Towards improved menstrual health: the impact of period products on reproductive tract infections

Knowledge, Behaviors and Prevalence of Reproductive Tract Infections: A Descriptive Study on Rural Women in Hunchun, China

Background: Women’s undernutrition is a major concern in many sub-Saharan African countries including Ethiopia; however, little information exists on its spatial and temporal variation within a single national context. This paper examines spatial and temporal variations in women’s undernutrition and its determinants in Ethiopia between 2000 and 2016. Data source and methods : We use data from the Ethiopia Demographic and Health Surveys from 2000 to 2016. We used multilevel logistic regression models with region-level random effects to estimate determinants of undernutrition. Results: The results show substantial regional variations in women’s undernutrition in Ethiopia, which show mixed patterns over time. Also, the regional variations are significantly affected by age, education level, marital status, wealth, occupational status and type of residence as well as some aggregate factors. Undernutrition risks are considerably higher for teenage women, no education, never-married, unemployed, and rural women, as well as women from poor households than their counterparts. Additionally, in regions with lower levels of women’s education, the risk of undernutrition was higher. Conclusions : Regional variations in women’s undernutrition in Ethiopia are significantly determined by individual sociodemographic, economic and community level characteristics. Policy decisions should focus on bridging the regional disparities in the country, especially in areas that have made little progress in reducing women’s undernutrition.

The goal of this study was to examine risk of reproductive tract infections (RTIs) among women in rural China, including prevalence, influence of sociodemographic characteristics, knowledge, hygienic practices, attitudes, and behaviors related to premarital and extramarital sex, and abortion. During 2000, a stratified cluster sample of 606 rural married women in Hainan province completed an interviewer-administered standardized questionnaire. Overall, 39% of participants reported at least 1 RTI symptom in their lifetime and 20% during the past 6 months. Having had premarital sex, having sex during menstruation, belonging to an ethnic minority, being knowledgeable about RTIs, and living in a village at medium economic level were all related to having RTI symptoms. Among married women in rural China, the prevalence of RTI symptoms was high, indicating the need for health education, particularly targeting women from ethnic minorities and resource-poor areas.

To define the prevalences and manifestations of reproductive tract infections (RTIs) in rural Peruvian women. During 1997-98, we visited 18 rural districts in coastal, highlands, and jungle regions of Peru. We administered standardized questionnaires and pelvic examinations to members of women's community-based organizations; and collected vaginal fluid for pH, amine odour, Gram stain, microscopy, and culture for Trichomonas vaginalis; cervical specimens for Chlamydia trachomatis, Neisseria gonorrhoeae; human papilloma virus (HPV) by polymerase chain reaction (PCR) assays, and blood for syphilis serology. The 754 participants averaged 36.9 years of age and 1.7 sex partners ever; 77% reported symptoms indicative of RTIs; 51% and 26% reported their symptoms spontaneously or only with specific questioning, respectively. Symptoms reported spontaneously included abnormal vaginal discharge (29.3% and 22.9%, respectively). One or more RTIs, found in 70.4% of participants, included bacterial vaginosis (43.7%), trichomoniasis (16.5%), vulvovaginal candidiasis (4.5%), chlamydial infection (6.8%), gonorrhoea (1.2%), syphilis seropositivity (1.7%), cervical HPV infection (4.9%), and genital warts or ulcers (2.8%). Of 715 adequate Pap smears, 7 revealed cancer, 4 high-grade squamous intra-epithelial lesions (SIL) and 15 low-grade SIL. Clinical algorithms had very low sensitivity and predictive values for cervical infection, but over half the women with symptoms of malodorous vaginal discharge, signs of abnormal vaginal discharge, or both, had bacterial vaginosis or trichomoniasis. Overall, 77% of women had symptoms indicative of RTIs, and 70% had objective evidence of one or more RTIs. Women with selected symptoms and signs of vaginal infection could benefit from standard metronidazole therapy.

