Symptoms Of Reproductive Tract Infections Research Articles

Prevalence of self-reported symptoms of reproductive tract infections and promoting an awareness of reproductive health among adolescent girls through education approach in Kumbakonam rural region of Tamil Nadu state

ABSTRACT Introduction: Adolescent females in India particularly from rural areas indicate sparse sexual and reproductive health (SRH) information and are at risk of unfavourable sexual and reproductive health outcomes. Objectives: The study was primarily intended to assess the effect of structured interventional education on awareness and practices of school-going adolescent girls about sexual and reproductive health. Methods: This was an interventional study comprising of interactive strategies, namely peer-led approach, flipped learning, skit, scenario-based discussion and puppetry. The pre- and post-test was conducted among 1232 girls in selected schools at rural block in Kumbakonam rural region of Tamil Nadu State of India. Results: The participants reported statistically significant gain in knowledge, attitudes and practices about reproductive health due to educational intervention (P < 0.001). Nearly 50% of participants were aware about various contraceptive methods before intervention. The prevalence of self-reported symptoms of RTIs/STIs was 23.7%. Nearly more than half of participants were aware about various contraceptive methods. Conclusions: Peer-led education can be a potential health promotion strategy among adolescent population.

Women's self-reported symptoms of reproductive tract infection, medical consultations, and factors influencing them in less developed regions: perimenopausal and older women in need of urgent attention.

Reproductive tract infections (RTIs) represent a critical public health concern impacting women's health, particularly pronounced in developing countries. We aim to investigates the prevalence of self-reported RTI symptoms in women aged 18 to 65 and the factors influencing gynecological examination behavior and associated risks are explored. From May 6, 2022, to September 20, 2022, a comprehensive survey engaged 20,864 women aged 18 to 65 in 19 townships in Lueyang, Shaanxi. Each survey team, comprising a gynecologist, two female health center staff, and a master's student, conducted face-to-face questionnaire surveys in villages and households. The questionnaire featured three sections: prevalence of self-reported RTI symptoms, gynecological examination history, and factors influencing examination behavior. The high response rate of 98.69% yielded 20,590 valid questionnaires. Among surveyed women, 42.04% reported RTI symptoms, with a higher prevalence in those aged 30 and above, peaking at 44.88% in the 50-59 age group. Vulvar itching (24.73%), abnormal vaginal discharge (17.41%), and urinary tract irritation signs (11.73%) were most common. Older adult women (≥60) reported higher frequency and longer duration of symptoms. Only 9.88% of symptomatic women underwent gynecological examinations in 2022. Examination likelihood decreased with age, presenting a critical gap in healthcare utilization among older women. Reasons for checkups included routine checkups (47.02%), symptom concerns (41.29%), and the availability of free medical checkup programs (9.82%). Barriers included perceived lack of serious symptoms (23.7%), lack of necessity (4.41%) and lack of time (3.98%). Among those examined, 40.58% had a diagnosis of gynecological disorders, including pelvic inflammatory disease, human papilloma virus infection and cervical cancer. Widespread RTI symptoms, particularly in perimenopausal and older women, underscore the need for enhanced healthcare. Barriers to gynecological examinations include awareness, education, and accessibility issues. Strategies must prioritize health education, routine examinations, and improved healthcare infrastructure in underdeveloped regions.

Exploring the Socio-personal Factors Associated with the Prevalence of Symptoms of Reproductive Tract Infections among Sexually Active Married Women in Ernakulam District of Kerala, India

Abstract Background: Reproductive Tract Infections (RTIs)/Sexually Transmitted Infections (STIs) are the main cause of maternal mortality and morbidity in India. The prevalence of the symptoms of RTIs was found to be very high in community-based studies. However only a few studies have explored the factors associated with it. This study aims to determine the socio-personal factors associated with the prevalence of symptoms of RTIs among sexually active married women in Ernakulam district of Kerala. Material and Methods: The study adopted a cross-sectional approach and was conducted among 640 married women in the reproductive age group. Results: The prevalence of the symptoms of RTIs was found to be 56.9% and about 60.16% of them had experienced multiple symptoms. Multivariate analysis showed that those women living in the urban areas (OR: 0.49, 95% CI: 0.334, 0.719), having no previous history of obstetric/gynecological risk factors (OR: 1.89, 95% CI: 1.119, 3.19) and using both clothes and sanitary pads interchangeably during menstruation (OR: 0.46, 95% CI: 0.282, 0.734) were found to be at less risk of contracting RTIs. Conclusion: The use of sanitary pads along with cloth pads can be enhanced rather than only using reusable cloths during menstruation. Also, efforts to improve the reproductive health of the women and reduce the obstetric/gynaecological risk factors should be devised to curtail the peak of RTIs.

