NORTHERN INTERNATIONAL HEALTH ACADEMY, ZARIA

DEPARTMENT OF MEDICAL LABORATORY TECHNICIAN

ASSIGNMENT QUESTION
PREVALANCE OF CANDIDA ALBICANS AMONG THE PREGNANT
WOMAN AT THE ANTE-NATAL CLINIC OF KAMPALA
INTERNATIONAL UNIVERSITY- TEACHING HOSPITAL BETWEEN
JUNE 2013 TO MAY 2014

BY:

AMAMA ABDULKADIR
REG NO: NIHAZ/2022-2023/M.L.T.1008

LECTURER:
MLS. YAKEEM

MAY, 2023

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 TABL E OF CONTENTS
CHAPTER ONE
Introduction

1.0 Introduction
1.1 Background - - - - - - - - 4
1.2 Problem Statement - - - - - - - 5
1.3 Purpose - - - - - - - - - 5
1.4 Study Objectives - - - - - - - - 5
1.5 Justification - - - - - - - - - 5
CHAPTER TWO
Literature Review
2.1 Introduction Definition - - - - - - - 6
2.2 Epidemiology - - - - - - - - 6
2.3 Etiology and Pathophysiology - - - - - - 7
2.4 Transmission and Risk Factors - - - - - - 7
2.5 Signs and Symptoms - - - - - - - 7
2.6 Diagnosis - - - - - - - - - 8
2.7 Treatment - - - - - - - - - 8
CHAPTER THREE
Research Methodology
3.1 Study design - - - - - - - - 9
3.2 Study area - - - - - - - - - 9
3.3 Study population - - - - - - - - 9
3.4 Sample size determination - - - - - - 9
3.5 Exclusion criteria - - - - - - - - 9
3.7 Specimen collection - - - - - - - 9
3.8 Data collection methods - - - - - - - 9
3.9 Reliability /Validity - - - - - - - 10

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3.9 Data analysis - - - - - - - - 10
3.10 Ethical considerations - - - - - - - 10
3.11 Study limitations - - - - - - - - 10
CHAPTER FOUR
Presentation and Analysis of Findings

4.1 Introduction - - - - - - - - 11
4.2 Demographic Characteristics - - - - - - 11

CHAPTER FIVE
Discussion, Conclusion and Recommendation
5.1 Discussion - - - - - - - - - 15
5.2 Conclusions - - - - - - - - 16
5.3 Recommendations - - - - - - - - 16
5.5 References - - - - - - - - -

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 CHAPTER ONE
Introduction

1.1 BACKGROUND
Candidiasis is the most common opportunistic fungal infection ‘Vaginitis is one
of the principal motives that lead women to seek out an obstetrician or
gynecologist. Candidiasis is responsible for 90% of the cases of infectious
vaginitis. Vulvovaginal candidiasis (WC) is a fungal infection of the female lower
genital tract-the vulva and the vagina, caused by Candida species. It is also known
as candidosis or moniliasis. WC can be recurrent or relapsing is the fourth most
common cause of nosocomial bloodstream infection in the United States“
Candida species are part of the lower genital tract flora in 20-50 % of healthy
asymptomatic women. Carrier rates are higher in women treated with broad
spectrum antibiotics, pregnant women, diabetic women and women with
HIV/AID S8“
Candida albicans is both the most frequent colonizer and responsible for most
cases of WC”. Nevertheless, over the last decades there have been reports
demonstrating an increment in the frequency of cases caused by non-albicans
species with Candida glabrata consistently being the leading species“
In pregnancy, Physiological changes taking place during pregnancy lead to
suppression of the immune system hence favoring the growth of normal flora.
There is also high levels of estrogen and increased availability of sugars during
pregnancy. Candidiasis is thus more common in pregnant Women than in other
times of a Woman's life.
When candidiasis is not diagnosed in pregnancy, it not only causes psychological
and physical stress to the mother but the fetus is most likely to acquire the fungus
via the birth canal during delivery leading to neonatal candidiasis of the
oropharynx. This presents with visible white plaques on the oral mucosa and the
under lying mucosa is inflamed and friable, causing feeding to be very difficult.
Infection of candidiasis from the neonate’s mouth to the mother’s breast can occur
during breast feeding causing the nipples to be inflamed and sore. The Candida
can spread from the nipple cracks to become systemic via blood vessels.
Persistent infection is common in breastfed infants as a result of colonization or
infection of the mother’s nipples. Thus, treatment of the neonate and the mother
should be done at the same time.”

