RESEARCH ARTICLE |
https://doi.org/10.5005/jp-journals-11003-0127 |
Reproductive Tract Infections and Its Determinants among Married Women of an Urban Area of Ghaziabad
1-3Department of Community Medicine, Army College of Medical Sciences, Delhi, India
Corresponding Author: Kritika Tiwari, Department of Community Medicine, Army College of Medical Sciences, Delhi, India, Phone: +91 8630425932, e-mail: kritika.nik@gmail.com
Received on: 05 May 2023; Accepted on: 29 May 2023; Published on: 28 June 2023
ABSTRACT
Aim and background: Prevention and management of reproductive tract infections (RTI)/sexually transmitted infections (STI) is a proven and cost-effective strategy to reduce reproductive morbidity and chronic complications among the sexually active population. This study was conducted to find the prevalence, common symptoms, and determinants of RTI/STI.
Materials and methods: This cross-sectional study was conducted among 112 married women of reproductive age group attending the outpatient department (OPD) of an urban health training center (UHTC) of Ghaziabad, Uttar Pradesh, India, after taking informed consent using a pretested structured questionnaire. The results were analyzed by the Statistical Package for the Social Sciences (SPSS) software. Chi-squared and Fischer exact tests were used as tests of statistical significance, and significant predictor variables were subjected to binary logistic regression analysis.
Results: Half of the study population belonged to the 26–35 years age group. Approximately 90% of women were using sanitary pads, and 30% were facing menstrual problems. We found that 82.1% had heard of RTI/STI, and >50% of the women had symptoms of RTI/STI. The most common symptom of RTI/STI was low backache followed by vaginal discharge, lower abdominal pain, and genital itching, and the least common was vulval/inguinal ulcer/swelling. Education (below graduation), living in a joint family, parity, suffering from menstrual problems, intrauterine contraceptive device (IUCD) use, and not using condoms were found to be significantly associated with RTI/STI symptoms, but after binary logistic regression analysis, only education, menstrual problems, and condom use were found to be the significant predictor variables of RTI/STI.
Conclusion: More than half of the study participants had symptoms of RTI/STI. Hence, opportunistic screening for early diagnosis and management is recommended.
Clinical significance: Opportunistic screening of the symptoms of RTI/STI and its syndromic management, along with partner management, can help in reducing the burden of RTI/STI.
How to cite this article: Tiwari K, Kaur G, Arora P. Reproductive Tract Infections and Its Determinants among Married Women of an Urban Area of Ghaziabad. J Med Acad 2023;6(1):15-19.
Source of support: Nil
Conflict of interest: None
Keywords: Contraceptive usage, Menstrual problems, Reproductive tract infections, Sexually transmitted infections, Suraksha clinic, Women of reproductive age group
INTRODUCTION
Reproductive tract infections (RTIs) include infections transmitted through sexual contact [sexually transmitted infections (STIs)], endogenous infections affecting the reproductive tract as well as reproductive tract infections acquired through exogenous sources. RTIs refer to the site of infection, whereas STI refers to the predominant mode of transmission of infection.1 Most of the RTIs are curable, albeit a significant cause of morbidity. If neglected, RTIs are known to engender complications like chronic pain, pelvic inflammatory diseases, pregnancy complications including congenital infections, as well as infertility.2-5 In addition to giving rise to high morbidity and chronic complications, STIs can also facilitate human immunodeficiency virus (HIV) transmission. Hence, early diagnosis, proper counseling and treatment are of paramount importance. The Government of India has integrated RTI/STI services to National Aids Control Organization through Suraksha Clinics. Suraksha Clinics provide standardized reproductive and sexual health services free of cost, which includes diagnosis, counseling, and treatment through syndromic management and color-coded kits for RTIs/STIs.6 Prevention and management of RTI/STI is a proven and cost-effective strategy to reduce reproductive morbidity and chronic complications among the sexually active population. Early diagnosis of RTIs/STIs is a challenge in itself, as people hesitate to seek medical help for such problems. Such infections are still stigmatized in India.7
Literature on opportunistic screening and treatment of RTI/STI cases is not readily available in Ghaziabad. Hence, the present study was conducted with the aim of finding the prevalence, common symptoms and determinants of RTI/STI among married women of reproductive age group (15–45 years) attending the outpatient department (OPD) of an urban health training center (UHTC) of Ghaziabad.