IntroductionThe public health burden of reproductive tract infections (RTIs) among women in rural areas of low-income countries is poorly addressed because health care seeking for treatment of RTIs is inadequate. There are gaps in knowledge about whether low care seeking behavior stems from challenges in accessing health care versus women's recognition of and response to RTI-specific disease symptoms. We aim to identify determinants of care seeking behavior and analyze the difference in utilization of health care resources in response to symptoms of an RTI versus non-RTI disease symptoms in rural India. This will aid in the design of interventions that promote RTI care seeking behavior.MethodsOur analysis uses data from a cross-sectional, population-based surveillance survey among rural, non-pregnant women in Odisha, India, from 2013–2014 (n = 3,600). We utilized bivariate logistic regression to determine the degree that certain determinants are associated with a woman’s likelihood to seek RTI treatment, and chi-Squared tests to assess for differences in health care resources used for non-RTI versus RTI symptoms.ResultsMarried women were significantly more likely to seek health care for RTI symptoms (Odds Ratio (OR) = 1.9, 95% Confidence Interval (CI): 1.2–3.0) while unmarried adolescents were less likely to seek treatment (OR = 0.4, CI: 0.2–0.6). There was no association between RTI health care seeking with education level, belief about whether symptoms can be treated, or poverty. The majority (73.8%) of women who did not seek treatment for RTI symptoms reported not seeking treatment because they did not know treatment was needed. Women utilized formal health care providers at a higher rate in response to RTI symptoms than in response to their most recent symptoms of any kind (p = 0.003).ConclusionsCommunity-based reproductive health education interventions are needed to increase health care seeking behavior for RTIs in rural Indian women. Interventions should target unmarried women and focus on both sexual health education and access to care.

Introduction: Women’s health during the reproductive or fertile years is relevant not only to women themselves, but also its impact on the health and development of the next generation. Reproductive tract infections are a hidden epidemic leading to enormous health and economic consequences worldwide. Materials and methods: A comparative descriptive study was conducted to assess the knowledge and attitude of urban and rural women regarding Reproductive Tract Infections (RTIs) in selected Urban and Rural areas Guntur Dist. Andhra Pradesh. The study was conducted among the women who are in the age group of 20 years to 60 years. Sample for this study was 75 women from urban area and 75 women from rural area, comprising a total size of 150 and the participants are selected by Simple random sampling technique. Structured Knowledge questionnaire and Likert 5 point attitude scale was used to collect the data. The responses are tabulated, organized, analyzed and interpreted by using descriptive and inferential statistics based on objectives of the study. Results: Findings revealed that half (49.33%) of the respondents from urban area had moderately adequate knowledge and three fourth (84%) of the rural women had inadequate knowledge. Majority (66.66%) of the urban women had highly favorable attitude and most (97.33%) of the rural women had only favorable attitude regarding RTIs. The relationship between the knowledge and attitude level of the urban women (r=0.765) and rural women (r=0.514) revealed that there was strong positive correlation. Conclusion: The study concluded that the knowledge and attitude of urban women was high compared to rural women. There is a need to educate the women on preventive strategies as women are less likely to seek treatment because of the stigma associated with it.

Recent studies in Indonesia have reported significant levels of STDs in low-risk urban groups. To gather data on rural women, a prevalence study was undertaken in Bali utilizing a women's health mobile clinic. Rural (n=312) women were tested for vaginal reproductive tract infections (RTIs) by on-site wet mount, for Neisseria gonorrhoeae and Chlamydia trachomatis by unamplified DNA (Gen-Probe) test, and for syphilis by rapid plasma reagin (RPR). Results were: candidiasis 5.8%; bacterial vaginosis (BV) 37.2%; trichomoniasis 15.1%; gonorrhoea 0.7%; chlamydial infection 5.6%; syphilis 0%. Overall 55.1% had at least one RTI and 19.2% had at least one STD. Reported non-monogamy, pain with urination and genital lesions, observed cervical friability and cervical motion tenderness were associated with cervical STD infection (P<0.05). We conclude that there is a need for improved services for STD prevention and RTI/STD management in rural Bali, and for condom promotion.

Despite being curable reproductive tract infections (RTIs) including sexually transmitted infections continue to be a major health problem in developing countries. The present study was undertaken to know the prevalence of trichomoniasis, vaginal candidiasis, genital herpes, chlamydiasis, and actinomycosis in rural and urban women of Haryana by using wet mount, PAP smear, and fluorescent microscopic examination. Patients suspected of suffering from bacterial vaginosis were given treatment and were not included in the study. RTIs were seen in 16.6% of urban and 28.7% of rural women. The highest prevalence seen was that of trichomoniasis in both rural (24.2%) and urban (15.7%) women, followed by candidiasis (4.2% in rural and 0.6% in urban women), genital herpes (0.3% in rural and 0.2% in urban women), and chlamydiasis (0.02% in rural and 0.05% in urban women). Pelvic actinomycosis was seen in 1.4% of rural and 0.06% of urban women using intrauterine contraceptive devices. Mixed infection of Trichomonas vaginalis with Candida spp. was seen in 6.3% of rural women only. It is desirable to have a baseline profile of the prevalence of various agents causing RTIs in a particular geographic area and population which will help in better syndromic management of the patients.