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1.2 PROBLEM STATEMENT
Considering the above physiological changes in pregnancy and the effect of
untreated vaginal candidiasis in pregnant Women to the neonate, it is important
to study the prevalance of vaginal candidiasis in these Women in KIU-TH ante-
natal clinic.
1.3 PURPOSE
The main aim of the study is to collect data to establish the prevalence of vaginal
candidiasis among pregnant Women in order to create awareness to the problem
and come up with feasible recommendations on how to curb it and offer early and
effective treatment to avoid the adverse effects related to this infections to make
early diagnosis and appropriate management.
1.4 STUDY OBIECTIVES
1.4.1 Broad Objective
To assess the prevalence of vaginal candidiasis in pregnant women in KIU- TH
ante-natal clinic.
1.4.2 Specific Objectives
1. To assess the age of the affected pregnant women
2. To assess the education level of these Women
3. To assess the occupation of these Women
4. To assess the risks for vaginal candidiasis in pregnant women
1.5 JUSTIFICATION
This study is therefore important because it will show the prevalence of vaginal
candidiasis in pregnant women and thus augment the efforts of the medical
Workers who have been involved in creating awareness of this problem. It will
enlighten medical workers on the need for early detection of vaginal candidiasis
and provide effective treatment to prevent the adverse effects in pregnancy.

The study also hopes to provide information that will be utilized by the people
implementing policies and the management of the hospitals in providing funds to
create awareness and treatment for the affected pregnant women. Lastly, I am
carrying it out as a partial fulfillment for the award of MB Ch B degree.

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 CHAPTER TWO
LITERATURE REVIEW

2.1 Introduction/ Definition

Candida albicans can be identified by culture from the vagina during pregnancy
in approximately 25 percent of women. It involves overgrowth of the yeast or
fungus. the organism is carrried normally in the small gut, under the nails, in the
vagina and on the skin. It is an opportunistic organism growing under favorable
conditions.
Asymptomatic colonization requires no treatment, but the organism may
sometimes cause an extremely profuse, irritating discharge associated with a
pruritic, tender, edematous vulva.
C al bi cans frequently inhabits the mouth, throat, large intestine, and vagina
normally. Clinical infection may be associated with a systemic disorder (diabetes
mellitus, human immunodeficiency virus [HIV], obesity), pregnancy, medication
(antibiotics, corticosteroids, oral contraceptives), and chronic debilitation.26
During pregnancy, vulvo-vaginal candidiasis may be more difficult to eradicate.
The azoles have not been Well studied for use during the first trimester; therefore,
treatment should be avoided until the second trimester, or l tablet of nystatin
100,000 units may be administered vaginally at night for 2 weeks during the first
trimester.
Effective treatment is given with a number of azole creams that include 2-percent
butoconazole, l-percent clotrimazole, 2-percent miconazole, and 0.4- or 0.8-
percent terconazole”
Topical treatment is recommended, although oral azoles are generally considered
safezs Clotrimazole, miconazole, nystatin, and terconazole are also available as
vaginal tablets.
In some women, infection is likely to recur and require repeated treatment during
pregnancy. In these cases, symptomatic infection usually subsides after
pregnancy”

