ABSTRACT

This study examined the prevalence of fungal infections among pregnant women receiving antenatal and other obstetric services at Wushishi General Hospital. The research was carried out among pregnant women attending the Obstetrics and Gynaecology Unit from March to June 2021. A descriptive cross-sectional research design was used. The participants were pregnant women who experienced symptoms such as unusual vaginal discharge, itching, genital irritation or a burning sensation during urination. A non-probability sampling method was adopted to select 100 pregnant women for the study. Information was collected through self-interviews and questionnaires.

The results revealed that 48 (48%) of the samples were positive for vulvovaginal candidiasis (VC), while 52 (52%) tested negative. Among the positive samples, Candida albicans was the most commonly identified species, accounting for 28 cases (58%). C. parapsilosis accounted for 10 cases (21%), followed by C. guilliermondii with 8 cases (17%) and C. glabrata with 2 cases (4%). With respect to the stages of pregnancy, 24 (50%) of the infected women were in their third trimester, 16 (33%) were in their first trimester and 8 (17%) were in their second trimester. The analysis established a statistically significant relationship between vulvovaginal candidiasis and the duration of pregnancy (p = 0.001). In addition, 14 (29%) of the infected women indicated that they had previously experienced the condition, with C. albicans being the most frequently reported causative organism.

The study established that vulvovaginal candidiasis was a notable fungal infection among the pregnant women investigated, with a prevalence of 48%. The major symptoms reported included itching, pain and whitish vaginal discharge. The findings also emphasised the importance of laboratory testing in distinguishing vulvovaginal candidiasis from other conditions that may produce similar symptoms. The study recommended that healthcare providers should not rely exclusively on clinical symptoms when diagnosing fungal infections but should also conduct appropriate laboratory investigations. It further recommended health education programmes for pregnant women to encourage preventive practices, early detection and appropriate treatment, particularly because reproductive tract infections may have unfavourable consequences for maternal and newborn health.

CHAPTER ONE

INTRODUCTION

1.1 Introduction

Fungal infections, medically referred to as mycoses, are illnesses caused by different types of fungi and can affect various parts of the human body, including the skin and reproductive system (Abdelaziz et al., 2021; Rasti et al., 2020). Fungi exist in large numbers in the natural environment and can be found in soil, plants, household materials and on human skin. Although many fungal organisms do not cause harm, some species can produce infections that result in skin irritation, rashes, swellings and other health problems. When fungi enter and affect body tissues, the infection may remain limited to the skin or spread to deeper tissues, bones and internal organs. In some cases, different parts of the body may be affected. The signs and symptoms experienced usually depend on the part of the body involved and may include skin irritation, rashes and abnormal vaginal discharge (Abdelaziz et al., 2021; Rasti et al., 2020).

Candidiasis is an infection caused by yeast organisms belonging to the genus Candida. Several species within this genus are capable of causing infections in humans, although Candida albicans is among the most commonly identified. Under normal conditions, Candida organisms may naturally exist on the skin and in different parts of the body, including the mouth, throat, digestive tract and vagina, without necessarily causing an infection or producing noticeable symptoms (Rathod & Buffler, 2021).

Vulvovaginal candidiasis (VVC), which is also known as vaginal candidiasis, moniliasis or thrush, is a condition commonly associated with thick, whitish vaginal discharge that may have a cottage-cheese-like appearance. It may also cause inflammation, itching and irritation around the vulva and vagina (Zhou et al., 2009). Different microorganisms, including bacteria, fungi, viruses and parasites, can affect the vaginal area. Some common reproductive tract infections among women of reproductive age are bacterial vaginosis (BV), candidiasis, trichomoniasis and infections caused by Chlamydia trachomatis. These infections deserve particular attention during pregnancy because they may affect the health of both the mother and the developing baby (Abdelaziz et al., 2021).

Vaginal infections, particularly vaginitis and vaginosis, are important reproductive health concerns among pregnant women. Certain infections have been linked with pregnancy-related complications such as premature labour, infection of the amniotic fluid, early rupture of the fetal membranes and low birth weight. These conditions may contribute to poor outcomes around the time of delivery. Early identification and proper treatment of infections are therefore important in reducing the possibility of complications, including premature birth and its associated health consequences (Abdelaziz et al., 2021; Rasti et al., 2020).

Vulvovaginal candidiasis is a common gynaecological condition that may cause significant discomfort and emotional distress among affected women, including pregnant women (Kamath et al., 2021). In certain cases, Candida infections may also be linked to infections in newborn babies, making proper examination and management during pregnancy important (Rasti et al., 2020). The condition can affect women of different age groups and does not necessarily depend on sexual activity. Women experiencing the infection commonly seek medical attention because of symptoms such as unusual vaginal discharge and irritation around the genital area (Rathod & Buffler, 2021; Oyewole et al., 2020).

Studies carried out in different parts of the world have identified Candida albicans as one of the major organisms responsible for symptomatic vaginal candidiasis. Other species, generally classified as non-albicans Candida, include C. tropicalis, C. glabrata and C. krusei. Identifying the particular species responsible for an infection is important because different Candida species may not respond in the same way to antifungal medications. The growing recognition of infections caused by non-albicans Candida species makes laboratory examination and accurate identification increasingly important in the diagnosis and treatment of the condition (Kazemi et al., 2020).

