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ORIGINAL ARTICLE
Year : 2016  |  Volume : 4  |  Issue : 1  |  Page : 1-5

Trichomonas vaginalis infection among women of reproductive age in a rural community in Nigeria


1 Department of Medical Microbiology, College of Health Sciences, Igbinedion University, Okada, Edo State, Nigeria
2 Department of Obstetrics and Gynecology, Irrua Specialist Hospital, Irrua, Edo State, Nigeria
3 Department of Microbiology, Faculty of Natural Science, Igbinedion University, Okada, Edo State, Nigeria
4 Immunology Unit, Department of Chemical Pathology, College of Medicine, University of Ibadan, Ibadan, Nigeria; Faculty of Health and Social Care Sciences, St George's University of London and Kingston University, Kingston, UK

Date of Web Publication2-Jul-2018

Correspondence Address:
Dr. Bankole Henry Oladeinde
Department of Medical Microbiology, College of Health Sciences, Igbinedion University, Okada, Edo State
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njecp.njecp_35_15

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  Abstract 


Background: Trichomonas vaginalis infection is associated with adverse reproductive outcomes and an increased risk for HIV transmission. Data on the prevalence of trichomoniasis among women in rural Nigeria are sparse. Against this background, this study aimed at determining the prevalence and associated risk factors for T. vaginalis infection among women of reproductive age in rural Okada community of Edo State, Nigeria. Materials and Methods: A pair of high vaginal swabs was collected from 311 women (consisting of 217 pregnant and 94 nonpregnant women) and examined microscopically for the presence of T. vaginalis. A detailed questionnaire was used to obtain demographic information from the study participants. Results: The overall prevalence of T. vaginalis infection was 7.7%. Although the prevalence of T. vaginalis infection was higher among pregnant than nonpregnant women, the difference was not statistically significant (pregnant vs. nonpregnant: 8.2% vs. 6.4%; odds ratio = 1.327, 95% confidence interval = 0.509, 3.457, P = 0.649). The prevalence of Trichomoniasis was not significantly affected by age, marital status, occupation, and educational status among pregnant and nonpregnant women (P > 0.05). The prevalence of T. vaginalis was significantly (P = 0.004) higher among pregnant women in polygamous unions than their counterparts in monogamous ones. Conclusions: The prevalence of T. vaginalsis infection was high and not significantly affected by pregnancy status. Of all factors examined, only the type of marriage was found to significantly affect the prevalence of T. vaginalis infection among pregnant category of study participants. Increased emphasis on screening of trichomoniasis among rural women is advocated.

Keywords: Nigeria, rural community, trichomoniasis, women


How to cite this article:
Oladeinde BH, Oladeinde OB, Imade OS, Onifade AA. Trichomonas vaginalis infection among women of reproductive age in a rural community in Nigeria. Niger J Exp Clin Biosci 2016;4:1-5

How to cite this URL:
Oladeinde BH, Oladeinde OB, Imade OS, Onifade AA. Trichomonas vaginalis infection among women of reproductive age in a rural community in Nigeria. Niger J Exp Clin Biosci [serial online] 2016 [cited 2018 Jul 19];4:1-5. Available from: http://www.njecbonline.org/text.asp?2016/4/1/1/235808




  Introduction Top


Trichomonas vaginalis is a parasitic protozoan that infects the urogenital tract of both men and women worldwide.[1] Trichomoniasis is reported to affect an estimated 180 million people annually, making it the most prevalent nonviral sexually transmitted pathogen worldwide.[2] It is associated with several negative medical outcomes. Trichomoniasis has been reported as a predisposing factor for HIV infection and cancer.[3] In women, the disease presents with a broad range of symptoms ranging from a severe inflammation and irritation of the vagina with frothy malodorous vaginal discharge to a relatively asymptomatic state.[2] In pregnancy, T. vaginalis infections have been associated with premature membrane rupture, premature labor, low birth weight infants, and postabortion/posthysterectomy infections.[2] Its role in infertility and neoplastic transformation of cervical tissues has also been documented.[4] Transmission of T. vaginalis infection from mother to neonate during delivery has also been reported.[4]

Poverty, poor personal hygiene, and illiteracy are known risk factors for acquisition of T. vaginalis infection,[3],[5] and these factors are rife in many rural communities of Nigeria,[6] including Okada community. While a few studies on T. vaginalis exist in Nigeria, none have strictly focused on women living in rural populations. Many cases of T. vaginalis infection remain undiagnosed.[1] Against this background and the paucity of report of T. vaginalis infection among women of reproductive age in rural Okada community and environs of Edo State Nigeria, this study was conducted.


  Materials and Methods Top


Study area

Okada, a rural community, is the headquarters of Ovia northeast local government area of Edo State. The local government area has an estimated population of 155,344 people.[7] The study was conducted at the Igbinedion University Teaching Hospital Okada, Edo State, Nigeria, from February 2013 to January 2014. The Igbinedion University Teaching Hospital, Okada, is the only tertiary health-care facility in Okada community of Edo State, Nigeria. Some neighboring rural communities (villages) also attend the hospital.

