RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA
Proforma for registration of subject for dissertation
1. / Name of the candidate and address / Ms. sWARNALATHA pALLIPAMULAIst Year M. Sc Nursing
E.T.C.M. College Of Nursing,
Post Box No. 4, Kolar
2. / name of the institution / E.T.C.M. College Of Nursing. Kolar.- 563 101
3. / course of study and subject / Master Degree In Nursing
Medical Surgical Nursing
4. / date of admission to course / June 2008
5. / title of the topic / A study to assess the knowledge of female patients regarding vaginal infections in selected hospital at Kolar with a view to develop information booklet on prevention of these infections.
6. BRIEF RESUME OF THE INTENTED WORK:
INTRODUCTION:
Women’s health is a unique specialty of health care. As their presence in the labor market has increased, women have faced major changes in their roles, lifestyles and family patterns. Moreover they have encountered environmental hazards and stress, prompting them to focus greater attention on health and health – promoting practices. As a result, some women are taking a greater interest in and responsibility for their own health care. Many others do not have the time, finances, or their resources to do so. 1
Some disorders are self limited and causes only minor inconvenience to the women. Others are life threatening and requires immediate attention and long term therapy. Many disorders are managed at home where as other requires hospitalization and surgical intervention. All disorders require understanding in preventing the occurrence. 1
Disorders of the female reproductive system including Infections are common problem in women. It is difficult to know the true % of women affected by infection. In the world vaginal infections are one of the most common reasons woman see the doctor. Roughly more than 10 millions are affected every year. Infections cause only discomfort although the discomfort may be substantial. However those infections occasionally become serious. According to recent research, the incidence of vaginal yeast infections has doubled over the last 20 years, possibly because of changes in lifestyle, environmental changes, or mutations in the yeast organism itself. 2
Yeast infections are a very common and most women, about 70% of them, will get a yeast infection at least once in their lifetimes. And some of these women will get recurring yeast infections. Women usually do not get yeast infections from sex. Instead, a weakened immune system is the most common cause of yeast infections. Most physicians discourage women from diagnosing and treating themselves with over-the-counter medications, because symptoms may be produced by more serious vaginal infections, such as bacterial vaginosis or trichomoniasis. Trichomoniasis produces symptoms that are similar to other vaginal infections, but it is much more serious and requires specific treatment. 3
Bacterial vaginitis is the most medical problem in woman that is associated with substantial discomfort and frequent medical visit. Roughly 5 to 10 million people are affected with bacterial vaginosis. Bacterial vaginitis is a poly microbial infection of the vagina and should not be considered on exclusively sexually transmitted disease. This study explains with case of 17years old female virgin adolescent with recurrent malodorous vaginal discharge for 6 months before referred to hospital she had been treated unsuccessfully with conservative treatment options. 4
The nurses encourage women to determine their own health goals and behaviours, she assess and teaches about health and illness offers intervention strategies and provides support counseling. This will help others in taking responsibility of self-regulation. The systematic assessment of knowledge of people will help nurses to identify the need of developing strategies or guidelines in prevention of disorders. 5
6.1 NEED FOR THE STUDY:
Women use the health care system more often than men and make up the majority of health care workers, addressing women’s health need and concerns. 1
Advance in medical science have made it possible to treat effectively many disorders of the female reproductive system but for optimum benefit from treatment, early diagnosis is essential. As people become better informed about normal reproductive function, throughout life they are able to recognize and report symptoms indicative of early disease. Since nurse is the member of health team consulted by a women with symptoms related to the reproductive system, she needs to know those for which she may safely suggest conservative hygienic measure. 6
