Prevalence of Reproductive Tract Infections among Married Women in Perth

This cross-sectional study aims to assess the prevalence of reproductive tract infections (RTIs) and associated health seeking behaviour among married women in Perth, WA. The study will be conducted across three suburbs and two local government areas of Perth, and will explore the association between prevalence rates of RTI with pre-determined socio-demographic variables.

Running head: EPIDEMIOLOGY
Written Report- Assessment 2
Name of the Student
Name of the University
Author Note

1EPIDEMIOLOGY
Executive summary
Reproductive tract infection (RTI) affect the reproductive tract, a part of both male and
female reproductive system. Common RTI include STD (sexually transmitted diseases),
endogenous infections, and iatrogenic infections. The research proposal given below was
based on an epidemiological survey that intended to be conducted across three suburbs, and
two local government areas of Perth. The proposal elaborated on the cross-sectional research
design that would recruit married women of reproductive age, to determine the prevalence of
RTI symptoms and their help seeking behaviours. The proposal also illustrated the way by
which the expected outcomes would govern future health initiatives.

2EPIDEMIOLOGY
Table of Contents
Title............................................................................................................................................3
Project summary.........................................................................................................................3
Rationale and Background.........................................................................................................4
Study goals and objectives.........................................................................................................5
Research aim..........................................................................................................................5
Specific objectives.................................................................................................................6
Study design and methods..........................................................................................................6
Research design......................................................................................................................6
Study area...............................................................................................................................6
Sampling design.....................................................................................................................6
Sample size calculation..........................................................................................................7
Data collection.......................................................................................................................7
Data analysis..........................................................................................................................8
Ethical considerations............................................................................................................8
Limitations.............................................................................................................................9
Study impact...............................................................................................................................9
Project management arrangements............................................................................................9
References................................................................................................................................11

3EPIDEMIOLOGY
Title
A study to assess prevalence of reproductive tract infections and health seeking
behaviour among married women in selected areas of Perth, WA.
Project summary
Reproductive tract infections (RTIs) are usually caused due to organisms that are
typically existing in the reproductive tract, or brought from the external environment during
medical procedures and/or sexual contact. These dissimilar but overlying classes of RTI are
called sexually transmitted infections (STIs), endogenous, and iatrogenic, imitating how they
are developed and spread (Tibary & Fite, 2013). RTIs affect the upper portion of the
reproductive system of women namely, the ovary, fallopian tubes, and the uterus, and the
lower part that comprises of the cervix, vagina, and the vulva. While endogenous infections
arise from an infectious agent that was already existing in the body in an asymptomatic form,
iatrogenesis occurs due to the activity of one or more than one healthcare professionals who
promote the use of certain services and products that fails to support the health goals.
Sexually transmitted infections (STDs) are in turn spread due to sexual activity, especially
vaginal intercourse, oral sex, and anal sex (Anderson et al., 2013).
RTIs are considered as the most essential incidents that lead to perinatal and maternal
mortality and morbidity every year. Some of the serious health complications that are related
to RTIs include pelvic inflammatory disease, ectopic pregnancy, miscarriage, congenital
infection, preterm labour, and stillbirth. RTIs might also result in the onset of chronic
disabilities such as, genital cancer, infertility and death. Augmented risk of AIDS is another
concern of RTIs (De Boer et al., 2014). The proposal will be a cross-sectional study where
the prevalence of RTIs among married women belonging to the reproductive age group will
be assessed, followed by exploring their health seeking behaviour from their responses. The