MATERIALS AND METHODS
Study Design
It was a cross-sectional study conducted among married women of reproductive age group (15–45 years) attending the general OPD of a UHTC of Ghaziabad after taking informed consent from the subjects and ethical clearance from the institute.
Sample Size and Sampling Method
Taking the prevalence of RTI/STI among married women as 42.3%,8 allowable errors as 10% and 10% as the nonresponse rate, the sample size was calculated as 112. Consecutive sampling was done.
Subject Selection
Inclusion Criteria
Married women of reproductive age group (15–45 years) attending the OPD of UHTC for any complaint.
Exclusion Criteria
Women not willing to participate in the study.
Study Tools
A pretested structured questionnaire with four sections was used. The first section had sociodemographic details (age, education, occupation, socioeconomic status, and family type). The second section had questions regarding the reproductive profile of the participant, including age at marriage, parity, abortions, any menstrual problem, sanitary pad use, knowledge regarding RTI/STI, and HIV/acquired immunodeficiency syndrome (AIDS). The third section dealt with contraceptive usage, including the method of contraception currently used. The fourth section was devoted to the presence of any RTI/STI symptoms in the subject at the time of the interview.
Data Analysis
The data were entered in Microsoft Excel and analyzed by Statistical Package for the Social Sciences (SPSS) software. Numbers and percentages of categorical variables were presented in tables and figures. The presence of RTI/STI symptoms was the outcome variable, and other variables in the questionnaire were analyzed as independent variables. Chi-squared and Fischer exact tests were used as tests of statistical significance, significant predictor variables were subjected to binary logistic regression analysis, and enter method was used for variable selection.
RESULTS
This cross-sectional study was conducted among 112 married women of reproductive age group (15–45 years). As depicted in Table 1, half of the study population belonged to the 26–35 years age group. A total of 39.3% of women were graduates, but only 21.4% were employed; the majority belonged to lower middle class and nuclear families.
| S. No. | Characteristic | Number | Percentage |
|---|---|---|---|
| 1 | Age (years) | ||
| 15–25 | 24 | 21.4 | |
| 26–35 | 50 | 50 | |
| 36–45 | 32 | 28.6 | |
| 2 | Education | ||
| Illiterate | 4 | 3.6 | |
| High school | 8 | 7.1 | |
| Matric | 28 | 25 | |
| Intermediate | 28 | 25 | |
| Graduate/postgraduate/professional | 44 | 39.3 | |
| 3 | Occupation | ||
| Homemaker | 88 | 78.6 | |
| Employed | 24 | 21.4 | |
| 4 | Socioeconomic status (modified BG Prasad classification) | ||
| Lower middle class | 80 | 71.4 | |
| Upper middle class | 32 | 28.6 | |
| 5 | Family type | ||
| Nuclear | 80 | 71.4 | |
| Joint | 32 | 28.6 |
The reproductive profile of the study population is depicted in Table 2. A total of 67.9% of the women were married at the age of 21 years or more, and 39.3% were parous. Around 60% of the women had no history of abortion, and around 30% were facing some kind of menstrual problems (dysmenorrhea, irregular periods, or heavy bleeding). Around 90% of the study participants were using sanitary pads during menstruation. We found that 82.1% had heard of RTI/STI, and almost everyone was aware of HIV/AIDS except four participants. About >50% of the women had symptoms of RTI/STI.
| S. No. | Characteristics | Number | Percentage |
|---|---|---|---|
| 1 | Age at marriage | ||
| <21 years | 36 | 32.1 | |
| ≥21 years | 76 | 67.9 | |
| 2 | Parity | ||
| Yes | 44 | 39.3 | |
| No | 68 | 60.7 | |
| 3 | Abortions | ||
| Yes | 44 | 39.3 | |
| No | 68 | 60.7 | |
| 4 | Any menstrual problems | ||
| Yes | 32 | 28.6 | |
| No | 80 | 71.4 | |
| 5 | Use of sanitary pads during menstruation | ||
| Yes | 100 | 89.3 | |
| No | 12 | 10.7 | |
| 6 | Knowledge regarding RTI/STI | ||
| Yes | 92 | 82.1 | |
| No | 20 | 17.9 | |
| 7 | Knowledge regarding HIV/AIDS | ||
| Yes | 108 | 96.4 | |
| No | 4 | 3.6 | |
| 8 | Any symptom of RTI/STI | ||
| Yes | 60 | 53.6 | |
| No | 52 | 46.4 |
Contraceptive usage was found to be nearly 70% in the study population, with contraceptive pills (21%), condoms (20%) and intrauterine contraceptive device (IUCD) (16%) among the three most used contraceptives (Fig. 1).
