Prevalence of chlamydia infection among patients with ectopic pregnancy and incomplete abortion at the Kenyatta National Hospital

Abstract

Background: Ectopic pregnancy is the leading acute gynaecological emergency in Kenya. There has been an association between Chlamydia infection and ectopic pregnancy. Objective: To describe and compare the prevalence of Chlamydia infection in patients with ectopic and incomplete abortion at the Kenyatta National Hospital Design: A case control study. The cases were patients with ectopic pregnancy while the controls were those with incomplete abortion. Setting: Acute gynaecological ward at the Kenyatta National Hospital. Subjects: Patients with ectopic pregnancy and incomplete abortion. - Methods: A cervical swab was taken from a patient with an ectopic

pregnancy post-operatively. Another swab was taken from an age matched client presenting at the acute gyna~cological ward with an incomplete abortion. Detection of Chlamydia ,antig. ens in the samples was done through rapid immunoassay using Diaspot! Chlamydia Rapid Test Device. Social demographic profiles of the participants were also extracted using a structured questionnaire. Data management: Data was collected using a structured questionnaire by the principal investigator. Data entry was done using Access database while data analysis was done using the SPSS 12 for Windows programme. Results: 40 participants were recruited wit'f, ectopic pregnancies and 40 with incomplete abortions. The prevalence of Chlamydia was 8% (3/40) among those with ectopic pregnancy and 3% (1/40) in those with incomplete abortion. The difference was not statistically significant. Discussion: Prevalence of Chlamydia infection was found to be lower than expected in both cases and controls. Conclusions and recommendations: Although not statistically significant, prevalence of Chlamydia was 3 times greater among patients with ectopic pregnancy than among those with incomplete abortion. Studies on other causes of tubal damage leading to ectopic pregnancy should be done. INTRODUCTION Chlamydia trachomatis is an obligate intracellular bacterium that commonly - attaches to columnar or transiti.ofl~1 epithelium. C. trachomatis infections are an enormous public health problem throughout the world, accounting for most bacterial sexually transmitted diseases. WHO estimated that there were sixteen million new cases of chlamydia in sub-Saharan Africa in 1999.1 , . . Although there are no recent global Chlamydia prevalence estimates country data from US and UK suggest that the preva lence may have increased." A study in women undergoing tubal ligation found chlamydia prevalence to be 14.9%,3 while 9 % of women aged 18 - 40 years attending an STD clinic in Nairobi, were found to have Chlarnydia." Lagarde, et al in a multicenter study in Kisumu, reported the prevalence of chlamydia to be 4.5% in women selected from the general population. Most pregnant women have asymptomatic infection but some present with urethral syndrome, urethritis or Bartholins gland infection." Chlamydia