ABSTRACT

This study examined the prevalence of fungal infection among pregnant women attending Wushishi General Hospital. The study covered pregnant women who attend the unit of obstetrics and gynecology during the period of March – June 2021. This study adopted a descriptive –cross-sectional research design. The study included pregnant women who presented with self-reported symptoms of abnormal vaginal discharge, itching, and genital burning or burning micturition. The study utilized a non-probability sampling method, totaling one hundred pregnant women. Data was collected by self-interviewing and questionnaire. The result revealed that 48 (48%) samples were positive for VC, while 52 (52%) samples were negative. The most frequently encountered species was Candida albicans 28 (58%), followed by C. parapsilosis 10 (21%), C. guilliermondii 8 (17%), and C. glabrata 2 (4%). According to the duration of pregnancy, 24 (50%) of infected pregnant women were in the third trimester, 16 (33%), 8 (17%) in the first and second trimester respectively. Statistically, there was a significant association (p value= 0.001) between VC and duration of pregnancy. Regarding the medical history of the disease (VC), 14 (29%) of pregnant women have a past infection; C. abicans is the most causative agent for all cases. This study concluded that VC is a fungal disease of considerable importance during pregnancy as (48%) of pregnant women under study suffered from it. Also, Itching, pain, and whitish vaginal discharge were the main signs and symptoms of VVC, but laboratory support is necessary for a differential diagnosis or to confirm the clinical diagnosis of vaginal candidiasis. The study recommended that diagnosis of fungal infection should not be made on clinical criteria only, because sometimes women have another condition. Also, Health education program should be introduced for all pregnant women to recommend prevention, early diagnosis, and increase awareness about the importance of treatment because multiple unreasonable miscarriage and neonatal death has been reported.

 

 

 

 

CHAPTER ONE

INTRODUCTION

1.1. Introduction

A fungal infection, also called mycosis, is a skin disease caused by a fungus (Abdelaziz et al., 2021., Rasti et al., 2020). There are millions of species of fungi. They live in the dirt, on plants, on household surfaces, and on your skin. Sometimes, they can lead to skin problems like rashes or bumps. A fungus that invades the tissue can cause a disease that’s confined to the skin, spreads into tissue, bones, and organs, or affects the whole body (Abdelaziz et al., 2021., Rasti et al., 2020). Symptoms depend on the area affected but can include skin rash or vaginal infection resulting in abnormal discharge. Candidiasis is a fungal infection caused by a yeast (a type of fungus) called Candida. Some species of Candida can cause infection in people; the most common is Candida albicans. Candida normally lives on the skin and inside the body, in places such as the mouth, throat, gut, and vagina, without causing any problems (Rathod and Buffler, 2021).

Vulvovaginal Candidiasis (VVC) is described as consisting of a white “cottage cheese” discharge with associated vulval 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 women of reproductive age, with high incidences during pregnancy (Abdelaziz et al., 2021).

Microbial infections of the vagina (vaginosis and vaginitis) among pregnant women are serious problems because they can lead to serious medical complications such as preterm labor, amniotic fluid infection, premature rupture of the fetal membranes, and low birth weight of the neonate (LBW), leading to high prenatal mortality. However, proper identification and treatment will reduce the risk of preterm birth and its consequences (Abdelaziz et al., 2021., Rasti et al., 2020).

Vulvovaginal candidiasis (moniliasis or thrush) is a commonly reported gynecological condition and frequently distressing infection for many pregnant women (Kamath et al., 2021). Which may cause systemic infections in neonates (Rasti et al., 2020). And is diagnosed in a large proportion of women of different age groups, regardless of their sexual activities presenting to medical facilities with a complaint of abnormal vaginal discharge (Rathod and Buffler, 2021., Oyewole et al., 2020).