Study population

A total of 311 women consisting of 217 pregnant and 94 nonpregnant women attending the Antenatal and Gyneocology clinics of Igbinedion University, Okada, were recruited for this study. The age range of participants was 17–38 years. Women who had used some form of vaginal agents or antibiotics in the last 7 days were exempted from this study. All menstruating nonpregnant women were also excluded from this study. A simple random sampling technique was employed in selecting participants for this study. Informed consent was obtained from all participants before the collection of specimen. A questionnaire was used to obtain relevant information from each participant. The study was approved by the Ethical Committee of Igbinedion University, Okada, Nigeria.

Sample size determination

To calculate the minimum sample size required for accuracy in estimating proportions from our population, the formula

N = Z 2* P (1−P)/D 2

where N = Minimum sample size, D = Desired level of significance (set at 0.05), Z = Confidence interval (1.96), and P = Prevalence rate (18.7%) in a target population from a previous study.[2]

Note that converting 18.7% to proportion will give 18.7/100 = 0.187 = P.

Thus, 1−P will equal 1−0.187 = 0.813

Computing the above values will give: (1.96)2 × 0.187 × 0.813/0.0025 = 233 patients.

Thus, the minimum number of patients to be sampled required for accuracy in estimating proportions from population was 233.

Collection and processing of specimen

A pair of high vaginal swabs was collected from each participant and was immediately transferred to the laboratory for analysis. A wet smear was prepared from both swabs and examined microscopically for characteristic motile T. vaginalis by two medical laboratory scientists, using a previously described method.[8] Briefly, 0.3 ml of sterile phosphate-buffered saline was poured in each swab and a drop from the resulting suspension was placed on a grease-free clean glass slide. This was covered immediately with a cover slip and examined microscopically using a ×40 objective lens.

Statistical analysis

The data obtained were analyzed using Chi-square (χ2) test and odds ratio analysis using the statistical software INSTAT (GraphPad software Inc., La Jolla, CA, USA).


  Results Top


The overall prevalence of T. vaginalis infection was 7.7%. Although pregnant women were observed to have a higher prevalence (8.2%) of T. vaginalis infection than nonpregnant women (6.4%), the difference did not reach statistical significance (pregnant vs. nonpregnant: 8.2% vs. 6.4%; odds ratio = 1.327, 95% confidence interval = 0.509, 3.457, P = 0.649) [Table 1].
Table 1: Prevalence of Trichomonas vaginalis infection among women

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Pregnant and nonpregnant women within the ages of 22–26 years and 27–31 years, respectively, had the highest prevalence of T. vaginalis infection. Age did not, however, significantly affect the prevalence of T. vaginalis among pregnant and nonpregnant women (P > 0.05). Single and married women in the pregnant group of study participants had the highest prevalence of (T. vaginalis) infection. Among the nonpregnant women, however, widows were observed to have the highest (11.1%) prevalence. Marital status did not significantly affect the prevalence of T. vaginalis infection (P > 0.05) among pregnant and nonpregnant women in this study [Table 2].
Table 2: Risk factors associated with Trichomonas vaginalis infection among women

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Pregnant women in polygamous marriages were observed to have a statistically significantly (P = 0.004) higher prevalence of T. vaginalis infection than those in monogamous unions. Although nonpregnant women in polygamous unions also had a higher prevalence of T. vaginalis infection than those in monogamous ones, the difference did not reach statistical significance (P = 0.270). Traders in both groups of study participants had the highest prevalence of T. vaginalis infection. Participants' occupation, however, did not significantly affect the prevalence of T. vaginalis infection in both groups of women (P > 0.05) [Table 2].

In the pregnant group of study participants, those with a primary education had the highest prevalence (9.9%) of T. vaginalis infection. Among nonpregnant women, those with no formal education were mostly infected with T. vaginalis. Educational status, however, did not significantly affect the prevalence of T. vaginalis among the study participants (P > 0.05) [Table 2].


  Discussion Top


Factors reported to promote infestation with T. vaginaiis such as poverty, low personal hygiene, and illiteracy [3],[5] are rife in rural communities of Nigeria.[6] While data on the prevalence of Trichomoniasis among women are abound in Nigeria, to the authors' knowledge, none have strictly focused on women living in rural populations. Against this background, this study aimed at determining the prevalence and risk factors for acquisition of T. vaginalis infection among women of reproductive age in rural Okada community of Edo State, Nigeria.

