Prevalence, Bacteriology and Factors associated with Pelvic Inflammatory Disease Among Women Attending the Gynecology Clinic at Kampala International University Teaching Hospital, Uganda.
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Date
2020-01
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Kampala International University
Abstract
Background: Pelvic inflammatory disease (PID) is major health problem in developed and developing country involving more young women. It is associated with high rate of female reproductive health morbidity; it can complicate with ectopic pregnancy, infertility and chronic pelvic pain. A poor response therapy increases the likelihood of these complications; this could be due to an increase in antimicrobial resistant pathogens.
Objectives: To determine prevalence, identify factors, common bacterial pathogens from endocervical swab of women with PID and antibacterial susceptibility pattern at Kampala International University Teaching Hospital.
Research methods: This was a cross-sectional study conducted among women who attended gynecology clinic at Kampala International University Teaching Hospital. Consecutive enrolment of 324 participants who consented to participate was done daily until a required sample size was realized from November 2019 to January 2020. Structured questionnaires were used to collect data on associated factors; endocervical swab was taken from patient clinically diagnosed with PID. Culturing for colony characteristics followed by Gram stain was used for provisional identity of pathogenic bacteria. Further identification was done by a set of biochemical tests. Antibacterial susceptibility pattern of isolated bacterial pathogens was determined by Kirby Bauer disc diffusion method, a rapid diagnostic test to detect Chlamydia antibody in the endocervical swab sample was also used to identify the Chlamydia trachomatis carriers among the patients. Data was analyzed using STATA VERSION 14.2.
Results: The prevalence of pelvic inflammatory disease was 19.1%. Not being educated, having two or more sexual partners, previous history of PID and induced abortion, also the previous use of contraceptives specifically the use of IUD ,were all significantly associated with Pelvic inflammatory disease (P value <0.05). The isolated bacteria was Staphylococcus aureus and the least-prevalent pathogen was citrobacter species. Staphylocccocus aureus showed high susceptibility to Imipenem. The high resistence rate of more than 60% was seen to the commonly prescribed antibiotics as recommended by Uganda clinical guideline these were Doxicillin, ciprofloxacin, Cefixim and Ceftriaxon.
Conclusion and recommendations: The prevalence of PID is HIGH at KIU-TH. Not being educated, having two or more sexual partners, previous history of PID and induced abortion, also the previous use of contraceptives specifically the use of IUD are significantly associated with PID. Staphylococcus aureus is the commonest organism isolated from the endocervical swab of patients with PID. Awareness amongst health workers and patients about these major factors so that management can be directed. Rational use of antibiotics by health workers is paramount to combat resistance.
Description
A Research dissertation submitted to the school of postgraduate studies in partial fulfillment of the requirements for the award of degree of master of Medicine in obstetrics and gynecology of Kampala International University