Prevalence of bacterial vaginosis in pregnant women attending Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria using the complete Amsel’s diagnostic criteria

Abstract

Background: Bacterial vaginosis (BV) in pregnant women remains a cause for clinical concern among clinicians and health care professionals. BV  has been linked to prenatal, antenatal and postnatal challenges in pregnant women. Information on prevalence of BV across trimesters of  pregnancy is expected to give better clinical insight into the pathophysiology of this polymicrobial disorder. This study was conducted to determine  the prevalence of BV in pregnant women attending the Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, Nigeria.

Methodology: This was a cross-sectional study of 120 pregnant women (40 in each trimester of pregnancy) who had symptoms suggestive of BV,  selected by systematic random sampling from among the women attending the Obstetrics and Gynaecology (O & G) clinic of NAUTH, Nnewi. Each  subject participant was examined by the attending clinician, and high vaginal swab (HVS) sample was collected for diagnostic analysis of BV using  with complete Amsel’s clinical criteria, which consists of three of the four criteria; (i) adherent and homogenous vaginal discharge, (ii) vaginal pH >  4.5, (iii) detection of clue cells on saline wet mount, and (iv) amine odor after the addition of potassium hydroxide (positive Whiff test).

Results: The mean age of the 120 selected participants was 27.25±6.09 years. The age groups 25-29 (36.7%) and 20-24 years (33.3%) constituted the  largest proportion, while age groups <20 (5.0%) and 40-45 years (5.0%) constituted the least. Of the 120 participants, 26 (21.7%) were positive for BV  by the Amsel’s criteria. Pregnant women in age group <20 years had the highest prevalence of BV (100%, 6/6), followed by those in the age groups  20-24 (27.5%), 40-45 (16.7%), 25-29 (15.9%), 30-34 (9.1%) and 35-39 years (0%) (X²=28.063, p=0.0001). Prevalence of BV was significantly higher in  single (unmarried) pregnant women (45.5%, X²=4.038, p=0.045), women with primary school education level (66.7%, X²=14.530, p=0.001),  unemployed women (36.1%, X²=13.278, p=0.0013), and nulliparous women [36.4%, X² (for trend) = 4.805, p=0.0274), while there was no significant  difference in the prevalence of BV with relation to trimester of pregnancy (X²=2.750, p=0.253).

Conclusion: This study reveals a relatively high prevalence of BV and significant association with factors such as age group, education and  occupational status among pregnant women attending NAUTH Nnewi. Regular screening of women for BV prenatally may enable appropriate  interventions to prevent adverse pregnancy outcomes.