Community health education played a major role in a study of sexually transmitted diseases (STDs) and other reproductive tract infections which we conducted in rural and periurban communities of the Asaro Valley near Goroka in the Eastern Highlands Province of Papua New Guinea. We found that most women had little knowledge about STDs, which they often did not realize were sexually transmitted. Even major signs and symptoms were thought to be normal and many women had not sought treatment until irreversible damage was done. Knowledge of the complications of STDs, such as infertility and stillbirth, was also slight in these women. It is apparent that there is a desperate need for more reproductive health education at the community level. In developing our health education methods, we found that simple line drawings of male and female reproductive organs and of people with different signs of STDs proved useful. These were quick and easy to produce from readily available materials. It was important to separate men and women into different groups with educators of the same sex, and to create a very informal atmosphere, encouraging free-ranging discussion. Following health education and sensitive interviewing, almost all the women selected for the community-based study of the prevalence of reproductive tract infections consented to vaginal examination, even if they were asymptomatic. Additionally, many nonselected women requested examination. PIP: This paper discusses the health education program carried out in the rural and periurban communities of the Asaro Valley in Papua, New Guinea, where knowledge of STDs is low and risky sexual behaviors are extremely common. The educational program seeks to ensure that the participants understand the reasons for the study and to raise their awareness of the transmission, treatment, and prevention of STDs. All members of the village were encouraged to participate in the educational workshop, which included lectures, group discussions, one-on-one health education, demonstrations, and interviews. After training workshops, practice sessions were also organized to assess the effectiveness of the different teaching methods and visual aids used. It was found that simple line drawings of male and female reproductive organs and of people with different signs of various STDs were useful. It was necessary to divide men and women into two groups with educators of the same sex, which created a more relaxed and free-flowing discussion. Considering that a majority of the women had no experience in using condoms, a demonstration of their use and how to put them on using bananas as models was performed. The questions asked by the women during discussions and private interviews proved that their level of biomedical knowledge about STDs and reproductive health was low, as was their knowledge of the anatomy and physiology of the reproductive system. A high frequency of risky behaviors was also observed, including involvement with multiple sexual partners, commonly in men and young women, with condoms virtually never used. Apparently there is a need for widespread community-based sexual and reproductive health education that is responsive to the needs of people living in rural areas.
Health Education - methods ; Health Education - organization & ; administration ; Health Knowledge, Attitudes, Practice ; Papua New Guinea ; Program Evaluation ; Sexually Transmitted Diseases - prevention & ; control

We conducted a community-based study of the prevalence of sexually transmitted diseases in rural and periurban communities in Eastern Highlands Province. We interviewed a stratified random sample of women and men, examined the women for evidence of sexually transmitted diseases (STDs) and collected specimens for diagnosis of syphilis, by serology and dark-field microscopy, gonorrhoea, by Gram stain and culture, chlamydial infection, by polymerase chain reaction (PCR) and direct immunofluorescence (DIF), trichomoniasis, by wet mount, and bacterial vaginosis, by wet mount and Gram stain. The men were tested for chlamydial infection only (first void urine tested by PCR and DIF). 201 women and 169 men were tested. Additionally, adults in the same communities who had not been randomly selected were offered the same services. An extra 243 women and 85 men were tested in this way. The laboratory results confirmed the clinical impression of an extremely high prevalence of STDs in this population. Among those randomly selected, 46% of the women had trichomonal vaginal infections and 26% had Chlamydia trachomatis infections detected by PCR, while 25% of the men had chlamydial infections. Other infections were much less common. 58% had one or more STDs. The prevalence of infection in self-selected adults was similar to that found in those randomly selected.
Chlamydia Infections - diagnosis ; Chlamydia Infections - epidemiology ; Data Collection ; Papua New Guinea - epidemiology ; Prevalence ; Rural Population ; Sexually Transmitted Diseases - epidemiology ; Trichomonas Vaginitis - diagnosis