Knowledge, attitude and practices (KAP) among clinicians on aetiologic management of abnormal vaginal discharge in pregnant women at Kawempe National Referral Hospital.

Abstract

Introduction: Aetiologic management of STIs to treat the curable abnormal vaginal discharge caused by bacterial vaginosis, chlamydia, gonorrhea, and trichomoniasis is a sensitive and specific tool to achieve WHO’s global target of eliminating these infections among pregnant women by 2030. There has not been a national adoption of this approach policy wise. However, individual clinicians apply it variably in Uganda. CDC guidelines are a globally recognised document adoptable to implement aetiologic management. Constructs measuring knowledge, attitudes and practices among KNRH clinicians were developed with reference to this guideline. There has never been a study done to ascertain knowledge, attitudes, and practices of clinicians in relation to aetiologic management of AVD causing organisms at KNRH thus the intention of this study. Method: A cross-sectional study was conducted among 184 treating clinicians including specialists, SHOs, intern doctors, midwives and nurses adopting quantitative approaches. A self-developed structured questionnaire using a likert scale was developed using CDC guidelines for aetiologic management of STIs to measure categorical variables - level of knowledge, attitude and practices. Results: Universally, the Level of knowledge was low with over 50% of the clinicians having inadequate knowledge. Adequate levels of knowledge were predominantly noted among intern doctors 34 (68%), specialists 3 (60%) and SHOs 29 (54%). For attitude, 81 (44%) of clinicians had a positive attitude, 77 (42%) had a relatively positive attitude and only 26 (14%) had a negative attitude. More nurses 10 (63%) had a positive attitude followed by specialists 3 (60%). Excellent practice was noted in 36 (20%) of clinicians, good practice in 76 (41%) of clinicians and improper practice in 54 (29%) of clinicians. Excellent practice was most frequent among specialists 3 (60%), SHOs 15 (28%) and midwives 9 (15%) respectively. Ironically, nurses 3(19%) and intern doctors 7(14%) were the most non-applicants. Conclusions and recommendations: The level of knowledge is not adequate for clinicians. Attitude for using aetiologic management is positive for most clinicians thus high motivation to use test and treat but excellent practice was very low with 36 (20%) of clinicians noted. Therefore, there was a low knowledge among majority of clinicians but a positive attitude and the positive attitude did not translate into excellent or right practice. There is need to harmonize practice of aetiologic management through formal trainings and drafting hospital and national guidelines to aid use.