4EPIDEMIOLOGY
research approach will follow an epidemiological survey where a medical survey will be
conducted with the aim of discovering the rates of reproductive tract infection among women
in Perth. The findings of the survey will be coded and analysed into specific data patterns
called themes, to devise different ways by which the disease can be prevented from
spreading.
Rationale and Background
The burden of untouched RTIs is particularly substantial for women because these
contagions are frequently asymptomatic or the indications are not identifiable. Illness and
mortality connected to RTIs rob the society of significant contributions made by females in
terms of social, economic, and cultural development (Moore et al., 2015). Though RTIs
creates an impact on females in both industrialised and developing countries, these infections
are considered as a crucial public health concern in areas of the world that has lack of
adequate resources (Hassan, 2015). Demographic variations in developing nations have led to
an intense upsurge in the number of teenage and young adult females and males in their
maximum sexually active years that converts into a greater amount of the populace at risk for
RTIs (Silasi et al., 2015).
Reports from the World Health Organization suggests that an estimated 1 million
sexually transmitted infections (STIs) affect people every day, on a global scale. Of 357
million new infections, trichomoniasis, syphilis, and gonorrhoea are most widespread. While
most STI signs and symptoms are not easily recognised, syphilis affects more than 900 000
pregnant women, thus leading to adverse birth outcomes, mother-to-child transmission, and
infertility (WHO, 2016).
Lis, Rowhani-Rahbar and Manhart (2015) conducted a meta-analysis of female RTI
and Mycoplasma genitalium infection and found significant association between the infection

5EPIDEMIOLOGY
and elevated risks of preterm birth (OR, 1.89 [95% CI, 1.25–2.85]), cervicitis (OR, 1.66 [95%
confidence interval {CI}, 1.35–2.04]), and spontaneous abortion (OR, 1.82 [95% CI, 1.10–
3.03]). Upon conducting a cross-sectional study among married women, findings of another
study provided evidence for the prevalence of 17.3% of RTI. Some of the most common
signs and symptoms that were reported by female sufferers were dyspareunia (26.7%),
urinary (frequent urination 53.3%, dysuria 57.8%), unusual vaginal discharge (24.4%), and
vaginal itching (22.2%) (Philip, Benjamin & Sengupta, 2013). In the words of
Narayankhedkar, Hodiwala and Mane (2015) vaginitis is one of the most prevalent RTIs in
women who are sexually active. Some of the common symptoms that accompany this kind of
RTI include vulval itching, vaginal discharge, malodour, abdominal pain, and dysuria.
Verma, Kumar Meena and Banerjee (2015) also conducted a comparative prevalence
study and suggested that urban and rural areas demonstrated similar prevalence rates of RTIs
(42.3% and 42%, respectively). While 73% affected women sought treatment in the urban
areas, as less as 45.6% from the rural regions had health seeking behaviour. Conduction of a
house-to-house survey among women belonging to the reproductive age in rural communities
suggested that peri-vulval itching and white discharge were the common complaints. RTI had
a 70% prevalence in community, and 67% among females who attended Out Patient
Departments (OPD) (Mehta, Parikh & Bala, 2016).
The prevalence rates are supported by Rohilla et al. (2015) who confirmed syndromic
diagnosis of RTI among 92 patients from a tertiary care centre. Thus, the dominance of
laboratory confirmed RTIs was 27% in the target population. Considering the fact that the
prevalence and incidence of RTIs are found to greatly vary between different regions, within
a certain country, there is a need to focus on exploring the prevalence rates at a particular
region (Perth).

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Study goals and objectives
Research aim
The primary aim of the research is to explore the prevalence of reproductive tract
infections (RTIs) and associated health seeking behaviour among married women, of the
reproductive age group, in Perth, WA.
Specific objectives
 To determine the prevalence of RTI among married females
 To explore the health seeking behaviour, in relation to RTI among married women
 To assess the association between prevalence rates of RTI with pre-determined socio-
demographic variables
 To prepare and distribute pamphlets for promoting awareness on RTI
Study design and methods
Research design
The research is intended to be conducted in the form of a cross-sectional, community
based study. Cross-sectional surveys aim to gather essential information for drawing
inferences about a certain population of interest, at a particular time frame (Lebo & Weber,
2015). Cross-sectional surveys have also been pronounced as snaps of the inhabitants, on
whom data is collected. The study will be conducted from December 2018 to April 2019.
Study area
Perth ranks fourth in the population ranking in Australia, and is divided into 250
suburbs and 30 local government areas. The research will be conducted across three suburbs
of Perth namely, Churchlands, Waterford, Ashendon, and South Perth, and two government
areas namely, Town of Cambridge and Shire of Ashburton.

