الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Reproductive health (RH) is one of the corner stones of health and a major determinant and indicator of human social development.(1) RH is defined as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity, in all matters relating to the reproductive system and to its functions and processes.(2,3) RH encompasses family planning, maternity care, safe motherhood, prevention of unwanted pregnancies, reproductive tract infections (RTIs) including sexually transmitted infections (STIs), infertility, breast-feeding, infant and child health, adolescent RH, and it also includes harmful practices related to the reproductive system.(4)
There is very little known about health needs of adolescents in general and RH needs<in particular.(13) Data about knowledge, beliefs, attitude, reproductive health related behavior and health and social support needs of adolescents are needed. (13,14)
Traditionally in Egypt adolescents were shielded from information about reproduction and sexuality. Data about knowledge, beliefs, attitudes of Egyptian adolescent females regarding puberty changes and RH issues are lacking.(12) Reproductive tract infections (RTIs) are a major public health problem in both developed and developing countries. The adolescents remain the age group at greatest risk for acquiring these infections.(15)
Youth lower reproductive tract infections are preventable and treatable. A variety of medical and social factors put adolescents at particular risk for RTIs. Because of barriers to receiving care, young people may be unable to seek timely and effective treatment for their infections. Social taboos have tremendous impact and hence young people need accurate information about RTIs for timely management.(4,23)The reproductive health needs of youth have neither been researched nor addressed adequately; particularly their needs in this area are often misunderstood, unrecognized or underestimated. Early identification and early intervention of girls’ reproductive health issues is crucial. Health-seeking behavior (HSB) is a state in which individual in stable health is actively seeking ways to alter personal habits and/or the environment in order to move toward a higher level of wellness. Health education is the process of establishing individuals to make informed decisions about their personal health related behavior. It aims to improve health by encouraging adherence to medical treatment regimens and promoting healthy life styles.Aim of the study:1- To estimate frequency rate of RTIs among never-married female students attendin outpatient gynecology clinic in Alexandria University Students’ Hospital during one year prior to the study. 2- To identify some predisposing factors associated to RTIs among never-married university female students suffering from symptoms of RTIs.3- To assess knowledge, perceptions, and practices as regards RTIs and reproductive
health among those students.
4- To construct and implement a culturally sensitive RTIs and reproductive health
education intervention for a group of those students suffering from symptoms of RTIs.
5- To assess the impact of that educational intervention on their RTIs and reproductive
health knowledge, perception and practices.
Study setting:
The study will be conducted in Alexandria University Student’s Hospital Outpatient Gynecology Clinic.Target population:The study wasonducted on never-married female students attending the Outpatient University Gynecology Clinic suffering from symptoms of RTIs. The sample involved 120 students.
Study design:
A cross-sectional design was used to estimate the frequency rate of clinically
diagnosed RTIs and a quasi experimental design was used to evaluate the impact of the
RTIs and reproductive health intervention program for a group of target population.
Methods of data collection:
The data was collected through the following tools and techniques:
I- Pre-intervention phase
(A) Record review sheet: A review sheet was designed to estimate frequency rate of
RTIs.
(B) Predesigned structured self-administered interview questionnaire: It was used as
a pretest tool, it was developed to obtain data about personal and socio-demographic
characteristics of the students including age, college, family size, crowding index,
family income, education and occupation of the parents and type of toilet whether
Arabic or western. Medical history and personal characteristics predispose to RTIs,
menstrual and gynecological histories and present complaints. Also data about health
and environmental facilities at home, also data about routine and menstrual hygienic
practices and sleeping arrangements, and data about knowledge and beliefs of the
students about RH and RTIs.
II- Intervention phase: A culturally sensitive educational intervention program was
tailored based on students’ educational needs assessment. The program aimed at
promoting RH through raising awareness and correcting common misconceptions and
wrong beliefs about RTIs and its implication on RH, as well as adopting sound
reproductive health practices among young never-married female students. Different educational methods were used such as group discussions, audio-visual
materials in the form of power-point presentation, colored posters, illustrations, models,
demonstration and value clarification.
