Sexual health

1. Sexual Health and STIs
Introduction
Sexual Health: is the enhancement of life and personal
relations, and not merely counselling and care related
to reproduction and STDs
Sexually transmitted diseases (STDs) are
 spread primarily through sexual intercourse
 have long term negative consequences including RTI,
infertility and stillbirths.
 a major public health problem in all countries, Specially
in developing countries, where access to adequate Dx
and Rx facilities is very limited or non-existent.
1

2. Introduction…
Women are more vulnerable to STDs
 Social and economic disadvantages that women
face
 by their exposure to the high risk sexual behaviour
of their partners
 many women are powerless to take steps to protect
themselves
 Their reproductive organs are at higher risk
2

3. Introduction…
 More than 1 million people acquire STI every day.
 It is estimated that annually there are 357 million new
cases of four curable STI among people aged 15–49
years:
 Trichomonas vaginalis (142 million)
 Chlamydia trachomatis (131 million)
 Neisseria gonorrhoea (78 million)
 syphilis (6 million).
3

4. Introduction…
 The prevalence of some viral STI is similarly high:-
 417 million people infected with herpes simplex type 2,
 291 million women harbouring the human papillomavirus.
4

5. Specific population at higher risk
 According to global health strategy each country
needs to define the specific populations that are most
affected by STI epidemics.
 populations most likely to have a high number of
sexual partners,
such as sexual workers and their clients.
 men who have sex with men (Anal sex)
 people with an existing STI including PLWHIV.
5

6.  young people and adolescents, children and young
people living on the street
 women, mobile populations,
 prisoners, drug users and
 people affected by conflict and civil unrest.
6
population at higher risk……

7. Mode of Transmission for STI/HIV
7
1.The most common mode of transmission is unprotected sex.
 Other forms of transmission are
2. Mother to child.
During pregnancy (HIV & syphilis)
At delivery (gonorrhea ,Chlamydia &HIV)
Through breast feeding(eg. HIV)
3.Unsafe (unsterile ) use of needles or injections.
4. Contact with blood or blood products (syphilis, HIV &hepatitis
).

8. Factors affecting transmission of STIs
8
Biological factors:
– Age, -young ages are more susceptible
– Sex, -women more easily infected than males
– Immune status– immuno-compromised
individuals are more susceptible.

9. 9
Behavioral factors:
– Changing sexual partners frequently.
– Having more than one sexual partner.
– Having sex with „casual‟ partners, (sex-workers).
– Having unprotected penetrative sexual intercourse.
– Substance abuse
Factors affecting transmission of STIs …..

10. 10
Socio-cultural factors
• Women have very little decision making power over
sexual practices and choices, including use of condoms.
• Women tend to be economically dependent on their male
partners and are therefore more likely to tolerate men‟s
risky behavior
• The girl-child tends to be married off to an adult male at a
very young age, thus exposing the girl to infections
Factors affecting transmission of STIs …..

11. 11
 Socio-cultural factors cont…
• In some societies a permissive attitude is taken
towards men allowing them to have more than
one sexual partner.
• Harmful traditional practices
Skin-piercing.
Use of unsterile needles to give injections.
Scarification or body piercing.
Circumcision using shared knives.
Factors affecting transmission of STIs …..

12.  VISION OF THE STRATEGY
 Zero new infections,
 zero STI complications and deaths, and
 zero discrimination
 resulting in people able to live long and healthy
lives.
 GOAL
 Ending STI epidemics as major public health
concerns.
12
Global STI elimination strategies

13.  TARGETS (2030):-
 90% reduction of T. pallidum incidence globally
 90% reduction in N. gonorrhoea incidence globally
 ≤ 50 cases of congenital syphilis per 100,000 live births in
80% of countries
 Sustain 90% national coverage and at least 80% in every
district in countries with the human papillomavirus vaccine in
their national immunization programme.
13
Global STI elimination strategies….
 By 2030, plan end the epidemics of AIDS,