Fig. 1: Contraceptive usage among the study population
The most common symptom of RTI/STI was low backache followed by vaginal discharge, lower abdominal pain, and genital itching, and the least common was vulval/inguinal ulcer/swelling (Fig. 2).
Fig. 2: Symptom distribution of RTI/STI among the study population
To find out the factors associated with RTI/STI symptoms, we performed Chi-squared and Fischer exact tests, as shown in Table 3. A p-value of <0.05 was taken as significant. RTI/STI symptoms were found to be less prevalent in women with higher education (graduation or higher), women living in nuclear families, nulliparous women and women, whose husbands were consistently using condoms (p-value of <0.05). RTI/STI symptoms were significantly higher in women suffering from menstrual problems and women using IUCD.
| Determinants | Symptom | Χ2 values | Degree of freedom | Χ2 p-value# | |
|---|---|---|---|---|---|
| Yes [No. (%)] | No [No. (%)] | ||||
| Education* | |||||
| Illiterate | 4 (100) | 0 (0) | 12.5 | 4 | 0.014 |
| High school | 4 (50) | 4 (50) | |||
| Matric | 20 (71.4) | 8 (28.6) | |||
| Intermediate | 16 (57.1) | 12 (42.9) | |||
| Graduate/postgraduate/professional | 16 (36.4) | 28 (63.6) | |||
| Family type | |||||
| Nuclear | 36 (45) | 44 (55) | 8.3 | 1 | 0.003 |
| Joint | 24 (75) | 8 (25) | |||
| Parity* | |||||
| Yes | 56 (60.9) | 36 (39.1) | 11.0 | 1 | 0.001 |
| No | 4 (20) | 16 (80) | |||
| Any menstrual problems* | |||||
| Yes | 28 (87.5) | 4 (12.5) | 20.7 | 1 | <0.001 |
| No | 32 (40) | 48 (60) | |||
| Condom use | |||||
| Yes | 8 (33.3) | 16 (66.7) | 5.03 | 1 | 0.022 |
| No | 52 (59.1) | 36 (40.9) | |||
| IUCD use* | |||||
| Yes | 16 (80) | 4 (20) | 6.84 | 1 | 0.012 |
| No | 44 (47.8) | 48 (52.2) | |||
*Fischer exact test; #Chi-square
The predictor variables, which were found to be significant by Chi-squared or Fischer exact test, were subjected to binary logistic regression in SPSS software. We have summarized the results of binary logistic regression in Table 4. Hosmer and Lemeshow’s Goodness of Fit test was found to be satisfactory. The regression model was statistically significant (p-value 0.002), and the pseudo-R squared was 0.430. Hence, this regression model explained 43% of the variance in the symptoms of RTI/STI. This regression model found education (below graduation), suffering from menstrual problems and not using condoms as the significant predictor variables of RTI/STI.
| Predictor variables | B# | 95% CI@ | p-value |
|---|---|---|---|
| Education | |||
| Illiterate | 0.66 | 1.2–3.1 | 0.028 |
| High school | |||
| Matriculate | |||
| Intermediate | |||
| Graduate/postgraduate/professional* | |||
| Family type | |||
| Nuclear | −0.13 | 0.2–3.1 | 0.835 |
| Joint* | |||
| Parity | |||
| Yes | 0.54 | 0.4–6.4 | 0.424 |
| No* | |||
| Any menstrual problems | |||
| Yes | 2.35 | 2.6–41.9 | 0.001 |
| No* | |||
| Condom use | |||
| Yes | 1.64 | 0.2–1.9 | 0.028 |
| No* | |||
| IUCD | |||
| Yes | 0.45 | 1.2–22.3 | 0.121 |
| No* | |||
*Reference category within each predictor variable; #B, regression coefficient; @CI, confidence interval; R2, 0.430; p-value, 0.002
DISCUSSION
This study was a cross-sectional study conducted in OPD of a UHTC of Ghaziabad among 112 married women of reproductive age group (15–45 years). Maximum women interviewed were in the 26–35-year-old age group, the majority belonging to the lower middle class and homemaker, similar to the studies performed by Agarwal et al. and Sharma et al. at Gwalior and Rishikesh, respectively.9,10 The Rishikesh study done in the year 2022 had 74% participants as homemakers, 3% illiterate, and 27% graduate or postgraduate,9 only 59% were homemakers in a study at Gwalior,10 whereas in our study 80% participants were homemakers, 3.6% were illiterate, but 39.3% had graduate or higher level of education, that is, despite better education level, a lesser percentage of the study participants in our study were engaged in the job. Maximum women (80%) lived in a nuclear family in our study, which is more as compared to the same in the Gwalior study (64%).10 Living in a nuclear family might be the reason for getting engaged in household work and looking after the children in this study.
