Abstract

This study investigated the prevalence of fungal infections among pregnant women attending Wushishi General Hospital. The study was conducted among pregnant women attending the Obstetrics and Gynaecology Unit between March and June 2021. A descriptive cross-sectional research design was adopted. Participants included pregnant women who reported symptoms such as abnormal vaginal discharge, itching, genital burning, or a burning sensation during urination. A non-probability sampling technique was employed to select a total of 100 pregnant women. Data were obtained through self-interviews and questionnaires.

The findings showed that 48 (48%) of the samples tested positive for vulvovaginal candidiasis (VC), while 52 (52%) tested negative. Candida albicans was the most frequently isolated species, accounting for 28 (58%) of the positive cases. This was followed by C. parapsilosis, with 10 (21%) cases; C. guilliermondii, with 8 (17%) cases; and C. glabrata, with 2 (4%) cases. Regarding the trimester of pregnancy, 24 (50%) of the infected women were in their third trimester, while 16 (33%) and 8 (17%) were in their first and second trimesters, respectively. A statistically significant association was observed between vulvovaginal candidiasis and the duration of pregnancy (p = 0.001). Concerning previous medical history, 14 (29%) of the affected pregnant women reported having experienced the infection previously, with C. albicans identified as the predominant causative organism in the reported cases.

The study concluded that vulvovaginal candidiasis is an important fungal infection during pregnancy, with 48% of the pregnant women investigated testing positive. Itching, pain, and whitish vaginal discharge were identified as the major symptoms associated with the infection. However, laboratory investigations are necessary to differentiate vulvovaginal candidiasis from other conditions and confirm the clinical diagnosis. The study recommended that fungal infections should not be diagnosed solely on the basis of clinical symptoms, as similar manifestations may result from other conditions. It further recommended the introduction of health education programmes for pregnant women to promote preventive practices, early diagnosis, and awareness of the importance of appropriate treatment, particularly in view of the potential adverse maternal and neonatal outcomes associated with reproductive tract infections.

CHAPTER ONE

INTRODUCTION

1.1 Introduction

Fungal infections, also known as mycoses, are diseases caused by fungi and may affect different parts of the body, including the skin and reproductive tract (Abdelaziz et al., 2021; Rasti et al., 2020). Millions of fungal species exist in the environment, where they can be found in soil, on plants, on household surfaces, and on human skin. Although many fungi exist without causing harm, certain species can produce infections that manifest as skin rashes, bumps, or other clinical conditions. When fungi invade body tissues, the resulting infection may remain localized to the skin, extend into deeper tissues, bones, and organs, or affect multiple parts of the body. The symptoms depend on the site of infection and may include skin irritation, rashes, or abnormal vaginal discharge (Abdelaziz et al., 2021; Rasti et al., 2020).

Candidiasis is a fungal infection caused by yeasts belonging to the genus Candida. Several Candida species are capable of causing infections in humans, with Candida albicans being one of the most common. Under normal circumstances, Candida organisms may inhabit the skin and different parts of the body, including the mouth, throat, gastrointestinal tract, and vagina, without producing symptoms or causing disease (Rathod & Buffler, 2021).

Vulvovaginal candidiasis (VVC), also referred to as vaginal candidiasis, moniliasis, or thrush, is characterized by symptoms such as thick, whitish vaginal discharge, often resembling cottage cheese, accompanied by inflammation and irritation of the vulva and vagina (Zhou et al., 2009). The vagina can be affected by several microorganisms, including bacteria, fungi, viruses, and parasites. Common reproductive tract infections among women of childbearing age include bacterial vaginosis (BV), candidiasis, trichomoniasis, and infections caused by Chlamydia trachomatis. These conditions are particularly important during pregnancy because of their potential implications for maternal and fetal health (Abdelaziz et al., 2021).

Vaginal infections, including vaginitis and vaginosis, constitute important health concerns among pregnant women because certain infections may be associated with complications such as preterm labour, infection of the amniotic fluid, premature rupture of the fetal membranes, and low birth weight. These complications may increase the risk of adverse perinatal outcomes. Appropriate identification and treatment of infections can help reduce the risk of complications, including premature delivery and its associated consequences (Abdelaziz et al., 2021; Rasti et al., 2020).

Vulvovaginal candidiasis is a frequently reported gynaecological condition that can cause considerable discomfort and distress among affected women, including those who are pregnant (Kamath et al., 2021). In some circumstances, Candida infections may also be associated with neonatal infections, making proper assessment and management important during pregnancy (Rasti et al., 2020). The condition is diagnosed among women across different age groups and may occur regardless of sexual activity. Many affected women seek medical attention because of symptoms such as abnormal vaginal discharge and genital irritation (Rathod & Buffler, 2021; Oyewole et al., 2020).

Research conducted in different parts of the world has identified Candida albicans as a major cause of symptomatic vaginal candidiasis. Other species, commonly referred to as non-albicans Candida, include C. tropicalis, C. glabrata, and C. krusei. Accurate identification of the causative species is important because different Candida species may respond differently to antifungal treatment. The increasing identification of non-albicans Candida species further emphasizes the importance of laboratory-based diagnosis and appropriate species identification (Kazemi et al., 2020).

