A Community Intervention Trial to Decrease the Rate of Chlamydia Infection

Specific Aim: Sufficient propaganda at schools in combination with obligatory annual screening of males and females starting at the age of 14 is a perfect decision for reducing the rate of Chlamydia infection ages 14-18 among ethnic group in Miami Dade Florida.

Goal 1: Reduce the rate of Chlamydia among ethnic group in Miami Dade Florida by 70% by means of annual screening of women aged 14-18 by 2013.

Objectives:

  1. Increase the monitoring rate of women aged 14-18 in healthcare establishments up to 90% by means of creating special database in the region.
  2. Annual testing of 90-95% of women aged 14-18 in Miami Dade Florida.
  3. Obligatory repeated visits in case of infection identification after professional treatment.
  4. Establishment of two centers where women aged 14-18 can have free screening and treatment recommendations.
  5. Reduction of Chlamydia infected by 70% by 2013.

Goal 2: Create 10 propaganda programs aimed at increasing students’ awareness of Chlamydia and its effects beginning with 14-year-old age among ethnic group in Miami Dade Florida.

Objectives:

  1. Create a group of medical employees who are going to develop a program aimed at informing students about Chlamydia, its symptoms, clinical course, treatment and consequences in case of failure to be cured.
  2. Creation of a date-schedule with terminal visits to the schools in the region.
  3. Formation of two anonymous centers where women can be informed about the problem consequences and where they can get an appropriate piece or advice for free.
  4. Change of sexual behavior among 60% of people aged 14-18.
  5. Increase the understanding of the necessity to use condoms up to 40%

Background and Significance

Background to the problem

Considering the situation devoted to the rate of Chlamydia infected people at age 14-18 among ethnic group in Miami Dade Florida, it is important to state that 71% of reported cases of infection were women, 73% of whom were aged between 15 and 24. Looking at the statistics of Chlamydia infection reported cases through the prism of time, the following numbers impress (Jordahl, & Brewer, 2010).

10-19 years Chlamydia cases for male Chlamydia cases for female
2010 271 1107
2009 491 2084
2008 457 1763
2007 432 1583

Table 1. Chlamydia reported cases in Miami-Dade (Jordahl, & Brewer, 2010).

The differences in the reported infections among ethnic groups are great. Thus, 49% of Blacks, 11% of Hispanics, 28% of Whites and 11% of other unknown groups were infected with Chlamydia in Florida in 2004 (Brownem n.d.). The research conducted by Bustamante, Sneed, O’Connell, Zhang, and Leguen (2006) states that the rates of Chlamydia cases are much higher at the age of 10-19 years old in comparison with pregnant 20 years old women. Looking at statistics, it may be noticed that 35% of girls aged 10-19 are infected with Chlamydia in comparison with 17% of 20 year old women. Much attention should be paid to ethnical groups, and especially to Non-Hispanic Black and Haitian ethnicity as their rates are the highest, 29% and 19% respectively, (Bustamante, Sneed, O’Connell, Zhang, & Leguen, 2006).

Being the age of the highest infection activity, behavioral, biological, and cultural reasons also impact the high rate of disease (Centers for Disease Control and Prevention, 2007). Stein (2006) insists that race/ethnicity plays vital role in the rate of Chlamydia infection. Reported cases of Chlamydia by black women who practice low risk behavior are higher as compared to white youths who practice traditional risk behavior. Therefore, implementing a community intervention directed at reducing the rate of infected males and females aged 14-18, much attention should be paid to the ethnic groups in Miami Dade Florida. The awareness of the society about the problem seriousness may help increase the screening rates and as a result reduce the rate of infection.

Health implications

The public health quality in Miami Dade Florida community is low due to the fact that many people are uninsured as they are unable to afford it (Ilcheva, Gorski, Lerma, Martinez, & Smith, 2008). This leads to problems which may be hardly considered. Being one of the most frequently reported infections, Chlamydia usually flows asymptomatically. According to Henneberger (2009) “even though symptoms of Chlamydia are usually mild or absent, serious complications that cause irreversible damage, including infertility, can occur ‘silently’ before a woman ever recognizes a problem” (p. 4). Treatment of Chlamydia is easy going if the infection is identified on time.