14. why the STI response should be a global priority?
 STI
 Increases the burden of morbidity and mortality
 Compromises quality of life
 Affect sexual and RH and new born and child health
 facilitate sexual transmission of HIV
 cause cellular changes that precede some cancers.
 impose a substantial strain on the budgets
 both households and national health systems
 have an adverse effect on the overall well-being of
individual
14

15. Classification of STI
 Sexually transmitted infections (STIs) are Infections
caused by organisms that are passed through
sexual activity with an infected partner.
E.g.: Chlamydia, gonorrhea, hepatitis B and C, herpes,
HPV, syphilis, trichomoniasis, and HIV.
15

16. Classification of STIs
A: Based on their character:- Common Classification of
STIs
1. Diseases characterized by genital ulcer
 Chancroid, Genital herpes simplex virus, Granuloma
inguinale , Lymphogranuloma Venarum, Syphilis
2. Diseases characterized by urethritis and cervicitis
 Chlamydial infection, Gonorrhea
3. Diseases characterized by vaginal discharge
 Bacterial vaginosis, trichomoniasis, Vulvovaginal
candidiasis
16

17. Classification…
B: Prognostic classification of STDs
 Curable (mostly bacterial)
- Gonorrhea -Syphilis
-Chlamydia -Trichomoniasis
 Noncurable (virus)
• HIV/AIDS
• Hepatitis
• Herpes
• Human papilloma virus
17

18. Classification…
C: Based on STI Pathogens:
 bacterial,
 viral and
 Protozoal
 More than 30 pathogens are transmissible through
sexual intercourse-oral, anal, or vaginal.
18

19. Classification…
1: sexually transmitted bacteria are:
 Neisseria gonorrhoea (causes gonorrhoea)
 Chlamydia trachomatis (chlamydial infections)
 Treponema pallidum (causes syphilis)
 Haemophilus ducreyi (causes chancroid)
19

20. Classification…
 2; Sexually transmitted viruses are:
 Human immunodeficiency virus (causes AIDS)
 Herpes simplex virus (causes genital herpes)
 Human papilloma virus (causes genital warts)
 Hepatitis B virus
 Cytomegalovirus
 3; The main parasitic organisms are:
 Trichomonas vaginalis (causes vaginal trichomoniasis)
20

21. Public Health Significance of STIs
1: STIs can lead to the development of serious
complications like:
 Women: cervical cancer, PID(8 - 10% ), chronic pelvic pain,
ectopic pregnancy and infertility.
 Men: infertility (20 - 40% )
 New born: blindness and lung damage
 Syphilis can result in
1. congenital syphilis for the baby
 accounts for about 1.3% of mortalities and 20 - 25% of
stillbirths and
2. fatal cardiac, neurological and other complications in adults
 Genital warts can lead to ano-genital cancers
21

22. Public Health Significance…
2: The links between STIs and HIV:
 The presence of an untreated STI enhances both
acquisition and transmission of HIV.
 E.g. HSV-2 plays an important role in the transmission of HIV.
 STI treatment is an important HIV prevention strategy.
 Integration of HIV/AIDS programs with STIs prevention
and care programs is economically advantageous.
 similar interventions and target audiences
22

23. Relation ship between STI & HIV /AIDS
23
• The relationship between STIs and HIV/transmission has
been described as an epidemiological synergy and share
the same risk factors.
1. STIs enhance the sexual transmission of
HIV through:
• Disrupting integrity of the skin barrier
• The presence of genital ulcers is known to increase
the risk of HIV transmission by 3-5 folds
• Inducing inflammation
• Increasing viral shedding

24. 24
2.HIV infection increase STIs through
Increased susceptibility to STIs among immuno
suppressed individuals.
Altering susceptibility of STI pathogens to
antibiotics = decreasing effectiveness of treatment.
The clinical features of various types of STIs are
influenced by co-infection with HIV.
Relation ship between STI & HIV /AIDS….

