Masters Thesis

Best practices of public health departments in controlling chlamydia infection in the United States

Chlamydia trachomatis is an intracellular bacterium that causes Chlamydia infections. It is the most common sexually transmitted disease, and is the most preventable cause of infertility in the United States. Since 1994, it has had the highest incidence of any sexually transmitted disease in the United States, and is acquired through sexual intercourse, which could be anal, vaginal or oral. The individuals most affected by the infection are aged 20-24, and females are far more affected by the infection than males. Chlamydia trachomatis is associated with the following infections namely—ocular infection, lymphogranuloma venereum and genitourinary infection. While the incidence rate of the infection in United States is 456.7/100,000 of the population that of Kern County is 706.4/100,000 of the population, which is much higher than the national average. It is estimated that about 2.8 million people are affected in the United States, and the average yearly cost of treatment for the infection is about $4.2 billion. Symptoms of Chlamydia infection vary from asymptomatic (mostly in males) to vaginal, urethral and rectal discharge, pelvic inflammatory pain, upper abdominal pain due to perihepatitis, pharyngeal infection, and Reiter’s syndrome. Some of the practices that help in Chlamydia control are free yearly screening, use of barrier contraception, motivational behavioral interventions (health promotion and organizational developmental theories), partner therapy, and home-based screening. The mainstay of Chlamydia control is increased screening since it is estimated that about 70% of individuals who have the infection are asymptomatic. Also, included in this paper are the core functions of Public Health Departments, which are policy development, health assessment and quality assurance, and their importance in the control of Chlamydia infection. Five county public health departments were selected at random from the four regional areas of the United States — West, South, Northeast and Midwest. The criteria that was used for the selection is population size greater than 500,000 and an incidence rate of Chlamydia infection <320/100,000 of the population. In addition, the study addressed the effects of demographics — gender, ethnicity, educational status, age of the population, percentage of the population that are females on the prevalence of Chlamydia in the community. The county public health departments used for the study are: Orange County in California, San Mateo County in California, Santa Clara County in California, Ventura County in California, and Westchester County in New York. The ultimate goal of the study is to come up with recommendations that can be implemented in Kern County, which would help in reducing the exponential rise in the incidence rate of the infection within the county. Data analysis was done using qualitative comparative methods — descriptive statistics, and recommendations were made based on the best practices of the five sample counties. Also discussed was the likelihood of Kern County Public Health Department accepting the recommendations, and lastly, identifying some of the setbacks hindering the control of Chlamydia infection in the county.

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