Factors associated with bacterial vaginosis in sexually active women enrolled in the Microbicide Development Program 301 Study.
Date
2014-03-27
Authors
Manyema, Mercy
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Abstract
Introduction
Bacterial vaginosis (BV) is a highly prevalent vaginal infection which poses a significant public health burden in Sub-Saharan Africa (SSA) due to its association with HIV, other STIs and several gynaecological and obstetrical complications. The aim of this study was to explore the underlying and proximate factors associated with BV and the relationships between them.
Materials and Methods
This study was a cross-sectional secondary analysis of the data collected during the Microbial Development Program (MDP) 301 trial. Logistic regression and structural equation modelling were used to test for the associations between BV and the explanatory variables and to test for the direct, indirect and total effects of the variables on BV.
Results
A total of 2 470 women were included in the analysis and of these 2 203 were aged 40 and below. The majority of them were unemployed at 72% and 51,8% were in the lowest socio-economic level. The baseline prevalence of BV was 40.5%. In the logistic regression, high socio-economic level (AOR=1.66; 95% CI 1.04-2.64) and using a condom during their last sexual encounter (AOR 0.82; 95% CI 0.69-0.97) were associated with BV infection. The STIs significantly associated with BV infection were: Herpes Simplex Virus 2 (HSV2) (AOR=1.31; 95% CI 1.10-1.56), trichomoniasis (AOR=2.68; 95% CI 1.97-3.64) and chlamydia infection (AOR 2.02; 95% CI 1.61-2.62). In the structural equation modelling (SEM) high socio-economic status had a positive direct effect on BV infection (beta=0.12, OR=1.14).Condom use during the last sex act had a negative direct effect on BV (beta=-0.043, OR=0.96). The presence of T.vaginalis, HSV2 or chlamydia infection had significant positive effects on BV infection.
Conclusions
Sexual behavioural factors and the presence of STIs were significantly associated with BV. The SEM analysis showed the interaction of contraceptive use and sexual behavioural factors. No interaction between the STIs and sexual behaviour could be demonstrated in this study.