The burden and determinants of reproductive tract infections in India: a population based study of women in Goa, India.

BACKGROUND/OBJECTIVE: Reproductive tract infections (RTI) present major health, social, and economic problems in developing countries. Our objective was to describe the prevalence and risk factors of RTIs in a population based sample of women aged 18-45 years. METHOD: 2494 women of 3000 randomly selected from the population defined by a primary health centre catchment area consented to participate. Participants were interviewed regarding complaints and risk factors. Laboratory specimens were collected for the diagnosis of RTIs. Analyses of risk factors were carried out separately for the outcomes of sexually transmitted infections: chlamydia, gonorrhoea, trichomoniasis; and endogenous infections: bacterial vaginosis (BV) and candida. RESULTS: Endogenous infections were relatively common (BV 17.8%; candida 8.5%), and sexually transmitted infections (STI) were infrequent (4.2%). Factors indicative of poverty and marginalisation were associated with STIs and BV. Gender disadvantage, particularly spousal violence, was associated with BV, while concern about a husband's extramarital relationships, an indicator of sexual risk, was associated with STI. Husband's discharge was strongly associated with STI, and a non-white vaginal discharge was associated with both STI and BV. Condom use and oral contraceptive use were associated with a reduced risk of BV. CONCLUSIONS: Most of the population burden of RTIs is attributed to endogenous infections. Socioeconomic deprivation and gender disadvantage are associated with raised risk for BV, while the risk factors for STIs indicated that disadvantaged women were likely to be infected by their husbands.

The burden and determinants of dysmenorrhoea: a population-based survey of 2262 women in Goa, India.

OBJECTIVE: To describe the prevalence and determinants of dysmenorrhoea, the most common menstrual complaint, in a community in India. DESIGN: Cross-sectional survey. SETTING: Catchment area of primary health centre in Goa, India. POPULATION: Three thousand women aged 18-45 years randomly selected. A total of 2494 women consented to participate (83.1%). METHODS: Eligible participants were asked standardised questions regarding menstrual complaints over the past 12 months, and socio-demographic, psychosocial and reproductive risk factors. Vaginal or urine specimens were collected for the diagnosis of reproductive tract infections. MAIN OUTCOME MEASURES: Dysmenorrhoea of moderate to severe intensity. RESULTS: A total of 2262 women were eligible. More than half reported dysmenorrhoea; moderate to severe dysmenorrhoea was reported by 755 participants (33.4%, 95% CI 31.4-35.4). There was a linear association between severity of pain and impact (medication and taking rest) and the onset of pain (premenstrual onset associated with more severe pain). On multivariate analyses, the risk of moderate-severe dysmenorrhoea was associated with the experience of violence (OR 2.23, 95% CI 1.5-34); other somatic complaints (OR 3.67, 95% CI 2.7-4.9 for highest somatoform symptom score category compared with the lowest); gynaecological complaints (non-menstrual lower abdominal pain: OR 1.78, 95% CI 1.3-2.3; dysuria: OR 1.98, 1.4-2.7); menorrhagia (OR 1.92, 95% CI 1.4-2.6); and illiteracy (OR 1.32, 95% CI 1.0-1.7). Having had a pregnancy (OR 0.53, 95% CI 0.4-0.7), older age of menarche (OR 0.70, 95% CI 0.5-0.9, for age >14 compared with <13 years) and older age (OR 0.43, 0.3-0.6 for age 40-50, compared with 18-24 years) were protective. CONCLUSIONS: The burden of dysmenorrhoea is greater than any other gynaecological complaint, and is associated with significant impact. Social disadvantage, co-morbidity with other somatic syndromes and reproductive factors are determinants of this complaint.

The reliability of a structured examination protocol and self administered vaginal swabs: a pilot study of gynaecological outpatients in Goa, India.

OBJECTIVES: Low participation rates for gynaecological examination and low reliability of clinical reporting of gynaecological examination findings are problems in community studies of gynaecological morbidity in India. This pilot study aimed to describe the reliability of a new examination protocol for recording the findings of gynaecological examination and the reliability and acceptability of the use of self administered vaginal swabs for the diagnosis of reproductive tract infections. METHOD: 75 women attending a gynaecology outpatient clinic were purposively sampled. Each woman was examined by two gynaecologists independently who recorded findings on the new examination protocol. Two swabs were collected from each woman, one by the gynaecologist and one by the woman. Swabs were smeared on separate slides which were stained and read for bacterial vaginosis and candidiasis by laboratory technicians blind to the mode of collection of the slides. RESULTS: The study showed a high inter-rater reliability for most of the items of the examination protocol. The interslide agreement for the diagnosis of the two RTIs was high. One third of women preferred the self administered swab. CONCLUSIONS: The examination protocol is a reliable method of recording gynaecological examination findings, and self administered swabs a useful way of obtaining vaginal specimens from women who did not wish to undergo gynaecological examinations in studies in the Indian setting.