PREVALENCE AND RISK FACTORS ASSOCIATED WITH VULVOVAGINAL CANDIDIASIS DURING PREGNANCY IN SANA'A, YEMEN
Background and objective: Women at pregnancy are further susceptible to vaginal colonization and yeast infection. The responsibility of Candida colonization in the incidence of preterm birth is correctly established. Knowing regional epidemiology and identifying risk factors of preterm birth are important for management and preventive strategies. The aim of the study was to reveal the prevalence of Candida species in vaginal swabs of pregnant women and determine odds ratio of risks for vulvovaginal candidiasis (VVC).
Methods: Pregnant women attendance routine antenatal visits in Al-Olify –family Center in Sana'a city were registered into a cross-sectional study carried out from June 2018 to March 2019. The laboratory works were carried out in the National Center of Public Laboratories (NCPHL). Samples of vaginal swabs were taken from contributors after obtaining oral consent. The classification of the Candida species was done by culture on HiCrome Candida Differential Agar at 35 °C for 48 h for making of species-specific colors. Data of demographic, clinical and risk factors were collected in a pre-designed questionnaire.
Results: A total of 190 pregnant women are included. The rate of VVC was 51.6%. Candida albicans accounted for 39.5% and non-Candida albicans accounted for 12.1% of isolates, mainly C. glabrata (4.7%), C. lipolytica (3.2%), and C. famata (2.1%). When VVC risk factors were considered, there were significant risk factors with the age group 20-24 years (61%, odds ratio (OR) = 1.8), first trimester of pregnancy (61.1%, OR = 1.7), Multipara of parity (61.8%, OR = 1.9), low socioeconomic level (60.1%, OR =2.4), and illiteracy (68%, OR = 2.2). When clinical symptoms were considered, only 86.2% of affected females had clinical signs of VVC.
Conclusions: There is a high probable rate of VVC is found among pregnant women in Yemen, undiagnosed and unnoticed; and this highlights the need for health authorities to develop strategies for diagnosing VVC, including vaginal swabs for candidiasis as a routine procedure for all pregnant women. This study also revealed a steady increase in time with a non-C. albicans species prevalence rate. VVC syndrome management guidelines in Yemen should be revised to include a special protocol for pregnant women.
Peer Review History:
Received 14 May 2020; Revised 15 June; Accepted 1 July, Available online 15 July 2020
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