Abstract

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Research Question:
What is the burden of Reproductive Tract Infections in Women of reproductive age group in rural Indore?
Objective:
1) To find out the magnitude of problem of RTIs in women aged 15-44 years in villages of Double Chowki PHC of Indore District, Madhya Pradesh.
2) To study the epidemiological determinants of RTIs.
Design:
Cross-sectional study. Setting: 7-subcentre villages comming under Double Chowki PHC of Indore district.
Material and Methods:
The study was conducted in 7 subcentre villages. The study included all women in the age group of 15-44 years. The sample size was calculated as 421 women taking 5% allowable error. The number of women studied in each village was selected by probability proportional to size (PPS) sampling technique. In the second stage the primary unit of survey was selected using systematic random sampling at each village level. The cases were identified using Syndromic approach and were referred to the subcentre for further clinical examination and treatment.
Results:
The proportion of RTIs symptomatics was found to be 18.7%. Among 79 RTIs symptomatic women, majority (49.3%) of women had only vaginal discharge followed by 37.9% women had vaginal discharge with lower abdominal pain. 1.3% of them had only other symptoms of RTIs which includes genital ulcer, mucopus from cervix and inguinal lymphadenopathy, 5.1% were having vaginal discharge with other symptoms of RTIs and 6.4% had pain in lower abdomen with other symptoms of RTIs.
Conclusion:
There was significant association between RTIs symptomatics and age, age at menarche, age at marriage, age at first conception. The proportion of RTIs symptomatics did not differ significantly with education, occupation, socioeconomic status, religion, parity, history of abortion, use of IUCD, and hygienic practices during menstrual period.

Introduction

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Reproductive tract infection covers three types of infections:
1. Sexually transmitted infections.
2. Endogenous infections, that result from overgrowth of organisms normally present in the reproductive tract.
3. Iatrogenic infections associated with medical procedures including abortions and insertion of intra uterine devices.[1]
According to World Health Organisation, the global burden of sexually transmitted infections is estimated to be 333 million cases annually. Based on a number of prevalence surveys and a review of available literature the annual incidence of RTIs/ STDs in Indiais estimated at 5%, or approximately 40 million new infections every year.[2]
This study was carried out with the following objectives:
1) To find out the magnitude of problem of RTIs in women aged 15-44 years in villages of Double Chowki PHC.
2) To study the epidemiological determinants of RTIs.

Methods

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The study was conducted in 7-subcentre villages comming under Double Chowki PHC of Indore district. The study included all women in the age group of 15-44 years.The study was conducted from January200 to February 2005.

Sample size:
Taking prevalence of RTI in women as 20.9% as studied in community based cross-sectional study conducted in Talegaon PHC area of Wardha district[3], the sample size was calculated as 421 women taking 5% allowable error.
The number of women studied in each village was selected by probability proportional to size (PPS) sampling technique. In the second stage the primary unit of survey was selected using systematic random sampling at each village level.
The study subjects were interviewed using questionnaire, which was pretested, in the field before starting data collection.
The cases were identified using Syndromic approach [4] and were referred   to the subcentre for further clinical examination and treatment.
For examination written informed consent was obtained.
All women examined in the subcentre were subjected to laboratory investigation for  confirmation of RTI.
Those not willing for clinical examination were not included.
Vaginitis was diagnosed when the vaginal wall was visibly inflamed.[5]
The cervix was described as abnormal if oedematous or friable or when mucopurulent   endocervical discharge was present. [5]
Lower abdominal pain was diagnosed when adenexae were palpable and tender on vaginal examination with or without restricted mobility of the uterus.[5]

Data analysis:
The data so collected was entered in the computer and the analysis was done using EPI Info 6 software. Possible association of variables and RTI was examined applying Chi-square test.

