V Usanga, L Abia-Bassey, P Inyang-etoh, S Udoh, F Ani, E Archibong
calabar, nigeria., pregnant women, prevalence, trichomonas vaginalis
V Usanga, L Abia-Bassey, P Inyang-etoh, S Udoh, F Ani, E Archibong. Trichomonas Vaginalis Infection Among Pregnant Women In Calabar, Cross River State, Nigeria.. The Internet Journal of Gynecology and Obstetrics. 2009 Volume 14 Number 2.
A total of 562 outpatient pregnant antenatal women made up of 220 from The General Hospital, Calabar (G.H) and 342 from The University of Calabar Teaching Hospital, Calabar (UCTH), were examined for
Trichomoniasis occur in females (males rarely exhibit any symptoms) if the normal acidity of the vagina is shifted from a semi acidic pH (3.8 - 4.2) to a much more basic one (5.0 - 6.0) that is conducive to
Complications of trichomonas vaginitis that have been reported in pregnant women include premature rupture of membranes, premature labour, low birth weight and post abortion infections (6).
Trichomoniasis is also linked to increased mortality as well as predisposing to HIV infection, AIDS and cervical cancers (6) (7) and increases the susceptibility to other viruses infection, including herpes, human papillomavirus (HPV) and AIDS (8). Cervicitis due to trichomoniasis is characterized by purulent discharges in the endocervical canal and easily induced endocervical bleeding (4).
Persons with trichomoniasis are twice as likely to develop HIV infection as the general population (9); this is explained by the fact that an association exists between acquisition of
Symptomatic trichomoniasis is more common in women than in men: trichomoniasis in men is less clinically apparent but when infected, organism is found in the anterior urethra, external genitalia, prostate, epididymis and in semen (10), while symptoms range from none to urethritis complicated by prostatitis, epididymitis, urethral stricture disease and infertility (10).
The incidence of trichomoniasis depends on the population screened / examined. Certain factors such as poor personal hygiene, multiple sex partners, low socio-economic status and underdevelopment are documented to be associated with high incidence of infection (11)
Trichomoniasis is reported to be the most common pathogenic protozoan infection of humans in industrialized countries with an estimated 180 million infections acquired annually worldwide (12)(13) while in the United States of America, 5 million women and 1 million men are infected annually (13). In Africa, the prevalence of trichomoniasis is reported to be much higher (13).
This study is set to determine the prevalence of
Materials and Methods
The study location was Calabar, the capital city of Cross River State. Cross River State is in the south eastern region of Nigeria and shares boundaries with Benue State to the North, Ebonyi and Abia States to the West and to the East by Cameroon Republic. The city has a population of 2 millions inhabitants and is nicknamed “Canaan City” because of her rich cultural, social life and designated tourist destination.
Collection of samples
The Study was prospective in nature and conducted between December 2007 to November 2008 among pregnant women attending antenatal clinic for the first time during their pregnancy. Ethical approvals were given from the hospitals included in the study. Participation was voluntary and informed consent was obtained. Information on the demographic characteristics, education, and behavioral risk factors was obtained through a pre-designed structured questionnaire.
High vaginal swab samples were collected from each pregnant woman by inserting a sterile speculum into the posterior fornix of the vagina while the individual is in the lithotomic position. The nature of the collected samples were noted such as the color, consistency and odor. Samples collected were transported to the laboratory immediately for processing. Where delay was inevitable, HVS specimens were put in Stuart transport medium (STM) [Oxoid Ltd, UK] (14) and processed in the laboratory within 1 -2 hours of collection.
Wet mounts of all swab samples were made in sterile normal saline on clean slides, covered with a cover slide and examined under the low power (10x) and high power (40x) magnifications for presence of motile trichomonads
A smear of the secretion was also made on a slide, air-dried and fixed in absolute methanol for 1 minute. Diluted Giemsa stain was poured on the smear and allowed to stain for 10 minutes after which it was washed, air dried and examined under microscope with oil immersion (X100) magnification for presence of trichomonads.
Statistical analysis of the results was conducted using Chi-square at 0.05% with an appropriate degree of freedom. A P-value of a level less than 0.05 (P 0.05) was considered statistically significant.
Out of the 562 pregnant ante-natal women examined for
Table 2 shows the age specific distribution of
Peak prevalence was recorded in pregnant women in the first trimester of pregnancy 9(8.3%) followed by those in the second 16(4.4%) and third 3(4.3%) trimesters respectively as shown in table 3. Statistical analysis of the relationship between these trimesters and infection prevalence was significant (P <0.05).
Occurrence of infection by marital status as depicted in table 4 shows that pregnant single women were more infected 7(5.3%) followed by married pregnant women. No
Infection was more in pregnant women with primary school education 12(6.4%), followed by those with secondary education qualification 11(4.8%) and in pregnant women with higher education 6(4.4%). However, no
The result of this study has demonstrated the prevalence and occurrence of
This result partly agrees with findings from previous studies, for example 4.7% reported in Illorin, Nigeria (15); 2.7% prevalence in Jos, Nigeria (16), 2.8% in Abakaliki, Nigeria (17) and 3.3% in Lagos, Nigeria (18).
However, this observation is at variance with a higher prevalence rate reported in a number of other studies; for example, 12.5% in Enugu, Nigeria (19), 15.0% in Benin City, Nigeria (20), 17.7% in Uyo, Nigeria (21), 18.7% in Zaria, Nigeria (22) 24.7% in Tanzania (23), 34.0% in Nairobi, Kenya (24) and 49.2% in South Africa (25).
There is a general consensus that the prevalence of
Amongst the different age groups investigated,
Women in the first trimester of pregnancy were observed to be more infected with
However, this observation was in contrast with findings in Abakaliki, Nigeria (17) who reported that women in the third trimester of pregnancy were more infected with
Marital status of pregnant women examined for
The use of wet mount and Giemsa staining methods greatly enhanced the detection of
The high incidence of
Certain factors such as poor personal hygiene, multiple sex partners, low socio-economic status and under development are also associated with high incidence of infection (21) (22). Neonatal trichomoniasis can be acquired during passage through an infected birth canal (35) and it is estimated that 2-17% of female babies acquire trichomoniasis through direct vulvo-vaginal contamination (9) .Trichomoniasis is an infection of multiple sites (eg. Vaginal epithelium, skene glands, bartholin glands, urethra), thus prompt diagnosis is important for eliminating infection in the patient and sexual partners and treatment of sexual partners is thought to increase cure rates (4).
Our study has confirmed the endemicity of trichomonas vaginalis infection among pregnant women in Calabar, Cross River State and suggests that the control of trichomoniasis can best be accomplished by public health programmes through persistent efforts to educate people on the need to improve on their personal hygiene, screen, diagnose, treat patients and sexual partners and follow up on the high risk individuals within communities.