IJCM_95A: To Assess the knowledge and practice regarding reproductive tract infection among female of reproductive age group in Raipur city Chhattisgarh

Background: Reproductive tract infection (RTI) is a global health problem among women, especially in South East Asia Region (SEAR) countries. They may progress to serious complications and cause a high degree of morbidity during the sexually active period of life. More than a million women and infants die of the complications of RTI every year. RTI has become a silent epidemic that devastates women’s lives. Globally, three different types of RTI cause significant amounts of morbidity and mortality among women – sexually transmitted infections (STIs) (including gonorrhea, chlamydia, syphilis, trichomonas, and HIV infections); endogenous infections resulting from the overgrowth of organisms normally present in the reproductive tract (such as candidiasis and bacterial vaginosis); and iatrogenic infections related to medical procedures (such as menstrual regulation, abortion or IUD insertion). The presence of STI increases the risk of acquiring and transmitting HIV infection by three to five times. Objectives: 1- To Assess the knowledge of female what is reproductive tract infection how it occur and spread among residents of Raipur City, Chhattisgarh. 2- To Assess the Factors associated with Knowledge among residents of Raipur City, Chhattisgarh. Methodology: This is an observational cross-sectional study conducted in Raipur City of Chhattisgarh state during the month October 23-January 2024. A pre-designed, self-administered, semi-structured questionnaire was used for data collection. Systematic Random sampling technique was adopted to select the 350 Study participants. Results: The majority of subjects were between the age of 15-34 year. Most of the subject were of lower middle class socioeconomic status. Additionally, 37.8% of participants were graduates, 59.4% were married and 70% were unemployed. 30.3% subjects had not heard about Reproductive tract infection. 50.6% subjects don’t know about symptoms of RTI, almost half 49.4% subject don’t have knowledge about effect of RTI on health and only 84% female believed that good personal hygiene prevent RTI. 45.1% subjects did not wash their private part after urination, 10.5% female did not wash their used cloth daily after each use. 63.9% female used feminine hygiene products to maintain personal hygiene, 10% female did not change their cloth daily, 33.1% women did not change their pad/ cloth within every 4–6-hour interval during menstruation. Conclusion: Educate women through camps about genital hygiene practices to reduce the risk of RTI. For increased usage of Sanitary pads, more number of sanitary vending machine should be installed in schools, colleges, and health facilities. Implement awareness programs, promoting regular check- ups and safe sex practices to mitigate the risk of RTI.

IJCM_217A: Literacy for health: Bridging the gap between female literacy and health seeking behaviour

Background: The private sector has maintained its dominance in the healthcare industry despite numerous government measures to improve public services. Public sector is still not a choice for treatment, various reasons being large distance from residence, poor quality of care, shortage of drugs, poor attitude of health care provider. Enumeration of the factors that defines pattern of the utilization of health services become utmost important. Hence, this study is being conducted to understand the factors behind the utilization of government health services. Objectives: i)To find the prevalence of Reproductive Tract Infections, among married women of reproductive age group, seeking treatment among rural and peri-urban areas of Aligarh. ii) To find the determinants of utilization of reproductive health services among married women in Aligarh. Methods: This cross-sectional study was conducted between 2020-2021 Data was collected through a pretested, semi-structured questionnaire through simple random sampling from 500 married women of reproductive age group, in the field areas registered under Department of Community Medicine, JNMCH A.M.U. Data was analysed using IBM SPSS 20.0. Proportion, frequencies, chi square were used to interpret the data. Results: Among total females interviewed 201 (40.2%) were found to have symptoms of Reproductive Tract Infections, out of them 165, (74.1%) sought treatment. Among 165 females who started treatment, 62.4 % of females seeking treatment were literate.69% females who delayed treatment were illiterate. Self-motivation for treatment was seen among 60.2 % of literate females. Area of residence, social class and female’s role in decision making also determined the treatment seeking behaviour. Conclusion: In our study female literacy has been found as major factor influencing the health seeking behaviour. Factors like place of residence, socio economic status, female role in decision making were significant. There is no denying the significant health benefits of supporting women’s education. Education has a crucial role in family planning, from the earliest stages to caring for one’s own health and newborn children.