Although vulvovaginal candidiasis is not generally considered a major direct cause of mortality, the discomfort and recurring symptoms associated with the condition can contribute to psychological distress, reduced quality of life, and increased healthcare expenditure. However, epidemiological information on the prevalence and distribution of vulvovaginal candidiasis remains limited in some settings, creating challenges for understanding its full public health burden (Rathod & Buffler, 2021).

Some studies have reported a substantial burden of vulvovaginal candidiasis among women in sub-Saharan Africa and other low-income settings. In certain populations, the reported prevalence has reached 55%, although the estimates vary according to the study population, diagnostic methods, and geographical location (Abdelaziz et al., 2021). These variations demonstrate the importance of conducting local investigations to determine the prevalence of fungal infections and identify the species responsible for infection in specific populations.

1.2 Statement of the Problem

In many developing countries, epidemiological information concerning fungal infections, particularly vaginal candidiasis among pregnant women, remains limited. Data on the prevalence and distribution of different vaginal Candida species are also insufficient in some settings (Nelson et al., 2020). This lack of information can make it difficult to understand the burden of infection, identify commonly occurring species, and develop appropriate diagnostic and treatment strategies.

In Nigeria, available studies have reported varying levels of vaginal fungal infections among pregnant women. A study conducted among pregnant women at Omdurman Maternity Hospital, as reported by Abdelaziz et al. (2021), identified Candida albicans in 16.6% of the participants. The study also recorded a higher proportion of infections among women in the third trimester (71.6%) compared with those in the second trimester (28.4%).

Similarly, a study investigating bacterial vaginosis and vaginal candidiasis among 100 pregnant women reported Gardnerella vaginalis in 14 (14%) samples and Candida albicans in 73 (73%) samples. A combined infection involving both Gardnerella vaginalis and Candida albicans was identified in 3 (3%) samples (Ahmed et al., 2021).

These findings indicate that vaginal infections may constitute a considerable health concern among pregnant women, although reported prevalence rates differ across studies and populations. Differences in geographical location, study design, diagnostic procedures, and participants' characteristics may contribute to these variations.

Despite the findings reported in other settings, there is a need for locally relevant information on fungal infections among pregnant women attending Wushishi General Hospital. Determining the prevalence of infection, identifying the Candida species involved, and examining possible associations with factors such as age, trimester of pregnancy, gravidity, and antifungal treatment history may contribute to a better understanding of the condition among the study population.

Consequently, this study was designed to investigate the prevalence of fungal infections among pregnant women attending Wushishi General Hospital between March and June 2021. It also sought to identify the Candida species present and examine the relationship between vaginal candidiasis and selected maternal characteristics.

1.3 Objectives of the Study

1.3.1 General Objective

The general objective of this study was to determine the prevalence of fungal infections among pregnant women attending Wushishi General Hospital between March and June 2021.

1.3.2 Specific Objectives

The specific objectives of the study were to:

1. Isolate and identify the different Candida species found among the pregnant women studied.

2. Determine the frequency of Candida albicans among the pregnant women attending Wushishi General Hospital.

3. Examine the association between vulvovaginal candidiasis and selected factors, including age, trimester of pregnancy, gravidity, and antifungal treatment history.

1.4 Justification of the Study

Vaginal candidiasis during pregnancy requires appropriate diagnosis and management because untreated or inadequately managed infections may cause persistent discomfort and, in some circumstances, be associated with adverse maternal or neonatal outcomes. Maternal Candida colonization may also contribute to fungal infections in newborns, including cutaneous candidiasis. Some reproductive tract infections have been associated with complications affecting reproductive health, emphasizing the importance of accurate diagnosis and timely treatment (Parveen et al., 2008).

Laboratory investigations are important in the diagnosis of vaginal fungal infections because clinical symptoms may resemble those of other reproductive tract conditions. Appropriate testing can assist healthcare professionals in identifying the causative organism, distinguishing between different infections, and selecting suitable treatment. Therefore, establishing the prevalence of fungal infections and identifying the species responsible can support more effective clinical management.

Furthermore, the need to improve awareness of fungal infections and strengthen the use of appropriate diagnostic procedures provided a basis for conducting this study. Information obtained from the investigation may help improve understanding of vaginal candidiasis among pregnant women attending Wushishi General Hospital and support the development of suitable diagnostic and health education interventions.

1.5 Scope of the Study

This study focused on determining the prevalence of fungal infections among pregnant women attending Wushishi General Hospital. The investigation was restricted to pregnant women who attended the Obstetrics and Gynaecology Unit between March and June 2021. The study examined the occurrence of vaginal candidiasis, the identification of Candida species, and the relationship between infection and selected maternal characteristics.

1.6 Limitations of the Study

Financial constraints: Limited financial resources may affect the researcher's ability to obtain relevant textbooks, journal articles, laboratory materials, and other information required for the study. Financial difficulties may also affect the resources available for data collection and other research activities.

Time constraints: The researcher is required to conduct this investigation alongside other academic responsibilities. As a result, the time available for reviewing relevant literature, collecting data, conducting laboratory procedures, analysing results, and completing the research may be limited.