Date of Award

Spring 5-12-2017

Degree Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

Public Health

First Advisor

Dr. Richard Rothenberg

Second Advisor

Dr. Moges Seyoum Ido

Abstract

Background: Bacterial vaginosis (BV) is an important genital syndrome affecting a large number of the women in the reproductive age group. It is identified by alterations in the normal vaginal flora and a malodorous discharge when symptomatic. Some of the risk factors for BV include low socio-economic status, poor hygiene, cigarette smoking, douching, antibiotic use for other conditions, young age of coitarche, new sex partners or multiple sex partners, race, ethnicity, education, income and age. This study will be determining the correlation of BV with the adverse pregnancy outcomes and the predictors that affect the adverse pregnancy outcomes in women diagnosed with bacterial vaginosis (BV).

Methods: Secondary data set from Rawalpindi Pakistan was analyzed using SAS. Outcome parameters included abortions, ectopic pregnancy and still birth. Chi-square test (for numbers) was used for bivariate analysis to determine the significance of association between categorical variables. The t-test was used for the univariate analysis of numeric variables. The potential risk factors, associated with bacterial vaginosis from the literature and results of this study were evaluated by logistic regression analysis. A multivariate logistic regression was run to look at all the adverse pregnancy outcomes of Bacterial Vaginosis individually and as a combination by controlling for all the socio-demographic and sexual risk factors.

Results: About half (49.4%) of the women had an adverse pregnancy outcome in the past, and abortion was the most prevalent (37.7%). A history still birth was seen in 31(9.3%) females and ectopic pregnancy was also observed in 31 (9.3%) females. On bivariate analyses, educational status (P-value= 0.0026), Economic status (P- value= 0.0010), having alive children (P-value=0.0001) and pregnancy status of women (P-value= 0.0327) showed a statistically significant association with the adverse pregnancy outcomes. Multivariable analyses showed no statistically significant associations between BV and the aggregate adverse pregnancy outcomes. Among the population characteristics, economic status and having an alive child showed significant associations with the adverse pregnancy outcomes. Specific outcome analyses showed no significant association between BV and abortions, still birth or ectopic pregnancy.

Discussion: For this study adverse outcomes were studied as individual entities, abortions, still birth and ectopic pregnancy and also as a combined entity (presence of either of the mentioned adverse outcome). We tried to look at the association of the history of past pregnancy outcomes and current diagnosis of BV in women at the time the study took place. In this study increased odds for abortions (OR=1.210, CI:0.506,4.451) were seen in people with bacterial vaginosis compared to the people without bacterial vaginosis when diagnosed with BV on the basis of Nugent scoring system, the gold standard criteria. Overall, this study revealed a mixed result of BV having and association with adverse pregnancy outcomes in females, based on any of the diagnosing criteria. Economic status was found to be significantly associated with the adverse pregnancy outcomes in females diagnosed with BV.

Available for download on Wednesday, May 02, 2018

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