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 Table of Contents  
ORIGINAL ARTICLE
Year : 2023  |  Volume : 13  |  Issue : 1  |  Page : 40-43

Chlamydia trachomatis seropositivity and associated risk factors among women attending a Northern Nigerian Tertiary Hospital


1 Materno-fetal Unit, Department of Obstetrics and Gynaecology, Ahmadu Bello University/Teaching Hospital, Zaria, Nigeria
2 Infertility Unit, Department of Obstetrics and Gynaecology, Ahmadu Bello University/Teaching Hospital, Zaria, Nigeria
3 Reproductive Health Unit, Department of Obstetrics and Gynaecology, Ahmadu Bello University/Teaching Hospital, Zaria, Nigeria
4 Department of Community Medicine, Ahmadu Bello University/Teaching Hospital, Zaria, Nigeria
5 Department of Medical Microbiology, Ahmadu Bello University/Teaching Hospital, Zaria, Nigeria

Date of Submission16-Oct-2022
Date of Acceptance17-Nov-2022
Date of Web Publication18-Jan-2023

Correspondence Address:
Dr. Rabi'at Muhammad Aliyu
Department of Obstetrics and Gynaecology, Ahmadu Bello University Teaching Hospital, Zaria
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jwas.jwas_240_22

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  Abstract 

Background: Genital Chlamydia trachomatis (Ct) is the commonest bacterial sexually transmitted infection globally. Acquisition of Ct infection is affected by biological and behavioural factors. Aim: Determine the prevalence of Ct infection and identify risk factors associated with Ct infection in sexually active fertile women in Northern Nigeria. Materials and Methods: One hundred and fifty sexually active women presenting to the Obstetrics and Gynaecology department of Ahmadu Bello University Teaching Hospital, Zaria were studied. Socio-demographic characteristics and history of risk factors for acquisition of genital Ct were obtained from the participants using a questionnaire. Their sera were tested for the presence of Ct immunoglobulin G using Enzyme-Linked Immunosorbent Assay. Results: The mean ages ± standard deviation of seropositive and seronegative women were 29.1 ± 7.3 years and 28.9 (SD 6.7) years respectively (P = 0.438). The prevalence of Ct infection was 6.7% (10/150). Occupation was associated with Ct seropositivity (P = 0.02). Number of sexual partners, age at coitarche; duration of sexual exposure and previous history suggestive of sexually transmitted infection were not associated with Ct seropositivity (P > 0.05). Conclusion: A low prevalence of Ct was found among fertile women. Lack of regular source of personal income was associated with Ct infection but the sexual behavioural factors studied were not.

Keywords: Chlamydia trachomatis, Nigeria, prevalence, risk factors, women


How to cite this article:
Aliyu RM, Adesiyun AG, Bawa US, Olorukooba AA, Aliyu S. Chlamydia trachomatis seropositivity and associated risk factors among women attending a Northern Nigerian Tertiary Hospital. J West Afr Coll Surg 2023;13:40-3

How to cite this URL:
Aliyu RM, Adesiyun AG, Bawa US, Olorukooba AA, Aliyu S. Chlamydia trachomatis seropositivity and associated risk factors among women attending a Northern Nigerian Tertiary Hospital. J West Afr Coll Surg [serial online] 2023 [cited 2023 Feb 6];13:40-3. Available from: https://jwacs-jcoac.com/text.asp?2023/13/1/40/367962




  Introduction Top


Largely asymptomatic in up to about 80% of females, genital Chlamydia trachomatis (Ct) is the commonest bacterial sexually transmitted infection (STI) worldwide.[1] Chlamydia trachomatis is an important public health problem across the globe because untreated infections can threaten human reproduction by causing adverse reproductive outcomes.[2]

