CHAPTER ONE
INTRODUCTION
1.1 Background
Pelvic inflammatory disease (PID) is an infection of the upper genital tract that has important
reproductive consequences to women (Paavonen et al., 2008). It is one of the most frequent
and occurring infection among non-pregnant women of reproductive age (Mahon et al.,
2005). PID is a complication often caused by some sexually transmitted disease (STDs) like
chlamydia caused by Chlamydia trichromatis and gonorrhea caused by Neisseria
gonorrhoeae, and other microorganisms which are not sexually transmitted like the normal
flora in the vagina such as Gardnerella vaginitis, Haemophilus influenza, enteric Gram
negative rods and Streptococcus agalactiae. These organisms can travel in to the upper
genital organ through Douching, altering the vagina normal flora leading to pelvic
inflammatory disease (Okon et al.,2008)
PID is caused by an ascending spread of microorganisms from the vagina or uterine cervix
into the upper genital tract (Raya et al., 2013, Shepherd, 2013). If left untreated, it progresses
to a pelvic inflammatory disease (Kennedy et al., 2012) which can lead to complications
such as infertility, ectopic pregnancy, menstrual disturbance, low birth weight babies, and
chronic pelvic pain.
Inherent defense mechanisms which exist to protect the colonization of the upper genital
tract are cervical mucus, endometrial and oviduct secretion which serves as a barrier against
ascending bacterial (Olowe et al., 2012, Soper, 2010). Endometritis and oviduct secretion
also protects the upper genitalia by washing out bacterial from the endometrium and
fallopian tube respectively (Olowe et al.,2012). Despite these defense mechanisms,
microorganisms still ascend the upper genital tract which is facilitated through passive
transport and through the aids of vectors such as spermatozoa (Kunz et al.,1996), uterine
instrumentation and insertion of intrauterine contraceptive device can inoculate the
endometrium which might lead to PID.
Some risk factors which are associated with the occurrence of PID include young age
(Simms et al.,2010), early coitarche ( Ugboma et al.,2014), multiple sex partners, previous
history of sexually transmitted infection or PID, inconsistent use of condom, inappropriate
insertion of intrauterine contraceptive device, induced abortion. Being a woman of
reproductive age is a risk factor because sexual activities usually occur during this stage. It
is more common in young women like does lower than 25years compared to woman older
than 25yrs.
The prevalence of PID among adolescent and young adult is attributed to behavioral,
anatomical and hormonal factors. They often engage in high risk sexual behavior such as
having multiple sexual partners, frequent and unprotected sex, low contraceptive use in
which they don’t consider the long term effect of this behavior ( Raya et al.,2013, Fetusi and
Blum, 2008).
Another factor that attributes to the high risk of acquiring PID among adolescent and young
adult could be the anatomy of their developing cervix. The epithelium of their immature
ectocervix is mainly columnar, exposing a relatively large surface area, which facilitates
attachment of microorganisms like C.trichomatis and N. gonorrhoeae. With increasing age,
this columnar tissue undergoes squamous cell epithelium which then covers the normal adult
ectocervix or simple regresses into the endocervical canal (Raya et al., 2013).

Similarly, those women with previous history of PID are at greater risk of acquiring PID
(Olowe et al 2012, Ugboma et al.,2014). These may be due to poor treatment leading to
chronicity of the infection, it could also be due to reinfection after treatment (Mahon et
al.,2005). Inaccurate information regarding PID and STIs among members of the public are
also known as risk factors for PID (Simms et al.,2006, WHO, 2006-2015), living in an
environment with high prevalence of STIs has also shown to increase the risk of developing
PID (Stepherd et al.,2012) This is because, the person with STIs and PID would easily
transmit the infection to others. Consistence use condom has been shown to significantly
reduce the risk for developing PID as well as preventing unwanted pregnancy. (Urassa et al.,
2008)
Laparoscopy has been found to be the gold standard in diagnosing PID, Fever greater than
38 degree Celsius, abnormal discharge from the cervix or vagina, gonorrhea and chlamydia
test positive, Endometrial biopsy, imaging such as ultrasound or magnetic resonance
imaging are the essential method in diagnosing PID ( Okon et al., 2008). This study aims at
identifying the prevalence and risk factors of pelvic inflammatory disease among women of
reproductive age attending the Regional Hospital Buea.
1.2 Problem Statements
Pelvic Inflammatory Disease has turn to be the major problem in the Regional Hospital Buea
due to an increase in the number of women diagnosed with pelvic inflammatory disease and
infertility among women visiting the gynecological section. Past record on pelvic
inflammatory disease from January to March 2023 indicates that 36 women were diagnosed
of PID with most of it being sexually transmitted and few were post-partum followed by 19
women diagnosed of Infertility with majority of the women being diagnosed of secondary
infertility and few were diagnosed of primary infertility, therefore presenting as a major
public health problem for the prevalence and risk factor of PID among women of
reproductive attending the Regional Hospital Buea (Records from Regional Hospital Buea).
Pelvic Inflammatory Disease is the cause of about 30% of infertility cases and 50% of
ectopic pregnancies. Therefore presenting as a significant public health and economic
burden for women in reproductive age (Oqba et al 2021). The incidence of acute PID has
decreased in many countries (Wisenfeld et al.,2012). In Africa its prevalence is quite high.
About 70% of PID hospital admission in sub-Saharan Africa are result of reproductive tract
infection, while 34% in Asia and 31% in developed countries( Brabin et al.,1993) , though
it is true prevalence is not well known because the majority of cases are subclinical
(Rohrbeck et al.,2002-2012, wisenfeld et al.,2012). According to previous studies, the
prevalence of PID varies between 0.28% and 67% worldwide (French et al.,2011). In
Cameroon, the prevalence of PID carried out in Yaounde in the gynecological unit of the
teaching hospital and the central hospital between October 1st 2013 and March 31st 2014 a
research was conducted and was recorded that, out of 1344 women who were seen for
gynecological problems giving a hospital based prevalence of PID, 70 patients was
diagnosed with acute PID (Nkwabong and Dingom, 2015). Apart from the research on the
prevalence of PID carried out by Nkwabong and Dingom in Yaoundé Cameroon, no research
has been carried out in Cameroon especially Buea with youths making the majority of the
population. This research addresses the prevalence and risk factors of PID among women
of Reproductive age attending the Regional Hospital Buea.
1.3 Rational
The purpose of this study was to determine the prevalence of pelvic inflammatory disease
and its associated risk factors among women of reproductive age attending Regional hospital

Buea during the period of data collection from January to March in order to recommend
solutions in the prevention of pelvic inflammatory disease.
1.4 Research Questions
 What is the prevalence of pelvic inflammatory disease among women of reproductive
age attending the Regional Hospital Buea
 What are the risk factors associated with the prevalence of pelvic inflammatory
disease among women of reproductive age attending the Regional Hospital Buea.
1.5 Objectives
1.5.1 General objectives
 The general objective is to determine the prevalence of pelvic inflammatory disease
and its associated risk factor among women of reproductive age attending the
Regional Hospital Buea.
1.5.2 Specific Objectives
 To determine the prevalence of pelvic inflammatory disease among women of
reproductive age attending the regional hospital Buea
 To identify the risk factors associated with the development of pelvic inflammatory
disease among women of reproductive age attending the regional hospital Buea