Irrespective of pregnancy status, the prevalence of T. vaginalis infection among the study participants was 7.7%. This is lower than 18.7% and 10.9% reported by other Nigerian studies, respectively.[2],[3] It is, however, higher than 3.3% and 0.0% reported elsewhere in Nigeria.[8],[9] The variation could be due to differences in geographical location, level of personal hygiene of study participants, type of study population, and diagnostic methods used. The prevalence of T. vaginalis infection among pregnant women (8.2%) and nonpregnant women (6.4%) observed in this study was higher than 1.5% and 1.8% recorded among the same group of women, respectively, in another Nigerian study.[8] Although it has been reported that changes in pH of vaginal mucosa during pregnancy favor its colonization by T. vaginalis,[2] the prevalence of T. vaginalis infection did not differ significantly between pregnant and nonpregnant women in this study. A similar finding has been reported elsewhere in Nigeria.[8]

In general, participants within the age group of 22–31 years had the highest prevalence of T. vaginalis infection. In the pregnant group of women, those within the age group of 22–26 years were mostly infected, while those within the age group of 27–31 years had the highest prevalence of T. vaginalis in the nonpregnant category of study participants. An earlier Nigerian study has reported similar findings.[3] With respect to marital status, married pregnant women and single pregnant women both had the highest prevalence of trichomoniasis. In the nonpregnant group, however, widows were observed to be mostly infected with T. vaginalis. Infection with T. vaginalis is reported to be associated with multiple sex partners.[10],[11] When used correctly, the male or female condoms have been reported to prevent sexual transmission of HIV infection and other sexually transmitted infections,[12] including trichomoniasis. Data from a recent reproductive health and HIV/AIDS survey by the Nigerian Federal Ministry of Health revealed that widows had the highest proportion of sex with more than one partner and lowest use of a condom in the last sexual act with a boyfriend.[13] This undoubtedly exposes them to a high risk of sexually transmitted infections including trichomoniasis. Marital status did not significantly affect the prevalence of T. vaginalis infection among pregnant and nonpregnant women in this study. Being in a polygamous marriage was significantly associated with the prevalence of T. vaginalis infection among pregnant women. Women in polygamous marriages officially share their husbands with one or more other women who may have had a perverse sexual history before marriage. This may increase the risk for transmission of sexually transmitted diseases including trichomoniasis.

With respect to occupational status, traders in both groups of the study participants were observed to have the highest prevalence of T. vaginalis infection. Multiple sexual partners and sexual promiscuity are known risk factors for T. vaginalis infection.[11] An important element of the process of trading is mobility. Commercial activities among rural dwellers are often carried out through periodic markets which require movement of persons from one place to another to buy and sell.[13] Several aspects of mobility such as opportunities to engage in transactional sex, isolation of communities of home and origin, and the desire for unique experiences all enhance the likelihood for casual sexual experiences at migration destinations.[14] This loss of sexual inhibition to casual sex at distant places may well expose traders to a host of infectious organisms, including T. vaginalis.

Pregnant women with a primary education and those with no formal education in the nonpregnant group had the highest prevalence of T. vaginalis infection. Low educational status has been reported to be associated with T. vaginalis infection in other Nigerian studies.[4],[15] Health education is a veritable tool for disease prevention.[16] Access to health information in rural Nigeria is generally poor.[6] Dissemination of health information in Nigeria is often done in English through electronic and print media. Women with little or no education may not be well positioned to understand vital information on prevention of diseases through such channel and thus present more frequently with infectious diseases such as trichomoniasis. Statistics, however, did not show any significant difference in the prevalence of T. vaginalis infection with respect to educational status among pregnant and nonpregnant women. In this study, diagnosis of T. vaginalis infection was limited to microscopic examination of swabs, due to the unavailability of more sensitive and sophisticated techniques used in other studies. This is an observed limitation to this study.


  Conclusion Top


Summarily, the overall prevalence of T. vaginalis infection among women in this study was 7.7% and was not significantly affected by age, occupation, educational, and marital status among pregnant and nonpregnant women. Pregnant women in polygamous unions were observed to have a significantly higher prevalence of T. vaginalis infection than their counterparts in monogamous relationship. The prevalence of trichomoniasis among pregnant and nonpregnant women with similar age group, marital status, occupation, and educational status did not differ significantly. Regular screening of women to detect trichomoniasis and treatment of those infected with T. viaginalis by relevant health authorities are advocated. Increased public enlightenment of women in rural settlements on risk factors for acquisition of T. vaginalsis infection in local dialect where necessary will also go a long way in curbing its spread.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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Ochei KC, Obeagu EI, Ugwu GU. George CN. Prevalence of Trichomonas vaginalis among pregnant women attending hospital in Irrua specialist teaching hospital in Edo state, Nigeria. J Dent Med Sci 2014;13:79-82.  Back to cited text no. 9
    
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Miller M, Liao Y, Gomez AM, Gaydos CA, D'Mellow D. Factors associated with the prevalence and incidence of Trichomonas vaginalis infection among African American women in New York city who use drugs. J Infect Dis 2008;197:503-9.  Back to cited text no. 10
    
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Oladeinde BH, Olley M, Imade OS, Onifade AA. Prevalence of HIV infection among patients with pulmonary tuberculosis in a rural tertiary hospital in Nigeria. Niger J Exp Clin Biosci 2014;2:90-4.  Back to cited text no. 14
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