25. Distinctive features of STD epidemiology
1. STDs typically have long latent or incubation period
before symptoms become apparent/transmission occurs.
2. Generic variation of STD causing organisms - difficulty
of developing vaccine against them.
3. Many people in developing countries seek treatment out
side the formal health system.
 E.g. came a week after the onset of symptoms.
25

26. Distinctive features…
5. Incomplete treatment may mask symptoms with out
cure thus facilitating disease spread.
6. Proper treatment for STDs are expensive
7. Sexuality is embarrassing to discuss
8. Treatment is not always simple or effective
26

27. Assessing STI Risk
1. Diagnostic/Traditional Approaches
 Etiologic and
 Clinical DX
2. Syndromic approach
27

28. 1 STI Diagnostic Approaches
28

29. Etiologic diagnosis
 Avoids over treatment.
 Satisfy patients who feel
not properly attended to
 Can be used to screen
asymptomatic patients
-requires skilled personnel and
sophisticated lab equipment
-Testing facilities usually not available
at PHC level where a large number of
patients seek care for STI
-expensive, time consuming .
-Delay in treatment and reluctance of
patients to wait for lab results
-Mixed infections often overlooked, thus
miss treatment/under treatment can
lead to complications and continued
transmission
advantages challenges
29
Etiologic diagnosis: using laboratory tests to
identify the causative agent

30. Clinical diagnosis
 Saves time for patients
 Reduces lab expenses
 Requires high clinical skill
 Mixed infections often
overlooked
 Doesn’t identify
asymptomatic STIs
ADVANTAGES CHALLENGES
30
Clinical diagnosis: using clinical experience to
identify the symptoms typical for a specific STI.

31. The Syndromic Approach to Case
Management
Syndromic approach is using clinical algorithms based on an STD
syndrome, constellation of symptoms and clinical signs, to
determine specific STD and therapy.
31

32. The Syndromic approach….
The Syndromic approach:-
Appropriate for high-risk groups and for symptomatic
individuals
The most effective way to treat persons with STIs;
 especially when no laboratory facilities are available.
 It relies on the use of a clinical flow chart – a step by
step standardised guide to decision making.
 well suited to resource poor settings and
 enables health care workers to make Dx within a short
time without special skills and sophisticated lab tests.
32

33. The Syndromic Approach…
Many different agents cause STIs, however, some of them
give rise to similar or overlapping clinical manifestations.
There were 7 STI syndromes
1. Urethral discharge
2. Genital ulcer
3. Inguinal bubo
4. Scrotal swelling
5. Vaginal discharge
6. Lower abdominal pain
7. Neonatal conjunctivitis
33

34. Urethral Discharge
Agents: N.gonnorhea, C. trachomitis, T. vaginalis
 Clinical presentation Burning sensation during urination
(dysuria), Urethral discharge,
 Complications: local spread & Dissemination,
Stricture & infertility
 Treatment; Ciprofloxacin 500mg PO stat or Spectinomycin
2gm IM stat Plus
 Doxycycline 100mg bid 7day or TTC 500mg qid 7d
or Erythromycin500 qid,7days
34

35. 35
Urethral discharge
35

36. 36
complains of urethral discharge or dysuria
Take history & Examine [Milk urethra if necessary]
Discharge present? Other STIs? No
Yes
Use appropriate flow chart
No
Yes
Urethral discharge
• Educate on RR
• Offer HIV CT
• Promote & provide
condoms
Treat for Gonorrhea & Chlamydia
•Educate on Risk Reduction
•Offer HIV CT
•Promote & provide condoms
• Partner management
• Advise to return in 7 days if symptoms
persist
36

37. vaginal discharge
Common causes of vaginal discharge
 Sexually transmitted
 Neisseria gonorrhoeae
 Chlamydia trachomatis
 Trichomonas vaginalis
 Endogenous infection
 Gardnerella vaginalis
 Candida albicans
37

38. 38
Vaginal discharge
38

39. 39

40. 40

41. 41
Vesicular
HSV2: Genital Herps
Non-Vesicualr
T. Pallidum: Syphilis
H. Ducreyi: Chancroid
C. Trachomatis Serovars L1-L3: LGV
K.Granulomatis): Granuloma ingunale
41

42. Lower abdominal pain
42

43. Scrotal swelling
43

44. Inguinal bubo
44

45. Neonatal conjunctivitis
45
ceftriaxone,50 mg/kg by intramuscular injection as a single dose.
Patients should be reviewed after 48 hours.

