A systematic review on the prevalence and utilization of health care services for reproductive tract infections/sexually transmitted infections: Evidence from India

Several studies have reported prevalence rate of reproductive tract infections (RTIs) but very few studies have described health seeking behavior of patients. This paper critically looks at and summarizes the available evidence, systematically. A structured search strategy was used to identify relevant articles, published during years 2000-2012. Forty-one full-text papers discussing prevalence and treatment utilization pattern were included as per PRISMA guidelines. Papers examining prevalence of sexually transmitted diseases used biochemical methods and standard protocol for diagnosis while studies on RTIs used different methods for diagnosis. The prevalence of RTIs has not changed much over the years and found to vary from 11% to 72% in the community-based studies. Stigma, embarrassment, illiteracy, lack of privacy, cost of care found to limit the use of services, but discussion on pathways of nonutilization remains unclear. Lack of methodological rigor, statistical power, specificity in case definitions as well as too little discussion on the limitation of selected method of diagnosis and reliance on observational evidence hampered the quality of studies on RTIs. Raising awareness among women regarding symptoms of RTIs and sexually transmitted infections and also about appropriate treatment has remained largely a neglected area and, therefore, we observed absence of health system studies in this area.