PREVALENCE AND ASSOCIATED RISK FACTORS OF TRICHOMONIASIS AMONG PREGNANT WOMEN ATTENDING ANTENATAL CARE IN THE DISTRICT HOSPITAL OF KUMBA

Abstract
Trichomonas vaginalis is the main cause of vaginal infection among females attending antenatal care in District hospital Kumba.

The objective of this work was to evaluate the prevalence of Trichomoniasis among females attending antenatal care in District Hospital Kumba since there are little or no data available for the current prevalence of Trichomoniasis in this region.

A cross sectional study was conducted from February to April 2019 of a total of 250 females by collecting their vaginal specimen for testing.

Well-structured questionnaires were done aimed at collecting participants’ sociodemographic information for SPSS analysis.

It was revealed that the prevalence of Trichomoniasis among females attending antenatal care in District Hospital Kumba was 10.0%.

The risk factors that predisposes these females to Trichomoniasis included, wearing of we pants, not using antiseptic solution to wash pants, the use of pit toilets, the use of well water for douching, no use of condoms during sex and having more than one sex partners. In conclusion the prevalence of Trichomoniasis among females in District Hospital Kumba was 5.3%.

It was recommended that Women should be adequately educated on vaginal hygiene; they should also be educated on the need to seek medical attention on early onset of genital symptoms for prompt treatment.

This would no doubt reduce the prevalence of Trichomoniasis as well as other STDs, Females are equally advised to go for regular checkup, Culture should be used in diagnosis rather than wet mount microcopy, and Women should reduce the rate of vaginal douching because it destroys the protective normal vaginal flora.
CHAPTER ONE
INTRODUCTION
1.1 Background of the Study
Trichomoniasis is caused by the protozoan parasite Trichomonas vaginalis which has been recognized as a cosmopolitan parasite of male and female genital tract (Jatau, Olonitola and Olayinka, 2006).

Humans are the only known host of Trichomonas vaginalis.

Trichomoniasis is mainly transmitted through sexual contact but may also be transmitted through sharing of towels and under wears with infected individuals (Alcamo, 2000).

Most cases of Trichomoniasis remain undiagnosed as it is currently not a target of sexually transmitted infections control and also because of its asymptomatic nature in about half of infected men and women (Schwebke and Burgess, 2004).

Most men are asymptomatic; whereas only about half of women are asymptomatic. Symptomatic women suffer from vaginal discharge, pruritus, irritation, odor, and edema or erythema (Trichomoniasis.org 2017).

Complications for men and women are prostatitis and vaginitis respectively.

Trichomoniasis is generally curable with metronidazole or sometimes Tinidazole (CDC, 2015).

Worldwide, there has been varying prevalence of this pathogen, grossly due to differences in participants’ characteristics and in sociodemographic/socioeconomic factors.

Trichomoniasis is likely the most common non-viral sexually transmitted infection (STI) in the world with a global prevalence estimated at 8.1 % for women and 1.0 % for men (WHO, 2010). WHO estimates that 180 million of new cases occur annually (WHO, 2012).

The prevalence of Trichomoniasis has been reported for a few African countries and ranges from 6.5%-40%, few of which are Kisumu in Kenya 29.3%, Ndola in Zambia 34.3%, Cotonou in Benin 32% and Yaoundé in Cameroon 17.6% in adult aged 15-49 (Buve’ et al., 2001).

The frequency of Trichomonas infection is not monitored in most countries nor do control programs exist. A better understanding of the epidemiology of this infection in women is needed to foster disease control programs in populations at risk for reproductive health complications.

Trichomoniasis in pregnancy has been shown to be associated with adverse pregnancy outcomes (Preethi et al., 2011).

These pregnancy outcomes include preterm labor, premature rupture of membranes, low birth weight and post-abortal sepsis (Preethi et al., 2011).

Although Trichomoniasis is diffused worldwide, its prevalence greatly varies among different populations. One of the reasons for the high prevalence of Trichomoniasis in Africa is the lack of STI screening program and limited control measures and nearly 90 % of these infections occurred among people living in resource-limited settings (WHO, 2008).

Factors such as poor personal hygiene, multiple sexual partners, low socioeconomic status, and under development have been reported to be associated with high incidence of infection (Crosby et al., 2002).

Other risk factors of Trichomoniasis include increased age, incarceration, intravenous drug use, commercial sex work (Freeman et al., 2010) and the presence of bacterial vaginosis (Rathod et al., 2011).

1.2 Statement of the Problem
Trichomoniasis is not a reportable infection, despite its high impact on public health, so data regarding diffusion of Trichomonas vaginitis are scarce and incomplete in most countries. In many cases, especially in asymptomatic patients, the infection is not recognized and its prevalence is therefore generally underestimated.

Until now, only a limited number of epidemiological investigations describing the prevalence of Trichomonas infection in the South west region of Cameroon have been reported in literature (Buve et al., 2001).

Despite the estimated large burden of Trichomoniasis in the African regions, there is little or no data available for the current prevalence, frequency, clinical presentation, demographic and risk factors of Trichomoniasis in Cameroon.

Therefore, this study will provide relevant data to fill the gap of the prevalence and associated risk factors of Trichomoniasis among women attending antenatal care in Kumba district hospital, SWR, Cameroon.
1.3 Objectives of the Study.
To determine the prevalence of Trichomoniasis among pregnant women attending antenatal care in the district hospital of Kumba.
To determine the risk factors associated to Trichomoniasis among pregnant women attending antenatal care in the district hospital of Kumba.
To assess knowledge of Transmission of Trichomoniasis among pregnant women.
1.4. Research Question
What is the prevalence of Trichomoniasis among pregnant women attending antenatal care in the district hospital of Kumba?
What are the risk factors associated to Trichomoniasis among women attending ANC in the district hospital of Kumba?
How knowledgeable are pregnant women about Trichomoniasis?
1.5 Significance of the Study
Screening females including pregnant women for Trichomoniasis is vital as the infection can be transmitted congenitally to unborn children. Congenital, intra-uterine infections are often the causes of infertility and fetal death resulting in both economic and social concerns. The results of this study will add to the wealth of knowledge in the control and prevention of this disease. Policy makers will make use of the information to develop better policies and the authorities responsible for ANC will be able to use these results and build health education and teach pregnant women during ANC and Infant Warfare Clinic (IWC) This work is also going to sensitize females about the risk of Trichomoniasis especially in pregnancy and the need to avoid its spread and save guard the health of their unborn babies. Hence early detection and treatment will be an important component of effort to reduce the disease burden in Kumba
1.6 Scope of the Study/ Delimitations
The study will be hospital based and conducted among pregnant women attending antenatal care in the Kumba district hospital from February to April 2019. Not all the women attending antenatal care in the District Hospital of Kumba was included in this study because of the limited time frame.