Evaluating the coverage of sexually transmitted infection prevention and control services in eight districts in Central Uganda: lot quality assurance sampling survey

Abstract

Introduction

Sexually transmitted infections (STIs) are a major global public health problem, associated with infertility, adverse pregnancy outcomes, and significant social and economic burdens. These challenges are particularly severe in underprivileged communities. A 2024 World Health Organisation report highlighted a global surge in STIs, requiring intensified efforts to improve their control and management. In order to appropriately respond and reverse the status quo, it is important to understand the extent to which the current interventions have reached the beneficiaries. This study aimed to assess the coverage of sexually transmitted infection (STI) services using the Lot Quality Assurance Sampling (LQAS) approach in eight districts of Central Uganda.

Methodology

A household survey was conducted in eight districts, targeting four population groups: mothers of children aged 0–11 months, women aged 15–49 years, men aged 15 + years, and youth aged 15–25 years. LQAS was used, with each district stratified into five supervision areas (SAs). In each SA, 19 respondents were randomly sampled from each target group. The survey assessed key indicators related to STIs, including knowledge of STI symptoms, knowledge of actions to take when infected with an STI, and engagement in risky sexual behavior. The study also examined condom use during risky sex, circumcision acceptance and non-acceptance among men, including reasons for its acceptance or non-acceptance. Overall and district-specific coverage was calculated with 95% confidence intervals. Indicator coverage in the SAs was classified using LQAS decision rules (DRs) for each indicator, using the overall coverage as benchmark for setting the DR.

Results

The findings revealed that mothers of children aged 0–11 months demonstrated superior knowledge of STIs and appropriate actions to take if one has an STI. Men (15 + years) and youth (15–24 years) reported engaging more in risky sexual behavior compared to women 15–49 years and mothers of children aged 0–11 months. Relatedly, men 15 + years reported higher condom use during risky intercourse. Youth were more likely to be circumcised than older men. Coverage for most indicators varied across SAs and districts. However, one in forty of the SAs fell short of average coverage in all the indicators. Personal hygiene was the leading motivator for circumcision acceptance while fear of pain was the leading driver for refusal to accept being circumcised.

Conclusions

The findings highlight vital disparities in STI knowledge and risky sexual behavior among different demographic groups. These findings inform public health strategies to address STI disparities and improve reproductive health outcomes. District and SA-specific bottleneck analysis is recommended in order to provide actionable solutions to improve low-indicator coverage in low-coverage districts and SAs.