2.2 Epidemiology
Vaginal Candidiasis is an infection prevalent throughout the world. Although it
is the second most common vaginal infection in North America after bacterial
vaginosis, vulvovaginal candidiasis is a non-notifiable disease and has been
excluded from the ranks of sexually transmitted diseases. Not surprisingly,

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vulvovaginal candidiasis has received scant attention by public health authorities,
funding agencies, and researchers.
2.3 Etiology and Pathophysiology
A research done to determine the prevalence in pregnant women of yeasts isolated
from vaginal exudates and their susceptibility to current antifungal drugs with a
total of 493 patients was studied between December 2000 and February 2004.
The prevalence of Candida spp. was 28% (Candida albicans 90.4%; Candida
glabrata 6.3%; Candida parapsilosis 1.1%, Candida kefyr 1.1 %; unidentified
species 1.1 %). Other fungal infections of the vagina are caused by
Saccharomyces cerevisiae (Brewer’s yeast) and rarely Trichosporon sp.
Candida albicans exists in small amounts in the vagina, without causing disease
or symptoms (approximately 25% of women without disease symptoms have this
organism present). The acidic nature of the vagina helps to prevent infection.
Symptoms appear when the number of the organism becomes larger in relation to
the other microorganisms that nonnally inhabit the vagina. Candida albicans
grows when an imbalance occurs, such as when the normal acidity of the vagina
changes or when hormonal balance changes, i.e the vagina has become less acidic
or when it is difficult for other microorganisms to survive. Thus Candida
multiplies. The three stage mechanisms of adhesion, blastopore germination and
epithelium invasion enable proliferation to occur“
2.4 Transmission and Risk Factors
Candidiasis can be due to conditions that affect the immune system, e.g.
pregnancy, following a course of antibiotics that were prescribed for another
purpose. The antibiotics change the normal balance between organisms in the
vagina by decreasing the number of protective or "Good" bacteria (lactobacilli)
which helps keep yeast levels in check.
Conditions that decrease the good bacteria will also increase the chance of a yeast
infection, or even steroid use, having diabetes or HIV/AIDS, use of birth control
pills, perfumed feminine hygiene sprays, deodorant tampons, or bubble bath, tight
jeans, synthetic underwear, or a wet swimsuit and douching”
Sexual acquisition is rarely important, although the physical trauma of intercourse
may be sufficient to trigger an attack in a predisposed individual”
2.5 Signs and Symptoms
Candidiasis presents with;34
 Abnormal vaginal discharge- Ranges from a slightly Watery, White
discharge to a thick, white, chunky discharge (like cottage cheese)

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  Inflammation of the vulvar skin
 Painful Micturation
 Redness and oedema of the vulva
 Vaginal and labial itching
 Satellite lesions (sores)
 Buming sensation
 Pain during intercourse ( Dyspareunia)
2.6 Diagnosis
For Candidiasis to be diagnosed a pelvic examination will be done. It may show
inflammation of the skin of the vulva, Within the vagina, and on the cewix. Any
lesions or sores should be inspected”
The health care provider may find dry, White plaques on the vaginal Wall.
The pH of vaginal fluid is usually normal, between 3.5 and 4.5.
The diagnosis can be confirmed by microscopy and culture of the vaginal fluid.
2.7 Treatment
All topical antifungal treatments can be used during pregnancy but oral treatments
should not be given to pregnant women. Applicators can be used to in seit topical
preparations into the vagina during pregnancy but expectant mothers may prefer
to insert pessaries using a finger“