46.  NB: All STD management approach should
emphasize the 4C’s ;
 counselling and education,
 condom promotion,
 compliance with RX and
 contacting partners for RX
46

47. Aim of Syndromic management of STIs:
• Prompt and effective detection and treatment of
STDs
• Decrease STD incidence and prevalence by reducing
period of infectiousness
47

48. Advantages and Limitations of Syndromic
Management
 A d v a n t a g e s :
 Complete STI DX and RX offered within a single visit.
 May not need sophisticated equipment & personnel
 Simple, rapid and inexpensive; So, its ideal for PHC
setting
 Clients are treated for a potential mixed infection.
 Curtails unnecessary referral to hospitals
 Contribute to reduction in HIV transmission
 Increase attendance at intervention units
48

49. Advantages and Limitations….
 C h a l l e n g e s
 Asymptomatic infections are missed
 Potential for over treatment
 unnecessary drug use, waste of drugs that could be used
to treat other clients, and the potential for microorganisms
to develop resistance to antimicrobial drugs.
49

50. Prevention and control of STIs
Why Invest in STI Prevention and Control Now?
 To reduce STI-related morbidity and mortality
 To prevent HIV infection because:
 Genital ulcer diseases have been estimated to increase
the risk of transmission of HIV 50–300-fold per
episode of unprotected sexual intercourse
 Improved syndromic management of STIs reduced HIV
incidence by 38%
50

51. Prevention….
 To prevent serious complication in women
o Infertility[30% to 40%], PID, ectopic PX and cervical cancer
 To prevent adverse pregnancy outcome
 Perinatal deaths
 Spontaneous abortions
 Preterm deliveries
E.g.: Syphilis --> 25% stillbirth and 14% in neonatal death
Gonococcal infection ----> spontaneous abortions and premature
deliveries, and up to 10% in perinatal deaths
chlamydial infection ---> 30% ophthalmia neonatorum, which can
lead to blindness
51

52. Prevention…
 To maintain or improve quality of life
 The physical, psychological and social consequences of
sexually transmitted infections severely compromise the
quality of life of those infected.
52

53. Strategies for reducing/control STI
1. Early diagnosis and treatment of patients:
 Proper treatment of STIs, i.e. use of correct and
effective medicines, treatment of sexual partners,
education and advice, reliable supply of condoms
2. Prevention by promoting safer sexual behaviours.
Safer sex: It is any sexual activity that reduces the risk of passing
STI and HIV from one person to another: includes
1. Consistent use of condom ƒ
2. Reducing the number of sexual partners
3. avoid “dry sex” 4. delay sexual onset
53

54. Strategies…
3. Education of patients and the general public;
Explain clearly and by step about
 the STD and its treatment
 and discuss the patients risk level including
o number of sexual partners, Patient’s protective behaviour
o sex with a new of different partner in the past few months
o exchange of sex for money, goods, and HIV infection
o Other non sexual risky behaviour (e.g. blood transfusion,)
o partners sexual br (other partners, STD, injecting drugs )
 the need to change sexual behaviour help the patient
decide to change his/her sex behaviour
54

55. Strategies…
 Barrier to changing behaviour
 Gender – women often have little control over their sexual
activities.
 Cultural practices – age differences at marriage, wife
inheritance.
 Religion may contribute to safe sex practices. but may
discourage open discussion about sexuality and protective
measures.
 the need to treat sexual partners
55

56. Strategies cont…
4. General access to quality condoms at affordable
prices
5. Inclusion of STI treatment in basic health services
6. Targeting vulnerable groups: Specific services for
populations with high-risk sexual behaviours
7.Treatment and education of sexual partners
56

57. Strategies…
8. Screening of clinically asymptomatic patients
9. Provision of counselling and voluntary testing for
HIV infection
10. Prevention and care of congenital syphilis and
neonatal conjunctivitis
11. Involvement of all relevant stakeholders, including
the private sector and the community.
57

58. Prevention and Control of STIs …..
58
STI can be controlled By;
1. Promotion of safer sexual behavior
2. Promotion of health care-seeking behavior
3. Early diagnosis and treatment
4. Identifying Target /vulnerable groups

59. 59
 Generally STI and HIV/AIDS preventive and Control
measures are classified in to three infection prevention
categories.
1. Primary (1o) Prevention :- prevention from getting
infection.
2. Secondary (2o) prevention :- early detection infection
and treatment before an infection being sever.
3. Tertiary(3o ) prevention :- treatment to prevent
permanent damage or disability.
Prevention and Control of STIs …..