Enhancing Well-Being: Menstrual Sanitation Practices Amongst Rural Adolescent Girls in Tamil Nadu, India

Aim: A campaign to afford free sanitary pads to teen girls in countryside regions has been launched by the Tamil Nadu government in India. The menstrual well-being and sanitation follows of teens in a rural area of North Tamil Nadu, India are discussed in this paper, as well as their experiences utilising sanitary pads and discarded clothing. Subject and Methods: 134 adolescent girls from four villages participated in a community-based study that lasted four months and used a pre- and post-design to collect qualitative and quantitative data. The awareness of menstruation and its practises, value of life, experience with and serenity with different clothes/pads, and symptoms of reproductive tract infections were all shielded in the questionnaires. Results: At the baseline survey 90% of girls at the time were wearing worn-out clothing. Sixty-eight percent of teenage females who participated in the study stated pads remained their top optimal. None of them liked wearing worn-out clothing. The quality of life significantly increased after the insertion of pads (p 0.000). Self-reported signs of recurrent reproductive tract infections did not significantly decrease. Conclusion: This study revealed that unhygienic behaviours, such as societal limitations on food and home chores, were extensively prevalent and that most adolescent females lacked the proper understanding regarding menstruation. This research underscores the need for menstrual hygiene education and awareness.

Intimate Partner Violence and Symptoms of Reproductive Tract Infections among Married Women in Aligarh

Intimate Partner Violence and Symptoms of Reproductive Tract Infections among Married Women in Aligarh

Self-reported Symptoms of Reproductive Tract Infections: The Question of Accuracy and Meaning

Verbal surveys are the most common way of gauging any population’s health status, but questions remain regarding the accuracy of the responses they elicit. The present paper compares women’s self-reports regarding their experiences with reproductive tract infections (RTIs) and the medical diagnosis that they went through to ascertain the presence or otherwise of the infections. Weak concordance was found between women’s self-reports and the medical diagnosis, with the former over-representing the presence of infections. Some of the selfreported symptoms were pathogenic in nature, as represented by the true positive reports, but the majority of the self-reports were false positives when compared to medical diagnosis. The conventional health surveys, relying solely on verbal responses, thus, do not essentially represent the actual health situation of a population studied, and any policy intervention formulated exclusively on this information would be flawed. There is a need to understand the non-medical context of illnesses to understand the disease fully.

Prevalence and risks of reproductive tract infections among women of urban slums in North India

Objective: To identify the prevalence, determinants of reproductive tract infection, and healthcare seeking behavior among ever married women of reproductive age residing in an urban slum of Faridabad, Haryana, North India. Methods: This community based cross-sectional study was conducted among ever married women aged between 15 and 49 years insured under employees state insurance scheme and residing in an urban slum of Faridabad. Simple random sampling technique was used to interview 149 eligible women using a predesigned structured questionnaire. Study variables included sociodemographic profile, family planning methods, menstrual absorbent usage, and symptoms of reproductive tract infection. Binary logistic regression was used to investigate the determinants of reproductive tract infection. Results: Of the women, 46.3% had at least one reproductive tract infection or sexually transmitted infection symptom and 28.9% among them sought treatment for the symptom. Vaginal discharge, itching (14.1%) and lower abdominal pain (30.2%) were the major symptoms reported. Non-usage of condoms as contraceptive was significantly associated with a higher rate of symptoms (50.4% vs. 20.0%). Abortion had a significantly high odds of having reproductive tract infection symptoms (aOR 3.71, 95% CI 1.59-8.62; P<0.01). Less frequent change in absorbent during menstruation was also reported to have a higher rate of symptoms. The majority of those who took treatment sought it from government or employees state insurance dispensary. 2% also went to faith healers. Conclusions: Nearly half of the study population have reproductive tract infection symptom. Abortions and non-usage of condom increase the risk of reproductive tract infection. Menstrual hygiene and condom usage are the significant interventions, which may reduce the prevalence of these symptoms.

