Factors associated with awareness about syphilis and gonorrhoea among women in Bangladesh

Introduction

Generally, women are in greater danger of contracting sexually transmitted infections compared with men¹. Treponema pallidum is a microaerophilic spirochete that causes syphilis, a chronic systemic venereal illness with various characteristics, which is also characterised by latent periods and flare-ups or incidents of energetic virus¹. Gonorrhoea is a general venereal illness caused by the bacterium Neisseria gonorrhoea. Symptoms include painful urination and pain around the urethra. Virtually any mucous membrane can be infected^2,3. Previous research has shown that the rate of awareness of gonorrhoea was 4%, while that for syphilis was 5% among 1,550 women in Bangladesh⁴, while further research showed that rate of awareness for syphilis and gonorrhoea was 0.9% and 0.5%, respectively⁴. The World Health Organization reported an incidence of 340 million individuals with gonorrhoea and syphilis among 15–49 year olds, the majority of whom resided in Asia⁵. In developed and developing countries, such as Bangladesh, gonorrhoea and syphilis area major health and economic problem⁵. Per day more than 1 million individuals obtain a sexually transmitted infection, and per year, a projected 500 million individuals contract one of four sexually transmitted infections, including gonorrhoea and syphilis⁶.

Geographic region, place of residence, respondent’s age, education, listening to the radio and watching television have a sufficient association with knowledge concerning sexually transmitted diseases, in general, among women in Bangladesh⁷. Syphilis and gonorrhoea are harmful to the health of women and infants^8–10. Gonorrhoea is caused by pelvic inflammatory diseases, which can lead to sterility, ectopic gravidity, and long-lasting pelvic pain^11–15,16. Additional, investigation specified that syphilis and gonorrhoea combined can be co-factors for HIV infection^16–18,19. In Bangladesh, previous studies have identified the sero-prevalence of sexually transmitted infections and reproductive tract infections in the general population²⁰. However, a nationwide study concerning the rate of awareness of syphilis and gonorrhoea, specifically, among women in Bangladesh is lacking. Consequently, the goal of this study is to identify the associated factors concerning knowledge about these diseases among women in Bangladesh.

Methods

Results

Table 2 presents the association between awareness about syphilis and gonorrhoea and the designated social-demographic variables of women in Bangladesh. The rate of awareness about syphilis and gonorrhoea among women in Bangladesh was 13.3% and 15.7%, respectively. Women who were <25 years, 25–35 years and 36–49 years had an awareness of 9.0%, 14.0%, 16.6% for syphilis, respectively, and 11.8%, 16.6%, 18.5% for gonorrhoea, respectively. Among all the women, 10.6% and 13.3% in rural areas and 18.2% and 20.4% in urban areas had awareness about syphilis and gonorrhoea in Bangladesh, respectively. Only 18.9% and 22.8% of women that were educated at a secondary or higher level had awareness about syphilis and gonorrhoea, respectively, and 18.1% and 21.0% rich women knew about syphilis and awareness, respectively. The women in the Barisal division had the highest (20.5% and 25.3%) awareness about syphilis and gonorrhoea of all the geographic regions (12.8% and 14.1%, Chittagong; 14.6% and 16.9%, Dhaka; 13.9% and 16.8%, Khulna; 10.9% and 13.1%, Rajshahi; 9.7% and 12.6%, Rangpur; 11.2% and 11.4%, Sylhet). Of the women who listen to radio only 17.5% and 20.2% knew about syphilis and gonorrhoea, respectively, and of those who watch TV only 17.8% and 20.4% had awareness.