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 CHAPTER THREE
RESEARCH METHODOLOGY
3.1 Study design
A descriptive retrospective cross-sectional case study was carried out.
3.2 Study area
The study was carried out in the ante-natal department in Kampala international
university teaching hospital
3.3 Study population
The target population was the pregnant women who attend the antenatal clinic in
Kampala international university teaching hospital. These Women were
randomly selected.
3.4 Sample size determination
It was done according to R. V Kvejcie & D. W Morgan table to determine sample
size for research activities’ education and psychological measurements with a
population size of 800, to have a sample size of 260 people.
3.5 Inclusion criteria
All pregnant Women aged l5 -45 years diagnosed with vaginal candidias were
included.
3.6 Exclusion criteria
The project excluded all non-pregnant women, pregnant women below 15 years
and pregnant Women with other health conditions that suppressed their immune
system, e.g. HIV-AIDS and Diabetes. Likewise all pregnant Women on steroids
or with chronic infections with prolonged use of antibiotics or with malignancies
are not to be included.
3.7 Specimen collection
High vaginal swabs of secretions were collected for fungal examination under
aseptic condition using a vaginal speculum with the help of a gynecologist and
sent to the laboratory for microscopy.
3.8 Data collection methods
Data was determined by quantitative method. This included the use of
documentary sources.

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3.9 Reliability/Validity
The research study to be conducted was the original work and the patients files
from Kampala international university ~teaching hospital record office and the
antenatal clinic records.
3.9 Data analysis
Raw data analyzed was going to be quantitative using Statistical Program for
Social Studies (SPSS) in the computer. The data was tallied in order to come up
with grouped data which was easy to compute and analyze. The analyzed data
was presented in form of tables and pie charts.
3.10 Ethical considerations
An introductory letter was obtained from Kampala international university
administration and according to the ethical rules put up by institutional review
board IRB/ research advisory panels RAP. It was presented to the Director of
Kampala international university —teaching hospital.
Privacy and confidentiality was observed at all stages of this research. To ensure
anonymity, no names was used but instead codes only known to researcher.
3.11 Study limitations
Inability by the hospital to carry out laboratory tests e. g. culture of vaginal
discharge samples to affirm the type of Candida species involved.
Inability to follow up the neonates born in other hospitals whose mothers attended
ante-natal clinic in Kampala international university-teaching hospital during the
study period.
Financial constraints, missing records, power supply interruptions and shortage
of time are some of the challenges to be faced.

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 CHAPTER FOUR
PRESENTATION AND ANALYSIS OF FINDINGS

4.1 Introduction
The research was carried out according to the design and methodology presented
in the previous chapter. Presented are the results from a sample of 260 outpatients
attending Kampala international university-teach1ng hospital Ante-natal clinic.
The findings are analyzed in the form of percentages, tables and pie chart
4.2 Demographic Characteristics
4.2.1 Total number of patients who attended the clinic between june 2013 to
may 2014
Table 1: Total number patients who attended the clinic between june 2013 to
may 2014
Candidiasis Infection Number Percentage
Yes 118 45.6
No 142 54.6
Total 260 100.0

Table 1 shows that of the total number of patient within one year in the clinic who
had vaginal candidiasis were 118 (45.4%) and those who weren’t infected 142
(54.6%)

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 CHAPTER FIVE
DISCUSSION, CONCLUSION AND RECOMMENDATION

5.1 DISCUSSION
5.1.1 DEMOGRAPHIC CHARACTERISTICS IN RELATION TO
SPECIFIC OBJECTIVES
5.1.1.1 Total number of patients presenting with vaginal candidiasis The
study revealed that of the total number of patients who attended the clinic within
one year were 260 , with 45.4% of them presenting with vaginal candidiasis and
those who weren’t infected were 54.6%. This is evidence that pregnancy is a risk
factor for Vaginal candidiasis. According to a research performed by Garcia
Heredia M the prevalance of vaginal candidiasis was 28%“ as compared to my
findings of 45.4% in a study population of 260.
5.1.1.2 Agerange
The study showed that the young mothers between 16- 25 were more infected
with
candidiasis by 47.4% followed by the middle aged mothers between 26- 35 with
41.9% and the least were the elderly mothers between36-45 with 10.8% This goes
on to indicate that the young pregnant women are more prone to recurrent vaginal
candidiasis in their subsequent pregnancy according to MeReC Bulletin unlike
the
elderly pregnant women. Hence the risk of depression and psychosexual
problems.
5.1.1.3 Education level
The pregnant women with primary education had the highest rate with 40.4%
followed by the ones with no formal education with 26.5%, then by the ones with
secondary education with 24.6% and the least was those with tertiary education
with 8.5%. The correlation between vaginal candidiasis and the level of education
of the pregnant women is of little significance. The patients with higher education
reflects that the patient get more knowledge on self hygiene and care therefore
those with tertiary education have a lower percentage of occurrence. This may be
due to conditions that decrease the good bacteria and also increase the chance of
a yeast infection e.g use of birth control pills, perfumed feminine hygiene sprays,
deodorant tampons, or bubble bath, tight jeans, synthetic underwear, or a wet
swimsuit and douching” which is more common with the women who have no
formal or primary education.

