RESEARCH ARTICLES
Sociodemographic characteristics and risk factors for sexually transmitted diseases among women assisted at primary care unit
Lincoln Vitor SantosI; Ana Dorcas de Melo InagakiII; Ana Cristina Freire AbudIII; Julian Katrin Albuquerque de OliveiraIV; Caíque Jordan Nunes RibeiroV; Maria Ilda Alves de OliveiraVI
INurse o the Basic Health Unit of the Municipal Secretary of Health of São Cristóvão. Sergipe, Brazil. E-mail: lincoln_vitor@hotmail.com.
IIAdjunct Professor of the Federal University of Sergipe, Nursing Department. Aracaju, Sergipe, Brazil. E-mail: ana-dorcas@hotmail.com.
IIIAssistant Professor of the Federal University of Sergipe, Nursing Department. Aracaju, Sergipe, Brazil. E-mail: acfabud@uol.com.br.
IVNurse of the Basic Health Unit of the Municipal Secretary of Health of São Cristóvão. Sergipe, Brazil. E-mail: jukatrin@yahoo.com.br.
VStudent of Nursing of the Federal University of Sergipe. Aracaju, Sergipe, Brazil. Email: caiquejordan_enf@yahoo.com.br.
VIStudent of Nursing of the Federal University of Sergipe. Aracaju, Sergipe, Brazil. Email: ildinhaao16@hotmail.com.
ABSTRACT: This descriptive and retrospective study was conducted through the analysis of medical records of 343
women who underwent gynecological examination in a primary attention unit, in São Cristóvão, Sergipe, Brazil, from
January, 2009 to June, 2012. It aimed at outlining the sociodemographic profile of those women and at identifying risk factors for sexually transmitted diseases (STD). Data were recorded on the 2007 Excel and analysis showed those
women aged 25-59 (77.0%), had low education (30.0%), and did not have a paid job (20.0%). Patients who reported
having multiple sexual partners denied the use of condoms. Conclusions show unfavorable socioeconomic condition
associated with rejection of condoms make those women vulnerable to STD, and reinforce the need to implement
educational activities.
Keywords: Women's health; community health nursing; family planning; sexually transmitted diseases
INTRODUCTION
Traditionally, the nurse is configured as a leading professional in the actions of prevention and protection and recovery of health, especially through educational activities1.
The space of nurses is increasing, acquiring a proactive and decisive role in care to the population. Their work is critical to improving health in local, regional, national and even international2.
The basic health unit, as a gateway to the Single Health System (SUS) and as a space for the resolution of the main health problems in the community, has an important role in the detection, treatment and follow-up of problems that affect women's health3.
To perform the planning of public health actions to users of the SUS, it is essential to understand their socio-demographic characteristics and needs.
Thus, it becomes necessary to conduct studies on the subject, considering that the research favors the knowledge with current literature production, allows the identification of needs and priorities of the women and gives scientific basis assisted to the planning of promotion and health protection actions.
Given the above, this study aimed to draw the demographic profile of women who performed gynecological examination from January 2009 to June 2012, as well as to raise the risk factors of this population to sexually transmitted diseases (STD).
LITERATURE REVIEW
The nurse who works in the family's health is in a relevant position in the promotion, protection and recovery of health, since he tooks as one of his main activities the gynecologic approach, as well as their actions in family planning, cancer prevention and decrease the incidence of transmission of diseases/contagious and STD4.
With regard to sexual and reproductive health, nursing consultation aims at early detection of health problems related to the gynecological and reproductive function, as well as the discussion on the issues and/or concerns related to sexual function and sexuality5,6.
The STD encompasses all those diseases that can be acquired during the sexual act in both coitus and in the events that surround it. Additionally, the clinical gynecologic service aims at prevention of uterine cervical cancer that is associated with the human papilloma virus (HPV)7.
Several studies demonstrate that despite the knowledge of condom use as preventing STD and cervical cancer, most women presents their resistance routine using it in all sexual relations, they ignore the risk to which they are exposed and become vulnerable to these diseases7-9.
Several factors are described as determinants for not using the condoms, as well as to the reduced search for health service for gynecological examination, among them the lack of risk perception, shame, fear, lack of symptoms, the disinterest, low income and the difficulty of access to the services10.
However, highly educated women, with favorable socioeconomic condition and with access to health services by SUS or private, also exhibit resistance to condom use and the completion of gynecological examination11.
All women should perform the cytological examination known as Pap smear after initiated sexual activity and international and national institutions recommend it as a strategy for early detection of STD and cervical cancer prevention11.
In Brazil, since 1988, the Ministry of Health (MS), following guidelines from the World Health Organization (WHO), proposes the implementation of annual examination and after two negative consecutive annual results, every three years for women between 25 and 59 years old12.
METHODOLOGY
This is a descriptive study, retrospective, of analysis of descriptive nature and quantitative approach, developed in a basic health unit in the municipality of São Cristóvão/SE, whose population totals 950 registered families or 3300 inhabitants.
The samples were of 343 women who have been subjected to gynecological clinical examination during the period January 2009 to June 2012, whose records of the examination were in their charts.
The data were collected in the period from 25 June to August 31, 2012, after the approval of a research project by the Research Ethics Committee of the University Hospital of the Federal University of Sergipe, in June 18, 2012, under paragraph CAAE 01174612.3.0000.0058, in accordance with resolution No. 196/96, of the National Health Council. To obtain the data, analysis of patient records were done. The search was conducted in the file, where all family files and the charts were consulted, one by one, in search of the records of gynecologic consultation done by the nurses.
Data analysis was performed in Excel 2007 and they were described from the distribution of the variables through the absolute and relative frequencies and through measures of central tendency and variability.