Discussion:

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The proportion of RTIs symptomatics was found to be 18.7%. The prevalence reported by others was 48.5% (Abraham et.al [6]), 14.6% (Thomas et.al [7]), 18.4% (NFHS II [8], India) and 18.6% (NFHS II [8], Maharashtra) and 50% (Bang et.al.[5])
Among 79 RTIs symptomatic women, majority (49.3%) of women had only vaginal discharge followed by 37.9% women had vaginal discharge with lower abdominal pain. 1.3% of them had only other symptoms of RTIs which includes genital ulcer, mucopus from cervix and inguinal lymphadenopathy, 5.1% were having vaginal discharge with other symptoms of RTIs and 6.4% pain lower abdomen with other symptoms of RTIs. Bang et.al [5] reported vaginal discharge 13.5%, pelvic inflammatory disease 24.15%, cervicitis 48.74% and other symptoms 8% in women. Abraham et.al [6] reported vaginal discharge in 28% of women, pelvic inflammatory disease in 6% and cervicitis in 8% women. Deoki Nandan et.al [9] reported vaginal discharge in 92%, lower abdominal pain in 56% and genital ulcer in 7% women .
Proportion of RTIs symptomatics was highest (38%), in the age group of 30-34 years followed by 24.3% in the age group of 25-29 years. The minimum proportion of RTIs symptomatics was found in the age group of 40 years and above. The proportion differed significantly in different age group. (p7, Deoki Nandan et.al [9], Abraham et.al [6] reported almost similar findings in relation to RTIs symptomatics.
The proportion of RTIs symptomatics was more (21.4%) among married women, than among unmarried women (8.4%). The difference was statistically significant. (p10found that 92.03% of women having RTIs symptoms were married. Chopra et.al [5] found that 67% of patients were married .
The proportion of RTIs symptomatics was highest (60.5%) among women who married at the age of 18-20 years. RTIs symptoms differed significantly with age at marriage. (p6also found that young married women suffered more (57%) from RTIs .
On laboratory investigation, in the present study, 48.7% had Trichomonas Vaginalis, 23.3% had Candida albicans and 13.4% bacterial vaginitis. 16.6% of the smears were negative. Bang et al [5] found 13.98% having Trichomonas vaginalis, 34.05% Candidial vaginitis and 62.19% Bacterial vaginitis. Abraham et.al 6 found Trichomoniasis 13%, candidiasis 10%, Bacterial vaginosis 18%. The presence of bacterially positive infection in the present study was found to be 11.87% which is much lower than reported in other studies – varying from 46%, Bang et.al 5 to 68%, Bhatia  et.al 11 .

References:

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1. Hatcher RA, Kowal D, Guest F, Frussel, J. Contraceptives Technology. International edition. AIDS and STD. Atlanta,, 1989, 76-121.
2. Pachauri S. Management of RTI/STI, inIndia’s Family Welfare Programme. World Bank, Washington 1996.
3. Epidemiology of reproductive tract infection in rural Wardha. Thesis submitted toNagpurUniversity. Dept of Community Medicine, Mahatma Gandhi Institute of Medical Sciences, Sevagram, 1999.
4. World Health Organisation. Management of patients with sexually transmitted diseases,Geneva. Technical Report Series, No.810, 1991.
5. Bang RA, Bang A.P, Baitule M, Chaudhary Y, Sarmukaddam S, Tale O. High prevalence of Gynaecological Diseases in rural women. The Lancet, 1989. 1: 85-87.
6. Abraham J, Prasad J and Abraham S; Gynaecological problem among young married women in Tamil Nadu, India; Christian Medical College, Vellore, India. Unpublished study.
7. Thomas K and SP Thayagarajan. Community prevalence of sexually transmitted diseases and human immunodeficiency virus infection in Tamil Nadu,India: A probability proportional to size cluster survey. The National Medical Journal ofIndia, 15(3), 2003,135-139.
8. National Family Health Survey II (1998-99),India. International Institute for Population Sciences, Mumbai, 2000.
9. Deoki Nandan and Mishra SK. Estimation of prevalence of RTIs/STDs among women of reproductive age group in District Agra. Indian Journal of Community Medicine Vol 27, No.3, Jul-Sept, 2002:110-113.
10. Aggarwal K and Jain VK. Trends of STDs at Rohatak. Indian Jour Sex Transm Dis, 2002, 23: 19-21.
11. Bhatia J and Cleland J. Levels and determinants of gynaecological Morbidity in a district of South –India. Studies in Family planning, 1997, 28(2): 95-103.

Source(s) of Funding

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none

Competing Interests

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none

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