60. Primary prevention
60
 Abstinence from sexual activity
Safer sexual behaviors
1. delaying the age of sexual debut
2. Life-long mutual monogamy(Only one sexual partners)
3. Correct and consistent use of condoms .
4. Avoid anal sex-B/c it increase the risk of transmission over
vaginal sex.
sexual activity usually refers to vaginal, anal, or oral sex with
another person.
Unsafe sex is any kind of sex that puts a person at risk of a
sexually transmitted infection (STI) or unplanned pregnancy

61. Secondary prevention
61
 Secondary prevention-early treatment to prevent the
disease from being sever.
 Promoting STI care-seeking behaviour, through:
Public education campaigns
Providing non-stigmatizing and non-discriminatory
health facilities
Counseling for partner/s treatment
Ensuring a continuous supply of highly effective drugs

62. Prevention of HIV/AIDS
62
 There's no vaccine to prevent HIV infection and no
cure for AIDS.
 But it's possible to protect yourself and others from
infection.
 Thus, acquiring knowledge about HIV and avoiding
any behavior that allows the entrance of HIV-infected
fluids such as blood, semen, vaginal secretions, and
breast milk into your body is a unique method of
preventing HIV infection.
 On the top of that, the following strategies are applied
to prevent the transmission of HIV/AIDS.

63. 63
1. ABC strategy:
A=Abstinence, Sometimes ABCD
B=be faithful, D= don‟t use unsterile sharp material
C=use condom
 Abstain from sexual intercourse is the only method that is
100% effective.
 The ABC strategy promotes safer sexual behavior,
Prevention of HIV/AIDS cont….

64. 64
2. Avoiding of sharing sharp materials
3. Avoid risky sexual behaviours
4. Screening Blood Transfusion
5. Voluntary Counseling and Testing
6. Prevention of mother to child HIV transmission
(PMTCT )
7. Avoidance of unwanted pregnancies among infected
mothers
8. Use of antiretroviral therapy
9. Provision of post exposure prophylaxis
Prevention of HIV/AIDS cont…..

65. Protecting adolescent From SRH problems
65
 One of the important concerns of young people is their
sexual relationships.
 young people need to know how they can maintain
healthy personal relationships.
 As a Health worker, you need to educate young people
in what constitutes safer sex and the consequences of
unsafe sexual practices.

66. How to negotiate safer sex
66
 Be assertive, not aggressive
 Say clearly and nicely what you want
 Listen to what your partner is saying
 Use reasons for safer sex that are about you, not your
partner
 Be positive
 Turn negative objection into a positive statement
 Never blame the other person for not wanting to be safe

67. Factors affecting SRH care
67
Factors that challenge the provision of SRH services
particularly for adolescent are;
1. Inadequate levels of knowledge about human sexuality.
2. Inappropriate or poor-quality reproductive health
information and services.
3. The prevalence of high-risk sexual behavior.
4. Discriminatory social practices.
5. Negative attitudes towards women and girls.
6. The limited power many women and girls have over their
sexual and reproductive lives.

68. Generally, these factors can be categorized in to three.
1. Individual/personal factors
 Marital status
 Gender norms
 Sexual activities
 Schooling status
 Childbearing status
 Economic status
 Rural/urban residence
Barriers for SRH service utilisation
68

69. 2. Cultural/social factors
 Awareness level of the communities
 Attitudes towards young people‟s sexual behaviour
 Attitude towards AYRH services
 Parent–child interactions
 Peer pressure
Con..
69

70. 3. Institutional factors
 Judgemental health workers
 Locations
 Timing
 Cost
 Space:
Con…
70

71. Summary of adolescent RH problems
71
 Generally, adolescents are at higher risk of the
following reproductive health problems
# 1.FGM (HTP)
# 2. GBV (mainly Sexual violence)
# 3. Marriage by abduction
# 4.Early marriage
# 5. Early pregnancy
# 6. Unsafe sexual behaviour
# 7. Substance abuse
# 8. Unwanted pregnancy
# 9. Abortion
# 10. STI including HIV/AIDS and others.......

