NSU Research Contributions
Title : Prevalence and symptoms of abnormal vaginal flora in rural sylhet, Bangladesh. Annals of Global Health
Authors : Karima Ladhani, Anne CC Lee, Mohammad A. Quaiyum, Luke C. Mullany, Dipak K. Mitra, Alain Labrique, Parul Christian, Parvez Ahmed, Iftekhar Rafiqullah, Samir Saha, Abdullah H. Baqui
Abstract : Background: 15 million babies are born preterm ( < 37 weeks of gestation) annually and preterm birth is the leading cause of neonatal mortality globally. In low- and middle-income countries where antenatal care coverage and screening is limited, estimates of the prevalence of maternal infections are also limited. There is a significant association between abnormal vaginal flora (AVF) and preterm birth. The objective of this study is to determine the prevalence of AVF, including intermediate flora and bacterial vaginosis (BV), and the frequency of self-reported symptoms among infected mothers in rural Bangladesh. Methods: In a population-based pregnancy cohort in Sylhet district Bangladesh, all eligible women in selected communities were screened for AVF using sterile self-administered vaginal swabs and answered questions about their symptoms (n¼3,166). AVF were classified by microscopic examination of a Gram stained sample of the vaginal smear and diagnosed by a Nugent score, a scoring system of 3 bacterial morphotypes (lactobacillus, gardnerella/bacteroides, and mobiluncus). AVF is defined as Nugent score >¼4, and includes intermediate flora (Nugent score 4-6) and bacterial vaginosis (Nugent score 7-10). Descriptive analyses were performed, and sensitivity and specificity of symptom-based screening were calculated. Proportions were compared using the Chi-square test. IRB approvals for this study were granted to John Hopkins University, ICDDRB, and Brigham and Women’s Hospital. Informed oral consent was obtained from all participants. Findings: Among 3,166 pregnant women screened, the prevalence of AVF was 15.4% (95% CI: 14.1% - 16.6%), with 6.8% (95% CI: 5.9% - 7.6%) intermediate flora and 8.6% BV (95% CI: 7.6% - 9.6%). 91.0% of women with AVF were asymptomatic. Among mothers with intermediate flora, 9.8% reported any symptoms (2.8% malodorous discharge, 1.4% grey discharge, 6.5% pruritus, 2.8% dyspareunia, 0.93% vaginal bleeding). Among mothers with BV, 8.5% reported any current vaginal symptoms (2.6% malodorous discharge, 0.74% grey discharge, 4.4% pruritus, 2.9% dyspareunia, 0.74% vaginal bleeding). Among mothers without AVF, 7.7% reported any symptoms (1.6% malodorous discharge, 0.54% grey discharge, 5.2% pruritus, 2.5% dyspareunia, 0.52% vaginal bleeding). There was no significant difference in the frequency of any vaginal symptoms among infected and uninfected women (c2(1)¼ 0.97, p¼0.33). Using clinical signs as a screening diagnostic tool would have only detected 9.0% of the women with AVF (sensitivity 9.0%, specificity 92.3%, PPV 17.5%, NPV 84.8%). Interpretation: The prevalence of AVF is high and the majority of mothers are asymptomatic. There is no significant difference in the prevalence of vaginal symptoms between mothers with and without AVF infection. A symptom-based screening approach is ineffective in identifying AVF and BV. Alternate and feasible diagnostic methods are needed to screen for AVF and BV in resource-limited settings
| Journal : Annals of Global Health | Volume : 81 | Year : February 2015 | Issue : 1 |
| Pages : 94-95 | City : | Edition : | Editors : |
| Publisher : | ISBN : | Book : | Chapter : |
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