Puberty health intervention to improve menstrual health and school attendance among adolescent girls in The Gambia: study methodology of a cluster-randomised controlled trial in rural Gambia (MEGAMBO TRIAL)

BackgroundMenstrual health (MH) is a recognised global public health challenge. Poor MH may lead to absence from school and work, and adverse health outcomes. However, reviews suggest a lack of rigorous evidence for the effectiveness of MH interventions on health and education outcomes. The objective of this paper is to describe the methods used in a cluster-randomised controlled trial to estimate the effect of a multi-component intervention to improve MH and school attendance in The Gambia.MethodsThe design ensured half the schools (25) were randomised to receive the intervention which comprised of the following components: (i) Peer education camps and menstrual hygiene laboratories in schools, (ii) Mother’s outreach sessions, (iii) Community meetings, and (iv) minor improvements of school Water Sanitation and Hygiene (WASH) facilities and maintenance. The intervention was run over a three-month period, and the evaluation was conducted at least three months after the last intervention activity was completed in the school or community. The other 25 schools acted as controls. Of these 25 control schools one Arabic school dropped out due to COVID-19. The primary outcome was the prevalence of girls missing at least one day of school during their last period. Secondary outcomes included: Urinary Tract Infection (UTI) symptoms, biochemical markers of UTI in urine, Reproductive Tract Infection symptoms, self-reported menstruation related wellbeing, social support and knowledge, perceptions and practices towards menstruation and MH in target school girls. In addition, a process evaluation using observations, routine monitoring data, survey data and interviews was undertaken to assess dose and reach (quantitative data) and assess acceptability, fidelity, context and possible mechanisms of impact (qualitative data). Cost and cost-effectiveness of the intervention package will also be assessed.ConclusionResults will add to scarce resources available on effectiveness of MH interventions on school attendance. A positive result may encourage policy makers to increase their commitment to improve operation and maintenance of school WASH facilities and include more information on menstruation into the curriculum and help in the reporting and management of infections related to adolescent menstruation.Trial Registration PACTR, PACTR201809769868245, Registered 14th August 2018, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=3539

Puberty- and Menstruation-Related Stressors Are Associated with Depression, Anxiety, and Reproductive Tract Infection Symptoms Among Adolescent Girls in Tanzania.

Puberty and menstruation are significant stressors for adolescent girls and young women in low-resource settings in sub-Saharan Africa. However, little is known about the impact of these stressors on girls' mental health and reproductive health. In 2018, a cross-sectional self-report survey was conducted with 581 adolescent girls and young women between 13 to 21years old who had reached menarche and were attending secondary school in Moshi, Tanzania. Structural equation modeling was used to examine the relationships of puberty-related stressors and menstruation-related stressors (menstrual deficits, movement/activity difficulties, and menstrual symptoms) to depression, anxiety, and the likelihood of reporting reproductive tract infection (RTI) symptoms. Puberty-specific stressors, menstrual symptoms, and menstrual deficits were associated with depression and anxiety. Movement/activity difficulties were associated with anxiety. Increases in menstrual symptoms, menstrual deficits, puberty stressors, and depression were associated with an increased likelihood of reporting a lifetime RTI. However, the relationship of puberty stressors and depression with RTIs was no longer significant in two of three models after correcting for Type I error. Overall, puberty- and menstruation-related stressors were associated with mental health and symptoms of reproductive tract infections. This suggests there is an important relationship between stressors specific to adolescent girls and young women during puberty, mental health, and reproductive health. There is a need for adolescent-tailored interventions to reduce the negative impact of stressors among girls transitioning through puberty in sub-Saharan Africa.

