ABSTRACT

Background: Vulvovaginal Candidiasis (VVC) is described as consisting of a white “cottage cheese “discharge with associated vulvar and vaginal inflammation). The vagina could be infected by a variety of pathogens including bacteria, fungi, viruses, and parasites. Vaginal complaints such as Bacterial Vaginosis (BV), candidiasis, trichomoniasis, and Chlamydia trachomatis infections are common among adolescent age 18 to 25, with incidences during sex. The aims at assessing the knowledge perception, and attitude of adolescent girls 8 to 25 years towards the consequences of vagina candidiasis in molyko community.           The objectives of the study were to assess adolescent knowledge on vagina candidiasis, assessing adolescent attitudes towards vagina candidiasis and to assess adolescent knowledge towards the consequences of vagina candidiasis.

Materials and methods: The study employed a community-based survey design with a sample size of 100 adolescents’ girls aged 18 to 25, using a well-structured questionnaire. Simple random technique was used to collect data. The data was analyzed using MS excel version 2016 and results presented on tables.

Results: Of the 100 participants, majority 72(72%) admitted they know about vagina candidiasis but only 34 (34%) admitted to have suffered from vagina candidiasis with majority (66%) saying no. Of those who have been affected by vagina candidiasis, most of them have had the infection once (18%).

Conclusion: The findings of the current study reveal that the adolescents are having below average knowledge about vagina candidiasis. The findings suggest that there is a growing need of educating the adolescents on this research variable of vagina candidiasis.

CHAPTER ONE

1               INTRODUCTION

1.1         Background

Vulvovaginal Candidiasis (VVC) is described as consisting of a white “cottage cheese” discharge with associated vulvar and vaginal inflammation (Zhou et al., 2009). The vagina could be infected by a variety of pathogens including bacteria, fungi, viruses, and parasites. Vaginal complaints such as Bacterial Vaginosis (BV), candidiasis, trichomoniasis, and Chlamydia trachomatis infections are common among adolescent age 18 to 25, with incidences during sex (Abdelaziz et al., 2014). 

Vulvovaginal candidiasis (VVC) is a common fungal infection caused by Candida species, predominantly C. albicans ( Sobel JD, et al., 1985).The pathological hallmark of the disease is an acute inflammatory condition of the vulva and vaginal mucosa induced by and accompanied with overgrowth of Candida organisms that normally exists as a quiescent vaginal commensal (Fidel PL Jr et al., 2004). Signs/symptoms of VVC are typically characterized by white clumpy discharge, burning, redness and itching in the vulva and vagina, and dyspareunia (Sobel JD, et al., 1992). The onset of most VVC cases is believed to be associated with a wide range of predisposing factors or triggering events including the use of antibiotics, increased estrogen levels (e.g. high estrogen oral contraceptives, hormone replacement therapies, pregnancy), uncontrolled diabetes mellitus, sexual activities and tight-fit clothing (Force RW et al., 1998). In addition, an estimated 8 to 10% of women are susceptible to recurrent VVC (RVVC), having 4 or more episodes per annum (Sobel JD. et al., 1992). Multiple recurring infections are often idiopathic without regard to the array of potential risk factors. Unlike most episodic or sporadic VVC, RVVC cases require maintenance regimens with long-term use of antifungals over several months or longer to avoid recurrence (Fabric BC. et al., 2010).

However, several global studies have been reported. One reports the worldwide prevalence of RVVC at approximately 138 million women annually, and an additional 372 million over one’s lifetime, causing substantial morbidity and economic burden (Denning DW, et al., 2018). Another large-scale multi-country internet panel survey indicated a lifetime RVVC prevalence rate of 9% by age 50 with the vast majority of episodes occurring between 18 to 25 years of age (Blostein et al., 2017), which was remarkably similar to the historical estimates (Sobel JD et al..,2007). Despite these global studies on incidence/prevalence rates worldwide, current information/perspectives on VVC/RVVC disease trends is still needed and critical for reporting on aspects of vaginal infections, including diagnostics and therapeutic approaches, understanding host immunity and pathogenesis, and behavioral factors associated with disease etiology. Indeed, a large body of current literature on host defense mechanisms against VVC/RVVC and associated immunopathology (Cassini A, et al., 2017) has relied on long past historical epidemiological citations for VVC/RVVC that may not accurately reflect current disease-associated trends.

Candida Africana infections were more prevalent in Africa. One hundred and fifteen (40.6%) of patients with candida africana candidiasis were from seven different countries and Madagascar and Angola had the majority of cases.

In developing countries, there is scanty data on vaginal candidiasis in adolescents and the distribution of the vaginal Candida species (Nelson, 2013).

In Sudan, there is little data about vaginal infections in adolescent. Also, another study conducted to determine the prevalence of bacterial vaginosis and vaginal candidiasis in adolescent Candida albicans in 73 (73%) samples, combined infection with Gardnerella vaginalis and Candida albicans was detected in 3 (3%) samples (Ahmed et al., 2014).

