ABSTRACT

Background: Vaginal candidiasis is a fungal disease caused by a yeast type Candida. It affects more than 75% of women during the period of genital activity. Change in vagina pH due to various factors lead to the onset of the infection.  This study was aimed at Determining the prevalence of vaginal candidiasis in women of Childbearing age and look for associated factors or risk for its Occurrence. Method: This was a cross-sectional Analytical study from December 2022 to February 2023. Patients aged 15 to 49 years made up the study population. A questionnaire was completed specifying age, medical history, symptoms and risk factors before collection samples and Doe each vaginal sample cultures on SDA were performed. Statistical analysis was performed using SPSS 25.0. Results were considered significant when P<0.05. Results: Among 120 samples analyzed, 24 (13.3%) were positive for culture. The prevalence of Vaginal Candidiasis in this study was high 32 (26.7%) among those aged 42-49years. This study found out that practicing of unprotected sex was a significant risk factor for the incidence of vaginal candidiasis among women of child-bearing age. Conclusion: The Prevalence of vaginal candidiasis in this study was high (13.3%) among women of child bearing age; therefore sensitization should be reinforced in Kumba  so as to completely eliminate this infection from our community.

CHAPTER ONE

INTRODUCTION

1.1 Background of the study

Candidiasis is a fungal infection caused by yeasts from the genus Candida (Jose, 2020). Candida species are part of the natural vaginal flora in 20.0% – 50.0% of healthy women but may become pathogenic under certain conditions including the presence of invading pathogens or biochemical changes in the vaginal environment making them common aetiologic agents of vaginitis (Emeribe et al., 2015). Invading pathogens alter the normal microflora of the vagina while biochemical changes in the vagina stimulate the rapid proliferation of the natural Candida population, enhance their attachment to the epithelial cells of the vagina and promote germination of daughter yeast cells so that normal asymptomatic colonisation becomes symptomatic Candida infection (Wright, 2014). Protracted antimicrobial use have been known to cause irritation in body tissues making them susceptible to penetration and adherence by Candida species (Mbakwem, 2010).

Vaginal candidiasis; a yeast infection of the vulva and/or vagina caused by Candida species with Candida albicans being the major culprit is the most common type of fungal disease all over the world which affects the genital tract of women (Kamath et al., 2013; Esmaeilzadeh et al.,2009). Infection of the estrogenized vagina and the vestibulum that can spread to the outside of the labia minora, the labia majora, and the intercrural region is defined as vulvovaginal candidosis (Farr et al., 2021).

About 90% of this infection is caused by Candida albicans and 10% by other species of Candida (Emeribe et al., 2015). This infection has been reported as the commonest cause of vaginitis, second to bacterial vaginosis (Al-Ahmadey and Mohamed, 2014).  This infections occur when there is an imbalance in the pH of the vagina. The over-growth of this fungus in the vagina leads to a burning sensation in the vagina vulva, the production of heavy white/yellow curd- like discharge and/or an itchy vulva, dyspareunia, dysuria, irritation, soreness of the vulva and other discomforting symptoms that will ensure frequent hospital visits (Emeribe et al., 2014)

Based on the clinical presentation and antifungal response, vaginal candidiasis can be classified as either uncomplicated or complicated. Uncomplicated vaginal Candidiasis, mostly caused by C.albicans causes mild to moderate symptoms. Whereas complicated vaginal candidiasis is mostly caused by non-albicans Candida species (C. glabrata, C. tropicalis, C. krusei and C. parapsilosis) and are common among immune-compromised individuals and pregnant women (Hainer and Gibson, 2011).

Complicated vagina candidiasis occurs in nearly 10%-20% of women necessitating appropriate diagnosis. In the majority of cases, clinical diagnosis is apparent. However, microscopic diagnosis with KOH mount or Gram stain, use of immunochromatography test, and culture may be required especially in complicated vagina candidiasis (CDC, 2015).

There are common risk factors associated with or seen among female patients with vaginal candidiasis. These includes among other factors such as pregnancy, use of oral contraceptives and antibiotics, diabetes mellitus (Gonçalves et al., 2015). Some pregnancy-related factors such as increased estrogen levels, increased vaginal mucosal glycogen production, and decreased cell-mediated immunity are likely to cause both asymptomatic colonization and the increased risk of vagina candidiasis (Aguin and Sobel, 2015).

Treatment with intravaginal or systemic antifungal agents is effective in uncomplicated cases. In a complicated or recurrent VVC, combined intravaginal and systemic therapy may be required (CDC, 2015).

Given the multiple risk factors, changing disease patterns with increasing number of recurrent and complicated infections, it is essential to understand the management strategies in special situations and different treatment strategies (Ashwini et al., 2022).

Women are prone to this kind of infection, a good vaginal hygiene is essential in order to reduce the probability of candidiasis occurrence (Suzie, 2018).

1.2 Statement of problem

Vaginal candidiasis is an endemic problem globally. Since Candida species are part of the natural flora in healthy females. They become pathogen under certain conditions such as the presence of invading pathogens or biochemical changes in the vagina environment making them common aetiology agents to vaginitis.  There is a paucity of information on the prevalence and associated risk factors of vaginal candidiasis especially among apparently healthy females in the South West Region of Cameroon. Since Kumba is increasingly drawing residents from the local villages such as Mbonge, carrying out a study in this area will help provide value data for intervention and provide knowledge to the population which can be extrapolated to others communities.

1.3 Research Questions

1. What is the prevalence of vaginal candidiasis among women of the child bearing age in Kumba Regional Hospital Annex?
2. What is the association between socio-demograhic factors and vaginal candidiasis prevalence in Kumba Regional Hospital Annex?
3. What are the predisposing factors associated with vaginal candidiasis among women of child bearing age in Kumba Regional Hospital Annex?

1.4 Research Objectives

1.4.1 General Objectives

The main objective was to determine prevalence and risk factors associated with vaginal candidiasis among women of child bearing age attending the Kumba Regional Hospital Annex.

1.4.2 Specific Objectives

The specific objectives of the study are;

• To determine the prevalence of vaginal candidiasis among women of the child bearing age attending the Kumba Regional Hospital-Annex
• To determine the prevalence of vaginal candidiasis among women of child-bearing age with respect to socio-demographic data at the Kumba Regional Hospital-Annex.
• To determine the risk factors associated with vaginal candidiasis among women of child bearing age at the Kumba Regional Hospital-Annex.