Reproductive tract infection among the women of high-altitude areas of Lahaul and Spiti District of Himachal Pradesh, India

Background: Reproductive tract infection (RTI) is a serious public health problem particularly among the women in reproductive age group. Tribal women particularly living in high altitude cold areas are more vulnerable to these infections as availability of water for domestic purpose is scarce hence affects personal hygiene.Methods: A door to door survey was conducted by canvassing a pre-designed interview schedule for capturing the reported symptoms of RTI among 494 women in the age group 15-49 years in Lahaul and Spiti district of Himachal Pradesh.Results: Around 26% of the respondents reported one or the other symptoms of RTI experienced by them during three months preceding the survey. The reported symptoms were mostly related to discharge.Conclusions: The study is carried out among women of high-altitude tribal areas of Lahaul and Spiti district of Himachal Pradesh, where such data/information is not available. Maintenance of personal hygiene is poor, more than one-fourth women had one or the other symptoms of RTI. Lower economic status and personal hygiene practices are strongly associated with RTI. The findings of the study will draw attention of Scientists, Program managers to address the issues for qualitative improvement of female population of the area. Need to sensitise the masses on the issues of RTI and strengthen its outreach health services in the district.

Reproductive health in pre and post menopausal women: A special focus on migrants

Reproductive tract infections (RTIs) are extremely common and a major health concern for Indian women especially when they reach middle and later adulthood years. An attempt has been made in this study to examine the prevalence of reproductive tract infections among middle aged and older adult migrant women by using a mixed method approach. The study population consists of 200 middle aged women in pre menopausal (50-55 years) group and older women (55-65 years) group in post menopausal. Along with quantitative data, in-depth interviews and focused group discussions were organized. Results indicated that more than half of the respondents had symptoms of RTIs. The most frequently reported symptoms were abnormal vaginal discharge (48 percent), lower abdominal pain (63.2percent) and minor problems. The food consumption pattern was not satisfactory in almost all the respondents. The outcome of the study highlights a dire need to advance a healthy food system to prevent adverse reproductive health problems and avoid associated health care costs.

A Study on Prevalence of Reproductive Tract Infections among Married Women in a Rural Area of Kanchipuram Tamilnadu

Introduction: Reproductive Tract Infection (RTI) is a major public and reproductive health threat globally. The burden of RTI deprives contribution of women in socioeconomic and cultural development. The aim is to determine the prevalence of RTI in married women and to spell out various associating factors of RTI.
 Methodology: A cross sectional study done in the rural area around Sree Balaji Medical College. Using purposive sampling, 365 women were selected as study participants. Data collection was done using a pretested structured questionnaire. Data analysis was done using SPSS software version25.
 Results: Among the 365 women, who participated in the study, the prevalence of RTI was 42%. Those reported more symptoms of RTI belonged to 16-25 (37.2%) years of age group. The commonest symptom reported by the women was abnormal vaginal discharge (16.4%), followed by lower abdominal pain (10.94%). The symptoms of reproductive tract infection were associated with age, age at marriage, education, socioeconomic status and menstrual hygiene practices.
 Conclusion: Proper management, health education reduces high prevalence of RTI. Women should have enough knowledge to seek proper medical care for infections which are curable and reduces the risk of developing further complications.

Prevalence of Reproductive Tract Infections/Sexually Transmitted Infections among Rural Married Women – A Community Based Study Using Syndromic Approach

Introduction: Reproductive Tract Infections (RTIs) and Sexually transmitted infections (STIs) continue to be a major public health problem and affecting women's health. Objectives: To estimate the prevalence of RTIs/STIs among married women aged 18-49 years in rural areas and to determine the factors associated with these conditions. Method: A community-based cross-sectional study was carried out among 308 eligible married women aged 18-49 years in rural areas in District Sonipat, Haryana using the WHO-Syndromic Approach for diagnosis of RTIs/STIs. Results: The mean age of study subjects in our study was 32.1 years (SD = ± 8.3 years) with a range from 18 to 49 years. The overall RTIs/STIs prevalence was 49.3%. The most frequent symptom was vaginal discharge (55.3%) followed by pain during micturition (34.2%), dyspareunia (26.9%), pain lower abdomen (24.3%) and vulval itching (16.4%). RTI/STI symptoms were found significantly more among women who had history of any chronic disease, who had irregular menstrual cycles, used cloths as sanitary pads and among those whose husbands were substance users. Conclusions: This study revealed a high prevalence (49.3%) of RTIs/STIs. Awareness about symptoms of RTIs, menstrual and personnel hygiene, raising literacy level of women, drive against use of addictive substances etc. by husbands is needed for control and prevention of RTIs. Primary health care services in respect of reproductive health should be strengthened and raising awareness among women about reproductive health issues through suitable communication strategies in order to bring about a positive behavior change for effective control of STIs.

