Studies of reproductive health among childbearing age women in rural South IndiaEastman, Jamie (2013) Studies of reproductive health among childbearing age women in rural South India. Doctoral Dissertation, University of Pittsburgh. (Unpublished)
AbstractReproductive conditions and adverse birth outcomes disproportionately affect women in developing countries. Despite this fact, most research has been conducted with women in the United States and Europe. We sought to determine the burden and risk factors for reproductive outcomes among the 1,226 South Indian women in the Longitudinal Indian Family Health (LIFE) study. Bacterial vaginosis (BV) affected 14.1% (95% confidence interval (CI) 11.9-16.4%) of women in LIFE. When diagnosis by clue cells alone was compared to Nugent’s scoring, clue cell analysis had a sensitivity of 39.8% (95% CI 36.6-43.0%) and specificity of 81.2% (95% CI 78.6-83.8%), with higher sensitivity among non-pregnant women (41.5%; 95% CI 37.8-45.2%) compared to pregnant women (29.4%; 95% CI 22.9-35.9%). Use of clue cells alone for diagnosis was found to be inadequate for screening women for BV and a validated method is recommended for future practice. We investigated several potential risk factors to determine their association with BV. In the model adjusted for religion and water source, Muslim women were more likely to have BV compared to Hindu women, though the increase was not significant (adjusted odds ratio (ORadj) 1.8; 95% CI 0.9-3.6). Women using tap water were also more likely to have BV at baseline compared to those who used purchased water (ORadj 1.4; 95% CI 0.9-2.0), though this increase was also not significant. These potentially at risk groups should be targeted for future screening programs. Consanguineous marriage (CM) occurs in up to 46% of South Indian marriages. Among women in CMs, we found a significant increase in the risk of early (<10 weeks’ gestation) spontaneous abortion (SAB) (adjusted hazards ratio (HRadj) 2.7, 95% CI 1.1-7.0). There was also a trend toward an increase in risk of late SAB (11-22 weeks’ gestation) (HRadj 1.2, 95% CI 0.4-3.7) and all SAB (HRadj 1.9, 95% CI 0.9-3.8). Women in CMs should be identified by health care providers and given counseling prior to conception and throughout pregnancy. This dissertation yields public health significance by identifying high-risk groups who should be targeted for screening and counseling programs by the clinics serving this rural South Indian population. Share
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