The failure to treat Chlamydia infection appropriately may lead to pelvic inflammatory disease (40%), ectopic pregnancy, and infertility (approximately 20%) if identified too late (Centers for Disease Control and Prevention, 2009). Moreover, the following problems may affect women if appropriate treatment is not got on time, “conjunctivitis, urethritis, cervicitis, epidedymitis, reactive arthritis, proctocolitis, and perinatal infection” (Fiebach, 2007, p. 549). Early detection of the problem helps cope with the infection as treatment is easy and may be home conducted.

Effective interventions

Many attempts have been implemented with the purpose to react on the situation and reduce the rate of Chlamydia infected at the age of 14-18. Shafer et al. (2002) have conducted an original research with the purpose to understand whether clinical Chlamydia screening is effective when directed at sexually active women aged 14-18. The research showed that those who were in the experimental groups and were informed about the effectiveness of a new testing and its necessity resulted in higher rate (65%) of screening in the future (16-18 months after the experiment) as compared to those who were not affected (21%). 2.8% in the experimental clinic were infected in the comparison with 7.6% in a controlled one (Shafer et al., 2002).

Thus, it may be concluded that living in the world of innovative technologies and high spread of information, people should be additionally informed and directed. Using the case mentioned above, it can be highlighted that impacted population becomes more responsible in the relation to their healthcare.

Rationale

The program aimed at informing 14-18 years old women and men should be implemented in the society. It is possible to predict positive outcomes of this program as the attempt to apply the similar program were in early 1990s (Henneberger, 2009). Nowadays, the use of information technologies may increase the chances of the appropriate information delivery and consumption. Being informed about danger and specific rates among ethnic groups, people aged between 14 and 18 may be protected from being infected.

Annual screening is one of the main means for identifying the problem as having no symptoms in most cases, Chlamydia may easily develop and cause many problems. There are many diagnostic tests which may be used for identifying Chlamydia, such as tissue culture, direct fluorescent antibody, enzyme immunoassay, hybridization, polymerase chain reaction, standard displacement amplification, and transcription-mediated amplification (DeKoning, 2006, p. 263).

Reference List

Browne, K. (n.d.). HIV/AIDS and sexually transmitted diseases among juvenile delinquents. Florida Department of Health Bureau of HIV/AIDS.

Bustamante, M., Sneed, R., O’Connell, E., Zhang, G., & Leguen, F. (2006, December). Prevalence of Sexually Transmitted Diseases in Pregnant Women: Miami-Dade County, 2004-2005. Miami-Dade Country Health Department Office of Epidemiology and Disease Control, 7(12), 1-5.

Centers for Disease Control and Prevention. (2007). Sexually Transmitted Diseases Surveillance. Web.

Centers for Disease Control and Prevention. (2009). FY 2009 Congressional Justification. Web.

DeKoning, B. L. (Ed.). (2006). Recruit Medicine. Washington, DC: Government Printing Office.

Fiebach, N. H. (2007). Principles of ambulatory medicine. New York: Lippincott Williams & Wilkins.

Henneberger, S. (2009, June 8). The state of sexual and reproductive health in Florida. Health Indicator Report.

Ilcheva, M., Gorski, A., Lerma, V., Martinez, A, & Smith, S. (2008). Miami-Dade community action agency: comprehensive community needs assessment. FIU Metropolitan Center.

Jordahl, L. & Brewer, T. (2010). Now That You Know. Miami-Dade Co. Health Dept STD Program. Web.

Shafer, M. B., Tebb, K. P., Pantell, R. H., Wibbelsman, C. J., Neuhaus, J. M., Tipton, A. C. Kunin, S. B. Ko, T. H., Schweppe, D. M., & Bergman, D. A. (2002). Effect of a clinical practice improvement intervention on Chlamydial screening among adolescent girls. JAMA, 288(22):2846-2852.

Stein, C. R. (2006). Chlamydial infection among young adults: Selective screening and partner age difference. An investigation of the National Longitudinal Study of Adolescent Health. Chapel Hill.

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