From July 2016 to June 2019, 487 18- to 25 year -old girls with vulvo-vaginal infection in late puberty in West China Second University Hospital were retrospectively studied. The incidence of bacterial vaginosis (BV), the intermediate type of BV, vulvo-vaginal candidiasis (VVC), Trichomonas vaginalis (TV), and differences among the incidence of these infections for patients with different ages were analyzed.

In Brazil (2010), 404 women who had clinical symptoms of VVC were enrolled in this study. 70 youth and 90 adolescents were included. Candida albicans was the most prevalent, representing (72.9%) in the adolescent and (92.3%) in young. Differences in species distribution were noted between the two groups, being C. parapsilosis the second more prevalent species among adolescents (Dias et al., 2011).

In Nigeria (2012), study was conducted to determine the prevalence of vaginal candidiasis among adolescents. A total of sixty (60) adolescents were examined. A total of 42 (70%) isolates were obtained which comprises five different Candida species, namely Candida albicans, C. glabrata, C. tropicalis, C. krusei and C. pseudotropicalis with frequency of occurrence of 21 (50%), 9 (21.4%), 6 (14.3%), 5 (11.9%) and 1 (2.4%) respectively. The isolates obtained were related to number early adulthood. The isolates were also related to age, the age range of 21 to 25 years had the highest incidence (59.5%), followed by age range of 19 to 21 years (31.0%) and 18 years had the least (9.5%) percentage of occurrence (Oyewole et al., 2013).

In Maroua- Far-North Cameroon (2010), investigation was carried out at two referral hospitals, involving 211 (112 adolescents and 99 youths) women of age interval 16-28 years, to estimate the prevalence of vulvovaginal candidiasis (VVC) amongst Adolescents. The results indicated that the prevalence of VVC was higher amongst adolescents (55.4%) than youth (35.4%) (Toua et al., 2013). The prevalence of abnormal vaginal discharge in adolescents in Maiduguri, Nigeria (2012) was 31.5%. The frequency of abnormal vaginal discharge was 183 (45.8%) among those aged 20-23 years, 291 (72.8%) in youth, 223 (55.8%) in those with primary education and 293 (73.2%) in unemployed. Vulval pruritus 300 (75.0%) was significantly related to abnormal vaginal discharge (P< 0.001). The prevalence of C. albicans was 41%. The frequencies of vulval itching, dyspareunia and vulval excoriation among those with candidiasis were 151 (50.3%), 14 (56.0%) and 75 (75.0%) respectively (P< 0.001) (Ibrahim et al., 2013). The incidence of BV, the intermediate type of BV, TV, VVC, and unknown pathogenic vaginitis was 25.67%, 19.30%, 2.46%, 29.37%, and 23.20%, respectively. The incidence of BV and VVC was significantly higher than that of TV. The incidence of BV in the 18 -year-old group was significantly higher than that in other age groups. The incidence of VVC and non-albicans Candida infection in the 17-and 18-year-old groups was significantly higher than that in the 14-year-oldgroup.

1.2         Problem statement

In most developing countries, including Cameroon have implemented majors to eradicate vagina candidiasis as an important aspect in the health of the population as well as social and economic issues. Vagina Candidiasis is proximal to infertility to women in Cameroon and associated complications have serious public health implications for the country. Cameroon have recorded 23% of infertility because of vaginal candidiasis amongst adolescents (18 to 25 years) during the national health survey.

Reports have shown that vagina candidiasis infection is one of the most common genital tract infections seen in Africa and Cameroon in particular (Sule Oxy et al., 2020). It remains one of the fourth (4) major cause of infertility amongst adolescents in Africa and Cameroon in particular (Akadri et al., 2020). Vagina Candidiasis is one of the most causative agent of Vulvovaginal, a multifactorial infection disease of the lower female reproductive tract resulting in pathological infection in Cameroon today (Salman et al., 2020). In the molyko community some girls suffer from Vaginal candidiasis and it is a major problem. It disturbs them psychologically and which affects their daily activities, many of them don’t even know about vagina candidiasis and they turn to take antibiotics (over the counter drugs) thinking it will just go and it ends up causing more problems like infertility.

1.3         Research Questions

1. What knowledge do adolescents (18 to 25 years) have on vagina candidiasis
2. What is the perception of adolescents (18 to 25 years) towards the consequences of vagina candidiasis
3. What is the attitude of adolescents (18 to 25 years) towards vagina candidiasis

1.4         Objectives

1.4.1        General Objectives

Knowledge, perception and attitude of adolescent girls (18 to 25 years) towards the consequences of vagina candidiasis infection in the molyko community of Buea

1.4.2        Specific Objectives

1. To assess adolescents (18 to 25 years) knowledge on vagina candidiasis
2. To assess adolescents (18 to 25 years) attitudes towards vagina candidiasis
3. To asses adolescent (18 to 25 years) knowledge on the consequences of vagina candidiasis

1.5         Scope of study