Discussion and follow-up through e-mail and telephone contact to answer patients’
questions were offered by the researcher.III- Post-intervention phase: Impact of the intervention was approached by comparing
pre and post assessments among both experimental and control groups. Two final assessments were carried out for the experimental group; the first (post-test) was done
immediately after the program and the second (follow-up test) was done 1 month after
the program and one final assessment was carried out for the control group one month
after the pretest. Both the post-test and follow-up test questionnaires were the same as
pretest as regards knowledge and heath-belief model in addition to some questions
about compliance with hygienic practices, medication and outcome of treatment
(reinfection) in follow-up test.
Results:
The results obtained in the present study could be summarized in the following items:
Pre-intervention results:
The frequency rate of RTIs among never-married female students attending Outpatient
Gynecology Clinic in Alexandria University Students’ Hospital during 2014 was 19.7%.
The commonest complaints were pubic itching, cheese like discharge and low back pain.
About three fourths of the study sample (74.2%) exhibit bad hygienic practice
score level, 20.0% had fair level and only 5.8% of the study sample had good total
practice score level.
More than half (55.8%) of the study sample had poor level of total HSB score, 20.8%
had fair level and 23.4% had good level of total HSB score.
The main sources of information about RH &RTIs were the school and the
university, followed by relatives.
Less than half of the study sample (45.0%) had poor level of knowledge, those who
had fair level were 42.5% and only 12.5% had good level of knowledge.
About half of the study sample had moderate level of perceived susceptibility
(48.3%), perceived severity (47.5%) and cues to action (45.0%) while about two thirds of
the study sample (63.3%) had moderate level of perceived risk and about three fourths of
the study sample (75.8%) had moderate level of perceived barriers. On the other hand,
most of the study sample (84.2%) had high level of perceived benefits.
Post-intervention results:
Regarding practice, after intervention, there was a significant improvement in the
level of total practice score of experimental group as the percent of those who had bad
level of total practice score decreased from 91.7% to 55% and those who had fair level
increased from 8.3% to 40%.Regarding HSB, after intervention, there was improvement in the level of total HSB
score among experimental group as the percent of those who had poor level of HSB
decreased from 31.7% in the pre-intervention to 3.3% in the post-intervention and to 1.7%
in the follow- up assessments. Also, those who had fair level increased from 26.7% to 60%
post-intervention and to 68.3% in the follow up. The differences between levels of total
HSB score was found to be significant through different phases of assessment (P= 0.001).
Results of sub-sample show that after intervention, there was a significant
improvement in the level of total knowledge score among experimental group as the
percent of those who had good level of knowledge raised from 18.3% in the initial
assessment to 100% in the final assessment and those who had poor level decreased from
25% to 0.0%, also those with fair level decreased from 56.7% to 0.0% (p=0.001) and no
significant difference in control group results.
Regarding students’ perception, the results reveal after intervention, there was a
significant improvement among experimental group regarding nearly all the constructs of
HBM while the changes in the control group were minimal and insignificant except for
perceived barriers which exhibits significant change.
Regarding diagnosis, in experimental group, about 70.0% were diagnosed as fungal
vaginal infection, about 23.3% were diagnosed as bacterial infection and about 6.7% were
diagnosed as mixed vaginal infection. Concerning control group, about 40.0% were
diagnosed as fungal vaginal infection, about 43.3% were diagnosed as bacterial infection
and about 16.7% were diagnosed as mixed vaginal infection.
Regarding prognosis of RTIs, the results reveal that about 95.8% of the experimental
group improved and 4.2% need follow up. While, there was improvement in 88.3% of the
control group and about 11.7% need follow up.
Four variables proved to be significantly affecting patients’ improvement;
intervention program, mother education, knowledge total score and HSB total score.
Five variables proved to significantly affect practice percent change; knowledge
percent change, intervention program, perceived circumcision barriers, cues to action score
and family income.
Recommendations:
The study recommends the following:
University education can work with the media to develop message that provide accurate
information, correct the misunderstanding concerning different RH issues and RTIs.
Research should use larger sample sizes and including mothers along with adolescent
girls is needed to produce sufficient and comprehensive results on a national level.
The unmet information needs identified in the study should be the base for development
of educational programs for adolescents regarding reproductive health and RTIs.