Interlinking menstrual hygiene with Women's empowerment and reproductive tract infections: Evidence from India

BackgroundBreaking the silence on menstruation is essential for women and girls to achieve and exercise their full potential. The study explores the linkages between women empowerment, utilization of hygienic methods during menstruation, and its effect on reproductive tract infections (RTI) among women aged 15–24 years in India. MethodsThe study used the fourth round of Indian Demographic and Health Survey (NFHS-4), 2015–16. The information regarding the different dimensions of women empowerment has been collected from 122,351 women at the state level. Overall, 42,912 women aged 15–24 years surveyed in the state module were questioned regarding menstruation hygiene methods and different dimensions of women's empowerment. Bivariate and multivariate statistical techniques have been utilized to draw inferences from the data. ResultsFindings reveal that about 60% of women aged 15–24 utilized hygienic methods during menstruation in India. Owning a bank account, using mobile phones, and household decision-making emerged as significant factors that lead to the adoption of hygienic practices. Lack of menstrual hygiene method was found to result in adverse outcomes like RTI symptoms (genital sore/ulcer and had genital discharge) ConclusionsThe study concludes that the different dimensions of women empowerment are essential in accelerating the level of practicing hygienic menstruation methods and providing assistance against diverse malpractices and taboos attached to it. The existing approach for the use of menstrual hygiene methods should focus on women's right to decide on their own life and health.

Does menstrual hygiene management and water, sanitation, and hygiene predict reproductive tract infections among reproductive women in urban areas in Ethiopia?

Reproductive tract infections (RTIs) are a public health concern in Ethiopia. However, the relationship between menstrual hygiene management (MHM) and water, sanitation, and hygiene (WASH) factors to RTIs have not been well addressed. A community-based cross-sectional study was conducted from January to March 2019 among 602 systematically selected reproductive-age women aged 15-49 years in Dessie City. Data were collected using a questionnaire and a direct observation checklist. RTIs were identified by the presence during one year before data collection of one or more signs of vaginal discharge, itching/irritation or ulcers/lesions around the vulva, pain during urination and sexual intercourse, and lower abdominal pain and lower back pain. Data were analyzed using multivariable logistic regression analysis with 95%CI (confidence interval). The self-reported prevalence of RTIs was 11.0%(95%CI:8.5-13.7%) during one year prior to the survey. The most commonly reported symptoms of RTI were burning micturition (9.1%) and vaginal discharge (6.1%). Three-fourths 443(75.0%) of households used traditional pit latrines and the majority of the study participants 527(89.2%) did not meet the basic access requirement of 20 liters of water per capita per day. The majority 562(95.1%) of the study participants did not have multiple sexual partners during the last year and 97.8% did not practiced sexual intercourse during menstruation. The most common type of blood-absorbent material used was a sanitary pad 497(84.8%) followed by cloth 89(15.2%). Factors significantly associated with RTIs were using unclean latrines (AOR: 4.20; 95%CI:2.00-8.80), not washing hands with soap before touching the genital area (AOR: 3.94; 95%CI:1.49-10.45), history of symptoms of RTIs in the past year (AOR: 5.88; 95%CI:2.30-14.98), having multiple sexual partners in the past year (AOR: 4.46; 95%CI:1.59-12.53), changing absorbent material only once per day (AOR: 8.99; 95%CI:4.51-17.92), and washing the genital area only once per day during menstruation (AOR: 5.76; 95%CI:2.07-16.05). The self-reported prevalence of RTI showed that one women experienced RTI among ten reproductive-age women. Designing a women's health policy that focuses on ensuring availability of WASH facilities and improving MHM at the community level is key for sustainably preventing RTIs.

