Understanding Care-Seeking Behavior for Reproductive Tract Infections Among Afghan Women: A Cross-Sectional Study.

Abstract

Background: In Afghanistan, providing care for reproductive tract infections (RTIs) is challenging, among other factors, due to the extreme scarcity of reliable data. To address this gap, the present study investigates symptoms, potential risk factors, knowledge, and care-seeking behavior in the largest sample of women to date.

Methods: From September 16, 2022 to November 26, 2022, a structured questionnaire was administered to women presenting at multi-specialist clinics in the major cities of Afghanistan. Signs and symptoms of RTIs were investigated, together with reproductive history, hygiene practices, and sociodemographic characteristics. Logistic regression, adjusted for selected covariates, was used to assess predictors of delays (over 1 month) from symptoms onset to care-seeking, and of a history of RTI.

Results: A total of 601 responses were analyzed (80.2%). Mean age was 31.3 years (standard deviation [SD] 11.5). Signs symptoms related to RTIs were reported by 79.2%, knowledge of RTIs by only 23.0%, and care-seeking delays by up to 39.5%. Care-seeking delays were positively associated with abnormal vaginal discharge (odds ratios [OR] 4.12; 95% confidence intervals (CI) 2.01-8.45), lower abdominal pain (2.62; 1.44-4.77), and fever (1.93; 1.25-2.98) and negatively associated with being sedentary (0.38; 0.22-0.64), hand washing (0.61; 0.40-0.95), and knowledge about RTI, although borderline significant. A history of RTI (reported by 44.1%) was predicted by abnormal vaginal discharge, fever, irregular menstruations, and use of sanitary pads but not by the husbands' history of RTI.

Conclusions: The majority of women presenting at clinics in Afghanistan reported symptoms related to RTIs, delayed care-seeking, and lack of knowledge about RTI. Healthcare providers should inform the population about RTIs and their standard care pathway, while adopting a multi-dimensional approach accounting for the cultural background of the women.