A wide range of prevalence of Ct has been reported in the literature. This variation is largely due to the heterogeneity of the population studied and the diagnostic techniques used in these studies. In Nigeria, a prevalence of 3.5% – 26% has been reported among women attending out-patient clinics.[3],[4] Koledade et al.[5] found a prevalence of 31% among infertile women. Agholor et al.[6] reported a prevalence of 48% among women with ectopic pregnancy. Garba et al.[7] found a prevalence of 2% among pregnant women and Aliyu et al.[8] reported a prevalence of 3.6% among women with spontaneous miscarriage. The pooled prevalence of Ct infection in Sub-Saharan Africa among reproductive-age women is 7.8%.[2] Globally, 124.3 million cases of Ct were reported by World Health Organization (WHO) in 2016.[9]

Reported risk factors for acquisition of Ct include age less than 25 years, change of sexual partner, having more than one sexual partner, and early age at first sexual intercourse.[1],[4] These sexual behaviours vary between climes and are affected by the socio-cultural norms of the community.

In many developed countries, screening programmes for Ct exist to reduce transmission and reproductive tract morbidity but these are almost non-existent in many developing countries due to high costs, technical complexity relating to infrastructure, equipment, and expertise.[10] Such screening involves opportunistic and organized annual screening of high-risk women and effective case management.[1] These have reduced complications associated with Ct infection. However, in developing countries, such control measures are not readily available and case management is still by syndromic approach. This has contributed to the high burden of Ct infection and its complications in sub-Saharan Africa. In resource-limited countries, reports of Ct represent only the ‘tip of the ice berg’ because most women have an asymptomatic disease. Thus, Ct infection persists unnoticed and remains untreated for a longer period, thereby enhancing transmission of the infection to a sexual partners.[2]

Because screening and treatment of Ct infection in women will prevent reproductive morbidities, we aimed to determine the prevalence of Ct to estimate the disease burden and to identify the risk factors for this largely asymptomatic infection.


  Materials and Methods Top


The study was a cross-sectional study conducted among 150 sexually active fertile women with a history of pregnancy within the last 12 months evidenced by current pregnancy or having a pregnancy within the last 12 months presenting to the Obstetrics and Gynaecology department of Ahmadu Bello University Teaching Hospital, Zaria between January to April 2018. The formula for calculating sample size for a cross-sectional study (Z1-α/22 p(1-p)/d2) was used to obtain the minimum sample size. The prevalence of Ct of 8.7% obtained by Enwuru et al.[11] using a similar diagnostic technique of Enzyme-Linked Immunosorbent Assay (ELISA); where Z1-α/22 is the standard normal deviate at 95% confidence interval (1.96) and an absolute error (d) of 5% was used. Only non-consenting women were excluded. The data collection tool was a semi-structured, pretested, and interviewer-administered questionnaire. It had three sections namely: socio-demographic characteristics and reproductive profile; risk factors for Ct and laboratory IgG result. Under aseptic technique, 5mls of venous blood was obtained from each participant and the serum was tested for the presence of Ct immunoglobulin G using ELISA according to the manufacturer’s protocol.[12] Data obtained were analysed using SPSS version 21. For univariate level analysis, descriptive summary statistics were computed such as mean and standard deviations for quantitative variables like age, while for categorical variables like tribe and marital status, frequencies and percentages were used. At bivariate analysis, chi-square test was used to determine the association between sociodemographic variables and the presence of chlamydia infection. Binary logistic regression was used to determine the predictors of Ct infection at multivariate level analysis. The level of significance was set at <0.05. Ethical approval was obtained from the Health Research Ethical Committee of Ahmadu Bello University Teaching Hospital, Zaria (ABUTHZ/HREC/B03/2017).