Many women often face with problem associating micro organisms in genital tract and they mistakenly think they have yeast infection and treat themselves when in fact, they have a similar vaginal infection that will not respond to self treatment with over the counter yeast medications. 70% of woman self treated vaginal infections before calling a health care provider. Most often, they incorrectly thought they had yeast infections when in fact, it was bacterial vaginosis7
Strangely, in India, many women assume a “white discharge” to be “normal” in a married woman. With less than acceptable levels of personal hygiene many married couples are under the impression that the private area is naturally “dirty” and make no effort to ensure hygiene except for cursory washing during bathing. Vaginal infections are perhaps the most common infections affecting sexually active woman all over the world. They are often triggered by intercourse and may be bacterial fungal or viral in nature. 8
The prevalence and the cause of vaginitis are uncertain in the past because the condition is so often self diagnosed and self treated. In United States, bacterial vaginosis is currently the common cause of vaginitis accounting to 40-50% of cases in women of childbearing age. Vulva vaginal candidiasis is the second most common cause of vaginitis. An estimated 75% of women have vulva vaginal candidiasis. Trichomoniais is the third most common cause of vaginitis. It affects 180 million worldwide and currently accounts for 10-15% of vaginal infections. 9
Candidal vulva vaginitis is a common clinical problem that affects adult woman at least once during her life time. Roughly 80% yeast infections are due to candida albicans with other candida species. However 15%-20% of women have symptomatic colonization. Many women have frequently recurrent yeast infection. 9
Bacterial vaginosis has a complex and poorly understood pathophysiology even though it is a frequent cause of vagnitis in woman. The prevalence of this disorder is underestimated as 50% of woman with bacterial vaginosis are asymptomatic. The nomenclature for this infection has changed in recent years from non specific vaginitis to bacterial vaginosis. Bacterial vaginosis has also been found in virginal adolescents. Bacterial vaginosis is most likely associated with sexual transmission through the description of normal vaginal flora but it is not a STD.9
A study was conducted to assess the prevalence of associated micro organisms in genital discharge inorder to review the laboratory support and adjust prevention and control guidelines. 84 adolesents and 784 adults were studied. The study revealed that bacterial vaginosis was the most prevalent disease in the adult group with 23.8%, followed by candida 17.8%, agalactiae 5.9%, trachoma vaginalis 2.4%, 46.4% non bacterial vaginosis were found. Bacterial vaginosis and candida prevelance were commom in both groups. 10
Trichomonas vaginitis the incidence of trichomonas infections has been declining for the past 20 years and currently this accounts for only 10%-25% of vaginal infections, depending on the population study. Smoking increases trichomonas colonization through physiologic effect on the vaginal environment.9
A study revealed that the longitudinal trajectory of bacterial vaginosis during pregnancy. Vaginal sections were obtained in each trimester of pregnancy and were evaluated for bacterial vaginosis. 148 woman were evaluated 48% were bacterial vaginosis negative in all trimesters, compared with 14 (9.8%) were positive. Few woman became bacterial vaginosis as pregnancy progressed (6.1%). In this population few woman are bacterial vaginosis positive across their pregnancy. 11
It is clearly evident from the above studies that majority of female patients have faced with vaginal infections and they are unaware about preventive methods.
The concern of nurses is for people’s health– its promotion, maintenance and restoration. Together the health workers constituting the majority of the qualified health workforce in most of health system, they play vital role in bringing about health awareness and the necessary changes to address these challenges. By analyzing outcome the nurse creates a feedback system, conducive to learning and effecting change to develop a high quality of self-care. 12
6.2 REVIEW OF LITERATURE
Review of literature for the present study has been organized under the following headings.
