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Original Article
2 (
1
); 49-56

Community Based Study on Reproductive Tract Infection in a District of West Bengal - An Appraisal

Professor & Head, Dept. of Community Medicine, NRS Medical College, Kolkata;
Assistant Professor, Dept. of Community Medicine, NRS Medical College, Kolkata;
Professor & Head, Dept. of Community Medicine, Midnapur Medical College, Midnapur;
Associate Professor, Community Medicine, Murshidabad Medical College, Murshidabad;
Associate Professor, Community Medicine, IPGMER, Kolkata.
Corresponding Author: Prof. (Dr.) Anima Haldar, HOD Community Medicine, NRS Medical College; 138,A. J. C Bose Road, Kolkata - 700014

Address for correspondence: The Editor/ Managing Editor, Journal of Comprehensive Health Dept of Community medicine NRS Medical College, 138, AJC Bose Road, Kolkata-700014

Licence
This open access article is licensed under Creative Commons Attribution 4.0 International (CC BY 4.0). http://creativecommons.org/licenses/by/4.0

Abstract

Background:

Reproductive tract infections and sexually transmitted diseases represent a major public health problem in developing countries. As reported from different community based studies conducted in India, the range of self reported morbidity vary from 39- 84%. Majority of the women bear the problems silently without seeking advice and treatment. Objectives: to estimate the prevalence of RTIs morbidity among married women and identify different socio-environmental factors associated with it.

Materials & Methods:

A Community Based Cross - Sectional study was carried out in Howrah district of West Bengal during May 2009 to August 2009 to reveal the prevalence of Reproductive Tract Infection and its Social correlates. The respondents were 2000 currently married women (15-49yrs) selected by stratified multistage random sampling. House to house visit and data collection was done by faculty members of Community Medicine of different Medical colleges of W.B. using predesigned & pretested schedule.

Result:

The prevalence of RTI was 9.9% and was higher in 24-29 yrs age group. RTI was indirectly proportional to literacy status. Prevalence of RTI was significantly higher among those who did not use sanitary napkin or clean sundried domestic cloths. The occurrence of RTI was lower among those who used to practice barrier method of Contraception whereas it was higher among Cu-T users. Majority of symptomatic complained about vaginal discharge (44.7%).

Conclusion:

To prevent RTI morbidities, use of clean sundried domestic cloths, barrier method of contraception and awareness about small family norm are to be recommended through intervention in future.

Keywords

RTI
Social correlates
Contraceptive

INTRODUCTION

Reproductive tract infections and sexually transmitted diseases represent a major public health problem in developing countries.1 The annual incidence of RTI/STI in India is estimated at 5%, approximately 40 million of new infections take place every year2. The consequences of RTIs are numerous and potentially devastating which include post abortal and puerperal sepsis, ectopic pregnancy, foetal and perinatal death, cervical cancer, infertility, chronic physical pain, emotional distress and social rejection of women.3 As reported from different community based studies conducted in India, the range of self reported morbidity vary from 39- 84%.(4,5) In developing countries both the incidence/prevalence of RTIs/STIs are very high, they rank second as the cause of healthy life lost among women of reproductive age group after maternal morbidity and mortality6. Majority of the women bear the problems silently without seeking advice and treatment7-8.

So, with these above perspectives, the present community based cross sectional observational study was conducted to estimate the prevalence of RTIs morbidity among married women and identify different socio-environmental factors associated with RTI.

MATERIAL & METHODS

A community based cross-sectional observational study was undertaken in May 2009 to August 2009 by stratified multistage random sampling. The study population were currently married women of Howrah district of West Bengal. The sample size was calculated by considering prevalence of RTI as 50% and permissible level of error as 5% and was calculated as 1600. Out of total 14 blocks of Howrah district, 3 blocks had been selected randomly. From each rural block, 2 sub-centres and from each sub-centre areas 2 villages had been selected randomly. Total 4 wards were selected randomly from two municipality areas. So a total of 16 units (4 villages from each block and 2 wards from each municipality) had been chosen for study purpose. From each village/ ward 125 couples were selected to obtain a total sample size of 2000. The data were collected using a predesigned, pretested questionnaire interviewing the female partner of all couples in a house to house survey using standard technique. The study variables were age, age at marriage, literacy level, age at first conception, parity, birth interval, current use of contraceptives, ever use of contraception, RTI morbidities.RTI morbidities includes pain lower abdomen, vaginal discharge, pruritus vulve, low back pain, genital ulcer, inguinal bubo based on syndromic approach as recommended by Govt of India. All women with reproductive tract infection related morbidity were asked to consult nearby BPHC/ Sub-divisional or District hospital.

Data analysis was done with the help of Microsoft Excel and Epi-Info (3.5.4) software.

RESULTS

The present study revealed that only 9.85% reported symptoms suggestive of reproductive tract infection. Table-I indicated the relationship between socio-environmental co-relates and RTI. Vaginal discharge was the commonest symptom found (Fig-I). Prevalence of RTI was maximum (11.39%) in 24-29 years age group and minimum (6.51%) in age group 18-23 years. The difference was statistically significant. The prevalence of RTI was higher (46.18%) among illiterate & just literate group, least (6.6%) in graduate and above group educated group. The difference was statistically significant. Majority of women belonged to poor social class (53.5%) and very poor (BPL) comprised 33.6% of surveyed women; RTI prevalence was higher (12.0%) among BPL group and lowest (6.89%) among high social class group.