  Results Top


The mean age of the women studied was 28.9 (SD 6.9 years). The women were predominantly of Hausa ethnic group and Muslims. Majority (148, 98.7%) were married. About 41.3% had tertiary education and 50% had personal source of income. These characteristics are shown in [Table 1].
Table 1: Sociodemographic characteristics of study participants

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The prevalence of Ct IgG was found to be 6.7% (10/150). The mean ages of seropositive and seronegative women were 29.1 (SD 7.3) years and 28.9 (SD 6.7) years respectively (p = 0.438). The highest prevalence was seen in women aged 35–39 years. All seropositive women were married. Chlamydia trachomatis infection was associated with lack of regular source of income (p =0.02). However, other sociodemographic variables were similar between the groups that tested positive and negative to Ct infection as seen in [Table 2].
Table 2: Sociodemographic characteristics and seropositivity for Ct IgG

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The sexual behavioural risk factors studied were not found to be associated with Ct seropositivity (P > 0.05) as shown in [Table 3].
Table 3: Risk factors for Ct seropositivity

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  Discussion Top


The prevalence of Ct IgG seropositivity in our study was found to be 6.7% which is lower than that reported in a previous study in the same hospital.[4] While we studied a select group of fertile women, Ige et al.[4] reported a prevalence of 26% in the same setting when endocervical specimens of women in the reproductive age group were sampled and subjected to a polymerase chain reaction. Tukur et al.[13] found a prevalence of 38.3% among a select group of women with tubal infertility. Nwankwo et al.[10] from Kano studied multiple specimens using lateral flow immunoassay and found Ct prevalence to be 9.6% amongst patients attending infertility and sexually transmitted disease clinics. Thus, the variable sampling methods, Ct detection techniques; and study population could have accounted for this difference observed.

The highest prevalence in this study was seen in the cohort of women aged 35–39 years. This finding is not in concordance with findings by Nwankwo et al.[10] from Kano, Ikeme et al.[14] from Enugu, and Arinze et al.[15] from Port Harcourt that reported the highest prevalence of Ct infection to be among women aged ≤ 30 years. This may be due to the different study populations used by the researchers that constituted largely of undergraduate students and a select age bracket of not more than 34 years. Our study participants were all sexually active women of the reproductive age group that presented to the Obstetrics and Gynaecology clinic.

Lack of regular source of income was found to be associated with Ct infection and this agrees with findings by Okoror et al.[16] from Akure where lack of regular source of income had a significant association with Ct infection. This finding could be explained by impaired access to health care facilities for detection and treatment of Ct infection.

Having more than one-lifetime sexual partner and having a partner with multiple sexual contacts were not associated with Ct seropositivity and is consistent with finding by Ige et al.[4] that reported polygamous union and non-first order of marriage not to be associated with Ct infection. Commencing sexual activity at ≤ 24 years did not increase the odds of being seropositive in our study. This contrasts with the finding of Ige et al.[4] that reported a doubled risk of infection in women who commenced sexual activity before 18 years. The sexual act is an extremely private issue in most conservative settings like Nigeria. Thus, sexual history may be fraught with some inconsistencies that could affect this finding obtained. Similarly, having a history suggestive of an STI was not associated with Ct seropositivity in our study. Appropriate laboratory diagnosis is seldom achieved for STI in most resource-constrained settings, and often syndromic management is resorted to. What is perceived based on symptomatology as STI by mostly uninformed individuals, may not really be the case. Thus, laboratory diagnosis of STI should be encouraged and offered where available.

This study explored the burden of genital Ct by assessing the serological evidence of Ct infection among women at risk of Ct infection. However, the use of ELISA technique, type of specimen used in the study; and inability to differentiate acute Ct infection are limitations of this study.


  Conclusion Top


A low prevalence of Ct infection was found among fertile women. Lack of regular source of personal income was associated with Ct infection. Number of life-time sexual partners, age at first intercourse, duration of sexual activity and previous history suggestive of sexually transmitted infection were not associated with Ct infection.

Acknowledgement

We acknowledge the staff of the Obstetrics and Gynaecology department and medical laboratory scientists of the Medical Microbiology, Ahmadu Bello University, Zaria for supporting and conducting the ELISA tests respectively.