Objective: This study aimed to determine the prevalence of reproductive tract infections (RTIs) among fertile women in rural and urban areas. Methods: A systematic random sampling was conducted in women aged 15-49 years from rural and urban areas in Eastern Gujarat, India. They were surveyed using a structured pretested questionnaire. Descriptive statistics and Chi-square tests were performed using IBM SPSS statistics 23 and Open Epi software for analysis. Results: Of 192 women of reproductive age included in this survey, 96 each were from rural and urban area. The prevalence of RTIs was 64.6% and 66.7% for women from rural and urban areas, respectively. Rural women had a high level of awareness about RTIs compared to urban women, while approximately half of the women lacked knowledge about transmission. After exposure, burning micturition was predominant among rural women (54.2%), while vaginal discharge was the most common systom (57.3%) in urban women. Urban women demonstrated a higher tendency to seek healthcare (98.4%) compared to rural women (75.8%). Age, education, occupation, family type, marital status, menstrual hygiene practices, years of marriage and parity were significantly associated with RTIs in urban areas. Non-barrier contraceptive methods were associated with a higher prevalence of RTIs in both rural (25.9%) and urban (31.7%) areas. Conclusions: The results indicate that urban and rural areas may be affected differently by various factors, with stronger associations observed in urban areas. Further contextual understanding analysis and in-depth research are required to gain more comprehensive insights.

To explore the correlation between induced abortion and reproductive tract infections (RTIs). On the basis of keeping the representation of cities under study, 53 652 fertile women aged 15 - 49 were surveyed by using a stratified-cluster-random sampling. Investigation and gynecological examination were conducted by two steps - firstly converging at the clinics, and then visiting those households for someone who did not show up at the clinics. Among all the 32.0% (n=16 800) women ever having experienced the history of induced abortion, 21.1% (n = 11 090) of them had one, 7.6% (n=3976) women had two, and 4.1% (n=1734) women had at least three events. 59.0% (n=30 959) women among our studied samples had ever had RTI, with 30.9% (n=16 215) of them had only one 20.0% (n=10 494) women had two and 8.1% (n=4250) had three or more RTIs. Data from χ(2) text and ordinal regression analysis revealed that the rural married women who underwent more induced abortions were more likely to suffer from RTIs, especially cervical infection and PID. Our study showed that the rates of induced abortion and reproductive tract infections among married women in Anhui province were both high. Women who underwent induced abortions had a higher prevalence rate of reproductive tract infections.

Introduction: The high prevalence of risk factors in women in developing countries of South Asia appears to have been translated into early and severe CHD in contrast to their counterpart in the first world nations, which has been related to obesity and insulin resistance and genetically determined increased lipoprotein Lp(a) levels. Mental stress due to urbanization, sedentary life style and physical inactivity may be the most important factor initiating obesity and the clustering of all other risk factors hypertension, dyslipidaemia and (WHR). These risk factors vary in different regions of South Asia. Aims and Objectives: Our aim of the study was to describe and analyse differences between the frequency of risk factors such as psychological stress due to, socio-economical aspects, life style especially physical activity, and health behaviours which may contribute in the course of CAD in women of both rural and urban areas of Pakistan because no such significant data is available in women with CAD. Study Design: This descriptive cross-sectional comparative study was conducted in Cardiology Department of Dow University of Health and Sciences Karachi, Pakistan, from March 2014 to March 2016 by filling a questionnaire and laboratory data. The study group comprised female subjects around 577 (Urban 347 {60.1%} and Rural 230 {39.9%}) women ranged from 25-65 years of age who underwent coronary angiography and had definite coronary atherosclerotic diseases. Our study was conducted by examining the psychological stress in women of both areas and its strength of association with frequency of other risk factors in female patients of urban and rural areas with definite CHD taking account the difference in age and education level into account. Result: Analysis of this study conducted at department of Cardiology in Dow University Karachi from March 2014 to March 2017 revealed that the women of rural area were comparatively more physically active then women of urban area. Prevalence of mental stress, hypertension, diabetes, obesity, higher BMI, hyperlipidaemia (especially TC) waist and hip circumference of both areas were found to be different after adjustment made for age. A considerable association was found between psychological stress and other factors in ischemic heart disease patients showing the p-value (p=0.043). Psychological stress was found 82% in both groups and (13%) women had no stress rated as normal more in rural (26%) vs (04%) in urban population. Physical inactivity in women with CHD was found in 92% urban in contrast to 45% in rural population, (p=0.009). Hypertension prevalence was more in urban 253 in comparison to 151 women in rural area. Diabetes Mellitus was also found more in urban than rural population, especially in age below 50, 79 (23%) urban vs 60 (26%) in rural population. Women beyond 50 years of age, 85 (24%) urban vs 64 (27%) rural area had prevalence of obesity comparatively higher in urban residents 71 (20%) than 44(%) in rural dwellers and 32 (9%) urban vs 16 (7%) in rural women in age range below 50 years. Higher waist circumstance was observed more in urban residents (4.8 cm) whereas BMI was more (1.8 unit) in women of rural area than urban women. Prevalence of smoking and nicotine chewing was relatively higher in urban population in below 50 years of age with 30 (09%) urban vs 13 (05%) in rural women and in age beyond 50, 11 (03%) urban vs 10 (04%) in rural women was witnessed. Average total cholesterol, serum triglycerides and LDL were found to be higher in urban compared to rural area residents and HDL was comparatively lower in urban area group. Mean cholesterol level was seen at average of 353 mg% in urban vs 223 mg% in rural population. Serum cortisol level showed significant variation in urban group 19.1 vs 14.2 in rural group (sample, as well as serum fibrinogen was raised more raised in urban population). Conclusion: Our study shows increased prevalence of mental stress and physical inactivity in female residents of urban area leading to Higher blood pressure, DM, dyslipidaemia and central obesity specially in Waist circumference than rural area. The mental stress induced by excessive demands of work at home and at working place with too little control is not unique to women of urban areas.