72. Provide Adolescent and Youth-friendly SRH
services
 Adolescence and youth are critical phases of young
people’s development.
According to the WHO definition
 Adolescents are defined as 10-19-year-olds,
 Youth as 15-24 year olds, and
 Young people as 10-24 year old
72

73. What can be done to improve the quality of health
service provision to adolescents?
 The starting point for any initiative aimed at improving the
quality of health service provision to adolescents is the national
health policy and strategy developed by the ministry of health.
 which will provide answers to five critical questions:
1. What health outcomes are being aimed for?
2. Among which group of adolescents are these health outcomes
being aimed for?
3. What is the place of health service provision to adolescents
within an overall strategy to achieve these health outcomes?
4. What is the package of health services to be provided, to
achieve the health outcomes being aimed for?
5. Where (which type of health facility) and by whom (which type
of health service provider) should these health services be
provided by?
73

74. What to be done……..
 Precise answers to these questions will provide a sound
basis for developing a national strategy to improve the
quality of health service provision to adolescents.
 It is important to build on what already exists.
 Meaning efforts should be directed at making existing
service-delivery points –intended to provide health
services to all segments of the population – more
friendly to adolescents, rather than on setting up new
service-delivery points exclusively intended for
adolescents
74

75.  To improve the quality of adolescent health services,
efforts are needed to make health-service provision is
friendly, so that
 adolescents are more likely to be able and willing to
obtain the health services they need.
 The quality of care framework provides a useful
working definition of adolescent-friendly health
services.
 To be considered adolescent friendly, health services
should be accessible, acceptable, equitable,
appropriate and effective.
What to be done……..
75

76. Youth-Friendly service…..
 To be considered adolescent-friendly, services should have the
following characteristics:
 Equitable: All adolescents, not just certain groups, are able to obtain
the health services they need.
 Accessible: Adolescents are able to obtain the services that are
provided.
 Acceptable: Health services are provided in ways that meet the
expectations of adolescent clients.
Adolescents are willing to obtain the health services that are available.
 Appropriate: The right health services (i.e. the ones they need) are
provided to them.
 Effective: The right health services are provided in the right
way and make a positive contribution to the health of
adolescents.
76

77.  Adolescent and youth health services are “Youth friendly”, it
should be given:
 In the right place
 At the right time
 By the right price(free where necessary) and
 Delivered in the right style to be acceptable to young people.
 They should be equitable because they are inclusive and do
not discriminate one from others.
 It should be efficient- given with less money, time and power
wastage.
Youth-Friendly service…..
77

78. YFS Providers should have the following Characteristics
Well trained
Demonstrate respect and concern for young people
Knowledgeable of normal adolescent development
Have the skills to diagnose and treat common
conditions
Have access to the correct drugs and supplies
Know where to refer youth
Respect the confidentiality and privacy
Youth-Friendly service…..
78

79. Strategies for Implementing/improving YFS
 Service provider must see the person (the client) not the problem
 Training and staff support
 Making the service facilities acceptable
 Confidentiality and Privacy
 Services that are acceptable to the local communities
 Involving youth–-- during planning, designing program, monitoring
and evaluation of SRH programs.
 Involving community members--- help to design cultural acceptable
SRH services strategies.
Youth-Friendly service…..
79

80. characteristics of youth friendly clinics
 At Convenient location
 Offer privacy and avoid stigma
 Provide information and education materials
 Have convenient working hours for young people.
Youth-Friendly service…..
80