From Table 3, women aged 25–35 years and 36–49 years were, respectively, 1.91 and 3.01, and 1.77 and 2.63 times more aware of syphilis and gonorrhoea, respectively, compared to women aged <25 years. Women that lived in rural areas had 0.72 and 0.82 times less awareness about syphilis and gonorrhoea, respectively, than women living in urban areas in Bangladesh. Education was shown to be an important factor for awareness about syphilis and gonorrhoea among women: Women who had finished primary, secondary and higher teaching were, respectively, 1.56, 3.41, and 1.59, and 3.72 times more aware of syphilis and gonorrhoea than women who had no education. The level of awareness about syphilis and gonorrhoea increased with the level of women’s education. The middle class and rich women were, respectively, 1.17 and 1.23, and 1.06 and 1.22 times more aware of syphilis and gonorrhoea than poor women. In addition, women living in Dhaka, Khulna, Chittagong, Rajshahi, Rangpur and Sylhet divisions had less awareness about syphilis and gonorrhoea than women living in the Barisal division. Women who listen to radio and watch TV were, respectively, 1.17 and 1.01, and 1.13 and 1.11 times more aware of syphilis and gonorrhoea, respectively, compared to women who did not listen to radio or watch TV in Bangladesh.

Discussion

Awareness about syphilis and gonorrhoea leads to the promotion of health care among women in Bangladesh. The present study was designed to identify the awareness about syphilis and gonorrhoea among women. In this study, the rate of awareness about syphilis and gonorrhoea among women in Bangladesh is 13.3% and 15.7%, respectively. Bangladesh in previous studies shows that, the rate of awareness about syphilis and gonorrhoea is between 4–5.7% and 5–6.3% respectively,^4,16. The Bangladesh government should give urgent attention to increase awareness about the rate of syphilis and gonorrhoea in Bangladesh, since syphilis and gonorrhoea can lead to ectopic pregnancy, low birth weight, pelvic inflammatory diseases and infertility, which are increasing day-by-day¹⁶. Older women have a higher level of awareness about syphilis and gonorrhoea, since they have acquired knowledge related to sexuality and reproduction²². In this study, middle-aged and older women have better awareness about syphilis and gonorrhoea compared to younger women (<25 years). The old-style society system and health service overlook younger women in Bangladesh. The level of women’s education is significantly associated with awareness about syphilis and gonorrhoea. Education makes an important contribution to awareness, and it showed a statistically significant association with awareness in the current study (p<0.001). A higher level education provides women with various opportunities, such as practice of health scare and knowledge on reproductive health. This is supported by the encouraging effect of teaching for the development of awareness about syphilis and gonorrhoea seen in previous studies^23,24. In this study, women that live in urban areas have more awareness about syphilis and gonorrhoea, as do women in the Barisal (urban) area. Urban areas are exposed more to mass media and education programs compared with rural areas. Mass media is an important channel, as music, newspapers, songs and advertising can communicate awareness about syphilis and gonorrhoea. The major sources of information about syphilis and gonorrhoea for women are the radio and TV, and in the present study women that listened to the radio and watched TV were more likely to know about the two STIs. This is similar to the suggestion established by Khan and Goel in their research: The level of awareness increased with age and literacy, which shows policymakers that educational intervention programs may be effective^23,25. One of the limitations of this research is that the material was self-reported and few studies have studied syphilis and gonorrhoea in Bangladesh. Therefore, Bangladesh needs more research about these diseases.

Conclusions

Knowledge about infectious diseases, especially syphilis and gonorrhoea, in Bangladesh has been an important theme in population based studies. Educating women is an important step in increasing knowledge consciousness about syphilis and gonorrhoea. Highly effective sexual health education should be included in textbooks and infectious diseases prevention programmes, which will achieve positive health outcomes among rural poor women of Bangladesh. At present, awareness about syphilis and gonorrhoea shows there is more risk to women in different regions (Rajshahi, Rangpur, Sylhet and Chittagong divisions). Rural school based educational programmes are needed to increase the awareness about syphilis and gonorrhoea. However, mass media (broadcasting and television) play a large role in increasing awareness about infectious diseases, such as syphilis and gonorrhoea. Therefore, Bangladeshi government policy should focus on increasing educational programmes at the public level about syphilis and gonorrhoea through the use of radio, television, the Internet, newspapers and textbooks.

Ethical approval

Ethical approval for this study was not applicable, since ethical approval for the collection of data was previously approved for BDHS.

Data availability

The data from BDHS 2011 are free-to-access (https://dhsprogram.com/data/dataset/Bangladesh_Standard-DHS_2011.cfm?flag=0); however, before you can download data, users must register as a DHS data user. Dataset access is only granted for legitimate research purposes (https://dhsprogram.com/data/new-user-registration.cfm).