6.2.1 Review of literature related to vaginal infection.
6.2.2 Review of literature related to prevention of vaginal infection
6.2.1 REVIEW OF LITERATURE RELATED TO VAGINAL INFECTION:
A study was conducted in South Asia on the common genital complications in women. In genital complications, the abnormal vaginal discharge was common. The study undertaken 3000 women, who were selected randomly, in which 2494 women participated. The outcome was an incident case of the complaint of abnormal vaginal discharge at 6 months (T1) and 12 months (T2) review .In total T1 of the 2000 eligible women reviewed at T1 reported the complaint; and 80 of the 1999 women did not complain of abnormal discharge at (T1) reported it at (T2). Multivariate logistic regression analysis identified the following factors as associated with the complaints young age, religion, illiteracy, spouse’s extramarital relationship, depression and anxiety. The study concluded that reproductive health programme must strengthen the capacity of practitioners to assess and treat bacterial vaginosis and psychosocial problems in women with complaints of vaginal discharge. 13
A study was conducted on bacterial vaginosis among women in reproductive age (15-49) years residing both in rural and urban area. Bacteria vaginosis was diagnosed in 70(32.8%) subjects. A high percentage though asymptomatic (31.2%) were found to have bacterial vaginosis. High prevalence was seen in urban slums (38.6%), followed by rural (28.8%). 14
A study to determine the prevalence and correlation of bacterial vaginosis (BV) among young women of reproductive age was undertaken in Mysore, India. Between October 2005 and December 2006, 898 sexually active women of 15-30 years of age were enrolled from two reproductive health clinics. The women underwent an interview followed by physical examination, HSV-2 serologic testing, endocervical culture for Neisseria gonorrhoeae , and vaginal swabs for diagnosis of BV, Trichomonas vaginalis infection and candidiasis. Statistical analyses included conventional descriptive statistics and multivariable analysis using logistic regression. The population for the study comprised of 898 women, 391 who were diagnosed with endogenous reproductive tract infection and 157 with sexually transmitted infection. Only 863 women had Gram-stained vaginal smears available, out of which 165 were found to have BV and 133 were in the 'intermediate' stage. BV was related to concurrent infections with T. vaginalis and HSV-2 seropositivity. The study concluded that of BV at 19% was relatively low and co-infection with T. vaginalis was common. 15
6.2.3 REVIEW OF LITERATURE RELATED TO PREVENTION OF VAGINAL INFECTION:
A study was conducted on prevention and treatment of vaginosis and bacterial vaginosis relapses. The study enrolled 50 women good health, aged between 18 and 48 years, with assist diagnosis of bacterial vaginosis and vaginitis. The woman was randomized of two groups: group A comprised 25 patients with bacterial vaginitis and group B comprised 25 patients with vaginosis. The study revealed that Lactobacillus rhamnosus GR-1 and Lactobaccilus reuteri R-14, taken orally, were helpful in vaginosis and bacterial vaginosis treatment and in relapse prevention, as they can re-establish the vaginal ecosystem remarkably. 16
A randomized control trial study was conducted on 84 women with bacterial vaginosis who were diagnosed according to Amsel’s criteria. They were randomized to receive either oral metronidazole 500mg twice a day for seven days and Lactobacillus rhamnosus once a week at bed time for two months. Follow up was performed at days 30, 90 and 180. Safe and effective long term vaginal administration of Lactobacillus appears to be a useful complementary approach in the management of bacterial vaginosis. 17
A study was conducted on the effect of oral N-acetyl cysteine on recurrent preterm labor following treatment for vaginosis. A randomized double –blind placento-controlled trial with 2800 women between 16 and 18 weeks of pregnancy who had 1 previous preterm birth had just been successfully treated for bacterial vaginosis with metronidazole for 1 week. The study revealed that oral NAC was found to reduce the recurrence of birth in patients with bacterial vaginosis. 18
There are many steps can be taken to prevent vaginal infections.
Always wipe from front to back after bowel movements to prevent E. coli from the rectum from entering the vagina.Douching is never a good idea. Douching may disrupt the fragile balance of natural organisms in the vagina which may lead to bacterial or yeast infection and may also cause the spread of infection up into the reproductive tract where it can do damage. Keep the vaginal area clean and dry. Wash before and after sex with an antibacterial cleanser and thoroughly dry the vaginal area to prevent moisture from creating a breeding ground for bacteria. Avoid tight clothing and always wear white cotton panties that help absorb moisture and allow air to circulate. Avoid scented or treated toilet paper personal hygiene products perfumes spermicides and harsh soaps or detergents if the vaginal area is irritated. Practice safe sex! Always use condoms to prevent STDs or other vaginal infections unless you are in a long-term monogamous relationship. Diaphragms cervical caps and medication applicators should be thoroughly cleaned after each use. In any signs of a vaginal infection it is important that a physician makes diagnosis -- most vaginal infections are not yeast infections! Self-treatment with over-the-counter (OTC) remedies for yeast infections will not cure a bacterial infection and may increase risk of complications. 19
STATEMENT OF THE PROBLEM:
A Study to assess the knowledge of female patients regarding vaginal infections in selected hospital at Kolar, with a view to develop information booklet on prevention of those infections.
6.3 OBJECTIVES OF THE STUDY:
6.3.1. To assess the level of knowledge of female patients regarding vaginal infections on the basis of pre-test knowledge score.
6.3.2. To determine the association between the knowledge of female patients with selected demographic variables.