Smoking, poor nutrition, and sexually transmitted infections associated with pelvic inflammatory disease in remote North Queensland Indigenous communities, 1998-2005.

Ming Li,Robyn Mcdermott

doi:10.1186/s12905-015-0188-z

Ming Li, Robyn Mcdermott

Open Access

https://doi.org/10.1186/s12905-015-0188-z

Copy DOI

Abstract

BackgroundIndigenous women in remote North Queensland have a high prevalence of unhealthy lifestyle behaviors and associated health conditions such as sexual transmitted infections (STI). The association of severe pelvic inflammatory disease (PID) with these factors has not been studied. The purpose of this study is to associate the factors with severe PID, as indicated by hospitalization in a high risk population in North Queensland Indigenous communities.MethodsA cross-sectional association of 1445 Indigenous women using linked hospital separation and survey data during 1998–2005.ResultsThe mean age of participating women was 37.4 years, 60% were of Aboriginal and 40% were Torres Strait Island (TSI) people. More than half of them (52.5%) were smokers, 9.3% had chlamydia and 2.6% had gonorrhoea with the overall prevalence of STI among those less than 25 years of age being 23.9%. Among the 47 participants diagnosed with PID in the study period, 42.5% were under 25 years and 95.7% (45 cases) were under 55 years (OR 2.5, 95% CI 1.2-4.1 among women younger than 25 compared to those 25 years and over). PID was strongly associated with smoking (OR 3.1, 95% CI 1.4-9.2) independent of age, ethnicity, STI and folate status. Low red cell folate increased PID hospitalization by 4 times (95% CI 1.5-13.2 of lowest quartile compared to the highest quartile) regardless of age. Having a STI significantly increased the likelihood of severe PID by 2.2 times (95% CI: 1.03-4.5) in Indigenous women younger than 45 years, independent of smoking and folate level. The risk of PID hospitalization was higher for gonorrheal infections (OR 3.2, 955 CI 1.1-9.6) compared to chlamydial infections (OR 1.5 95% CI 0.7-3.5).ConclusionsYoung Indigenous women in North Queensland communities are at very high risk for STI and PID. Smoking, low folate, and STI are clustered, and are associated with PID hospitalizations. Much of this can be prevented with improved nutrition and access to preventive services, especially tobacco control, regular STI screening and treatment, as well as more investment in sexual health education and awareness.Electronic supplementary materialThe online version of this article (doi:10.1186/s12905-015-0188-z) contains supplementary material, which is available to authorized users.

Highlights

Indigenous women in remote North Queensland have a high prevalence of unhealthy lifestyle behaviors and associated health conditions such as sexual transmitted infections (STI)
It is theorized that factors that impair the immune system, including poor nutrition, may increase susceptibility to bacterial vaginosis (BV), which is associated with nonchlamydialnongonococcal pelvic inflammatory disease (PID) [5,6]
Forty seven women had PID recorded in the diagnosis fields in hospitalization records with a prevalence of 5.1%

Summary

Introduction

Indigenous women in remote North Queensland have a high prevalence of unhealthy lifestyle behaviors and associated health conditions such as sexual transmitted infections (STI). The purpose of this study is to associate the factors with severe PID, as indicated by hospitalization in a high risk population in North Queensland Indigenous communities. Pelvic inflammatory disease (PID) is defined as inflammation of the upper genital tract including the endometrium, fallopian tubes and/or contiguous structures that follow infection from micro-organisms that ascend from the cervix and/or vagina [1] It is associated with longterm morbidity including infertility, chronic pelvic pain, and ectopic pregnancy which are costly to individuals, and health care systems [2], but it is preventable and treatable with early diagnosis and effective management of sexually transmitted infections (STI) [3,4]. In spite of the direct and indirect evidence relating PID with STI, folate status, and cardiovascular conditions among various populations using different study designs, the association of these factors with PID has not been explored among

Objectives

Methods

Results

Discussion

Conclusion