Numerous studies around the world showed that Candida albicans is responsible for the largest number of symptomatic episodes of vaginal candidiasis. Nonalbicans species are most commonly represented by C. tropicalis, C. glabrata, and C. krusei. Accurate species identification is important for the treatment of the Candida infections, as the non-albicans species of Candida continue to be increasingly documented (Kazemi et al., 2020).

While not a cause of mortality, the morbidity associated with vulvovaginal candidiasis make it a major cause of mental distress and economic costs. Though there are well-recognized limitations of the existing epidemiologic data for vulvovaginal candidiasis (Rathod and Buffler, 2021).

For unknown reasons, they are more prevalent in women in sub-Saharan Africa and other low-income countries than in women in developed countries, affecting up to 55% of women in some studies (Abdelaziz et al., 2021).

 

1.2. Statement of the problem

In developing countries, there is scanty data on fungal infections such as vaginal candidiasis in pregnant women and the distribution of the vaginal Candida species (Nelson et al., 2020). In Nigeria, there is little data about vaginal infections in pregnant women; a crosssectional study of pregnant women was conducted at Omdurman Maternity Hospital, Niger State, Nigeria, found Candida albicans was detected in (16.6%). Higher infection rates were recorded among subjects in the third trimester (71.6%) than in the second trimester of gestation (28.4%) (Abdelaziz et al., 2021). Also another study conducted to determine the prevalence of bacterial vaginosis and vaginal candidiasis in the 100 pregnant women was to 14%, 73% respectively. Gardnerella vaginalis was isolated in 14 (14%) samples, Candida albicans in 73 (73%) samples, combined infection with Gardnerella vaginalis and Candida albicans was detected in 3 (3%) samples (Ahmed et al., 2021).

 

1.3. Objectives

This study designed to fulfill the following objectives:

1.3.1. General objective

To detect the prevalence of fungal infection among pregnant women attending Wushishi General Hospital in period from March to June 2021.

1.3.2. Specific objectives

1. To isolate and identify Candida
2. To establish the frequency of Candida albicans among pregnant women.

• To determine the association of vaginal candidiasis with age, trimester, gravidity and antifungal treatment.

 

1.4. Justification of the study

Vaginal candidiasis in untreated pregnant women can lead to transmission to their infant (such as cutaneous candidiasis of neonates) and may be associated with sterility and sub fertility as the complication of Pelvic Inflammatory Disease (PID) (Parveen et al., 2008), because of this accurate and prompt diagnosis is mandatory. Also, the laboratory can help the clinician to distinguish between different types of infections.

Increased awareness about mycosis and partial availability of resources were a motive to start establishing a specific technique in diagnosis of fungal vaginitis.

 

1.5 Scope of the study

The study focused on the prevalence of fungal infection among the pregnant women attending Wushishi General Hospital. The study was restricted to pregnant women who attend the unit of obstetric and gynecology during period of March – June 2021.

 

1.6 Limitation of the study

Financial constraint– Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information.

Time constraint– The researcher will simultaneously engage in this study with other academic work. This consequently will cut down on the time devoted for the research work.

 

 

 

 

 

 

CHAPTER TWO

LITERATURE REVIEW

2.1. Vaginal Candidiasis (VC)

2.1.1. Anatomy of the female genital tract

The female reproductive system consists of the paired ovaries and fallopian tubes, the single uterus and vagina, and the external genital structures (Scanlon and Sanders, 2007).

A normal function of the vaginal walls and the cervix is to produce secretions. The secretions can sometimes be noticed outside of the vagina (this is referred to as ‘ normal vaginal secretions and discharge change from time to time; sometimes clear, almost like water, and at other times, mucousy and whitish in color, sometimes scant and, at other times, larger in amount. These are normal variations.  Normal vaginal secretions and discharge may vary from one woman to another depending on: the stage of the menstrual cycle, menopause, whether a woman is taking contraceptives or hormone replacement medications, whether the woman is pregnant or not and state of sexual arousal (Berkow et al., 2001).

2.1.2. Definition of VC