Services for women\u2019s sexual and reproductive health in India: an analysis of treatment-seeking for symptoms of reproductive tract infections in a nationally representative survey

BackgroundWomen’s health policy in India has had a longstanding focus on maternal health and family planning. Recent policy highlights the importance of expanding women’s access to a broader range of sexual and reproductive health services. However, there has been very limited analysis of national survey data to examine the current status of treatment utilisation, variation across states and progress over time.MethodsThis paper examines women’s treatment patterns for reproductive tract infections in India, based on data collected in the National Family Health Survey, a cross-sectional, nationally representative household survey conducted between 2015-16. The survey covered 699,686 women between the ages 15 and 49, of which 91,818 ever sexually active women responded to questions related to symptoms of reproductive tract infections. We estimate prevalence of reported symptoms and treatment-seeking, describe regional variation and utilise multivariable logistic regression to identify factors associated with women’s treatment-seeking patterns.ResultsThirty-nine percent of women who reported symptoms of reproductive tract infections sought any advice or treatment. Women’s reported treatment-seeking in India has not changed since the last national survey a decade earlier. Reported symptoms and treatment-seeking varied widely across India, ranging from 64% in Punjab to 8% in Nagaland, with no clear regional pattern that emerged. Seventeen percent of symptomatic women sought services in the public sector, an improvement from 11% in 2005–06. Twenty-two percent utilised the private sector, with wide variation by states. National-level multivariable logistic regression indicated that treatment-seeking was associated with age, higher education, higher household wealth and having been employed in the past year. Women in the 25–35 age group had higher odds (aOR1.27; 95% CI: 1.10,1.50) of seeking treatment compared to both younger (15–19 years) and older (35 years and above) women, along with women with more than eight years of schooling (aOR: 1.23; 95% CI: 1.05,1.44) and from richer wealth quintiles (aOR: 1.53; 95% CI: 1.35,1.83).ConclusionWomen’s use of services for reproductive tract infections remains a challenge in most parts of India. Our findings highlight the need to address barriers to seeking care and to improve measurement of gynaecological ailments in national surveys.

Hand cleaning with ash for reducing the spread of viral and bacterial infections: a rapid review.

BackgroundHandwashing is important to reduce the spread and transmission of infectious disease. Ash, the residue from stoves and fires, is a material used for cleaning hands in settings where soap is not widely available.ObjectivesTo assess the benefits and harms of hand cleaning with ash compared with hand cleaning using soap or other materials for reducing the spread of viral and bacterial infections.Search methodsOn 26 March 2020 we searched CENTRAL, MEDLINE, Embase, WHO Global Index Medicus, and the WHO International Clinical Trials Registry Platform.Selection criteriaWe included all types of studies, in any population, that examined hand cleaning with ash compared to hand cleaning with any other material.Data collection and analysisTwo review authors independently screened titles and full texts, and one review author extracted outcome data and assessed risk of bias, which another review author double‐checked. We used the ROBINS‐I tool for observational studies, we used RoB 2.0 for three interventional studies, and we used GRADE to assess the certainty of the evidence. We planned to synthesise data with random‐effects meta‐analyses. Our prespecified outcome measures were overall mortality, number of cases of infections (as defined in the individual studies), severity of infectious disease, harms (as reported in the individual studies), and adherence.Main resultsWe included 14 studies described in 19 records using eight different study designs, but only one randomised trial. The studies were primarily conducted in rural settings in low‐ and lower‐middle‐income countries. Six studies reported outcome data relevant to our review.A retrospective case‐control study and a cohort study assessed diarrhoea in children under the age of five years and self‐reported reproductive tract symptoms in women, respectively. It was very uncertain whether the rate of hospital contacts for moderate‐to‐severe diarrhoea in children differed between households that cleaned hands using ash compared with households cleaning hands using soap (RR 0.97, 95% CI 0.84 to 1.11; very low‐certainty evidence). Similarly, it was very uncertain whether the rate of women experiencing symptoms of reproductive tract infection differed between women cleaning hands with ash compared with cleaning hands using soap (RR 0.48, 95% CI 0.12 to 1.86; very low‐certainty evidence) or when compared with handwashing with water only or not washing hands (RR 0.50, 95% CI 0.13 to 1.96; very low‐certainty evidence).Four studies reported on bacteriological counts after hand wash. We rated all four studies at high risk of bias, and we did not synthesise data due to methodological heterogeneity and unclear outcome reporting.Authors' conclusionsBased on the available evidence, the benefits and harms of hand cleaning with ash compared with soap or other materials for reducing the spread of viral or bacterial infections are uncertain.

Frequency and determinants of health care utilization for symptomatic reproductive tract infections in rural Indian women: A cross-sectional study.

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.