The most important period in the life span of women is the reproductive period, which extends from menarche to menopause.Reproductive tract infections are endemic in developing countries and entail a heavy toll on women.If untreated reproductive tract infections can lead to adverse health outcomes such as infertility, ectopic pregnancy and increased vulnerability to transmission of HIV.Quantitative evaluative approach was used and research design was one group pre-test post-test design.Sample were women of reproductive age group, sample size was 40 and sample technique was random sampling, setting for the study was Thano, Dehradun, tool used were self prepared knowledge questionnaire related to reproductive tract infections.Majority (80%) of the subjects were between 15 to 30 years.Majority (77.5%) of the subjects were married, majority of (77.5%) subjects had educational status up to higher secondary and above, majority of (55%) of the subjects have family monthly income above Rs 6,000, majority (65%) of the subjects were from nuclear family, majority of (57.5%) of the subjects had moderate pre-test knowledge score regarding reproductive tract infection.The mean of post-test knowledge score was higher than mean of pre-test knowledge score.Age, educational status and marital status had significant association with pre test knowledge score.Study showed that planned teaching programme regarding reproductive tract infections was effective in increasing women knowledge level.There was a significant association of knowledge level with age, educational status and marital status.

Women face greater challenges than men in accessing water, sanitation, and hygiene (WASH) resources to address their daily needs, and may respond to these challenges by adopting unsafe practices that increase the risk of reproductive tract infections (RTIs). WASH practices may change as women transition through socially-defined life stage experiences, like marriage and pregnancy. Thus, the relationship between WASH practices and RTIs might vary across female reproductive life stages. This cross-sectional study assessed the relationship between WASH exposures and self-reported RTI symptoms in 3,952 girls and women from two rural districts in India, and tested whether social exposures represented by reproductive life stage was an effect modifier of associations. In fully adjusted models, RTI symptoms were less common in women using a latrine without water for defecation versus open defecation (Odds Ratio (OR) = 0.69; Confidence Interval (CI) = 0.48, 0.98) and those walking shorter distances to a bathing location (OR = 0.79, CI = 0.63, 0.99), but there was no association between using a latrine with a water source and RTIs versus open defecation (OR = 1.09; CI = 0.69, 1.72). Unexpectedly, RTI symptoms were more common for women bathing daily with soap (OR = 6.55, CI = 3.60, 11.94) and for women washing their hands after defecation with soap (OR = 10.27; CI = 5.53, 19.08) or ash/soil/mud (OR = 6.02; CI = 3.07, 11.77) versus water only or no hand washing. WASH practices of girls and women varied across reproductive life stages, but the associations between WASH practices and RTI symptoms were not moderated by or confounded by life stage status. This study provides new evidence that WASH access and practices are associated with self-reported reproductive tract infection symptoms in rural Indian girls and women from different reproductive life stages. However, the counterintuitive directions of effect for soap use highlights that causality and mechanisms of effect cannot be inferred from this study design. Future research is needed to understand whether improvements in water and sanitation access could improve the practice of safe hygiene behaviors and reduce the global burden of RTIs in women.

