By way of reducing the incidence of HIV and other STIs, the Fourth National Health Plan (1999 – 2004) identifies “adopting syndromic management of STIs in all health centres, with appropriate training” and “integrating STI syndromic management in training curricula of medical doctors, nurses, medical assistants and clinical officers” as two of the main activities towards this aim. The National Reproductive Health Strategy 1999 – 2004 and the Malawi National HIV/AIDS Strategic framework 2000 – 2004 further endorse the importance of improving the management of STIs both in their own right, and in the prevention of transmission of HIV.
The Malawi Government adopted the Syndromic Management Approach in STIs in 1992, a policy decision endorsed by the results of a STI care management survey by Chilongozi et al (1996). The Ministry of Health was assisted by JSI-STAFH project in the implementation in 5 pilot sites. Based on the results of the JSI-STAFH project evaluation in 1997, service providers and trainers handbooks were revised and the duration of the training was extended to two weeks.
This edition of the service providers handbook updates the earlier versions based on the review and revision of the SMA Flowcharts by the STI taskforce in 2002. The taskforce aimed to make the flowcharts more user friendly, which has resulted in merging the 4 separate flowcharts for Genitourinary symptoms in women into one flowchart named Abnormal Vaginal Discharge. Two new flowcharts have been introduced, one for recurrent urethral discharge and one for neonatal conjunctivitis. All antibiotic regimens recommended in the flowcharts are based on previous guidelines, WHO recommendations and clinical efficacy studies carried out in Lilongwe by the University of North Carolina Project in 2001 and 2007.