: lack of access to antiretroviral therapy (ART) for HIV-infected women (88%; n=57), a need to discuss with partner before decision (82%; n=57) and fear of partner's reaction (54%; n=57). Comparison with previous periods showed that the acceptance rate increased with the duration of the program. Our study identified risk factors for HIV test refusal among pregnant women in Uganda and common reasons for not accepting testing. These findings may suggest modifications and improvements in the performance of HIV testing in this and similar populations.     

Gender based violence: knowledge and attitudes of health care providers in Nicaragua

OBJECTIVE: To assess the knowledge and attitudes of health care personnel towards the identification and referral of gender-based violence victims (GBV). Also, to identify barriers to identification and referral of GBV, and to assess the levels of knowledge about Norms and Procedures for Intra-Family Violence Care by the health care personnel of the Nicaraguan's Minister of Health (MINSA, for its initials in Spanish). MATERIAL AND METHODS: A cross-sectional study was conducted among healthcare professionals, including physicians, nurses and nursing technical aides (n=213), in 5 of the 17 Local Systems of Integral Attention (SILAIS) from the Integral Program of Attention for Women, Children and Adolescence (AIMNA) in the primary level of attention in MINSA, from April to June 2003. Attitude was measured with a Likert scale and an awareness index was created for intra-family violence care guidelines. The information was obtained using a self-administered instrument, based on the questionnaire of the study made among the personnel of the Mexican Institute for Social Security (IMSS, for its initials in Spanish), Morelos, Mexico. A logistic regression model was used to evaluate the association between attitude and several factors, as well as with the knowledge of care guidelines. RESULTS: In our population, 76.06% showed an attitude opposing GBV. In the multivariate analysis, the factors associated with opposition to GBV were: medical profession (OR 6.5, 95%CI 2.70-15.82), having a middle (OR 4.3, 95%CI 1.87-10.26) or high level (OR 3.3, 95%CI 1.03-10.75) of knowledge about intra-family violence guidelines and the closeness to relatives or friends who were victims of gender violence (OR 3.2, 95%CI 1.56-6.80). The lack of training on the subject (59.9%), fear of getting involved in legal issues (52.6%), and the concept that violence is a private affair and not a social one (50.7%), constituted the most important barriers to providing medical care. CONCLUSIONS: The health care personnel generally were observed to have high values in regard to an attitude of rejection towards GBV. However, we found barriers that show persisting traditional beliefs, such as considering violence to be a personal issue. Therefore, in order, to ensure a substantial improvement, better training about this subject is needed in medical school curricula with an emphasis on the gender perspective. The finding of the present study will allow improvements in health care reforms at the first level of care in the health sector in Nicaragua.