Financial support and sponsorship

Privately funded by researchers.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Centre for Disease Control and Prevention. Sexually Transmitted Disease Surveillance, 2018. Atlanta, GA: US Department of Health and Human Services; 2019. [updated; cited March 25 2021]. Available from https://www.cdc.gov/std/stats.  Back to cited text no. 1
    
2.
Hussen S, Wachamo D, Yohannes Z, Tadesse E Prevalence of chlamydia trachomatis infection among reproductive age women in sub saharan Africa: A systematic review and meta-analysis. bmc Infect Dis 2018;18:596.  Back to cited text no. 2
    
3.
Bello S, Tunau K, Nasir S, Yahaya M, Panti A, Hassan M, et al. Prevalence of genital Chlamydia trachomatis infection among patients attending a gynaecological clinic in a tertiary hospital. Sahel Med J 2019; 22:188-93.  Back to cited text no. 3
  [Full text]  
4.
Ige OT, Ige SO, Olayinka AT Prevalence of Chlamydia trachomatis infection among women of reproductive age group in a tertiary hospital in Northern Nigeria. Ann Trop Pathol 2018; 9:17-21.  Back to cited text no. 4
    
5.
Koledade A, Adesiyun A, Oguntayo A, Olayinka A, Randawa A, Samaila M Prevalence of Chlamydia trachomatis infection among women attending gynaecological clinic for infertility in Zaria, Nigeria. Internet J Gynaecol Obstet 2014;19:1-7.  Back to cited text no. 5
    
6.
Agholor K, Omo-Aghoja L, Okonofua F Association of anti-chlamydia antibodies with ectopic pregnancy in benin city, Nigeria: A case-control study. Afr Health Sci 2013;13:430-40.  Back to cited text no. 6
    
7.
Garba F, Abdulsalami M, Egbe N Seroprevalence of Chlamydia trachomatis infection among pregnant women attending antenatal clinics within Kaduna metropolis, North-Central, Nigeria. J Public Health Epidemiol 2018;10:320-2.  Back to cited text no. 7
    
8.
Aliyu RM, Adesiyun AG, Aliyu S Does genital Chlamydia trachomatis cause miscarriage in black women? Trop J Obstet Gynaecol 2019,36:455-8.  Back to cited text no. 8
    
9.
World Health Organisation. Guidelines for the treatment of Chlamydia trachomatis. 2016. Available from https://apps.who.int/iris/bitstream/handle/10665/246165/9789241549714-eng.pdf;jsessionid=2C61CBA5B89A09AF2D86C4DE0653823C?sequence=. [Last accessed on 15 Oct 2021].  Back to cited text no. 9
    
10.
Nwankwo EO, Sadiq MN Prevalence of chlamydia trachomatis infection among patients attending infertility and sexually transmitted diseases clinic (std) in kano, north western Nigeria. Afr Health Sci 2014;14:672-8.  Back to cited text no. 10
    
11.
Enwuru CP, Umeh SI Asymptomatic carriage of Chlamydia trachomatis among young adults in Owerri, South East Nigeria. IOSR J Nurs Health Sci 2014;3:49-53  Back to cited text no. 11
    
12.
Chlamydia Trachomatis IgG ELISA by Immuno-Biological Laboratories, Inc. (IBL-America). Available from https://www.ibl-america.com/chlamydia-trachomatis-igg-elisa/  Back to cited text no. 12
    
13.
Tukur J, Shittu SO, Abdul AM a case control study of active genital chlamydia trachomatis infection among patients with tubal infertility in northern Nigeria. Trop Doct 2006;36:14-6.  Back to cited text no. 13
    
14.
Ikeme AC, Ezegwui HU, Ikeako LC, Agbata I, Agbata E Seroprevalence of chlamydia trachomatis in enugu, Nigeria. Niger J Clin Pract 2011;14:176-80.  Back to cited text no. 14
    
15.
Arinze AU, Onyebuchi NV, Isreal J Genital chlamydia trachomatis infection among female undergraduate students of university of port harcourt, Nigeria. Niger Med J 2014;55:9-13.  Back to cited text no. 15
    
16.
Okoror LE, Otoickian C, Eniolorunda T, Omoniyi FD Prevalence and risk of chlamydia trachomatis in symptomatic patients attending clinics in southwest Nigeria. Arch Clin Micro2014;5. doi: 10.3823/285.  Back to cited text no. 16
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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