81. The following actions facilitate access by
adolescents to quality health services:
 Ensure availability of health care providers.
 Identify the training needs
 Standardize the guidelines and protocols.
 Equip and supply all service delivery points on an
ongoing basis.
 Design service delivery points taking into account privacy,
confidentiality, affordability and an enabling
environment.
 Establish suitable links with service delivery points for
referral that should be equally adolescent friendly.
81

82. The following actions facilitate access by adolescents
to quality health services cont…..
 Establish coordination with popular NGOs and
private providers and develop partnerships
 This is to ensure practice of uniform standards in the
government, private and NGO sectors.
 Strengthen the information system and feedback.
 Create awareness among adolescents on when, where
and how to get services.
 Create an enabling environment in the community to
promote timely care seeking by adolescents.
82

83. Cervical & breast cancer screening
83

84. Cervical & breast cancer screening
84
Introductions
 Cancer is a disease in which abnormal cells divide
uncontrollably and destroy body tissue.
 Breast and cervical cancers are the leading cancers
among women in developing countries.

85. FACTS:
85
 Cancer develops in the body very silently.
 Cancer is the cause of 12% of all deaths.
 Until it comes to a certain stage patients lead a normal
life without any complaints.
 Initially it produces mild symptoms as found in other
diseases.
 Cancer detected at early stage produces better results on
treatment and even cure.
 Advanced disease leads to financial and psychological
burden.

86. How To Detect Cancer Early
86
As simple as…..The Seven Danger Signals
The American Cancer Society uses the word C-A-U-T-I-O-N
to help recognize the seven early signs of cancer:
1. Change in bowel or bladder habits.
2. A sore that does not heal.
3. Unusual bleeding or discharge.
4. Thickening or lump in the breast, testicles, or elsewhere.

87. Cont…
87
5. Indigestion or difficulty swallowing.
6. Obvious change in the size, color, shape, or thickness of
a wart, or mouth sore.
7. Nagging /irritating cough or hoarseness.
These signs don't necessarily mean you have cancer, but
it's important to have them checked out.

88. Screening
88
 Screening refers to the use of simple tests across a
healthy population in order to identify individuals who
have disease, but do not yet have symptoms.
 Examples include breast cancer screening using
mammography and cervical cancer screening using
cytology screening methods.
 Benefits of screening
 Early detection and treatment possibly before it has
spread!

89. Cont…
89
 Reasons for late breast cancer diagnosis:
– Lack of knowledge by the population about the
symptoms
– A fatalistic attitude towards cancer & unawareness about
the possibility of cure
– Lack of knowledge by the medical & paramedical staff
– Lack of or disorganized screening programs
– Lack of health care facilities

90. Cont…
90
 Cervical cancer and HPV:
– over 90% of cases of cancer of the cervix are caused by an
infection with one or more types of HPV which is sexually
transmitted.
– the virus enters the cells of the cervix and slowly
causes cellular changes that can result in cancer.
– women generally infected in their teens or early
twenties, but invasive cancer may not develop for as
long as 10 to 20 years
– Immuno-depression may greatly shorten this interval.

91. Cancer prevention & care
91
Primary prevention of cancer
 Public awareness on cancer prevention and care.
 Tobacco control
 Promotion of healthy diet and physical activity.
 Control of harmful use of alcohol

92. Cont…
92
Early detection of cancer
 Promote breast self-awareness
 Clinical breast examination for all women above age
18 coming to health institutions for other complaints
 Population-based cervical cancer screening for all
women aged 30-49 every 5 years
Diagnosis and treatment of cancer

93. 93
Evaluate effectiveness of sexual and
reproductive health care
 What is monitoring?
 What is evaluation?

94. Monitoring SRH
94
Monitoring is:-
Monitoring is the day-to-day watch on.
 Continuous follow-up of on going activities.
 Carried out through observation.
It is regularly checking to see that SRH care is given as
needed or not.
 Generally monitoring is the routine process of data collection
used to measure whether SRH services are properly delivered
or not.
 It is used to take immediate corrective intervention.
 After assessing the achievement gaps from planned, take
appropriate corrective action and follow progress with
standard.