Although vulvovaginal candidiasis is not usually regarded as a major direct cause of death, its symptoms can cause considerable discomfort, especially when infections occur repeatedly. Persistent symptoms may affect women's emotional well-being, reduce their quality of life and increase the cost of seeking healthcare. Nevertheless, information about the prevalence and distribution of vulvovaginal candidiasis is still inadequate in some areas, making it difficult to determine the full extent of the condition as a public health problem (Rathod & Buffler, 2021).

Research findings from sub-Saharan Africa and other low-income regions have indicated that vulvovaginal candidiasis affects a considerable number of women. Some studies have recorded prevalence levels of up to 55% in particular populations. However, the reported figures differ depending on the characteristics of the participants, the diagnostic methods used and the geographical area where the research was conducted (Abdelaziz et al., 2021). These differences highlight the importance of conducting studies within specific communities and healthcare facilities to establish local prevalence rates and identify the fungal organisms responsible for infections.

1.2 Statement of the Problem

In many developing countries, reliable epidemiological information about fungal infections, especially vaginal candidiasis among pregnant women, remains inadequate. Information concerning the prevalence of the infection and the distribution of the different Candida species is also limited in some locations (Nelson et al., 2020). This shortage of information creates difficulties in determining the actual burden of the infection, recognising the species commonly responsible and developing appropriate methods for diagnosis and treatment.

Studies conducted in different settings have reported varying levels of vaginal fungal infections among pregnant women. A study involving pregnant women at Omdurman Maternity Hospital, as cited by Abdelaziz et al. (2021), identified Candida albicans in 16.6% of the participants. The findings also showed that infections were more common among women in their third trimester, who accounted for 71.6% of the cases, compared with 28.4% among women in their second trimester.

In another investigation involving 100 pregnant women, researchers examined the occurrence of bacterial vaginosis and vaginal candidiasis. The results showed that Gardnerella vaginalis was detected in 14 samples (14%), while Candida albicans was found in 73 samples (73%). Three samples (3%) showed a combined infection involving both Gardnerella vaginalis and Candida albicans (Ahmed et al., 2021).

The findings from these studies suggest that vaginal infections are an important reproductive health concern among pregnant women. However, the prevalence figures reported by different researchers are not always the same. Such differences may be connected to variations in geographical locations, research methods, laboratory procedures and the characteristics of the women who participated in the studies.

Although previous investigations have provided useful information about vaginal fungal infections in other locations, there is still a need for specific information about pregnant women attending Wushishi General Hospital. Establishing the prevalence of the infection, identifying the Candida species involved and examining possible relationships with maternal factors such as age, stage of pregnancy, gravidity and previous antifungal treatment may provide a clearer understanding of the condition among women attending the hospital.

Based on this need, the present study was undertaken to investigate the prevalence of fungal infections among pregnant women attending Wushishi General Hospital between March and June 2021. It also aimed to identify the different Candida species present in the samples and examine the association between vulvovaginal candidiasis and selected maternal characteristics.

1.3 Objectives of the Study

1.3.1 General Objective

The main objective of this study was to establish the prevalence of fungal infections among pregnant women attending Wushishi General Hospital during the period from March to June 2021.

1.3.2 Specific Objectives

The specific objectives of the study were to:

1. Isolate and identify the various Candida species present among the pregnant women who participated in the study.

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

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

1.4 Justification of the Study

Vaginal candidiasis during pregnancy requires proper investigation and treatment because infections that remain untreated or are not adequately managed may result in prolonged discomfort and may be associated with unfavourable maternal or neonatal outcomes in some circumstances. The presence of Candida organisms in pregnant women may also be associated with fungal infections in newborn babies, including infections affecting the skin. In addition, certain reproductive tract infections have been linked to complications that affect reproductive health. These concerns make early identification and appropriate treatment important (Parveen et al., 2008).

Laboratory testing plays an important role in diagnosing vaginal fungal infections because the symptoms may be similar to those produced by other reproductive tract conditions. Through appropriate laboratory investigations, healthcare professionals can identify the organism responsible for an infection, distinguish candidiasis from other conditions and make more suitable treatment decisions. Therefore, determining the prevalence of fungal infections and identifying the specific species involved may contribute to improved diagnosis and management.

The need to increase awareness of fungal infections and encourage the use of reliable diagnostic methods also provides a reason for conducting this research. The information obtained may improve understanding of vulvovaginal candidiasis among pregnant women attending Wushishi General Hospital. It may also provide useful evidence for planning appropriate diagnostic procedures and health education programmes aimed at preventing and managing the infection.

1.5 Scope of the Study

This research was designed to determine the prevalence of fungal infections among pregnant women attending Wushishi General Hospital. The study covered pregnant women who visited the hospital's Obstetrics and Gynaecology Unit between March and June 2021. Its major areas of investigation included the occurrence of vaginal candidiasis, the isolation and identification of different Candida species, and the association between the infection and selected maternal characteristics.

1.6 Limitations of the Study

Financial Constraints: Insufficient financial resources may limit the researcher's ability to purchase relevant textbooks, obtain journal publications, acquire laboratory materials and access other information needed to complete the research. Financial challenges may also restrict the resources available for collecting data and carrying out other research activities.

Time Constraints: The researcher is expected to carry out the study while attending to other academic responsibilities. This may reduce the time available for reviewing relevant literature, gathering information from participants, performing laboratory investigations, analysing the results and completing the research within the required period.