Comparison of Pap-Smear and Modified-Amsel’s Criteria in Screening for Bacterial Vaginosis among Women at Kiambu Level-V Hospital, Kiambu County, Kenya
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Date
2025-02
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Kenyatta University
Abstract
Bacterial vaginosis is a commonly experienced vaginal infection in reproductive age group women between 15 and 44 years old. Globally, 5-70% of women are affected. In Kenya the prevalence is between 10-50%. Bacterial vaginosis is a public health concern implicated in premature rupture of membranes, low birth weight, pelvic inflammatory disease, infertility and urogenital infections. Several methods exist for BV screening, among them Gram staining, Amsel‘s criteria, Papanicolaou smear, and Polymerase Chain Reaction. These methods require highly skilled microscopists, are not easily accessible, and they are expensive. The study’s’ main objective was to compare performance of the Modified Amsel‘s criteria and Pap smear to the gold standard method, Gram stain, to determine if the former which is simple and readily available is more suitable for bacterial vaginosis screening. A cross-sectional study involving 196 females between 18-55 years old was undertaken at the gynaecology Clinic in Kiambu level-V hospital, Kenya. A Pap smear and two high vaginal swabs were obtained from each participant. The Pap smear was evaluated as per the Bethesda system 2014 and smears positive for BV reported. In modified Amsel‘s criteria, the vaginal discharge was evaluated for homogeneity, pH, existence of clue cells and a fishy odour. For Gram stain method, smears were made on a slide and Gram-stained. Ten microscopic fields were observed for lactobacillus and Gardnerella morphotypes and rounded Gram rods. The bacteria were counted, scored and summed to get a full score within the range of 0-10. Purposive sampling method was used to recruit participants. The inclusion criteria was females between 18-55 years old who signed consent to be involved in the study. Exclusion criteria was pregnancy, menstruation and failure to give consent. Nominal and categorical data of the two methods was compared using Chi-square test. Statistical significance was determined by a p-value less than 0.05 at 95 percent Confidence Interval. Cohen’s Kappa statistics was used to determine the level of agreement of the two methods. Out of the 196 participants 46 (23.5%) were positive for BV by the Gram’s standard method, 60 (30.6%) by Modified Amsel’s criteria and 18 (9.2%) by Pap smear method. Sensitivity, Specificity, Positive Predictive Value and Negative Predictive Value of Pap smear was 32.6%, 98.0%, 83.3% and 82.5% respectively, while that of modified Amsel’s criteria was 82.6%, 85.3%, 63.3% and 94.1% respectively. There was slight agreement between Pap smear and modified Amsel’s criteria k=0.195 and p=0.063. Out of the analysed risk factors for Bacterial vaginosis, only age had a statistical association with BV (p=0.03). Prevalence of BV was 23.5%. Modified Amsel’s criteria was more accurate in screening for BV than Pap smear. These findings will inform policy makers on the most reliable method for BV screening in the absence of the gold standard.
Description
A Thesis Submitted in Partial Fulfilment of the Requirements for the Award of the Degree of Master of Science in Medical Laboratory Science (Clinical Histocytopathology) in the School Of Health Sciences, Kenyatta University, February, 2025
Supervisors;
1.Onesmus Muia Mutuku
2.Washingtone Arodi