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Sampling design
Sampling will be done by randomisation technique. The sampling method will assist
in removal of selection bias between the women who form the target population. The
eligibility criteria is given below:
Inclusion criteria:
 All married women of reproductive age
 Women of the following age group who have had presented with complaints that are
suggestive of RTI
 Married women of reproductive age who had been referred to the six healthcare
centres across the selected regions
Exclusion criteria:
 Women who have been residing in Perth for less than 6 months
 Women beyond reproductive age who have had experienced RTI symptoms
Following obtaining a list of women who are considered eligible for the research, home
visits will be scheduled, where the objective and technique of the study will be explained,
besides ensuring confidentiality of their replies.
Sample size calculation
This refers to the act of selecting the number of participants to be included in the
statistical sample (Charan & Biswas, 2013). Owing to the fact that cross-sectional studies are
conducted for estimating certain population parameters, like the prevalence of RTI in this
case, the below given formula will be used:

8EPIDEMIOLOGY
Data collection
A pre-tested, pre-designed, semi-structured interview will be used for questioning the
eligible married women. The interview will comprise of both closed and open ended
questions. The interview will comprise of the following parts:
 Questions for assessing the socio-demographic features of the subjects, data related to
identification namely, age, religion, address, socioeconomic status, and occupation
 Questions on marriage and menstrual history
 Questions related to obstetric history
 Questions that will explore knowledge of the women on RTIs and their history of
previous occurrence (if any)
 Questions on presence of any signs and symptoms related to RTI, their onset, and
frequency of occurrence in past one year
 Questions that will assess their treatment seeking conduct for the disease
Data analysis
Data analysis would utilise the SPSS version 21.0 software. This will help in
calculating the proportions and percentages for symptom prevalence and help seeking
behaviour (DiMaggio, 2013). A fisher exact test and chi square test will also be used for
calculating the significance of the results in univariate analysis. Presence of ‘p’ value of less
than 0.05 will be considered significant for the results.

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Ethical considerations
The objective, aims and procedure of the cross-sectional research will be explained to
all married women, the community nurses, and gynaecologists. Complete confidentiality will
be maintained, with regards to patient information, during all stages of the study. The women
will be given the opportunity to withdraw from the research or refuse to participate at any
point of time. Prior to conduction of the interview, an informed consent will be taken from all
women and the Human Research Ethics Committee.
Limitations
The study will not be able to obtain information on the history of several sexual
partners. A larger sample size will be required to validate accuracy of the findings. Receiving
a non-response to some question of the interview might also lead to bias.
Study impact
The primary impact of the study will be related to gaining a sound understanding of
the prevalence of symptoms that relate to RTI, in relation to different behavioural, obstetric,
and socio-demographic factors in the women population of Perth. The expected outcomes of
the study are that women belonging to all kinds of socioeconomic background will report
similar prevalence rates of RTI. However, while married women belonging to higher
economic background and with greater educational attainment are expected to demonstrate
more treatment seeking behaviour, those belonging to poor social status and with less
education are anticipated to manifest less of such behaviour. The results will be used to
educate the women about the indications of RTI, their deterrence, and the prominence of
timely management in both rural and urban areas. The epidemiological study findings will
also be disseminated across government departments to help them take necessary initiatives
for tackling this public health issue. This will also help in ensuring the availability of the RTI
cure kits across primary healthcare centres to upturn the utilisation of government services.

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Project management arrangements
The project will involve two researchers, women belonging to the reproductive age
group from Perth, their husbands, two community nurses, and gynaecologists from the
respective health centres from where the women will be selected. The Human Research
Ethics Committee of the university should also be consulted to seek their approval, prior to
conduction of the research on human participants. Six healthcare centres located across Perth
and their corresponding doctors from the gynaecology department shall also be prior
informed about the objective and plan of action. The two community nurses will be selected
from Perth Community Care Centre. Hence, the disciplines of nursing, women reproductive
health, and institutional ethics review will be involved in the project. An individual with
methodological expertise in statistical calculations will also be involved in validation of the
statistically pooled data.

