Reproductive Tract Bacterial Infections among Women of Reproductive Age Attending Homabay County Teaching and Referral Hospital in Homabay County, Kenya.
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Date
2025-04
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Kenyatta University
Abstract
Reproductive tract bacterial infections (RTBIs) are a leading cause of morbidity among sexually active women worldwide. Female reproductive tract infections can affect either the upper reproductive tract, which includes the fallopian tubes, ovaries, and uterus, or the lower reproductive tract, comprising the vagina, cervix, and vulva. Although studies have been conducted on the incidence, bacterial causative agents, and antibiotic susceptibility patterns of RTBIs in Kenya and other developing countries, gaps remain in comprehensive and up-to-date data. These gaps limit the effectiveness of diagnosis, treatment, and prevention strategies, posing an ongoing challenge to improving women’s reproductive health. To address this, the study aimed to assess the incidence of bacterial infections in the female reproductive tract and evaluate their antibiotic susceptibility. The research focused on women of reproductive age attending the antenatal, gynecological, and outpatient clinics at Homabay County teaching and referral hospital. Women of reproductive age seeking care at the hospital who consented to participate were enrolled in the study. A cross sectional study design was adopted, and a systematic sampling technique was employed. The minimum sample size was determined using Fisher et al.'s formula, based on a 37.4% incidence of reproductive tract bacterial infections. The patients were interviewed using a structured questionnaire, and subsequently, blood and high vaginal swab samples were obtained from each patient for the analysis of bacterial infections. Sample analysis was done at Homabay County Teaching and referral hospital laboratory. High vaginal swabs were examined for bacterial vaginosis, and grading was performed using Nugent’s criteria. The analysis identified Lactobacillus, Gardnerella, Bacteroides, Mobiluncus sp, and Neisseria gonorrhoea. Culture was performed to analyze Neisseria gonorrhoea using the King and Martin method. All gonorrhoea isolates were tested for antibiotic sensitivity using the disc diffusion method, and CLSI 2024 guidelines were used. Blood samples were examined for Treponema pallidum using a non-treponemal antigen test. The Chi-square test of association was used to assess the association between reproductive tract bacterial infections and socio-demographic factors. Fisher’s exact test was employed to assess the sensitivity of Neisseria gonorrhoea to various antibiotics commonly prescribed for treatment. The study employed Statistical Package for Social Sciences (SPSS) version 28, with a significance level set at P < 0.05. Findings on reproductive tract infections among 360 women showed 3.6% incidence. Treponema pallidum (10.8%), Neisseria gonorrhoea (3.6%), and bacterial vaginosis (5.3% Amsel, 3.1% Nugent) were identified. N. gonorrhoea exhibited 100% resistance to tetracycline, 34% resistance to penicillin, and 100% sensitivity to ceftriaxone. The study concludes that reproductive tract infections at Homabay County Hospital, driven by bacterial vaginosis, T. pallidum, and N. e, pose a public health challenge. N. gonorrhoea shows full resistance to tetracycline, partial to penicillin, and complete susceptibility to ceftriaxone. The study recommends prioritising ceftriaxone for gonorrhoea, enhancing screening, and monitoring resistance.
Description
A Thesis Submitted in Partial Fulfillment of the Requirement for the Award of the Degree of Master of Science in Infectious Diseases in the School of Health Sciences, Kenyatta University, April 2025.
Supervisor
1. Nelson C. Menza
2. Margaret W. Muturi