Community-based research on reproductive tract infections (R TI) has shown that many women in India suffer a significant burden of morbidity from gynaecological symptoms, accept these as normal and delay seeking treatment. This paper describes how gender inequalities influence women's experiences of gynaecological morbidity and health-seeking strategies. Data for this paper are obtained from three villages in Gujarat, India, through in-depth interviews with 18 women who reported symptoms of R TI. The sample was selected form women participating in savings groups operated by the collaborating non-governmental organisation. Women describe how they give priority to fulfilling their work responsibilities over their discomfort. They explain normative pressures to remain with the husband and produce children with two years of marriage. Women exposed to violence report that they did not reveal their symptoms to their husbands. Where there is a better marital communication, they describe their strategies to refuse sex in relation to their symptoms. Women also express helplessness with their social and health situations in context of seeking treatment. We conclude that gender inequalities, manifested through fertility, marriage and work norms, violence in marital relationships and poor psychological health, have resulted in rural Indian women accepting high thresholds of suffering, and not seeking treatment for their symptoms. We recommend that RTI prevention and treatment efforts be part of a larger process of empowering women and men in which there is a discussion of reproductive, sexual and health rights. 1. The study was conducted as part of a doctoral research on women's perceived morbidity and treatment-seeking behaviours for gynaecological symptoms. The results describing perceived morbidity and treatment-seeking behaviours are reported in forthcoming papers. 2. The terms 'morbidity' and 'symptoms' refer to medically defined categories that were used to identify women reporting gynaecological disease. In this paper we focus on 'illness', which refers to the meanings women give to health, experiences and perceptions of gynaecological symptoms (Zurayk et al. 1993). 3. Other than urban and rural population statistics, 2001 census data are not available for any other parameters, including tribal population and development indices. Therefore, we have used 1991 census data for these statistics. 4. The women's health programme has trained local women as traditional birth attendants and as barefoot gynaecologists who can use speculums, conduct pelvic examinations and provide treatment with validated local plant-based medicines. 5. Women who perceived infertility were included in the sample regardless of whether they had biomedically defined infertility or were trying to get pregnant soon after marriage. This selection criteria for infertility is based on women's perceptions because, based on previous research in this community, we felt that it was an im portant concern for women, impacting all other health-seeking behaviours related to gynaecological symptoms and, therefore, should be defined as such. 6. The sect known by the name of gayatri parivar has followers from several villages in the area. We are not aware of its reach in other parts of the state. Several women mentioned books published by the sect with guidelines on dietary and sexual practices. Three respondents explained sexual practices and drinking alcohol of their husbands based on the teachings of this sect.

Background: Maternal health voucher scheme, providing financial support to poor women, is popularly known as subsidies in maternity care services including antenatal, delivery and postnatal care and also economic barriers while seeking treatment from qualified service providers. The aim of this study is to evaluate the association of voucher scheme on receiving maternal healthcare services among the rural women in Bangladesh.Methods: This is a cross sectional study where total sample size was (n=500) rural women who were selected by using convenience sampling method. Among them, 250 women were voucher scheme receivers and other 250 women were non-voucher scheme receivers. A structured questionnaire was adopted for data collection between November and December 2015. In the final analysis, cross tabular analysis and logistic regression model were used, and adjusted odds ratios (ORs) were reported.Results: The study found a strong relation between voucher scheme and maternal healthcare services among the rural women in Bangladesh where majority (88.4%) voucher scheme receivers received information or treatment of Reproductive Tract Infections (RTIs) and Sexually Transmitted Infections (STIs) while non-voucher scheme receivers received only 10%. Most of the respondents (93%) voucher scheme receivers received at least 3 times of antenatal care visit; but only 28% received non-voucher scheme receivers at least 3 times of antenatal care visit. Voucher scheme receivers received 17.127 times more likelihood to receive skilled birth attendance and 25.344 times more likelihood to receive institutional delivery services and positively significant (5 percent) compared to those who did not receive maternal heath voucher scheme. Moreover, 92.4% voucher receivers received transport cost and 73.2%, received safe home delivery services while 22.8% non-voucher scheme receivers received transport cost and only 20.4% received safe home delivery services. Majority (94%) voucher scheme receivers received long time birth control services while only 19.2% non-voucher scheme receivers received long time birth control services.Conclusion: Women who did not receive maternal health voucher scheme found the status of lower antenatal, delivery and postnatal care services receiving trends compared to the women who received the maternal health voucher scheme. It is recommended an effective monitoring system and necessary interventions getting overall developed health status in Bangladesh.Bangladesh Journal of Medical Science Vol.17(4) 2018 p.545-555