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References
Anderson, C., Gallo, M. F., Hylton-Kong, T., Steiner, M. J., Hobbs, M. M., Macaluso, M., ...
& Warner, L. (2013). Randomized controlled trial on the effectiveness of counseling
messages for avoiding unprotected sexual intercourse during sexually transmitted
infection and reproductive tract infection treatment among female sexually
transmitted infection clinic patients. Sexually transmitted diseases, 40(2).
Charan, J., & Biswas, T. (2013). How to calculate sample size for different study designs in
medical research?. Indian journal of psychological medicine, 35(2), 121.
De Boer, M. W., LeBlanc, S. J., Dubuc, J., Meier, S., Heuwieser, W., Arlt, S., ... &
McDougall, S. (2014). Invited review: Systematic review of diagnostic tests for
reproductive-tract infection and inflammation in dairy cows. Journal of Dairy
science, 97(7), 3983-3999.
DiMaggio, C. (2013). Introduction. In SAS for Epidemiologists (pp. 1-5). Springer, New
York, NY.
Hassan, H. E. (2015). Infertility profile, psychological ramifications and reproductive tract
infection among infertile women, in northern Upper Egypt. Journal of Nursing
Education and Practice, 6(4), 92.
Lebo, M. J., & Weber, C. (2015). An effective approach to the repeated cross‐sectional
design. American Journal of Political Science, 59(1), 242-258.
Lis, R., Rowhani-Rahbar, A., & Manhart, L. E. (2015). Mycoplasma genitalium infection and
female reproductive tract disease: a meta-analysis. Clinical Infectious Diseases, 61(3),
418-426.

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Mehta, M., Parikh, S., & Bala, D. V. (2016). Prevalence of Reproductive Tract Infection
(RTI) Amongst Reproductive Age Women in Rural Area: A Missed Opportunity.
Retrieved from http://www.iapsmgc.org/index_pdf/201.pdf
Moore, K. R., Cole, S. R., Dittmer, D. P., Schoenbach, V. J., Smith, J. S., & Baird, D. D.
(2015). Self-reported reproductive tract infections and ultrasound diagnosed uterine
fibroids in African-American women. Journal of women's health, 24(6), 489-495.
Narayankhedkar, A., Hodiwala, A., & Mane, A. (2015). Clinicoetiological characterization of
infectious vaginitis amongst women of reproductive age group from Navi Mumbai,
India. Journal of sexually transmitted diseases, 2015.
Philip, P. S., Benjamin, A. I., & Sengupta, P. (2013). Prevalence of symptoms suggestive of
reproductive tract infections/sexually transmitted infections in women in an urban
area of Ludhiana. Indian journal of sexually transmitted diseases, 34(2), 83.
Rohilla, R., Agarwal, J., Qureshi, S., & Kalyan, R. (2015). Prevalence of Reproductive Tract
Infections/Sexually Transmitted Infections and Their Determinants in Women of
Reproductive Age Group, Attending STI Clinic at a Tertiary Care Centre in Lucknow,
India. Age, 20(4), 7.
Silasi, M., Cardenas, I., Kwon, J. Y., Racicot, K., Aldo, P., & Mor, G. (2015). Viral
infections during pregnancy. American journal of reproductive immunology, 73(3),
199-213.
Tibary, A., & Fite, C. L. (2013). Reproductive tract infections. Equine Infectious Diseases.
Elsevier, 84-103.
Verma, A., Kumar Meena, J., & Banerjee, B. (2015). A Comparative Study of Prevalence of
RTI/STI Symptoms and Treatment Seeking Behaviour among the Married Women in

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Urban and Rural Areas of Delhi. International journal of reproductive
medicine, 2015.
World Health Organization. (2016). Sexually transmitted infections (STIs). Retrieved from
http://www.who.int/news-room/fact-sheets/detail/sexually-transmitted-infections-
(stis).