Table - 1: Social Correlates and RTI among Respondents (n=2000)
Variables Total surveyed /
No of participants
No of symptomatic RTI cases
No Percentage
Statistical Test
Age group (yrs.)
< 18 21 2 9.5 X2 = 8.43, df = 3, p = 0.03
18 - 23 491 32 6.5
24 - 29 632 72 11.4
30 -35 573 59 10.3
≥ 36 283 32 11.3
Education
Illiterate 538 86 15.9 X2 = 137.2, df = 4, p = 0.0001
Just literate 129 39 30.2
Primary 426 47 11.0
Secondary 802 78 9.7
≥ Graduate 105 7 6.7
Type of family
Nuclear 1400 132 9.4 X2 = 0.97, df = 2, p = 0.616
Joint 560 61 10.9
Other 40 4 10.0
Social Class (Rs.)
Upper High (> 10000) 4 0 0.0 X2 = 5.962, df = 4, p = 0.202
High (5000-9999) 29 2 6.9
Upper middle (3000-4999) 33 3 9.1
Lower (1500-2999) 191 15 7.8
Poor(500-1499) 1070 96 8.9
BPL (< 500) 673 81 12.0

Regarding contraceptive practices, reproductive tract infections was lower (6.1%) among those who used to practice barrier method of contraception whereas it was 16.4% and 12.2% among Cu-T users and those who had undergone permanent sterilisation respectively (Table - II).

Table - 2: Reproductive Tract Infections in Relation to Reproductive Behaviour & Fertility Status of the Respondents (n=2000)
Variables Total surveyed /
No of participants
No of symptomatic RTI cases
No Percentage
Statistical
Test
Age at marriage (yrs.)
< 18 1102 114 10.3 X2 = 0.97, df
= 2, p =
0.614
18 - 23 842 79 9.4
24 - 29 48 4 8.3
≥ 30 8 0 0
No. of Children
No issue 676 50 7.4 X2 = 14.75,
df = 4, p =
0.0052
1 836 79 9.4
2 359 48 13.4
3 96 14 14.6
≥ 4 33 6 18.2
Contraceptive use
None 779 70 8.9 X2 = 9.693,
df = 5 p =
0.084
Condom 148 9 6.1
OCP 507 44 8.8
Cu-T 61 10 16.4
Ligation 368 45 12.2
Vasectomy 2 0 0.0
Other 135 19 14.1
Use of Sanitary napkin / clean sundried domestic cloths
Yes 462 21 4.5 X2 = 19.03,
df = 1, p =
0.000013
No 1538 176 11.4
Total 2000 197 9.9

Fig-I indicated that majority (45%) suffered from vaginal discharge followed by others (25.8%), pain abdomen (15.6%), low back pain (15.2%) and least suffered from dysuria (4.9%).

Fig.1:
Symptoms wise distribution of RTI cases

Regarding health seeking behaviour majority (57.8%) prefer to attend private practitioner followed by Govt hospital (45.8%) and 12.8% of the respondents also favoured quacks (Table- III).

Table - 3: Health Seeking Behaviour of the Respondents (n = 2000)
Fertility No. Percentage
Pvt. Practitioner 1155 57.8
Govt. Hospital 916 45.8
Nursing Home 78 3.9
Quacks 256 12.8
Ayurvedic 53 3.2
Homeopathy 100 5.0
Health worker 101 5.1
Others 6 0.3

Discussion

The present study revealed low prevalence of Reproductive tract infections (9.85%) in married women of age 15-49 years, probably due to accessibility of health care services. But earlier community based studies reported higher prevalence of RTIs4,9-11. The prevalence of RTIs/ STDs was found to be 49% in a rural area of district of Agra10 and 70% in rural area of Haryana11.Prevalence of RTI observed by studies done in slum and rural areas of Chandigarh12,13 was 21.6%,17,7% respectively. Prevalence of RTI was reported 29% in earlier study8 also 35.3% and 51.9% RTI prevalence reported from rural area of Meerut and Sirmour (H.P) respectively.14,15 RTI prevalence was maximum (11.39%) in 24-29 years age group in the present study and it was similar other studies done by Pant, Sharma14,15. But Rathor et al16 reported maximum prevalence in age group of 40-49 years and Nandan et al17 reported maximum in 15-24 years age group. Significantly higher prevalence of RTI was present among women with lower literacy. The findings of the present study corroborated with the findings of the earlier studies14,15. The prevalence of RTI was maximum Cu-T users, similar findings observed by Sharma et al15 whereas it was maximum among women who had sterilization as observed by Pant et al.14 RTI morbidities was significantly higher among who used general cloths as compared to Sanitary pad and clean cloths users and it was corroborated with the findings of Sharma et al 15.

It can be concluded from the present study that community based awareness generation programme about small family norm, maintenance of reproductive hygiene through use of sanitary napkins, practice of barrier method of contraception as well as education are essential to reduce RTI Morbidities. Special emphasis should be made to involve local quack practitioners about RTIs/STIs for early referral to higher health facility. So for quack practionars training programme should be arranged for early identification and referral of the patient by syndromic approach.. IEC activities need to be strengthened through mass media and interpersonal communication starting from grass root to tertiary care level.

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