95. Evaluating intervention in RH care
95
 Evaluation is the periodic assessment of the design,
implementation, outcomes and impact of RH care .
 It is used to assess the:-
1. Relevance and achievement of objectives.
2. Implementation performance in terms of effectiveness
and efficiency.

96. 96
Contribute to team planning for SRH care
 Community participation at all stages is essential to:-
 Ensure the acceptability, appropriateness and sustainability of
sexual and reproductive health projects.
 It is a concrete strategy for empowering refugee and displaced
young people to have a greater degree of control over their own
lives and the services which are provided to them.
 This means the active participation and support from parents,
teachers, religious and community leaders, health care providers,
as well as young people themselves are very important in SRH
care.

97. Team planning for SRH cont...
97
The Importance of Community Participation
 Community will give information about
 Problems existing in the camps
 Opinion leaders whose ideas are respected.
 Entry process into the community
 Cultural dimensions of the community in the camps
 Informal services that are used by young people for their
SRH.
 Available resources in terms of human resources especially
in formulation of culturally acceptable messages.

98. Team planning for SRH care…
98
 Participation of young people
 It is therefore important to involve them in:
1. Planning
2. Implementing of SRH programs
3. Evaluating

99. Team planning for SRH care…
99
 Involving young people in SRH Services provision is an effective.
Because they are;
 More flexible and often have an easier time adapting to a new
situation than their parents.
 They may also learn quickly how to “work" within new structures”.
 They tend to be more open to new ideas than their older.
 When motivated, they have huge sources of energy and enthusiasm.
 They can be far better communicators with their peer groups than
many adults.
 Therefore, Young people should be identified, participate in the design of
programmes, and eventually take a leadership role.

100. Perform reproductive health interventions
100
 Because of limited human, financial and infrastructure
resources, many developing countries are only able to
offer a core package of basic SRH services.
 Usually focused on maternal, newborn and child health,
including family planning.

101. SRH packages
10
1
Full SRH package delivered through primary health care with referrals would
include
1. Family planning/birth spacing services
2. Antenatal care, skilled attendance at delivery, and postnatal care
3. Management of obstetric and neonatal complications and emergencies
4. Prevention of abortion and management of complications resulting from unsafe
abortion
5. Prevention and treatment of reproductive tract infections and sexually
transmitted infections including HIV/AIDS
6. Early diagnosis and treatment for breast and cervical cancer
7. Promotion, education and support for exclusive breast feeding
8. Prevention and appropriate treatment of sub-fertility and infertility
9. Active discouragement of harmful practices such as female genital cutting
10. Adolescent sexual and reproductive health
11. Prevention and management of gender-based violence.

102. SRH interventions cont…
102
 Young people should be educated about the following important
life skills which are relevant to all areas of SRH.
Adolescents’ Important life skills for SRH are:-
1.How to make sound decisions about relationships and sexual
intercourse, and stand up for those decisions.
2.How to deal with the pressures of unwanted sex or drugs.
3. How to recognize a situation which might be risky or dangerous.
4. How and where to ask for help or support.
5. When ready to have sexual relationships, how to negotiate
protected sex or other forms of safer sex.
6. How to show compassion towards people with HIV/AIDS.
7. How to care for people with AIDS in the family or the community.

103. Summary
10
3
 Sexual and reproductive health programmes require a multi-
sectoral approach in order to be effective.
 Co-ordination, both between and within implementing agencies,
with respect to this work is essential.
 Information, Education and Communication (IEC programmes)
can provide useful and appropriate information, counseling and
advocacy.
 IEC also used in developing community participation and
individual commitment.
 Parents, teachers, community and religious leaders should be
consulted and briefed on the importance of sexual and reproductive
health programmes for young people.

104. Summary….
104
 Sexual and reproductive health programmes require a multi-
sectoral approach in order to be effective.
 Co-ordination, both between and within implementing agencies, with
respect to this work is essential.
 Information, Education and Communication (IEC programmes) can
provide useful and appropriate information, counseling and
advocacy.
 IEC also used in developing community participation and individual
commitment.
 Parents, teachers, community and religious leaders should be
consulted and briefed on the importance of sexual and
reproductive health programmes for young people.

105. Thank you!!!!!
105