Demographics variables studied were age, marital status, education and occupation. For identification of predisposing factors for STD and health care, the variables studied were multitude of the partner, use of contraceptives, especially condoms, use of drugs, tobacco and alcohol, as well as the reason for the search of the health service.
Results and Discussion
The 343 (100%) women who underwent gynecological clinical examination, in the period from January 2009 to June 2012, showed that age ranged between 13 to 78 years old, with average, median and sets equal to 34.9, 35 and 38 years old respectively.
It should be noted that, in the sample studied, 265 (77.2%) were women aged 25 to 59 years old, for which there is the recommendation of smear examination annually.
According to the 2010 Census, the municipality of São Cristóvão/SE has 78,864 inhabitants, of whom 33,671 (42.7%) are women from 10 years old13.
There is a predominance of low educational level among women studied, since about one-third of them has only the elementary school level or are illiterate, corroborating other studies conducted with clients assisted by SUS in the State of Sergipe. In a recent study, this ratio was 44.8%14.
Associated with low education it is observed the predominance of women who do not exercise remunerated activities, considered housewives 80 (23.3%) or undergo occupations with low payment, following the example of maids - 24 (7.0%). Still, 5 (1.5%) women reported being teachers, and four had only average level of education. Among the 4 (1.2%) women with higher level, two mentioned be students, one was a teacher and one was a caregiver of elderly age.
Most women, 242 (70.6%) said having fixed partner, stating being married or living in a stable union. Women who were considered without fixed partner were those who declared unmarried, divorced or widows, corresponding to 70 (20.4%) participants of the study.
With regard to the multiplicity of partners, 272 (79.3%) women reported having a single sexual partner and only 8 (2.3%) report having more than one partner, which expose the risk of acquiring STD and consequently, cervical cancer of uterus. It was considered the multiplicity of partner the one that is in the presence of concurrent sexual relationships in the period in which occurred the consultation. Due to limitation of retrospective studies of analysis of charts, which do not allow contact with the subjects of research for completion of information, it has not been possible to identify how many partners these women had throughout their lives, even among those who currently have only one partner. It is well known that even among women who do not have several partners simultaneously, throughout their lives may have had diverse partners and that constitutes a risk factor for STD, especially for not using condoms. All eight women who reported having multiple partners declared being unmarried and do not use condom, behavior that makes them highly vulnerable to STD.
It calls attention to the lack of information about the multitude of partner in the chart of 63 (18.4%) patients. This also occurred with other variables, demonstrating the poor quality of records in charts.
From the decade of 1990, it was abandoned the concept of risk group for the acquisition of STD/HIV/AIDS, being replaced by social vulnerability. Women have become so victims of these infections, since they do not require the use of a condom, usually because they are in stable relationships and use of hormonal contraceptive method, which ensures protection against unplanned pregnancy15.
As for the reason for the search of the health service, only 70 (20.4%) women did so spontaneously, as a routine health assessment, without presented charges, while the remaining 273 (79.6%) did so due to landslides, with or without vaginal itching, odor and pain, in addition to injuries, dyspareunia, bleeding or menstrual cycle changes. This fact confirms the statement that the lack of symptoms is one of the main justifications of the women not to perform a Pap smear10. Study reveals that younger women, without fixed partner, with low family income and education presented the highest prevalences reasons for non-completion of Pap smear16.
Women have been investigated using a variety of contraceptive methods, like the hormonal - 105 (30.6%), followed by definitive surgical - 83 (24.2%) and the condom with 50 (14.3%) patients. Almost 1/5 of the women denied making use of any type of contraception - 67 (19.5%), according to Figure 1. There was no record of any woman who used the female condom corroborating the studies that demonstrate that the use of it is not yet properly diffused7,17. Not using condom contributes to the vulnerability to STD and the risk of developing cervical cancer of uterus7,11,17. Additionally, only 50 (14.6%) women reported using latex male condom and only 5 (1.4%) reported the use of dual protection (contraceptive hormone with the condom), which demonstrates not only prevention of unplanned pregnancy, but also the prevention of STD.
Inserir Figura 1
Among the women studied, 7 (2.04%) reported being smokers, 1 ethilic (0.29%) and 1 adicted (0.29%).
Risk factors such as smoking, use of hormonal contraception and multiple partners predispose to occurrence of the cervical cancer. In addition to these, there is an intimate relationship between cancer and persistent infection by STD18.
Given the above, the main risk factors for STD observed in this study were not using condom, associated with low social status. Additionally, it worsens the situation for not performing gynecological examination, routinely seeking the health unit only when occurs any change demonstration. Risk factors such as smoking, alcoholism and family history or previous personnel were less mentioned.
It should be noted, therefore, that women are vulnerable to STD and consequently, to the involvement by the neoplastic diseases of the uterus due to exposure to risk and the lack of health control on a regular basis.
CONCLUSION
It is concluded that the women were mostly in reproductive age, they possessed low education and income and had fixed partner. As risk factors for STD we have to highlight low education, lack of health care evidenced by gynecological examination search only upon the occurrence of symptoms associated with direct exposure to STD due to non-use of condoms.
Therefore, it is evidenced the need for educational actions aimed at women with sexually active life in order to guide the risk behavior, promote the visibility of risk, stimulate preventive behavior, reduce gynecological changes and reduce the risk of developing cancer and STD.
The lack of registration in some charts about issues of importance to the design of women's health became a limiting factor of the study. The nurses who work in the area of family health need to be sensitized to the need for a full interview prior to the cytopathology exam, so they can identify early women's vulnerability situations and intervene in a timely manner and resolutive. Additionally it is necessary to compromise with the quality of the records to promote the follow-up assistance.
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