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

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 treatment^7-8.

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.

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).

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%).

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Fig.1:

Symptoms wise distribution of RTI cases

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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).

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 RTIs^4,9-11. 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 Chandigarh^12,13 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, Sharma^14,15. 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 studies^14,15. 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.