In our study, almost the same percentage of women gave a history of abortion (39.3%) as in a study done at Delhi by Verma et al. (39%).8
The majority of the women in our study (82.1%) had some knowledge of RTI/STI, whereas, in a study conducted at Gwalior in 2022, this percentage was slightly lower (71%).10 This difference can be attributed to more percentage of individuals having higher education in our study.
The contraceptive usage was found to be nearly 70% in this study which is slightly less as compared to National Family Health Survey (NFHS) 5 data (76.5%) for National Capital Territory (NCT).11 Condom was the most commonly used contraceptive in NFHS-511 and in a study conducted at Aligarh,12 but the use of contraceptive pills was slightly more than condom use in this study. IUCD was being used as a contraceptive by 16% of the study population in this study, whereas this percentage was only 6.6 in NFHS-5 NCT data.11
The prevalence of RTI/STI symptoms was higher in our study (53.6%) as compared to 26, 37.6 and 42.3%, respectively, in other similar studies.8,12,13 A study performed in Singarava by Mehta et al. had a very high prevalence of RTI/STI symptoms (70%), which might be due to rural areas and the lesser education level of the participants.14
Low backache was the most common complaint by women in this study, the same complaint being most prevalent in a study conducted in Delhi.8 Vaginal discharge was the most common symptom in some studies,13-15 whereas lower abdominal pain was most common in a study conducted at Rishikesh.9 Vulvar/peri vulvar itching was the second most common complaint in some studies,13-15 whereas it was the fourth common complaint in the present study. Like this study, vulvar/inguinal ulcer/swelling was least common in other studies, too.9,14
On applying tests of significance, education was a common protective factor for RTI/STI in this study and other studies.8,12 These two studies also found a history of abortion and IUCD use as significant factors for RTI/STI symptoms. In our study, a history of abortion was not found to be significantly associated with RTI/STI symptoms. IUCD was found to have a significant association, but it was ruled out in regression analysis. Consistent use of barrier methods of contraception was found to be protective against RTI/STI in our study and the studies mentioned above.8,12 In the present study, parous women were more prone to RTI/STI, but on regression analysis, parity was not found to be a significant predictor variable. Parity was found to be a significant factor in a study by Kumari et al.12 but insignificant in a study by Verma et al.8
CONCLUSION
More than half of the study participants had symptoms of RTI/STI, which represents an alarming situation. The most common symptom of RTI/STI was low backache followed by vaginal discharge, lower abdominal pain, and genital itching, and the least common was vulval/inguinal ulcer/swelling. Education (below graduation), suffering from menstrual problems and not using condoms were found to be the significant predictor variables of RTI/STI. Females with symptoms of RTI/STI were counseled and referred to the nearest Suraksha Clinic along with their husbands for a syndromic management approach.
Limitations
This was a small-scale study. The prevalence is based on self-reporting of symptoms. Male partners were not interviewed.
Recommendation
The authors recommend multi-center studies to know the prevalence of RTI/STI on a large scale through opportunistic screening so that such cases are diagnosed and treated early. Male counterparts should also be screened for the presence of RTI/STI symptoms and managed accordingly.
Clinical Significance
Opportunistic screening of the symptoms of RTI/STI and its syndromic management, along with partner management, can help in reducing the burden of RTI/STI.
ORCID
Kritika Tiwari https://orcid.org/0000-0003-0979-3003
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