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5.1.1.4 Occupation
The study of these pregnant women occupation in relation to vaginal candidiasis
revealed that the peasants and housewives had the highest count of 49.2%,
followed by the business women who are self employed by 33.5% and then the
pregnant women in the private sector by 9.6% and finally the government
employees had the least infection count of 7.7%.The correlation between vaginal
candidiasis and the occupation of the pregnant women which was significant. The
pregnant women who were peasants and housewives probably had the highest
infection rate due to the above risk factors. This correlates with the
socioeconomic
status.”
5.2 CONCLUSIONS
Pregnant women are more vulnerable to vaginal candidiasis irrespective of their
age, trimester, parity, occupation and educational level. With adequate
phannacotherapy, avoidance of contributing factors (eg, douching, wearing tight
underwears) and general personal hygiene, vaginal candidiasis and associated
symptoms can resolve within a short period of time.
Pregnancy is a risk factor for Vaginal Candidiasis. The age of the patient is a
major
factor for vaginal candidiasis because according to my study the young mothers
between 16- 25 were more infected. The patients educational level also
contributes
to the infection in pregnant women with primary education had the highest rate.
The peasants and housewives had the highest count.

5.3 RECOMMENDATIONS
1. There should be a high index of suspicion of vaginal candidiasis by medical
Workers, in pregnant women.
2. Medical Workers should reassure the mother that the disease is treatable to
reduce the risk of depression and psychosexual problems.
3. The management of the hospital should strive to create awareness of
vaginal candidiasis in pregnant Women.

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REFERENCES

1. Kliegman Robert M; Nelson Essentials of Pediatrics(2006), 5"‘ edition,

Elsevier pulishers, Pg 595-596

2. Adad SJ, de Lima RV, Sawan ZT, Silva ML, de Souza MA, Saldanha J C,

Falco VA, da Cunha AH, Murta EF. 2001. Sao Paulo Med J. 119(6):200-

205.

3. Okonko IOel al J. Microbiol. Biotech. Re-3., 2011, 1 (3): 176-184

4. Sobel JD. 2007. Lancet. 369(9577): 1961-71.

5. Ferris DG, Nyirjesy P, Sobel JD, Soper D, Pavletic A, Litaker MS. 2002.

6. Obstet.Gyneo0l. 99(3): 419-425.

7. Reed BD, Zazove P, Pierson CL, Gorenflo DW, Horrocks J. 2003. J.

Women ’s Health (Larchmt). 12(10): 979-89.

8. Cronje HS, Joubert G, Muir A, Chapman RD, Divan P, Bam RH. 1994. S

Atr Med J 1994; 84: 602-605.

9. McClelland RS, Richardson BA, Hassan WM, Graham SM, Kiarie J,

Baeten

JM,Mandaliya K, Jaoko W, Ndinya-Achola JO, Holmes KK. 2009. J.

Infect.

Dis. 15; 199(12):1883-1890.

10. Singh SI. 2003. Treatment of vulvovaginal candidiasis. Clin. Rev.

CPJ/RPC.

136(9): 26-30.

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